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On the Cause of Vincent's Disease as it Affects Sailors in Small Ships, With Observations on the Treatment

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ON
THE
CAUSE
OP
VI N CENT1S DISEASE
AS I T AFFECTS SAILORS IN SMALL S H I P S ,
WITH
OBSERVATIONS
ON
THE TREATMENT
BY
SURCEON LIEUTENANT JAMES CUTHBSRT, R . N . Y . R
ProQuest Number: 13849796
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I.
Y in c e n t’s d isease
w orld
but
in
it
tim es
is
in
h as been d e s c rib e d
of peace,
I have been
been to
fin d
s tr u c k by th e
some l e s i o n
to
th e
operate
d iffere n t
in
conducted
our d estro y ers,
su b ject
common t o
th o se
Perusal
cases
of th e
d iffere n t facto rs
( 8 4 ) . My i n v e s t i g a t i o n s
of our sm all s h ip s ,
d rifters
and carg o b o a t s .
and im p o r ta n t p a r t
ashore th a t t h e i r
of the
in c lu sio n
com m unity
is
so
in
a class
purpose o f i n v e s t i g a t i n g t h i s
disease
ju stifie d .
to
g iv e
a fu ll h isto rical
o u t l i n e w hich w i l l
in d ic a te
t h e m a n n e r i n w h ic h v ie w s on t h e
changed,
and w hich w i l l
clin ic a l
p ictu re,
the
d escrib e
ap p reciated
aetio lo g y
S ince
th at
co m p licatio n s
o pinions
are
s till
d iv id ed
used.
f a c t o r in th e
w ith th a ta s p e c t of th e
of th e
The i n v e s t i g a t i o n
A ugust 1939
covers
a p erio d
on a c a rg o b o a t
d estro y ers
co n d itio n .
in th e
d iets
C and D as b e in g t h e
in fec tio n ,
q u estio n ,
I t w ill
as regards th e
r e c e n t a u t h o r s have blam ed d i f i c i e n c y
p red isp o sin g
ty p ical
and t h e v a r i o u s m ethods
and b e s t m ethods o f t r e a t m e n t
a n y o n e o f v i t a m i n s A, B ^ , B g,
o f H .M .
s u b je c t have
*e n p a s s a n t 1 t h e
o f t r e a t m e n t w h ich have b een and a re
of
cases
t i m e s and t h e i r m anner o f l i v i n g
from l i f e
I propose
be
m arkedly.
a n d my e n d e a v o u r h a s
in fectio n .
sailo rs
m inesw eepers,
by th e m se lv e s f o r th e
is
circum stances,
in cid en ce r is e s
shows t h a t
lo c alities
T h e s e men f o r m a l a r g e
d iffere n t
of th e
i n c r e a s i n g number o f
of th e
am ongst th e
stirrin g
a ll p arts
certain
or co n d itio n
start
on th e
th ese
its
in
no e x c e p t i o n .
lite ra tu re
in
in
th em selv es f o r tre a tm e n t
and l e a d i n g
w ere
arisin g
tim e s o f war t h a t
The p r e s e n t w a r i s
p resen tin g
INTRODUCTION.
I have d e a lt
ch iefly
as w i l l be d e s c rib e d l a t e r .
from A p r i l 1939
in th e tr o p ic s ,
^
a p e r io d ^ o n one
i n t h e N o r t h S ea fro m D ecem ber 1939
to S e p t e m b e r 1 9 4 0 and a f u r t h e r p e r i o d ^ a t a s m a l l B.N. B ase
H o sp ita l d e a lin g w ith
s a i l o r s from s m a ll s h i p s o p e r a t i n g
N orth Sea under c o n d itio n s of severe
It
try
is
to
of th e
th o se
my i n t e n t i o n ,
as the
resu lt
make some c o n t r i b u t i o n ,
co n d itio n
on t h e
as i t
sm all
strain .
of personal o b serv atio n ,
however s l i g h t ,
a ffe c ts th e
in th e
seafarin g
s h i p s w i t h whom i t
to
to
o u r know ledge
classes,
esp ecially
h a s b e e n my p r i v i l e g e
to
serve.
II.
I
t h a n k t h e M e d i c a l D i r e c t o r Genfefral o f t h e N a v y f o r h i s
p erm issio n to
for
p u b l i s h t h i s w ork and S u r g e o n - C a p t a i n F e r g u s s o n ,
a l l o w i n g me t o
h o sp ital.
R .N .
ACKNOWLEDGMENTS.
for
I
am a l s o
c a r r y o u t my r e s e a r c h e s
in d eb ted to
on t h e
cases
R.N.
in h is
S u r g e o n - C o m m a n d e r (D ) P a t t e r s o n ,
a l l o w i n g me t o w o r k i n h i s
departm ent.
1.
III.
HISTORICAL OUTLINE,
v'/hile i n f e c t i o n ,
by th e
o f t h e m outh and t h r o a t
V in c e n tfs D isease
th at
th e
d isease
w ro te h is
goes by th e
o r P la u t- V in c e n t’ s D isease
and t h e
(1)
th e
1893.
is
evidence
surgeon p r a c tis in g
appears to
have f i r s t
organism s in 1882.
and s p i r i l l a
Hu go C a r l P l a u t
in th ro a t le s io n s
( 3 and 4
w rote
e n title d
an a r t i c l e
der D ip h th erie
found
cases
it
d escrib ed
in P etro g rad
d isease,
o ften
i n 1894
"S tu d ien Zur B a k te r ie lle n
und d e r A n g in en ". In
in
(2)
) , w h o s e na m e i s
o f V i n c e n t i n nam ing t h e
in
s e e n and
R auchfuss
lin k ed w ith th a t
b a cilli
th ere
na m e o f
o rg anism s w ere d e s c r ib e d b e f o re V in cen t
an A m erican d e n t a l
ty p ical
fu sifo rm b a c i lli
in
reg io n s u s u a lly
in Koch’ s la b o ra to r y
recorded
and. f u s i f o r m b a c i l l u s ,
paper.
V/.D. M i l l e r
B erlin
sp irillu m
d iag n o stik
he d e s c r ib e d f u s i f o r m - l i k e
o f ulcero -m em b ran o u s a n g in a .
and 89) was a d o c t o r and b a c t e r i o l o g i s t .
P lau t
(88
B orn i n L e i p z i g on
1 2 t h O c t o b e r 1 8 5 8 h e w a s a p p o i n t e d r,p r o f e s s o r "
i n 1 9 1 9 . He d i e d
in F ebruarjr 1928.
Jean H y acin th e V incent
B ordeaux in
1862,
(87)
now e n t e r e d
he e n te r e d th e M i l i t a r y
th e
field .
School of M edicine
i n 1889 became an ” a s s i s t a n t ” o f b a c t e r i o l o g y .
prom oted to
"professor” .
ch air of b acterio lo g y
a c tiv itie s
in fec tio u s
lo c a litie s,
on a l l
su b jects.
th a n b e fo re ^ th e
o rig in al
That
present
artic le
ap p licatio n
of chlorine
th e
i n t h e F r e n c h Army f r o m 1 9 1 4 - 1 8
on a n t i - g a s
clearly
i m p o r t a n t work on t y p h o i d
w ork on T .A .B . v a c c i n e s ,
w ith S to ed el
th o se
gangrene
sera.
in v e stig atio n s
and h e w o rk e d
A r t i c l e s w ere p u b lis h e d
He c l a i m s o u r i n t e r e s t b y d e s c r i b i n g m o r e
i n f e e t i o n w h i c h b e a r s h i s name.
appeared
i n 1896
p o u rritu re
sur le s
d ’h o p i t a l . ”
lesio n s
H is
(5).
in h o s p ita l gangrene in f e c tio n s ,
et
in th e
fo r d isin fe ctin g
same y e a r V i n c e n t d e s c r i b i n g f u s i f o r m b a c i l l i
”Sur l ’e tio lo g ie
th e
and e p i d e m i o l o g y o f V a l - d e - G r a c e . H is
w ork on th e
of Typhus o u tb re a k s
and
I n 1896 he was
By 1 9 0 2 h e h a d b e e n effected t o
w ere w ide, i n c l u d i n g
army o f F r a n c e ,
Born a t
e n title d
h is
and s p i r i l l a
artic le
a n a t o m o —p a t h o l o g i q u e s d e l a
2.
I n 1897 B ern h eim (6 )
sto m a titis
of u lcerativ e
a n d a n g i n a i n Y /h ic h h e f o u n d f u s i f o r m b a c i l l i
a s s o c ia tio n w ith
rep o rted
r e p o r t e d 30 c a s e s
sp irilla .
14 c a s e s
The f o l l o w i n g y e a r V i n c e n t
(7
o f ulcero-m em branous a n g in a w ith th e
org an ism s p r e s e n t.
S ince th e n th e
in
and 10)
same
i n f e c t i o n h a s b e e n known as
" V i n c e n t 1s A n g i n a ” .
M edical i n t e r e s t
made t o
be th e
cu ltu re
first
cu ltu re
of
th e
That
th e
su b ject w asaroused
organism s.
w orkers to
in 1898.
site s
in
V eillo n
have is o la te d
They u s e d
A t t e m p t s w e r e made t o
and V e s s p r e m i
(11)
from i t s
fu sifo rm is
first
d escrib ed th e ty p ic a l
to
from th e
o f tw o
d isease
lu n g
abscesses
in fectio n
succeed in
rab b its
and s u b c u ta n e o u sly
resu lted
ex p erim en tally
1905.
B oth th e
in th e
lo t
into
first
an e x h a u s tiv e
asp ects
(12)
A ll th e
heavy b re a th ,
more f u l l y
la ter.
W yatt W ingrave
(13)
aural
These w ere V i n c e n t 's
The n e x t
p u b lish ed
account of th e
d y sp h ag ia,
in
each
No
o rg an ism s w ere
sores w ith th e ty p ic a l
in th is
good d e s c r i p t i o n
o f th e m alady.
sp iro ch aetes
into
exudate.
In 1905 V in c e n t
was
Pus
e a c h o f tw o o t h e r s .
and V i n c e n t ' s
gangrenous
o f o th e r w orkers
T h is was t h e
and l u n g .
in trap erito n eally
W hile t h i s w asa s u c c e s s f u l e x p erim en t
was t h e
of th e
r a b b i t s w hich had been i n j e c t e d
su b cu tan eo u sly got fo u l
org an ism s
E xudate
i n one o f th e fo rm e r p a i r b u t th e o t h e r
developed gangrenous p e r i t o n i t i s
recovered.
in the b ra in
a b s c e s s e s was i n j e c t e d
case
asp ects on ly .
was t a k e n fro m a c a s e o f f a t a l f u s o - s p i r o c h a e t o s i s
m andible w ith m e ta s ta t ic
in pure
organism s.
clin ical
produce th e
was t h e
seem t o
a n a e r o b ic m ethods and m e n tio n a l i s t
same y e a r M oure o f B o r d e a u x ( 9 )
to n sillitis
and Z u b er (8)
t h e B.
from w h ich th e y o b ta in e d th e
of u lcerativ e
and a t t e m p t s w ere
a number o f f a i l u r e s
field .
an a r t i c l e
of th e
clin ica l
ty p ical
d isease
in E n g lish
sym ptom s o f s o r e t h r o a t ,
i n 1908 d e s c r i b e d
and w i l l b e
th e
fin d in g
describ ed
of
a l o n g w i t h m a n y common o r g a n i s m s .
sp irilla.
im p o rtan t
and
and p a t h o l o g i c a l
e t c , w ere m entioned
d ischarges
in th e L an cet.
o b s e r v a t i o n was by J .D .
R o llesto n
(14)
in
1912.
D escrib in g
t h a t when t h e
th e u lc e ra tio n
slough
separated
a deep
t o n s i l m ig h t h e a l up w ith s l i g h t
but
th e
u v u la
and membrane he
and more o r l e s s
stated
excav atio n of the
c icatricial
of th e
co n tractio n s
fau cial p illa rs
m ight
be d e s tr o y e d .
in
T h e n ca m e t h e
G r e a t Wa r o f 1 9 1 4 - 1 8
the
cases
w rote
number o f
on t h e
featu res
th e
su b ject
co n d itio n
(15)
agreem ent
A ll w o rk ers he
As e a r l y
a n d men i n
from th e
in
as to
and f u s i f o r m
to
th e
i n 1915 a g a in w ro te
on t h e
co n d itio n
up to
th e
B ritish
th e
t h e r e was
of th e
th e presence
d isease.
of spiro ch aetes
in d ia g n o sis.
both o f f i c e r s
Army w e r e w i d e l y a f f e c t e d
o f th e
le sio n s
d isease
he n o te d t h a t
and s u f f e r i n g
co nfusing
acute
and ( 2 )
In h is
patches
d escrip tio n
m ost m i l i t a r y
m e n , who w e r e
In
W ingrave th e n
up w ork” .
Then f o llo w e d
d iscu ssin g th e
c a s e s w ere in
th e
th ro ats
due to
and deep
a e t i o l o g y he o b se rv e d
recru its,
b o th o f f i c e r s
and
exhuasted by th e hard p re lim in a ry
He s t r e s s e d
th is
a good and a c c u r a t e
sp iro ch eate v a rie s
stressed
a case o f V in c e n t’ s angina w ith
or w ith " h o sp ita l"
"th o ro u g h ly
of
cam e a w a y
o r s ta p h y lo c o c c i w here u l c e r a t i o n
rare.
ch ro n ic
sym tom s b o r e no r e l a t i o n
th e
and n o t " e n m a s s e ” .
or sy p h ilis
is
(1)
p a t c h o f membrane.
d ip h th eria
strep to co cci
into
co n stitu tio n al
of not
slen d er
co n stan ts
as wesee in h i s p a p e r,
im p o rtan ce
The
He n o t e d t h a t m u c h
countries but th a t
clin ical
and
m alady.
th ro at
fittin g
tim e.
b o d i e s was e s s e n t i a l
" e n m orceaux"
th at
th a t
agreed t h a t
as 1915,
size
n ecro sis
e ssen tial
know ledge o f
th e
and n o te d t h a t
th e
now i n c l u d e t h e
in the
d ifferen t
said
He c l a s s i f i e d
ty p es
Man y w o r k e r s
advances
p o sitio n
had been w r i t t e n
no
im portant
rise
at th a t p erio d .
W. W i n g r t v e
review ed th e
atten d an t
of V in cen t’s d isease.
and I w i l l
o f t h e more
and i t s
co n sid erab ly
and u n d u l a t i n g w ith 4 t o
f a c t o r o f o v e r —t r a i n i n g .
d escrip tio n
in
size
of the
and s h a p e
organism s.
and i s
8 coarse unequal h u rv es.
4.
In
a dense m a trix
o r even
it
straig h t,
may b e l o o p e d ,
sin g le
When s e e n b y d a r k g r o u n d
o r in b u n d les.
illu m in atio n
w h i p l a s h . V i n c e n t 1s s p i r i l l u m
and t h i c k n e s s
co iled ,
Its
it
a ttain s
th a n Treponem a P a l l i d a
slig h tly
is
to
le n g th
lik e
sigm oid
is
1 0 - 20/TJ.
an e e l ,
or a
a much g r e a t e r
size
e v e r does
(see la te r
p h o to g rap h ).
The f u s i f o r m
straig h t,
The
body is
but
it
O ften
it
clear
e q u a t o r and i t
th e
has deeply
sp irilla
q uick
(a)
stain in g
b acilli
t h e more d e e p l y .
(b)
hot
o f m ethods o f
stain in g
to
and an
show
th at
c a r b o l - f u c h s i n f o llo w e d by a
(c)
d ilu ted
carb o l-fu ch sin
(d)
in d i s t i l l e d
w ater
i n k m e t h o d o r bfo c o l l a r g o l
(e)
L ev ad iti fo r tis s u e s .
th e
and s p i r o c h a e t e s v a r i e d
d isease,
fu sifo rm
and s p i r o c h a e t e s
evident
in
in
num bers o f f u s i f o r m
d ifferen t
pred o m in atin g l a t e r .
s o m e o f my own c a s e s
D iscussing th e
sta g e s of th e
th o se
la te r
in the
T h i s was s t r i k i n g l y
d escrip tio n ).
o f o rg an ism s he s t a t e d
of
th a t
s y p h i l i s w ere e s s e n t i a l l y
confined to th e s u rfa c e
of th e
to n sils
E v e n i n noma t h e y w e r e r a r e
in th e
deep s t r u c t u r e s .
T y p ic a l o rg an ism s had been d is c o v e re d
in th e
th ro at,
th e ir
and w e re
(see
d istrib u tio n
V in cen t’ s sp iro c h a e te s u n lik e
su p erficial
rela tiv e
o r g a n is m s b e i n g more num erous e a r l y
d isease
cry p ts.
accessory nasal
ear,
sin u ses
m eningeal
gangrenous lu n g ,
tissu e
are G ram -n eg ativ e,
The m e th o d s w h ic h h ad b e e n u s e d up t o
W ingrave o b se rv e d t h a t
m iddle
end i n p a i r s .
s a m e f a s h i o n w i t h n o h e a t . He t h o u g h t t h e B u r r i m e t h o d
was p o o r ,
to
ends.
equator.
o t h e r e le m e n ts m ust be o v e r s ta in e d
and weak a l c o h o l b a t h ,
in th e
o r end t o
organism s
a d escrip tio n
G iem sa,
B u r r i’s In d ian
at th e
as a
bands o r beads a d jo in in g th e
and f u s i f o r m
s p ir i l la w ell.
tim e w ere
alw ays t h i c k e s t
may o c c u r s i n g l y
fu sifo rm b a c illu s
o b serv atio n th a t
is
stain in g
Then f o llo w e d
th e
and a p p e a r s
b en t, or"boom erang” shaped rod w ith t a p e r i n g
size v a rie s
B oth t h e
slu g g ish ly m o tile
(when n e c r o t i c ) ,
and c e r e b r a l
v e n e re a l buboes
of th e neck
t h e gums,
abscesses,
c.s.
and e v e n i n t h e
or
nose,
decayed t e e th ,
flu id ,
cellu lar
and m e d i a s t i n a f o ll o w i n g t o n s i l l e c t o m y . •
It
is
of
in terest
now a s t h e y f o r m t h e
observed th a t
deeper th an
w hich
to note
b u lk
of th e
i n noma t h e
th a t
gum i n f e c t i o n s
cases
i n my own s e r i e s .
th an precede
or
th ey
sim ply fo llo w
actu ally
th e
cause n e c r o s is .
to
for
death of tis s u e s
A ll th e
le sio n s
in
note th a t
in th e
ad u lt,
in th e m orning,
o f V i n c e n t ’ s d i s e a s e w ere
constant
sap ro p h y tes.
th a t
a ton g u e
w e n t on t o
scrap in g
th e y w ere u n d o u b te d ly
favoured
In h i s
co n d itio n s
th e sis
from th e
deals.
r a th e r th a n
rich
sym biotic
are
a sso c ia te d w ith fo e to r
free
in th e
class
F o r exam ple he s t a t e d
in th e
or poor,
In
fin d in g s
is
esp ecially
selected
a g ain m en tio n in g th e
from th e
organism s
d im in u tio n o f r e s i s t i n g
cause
”in
fa c t th a t
an e m p h a tic
in
We s e e
in
b ro u g h t up to
th is
date
is
not
a rtic le
W ingrave
Io d in e,
silv e r
in d iv id u al
no c o m m u n ity ,
ch iefly
fact
o u tsid e
evidence” .
conclusions e .g .
from t h e
su b ject
as regards
p o in t
o f view
la te r.
en d e d by s u m m a ris in g t r e a t m e n t s u s e d up t o
chrom ic a c i d ,
s t a t e d , w ere n o t th o ro u g h .
apoplexy,
th a t th e
d ifficu lty
o f W i n g r a v e 's t h e w hole
deb a t e a b l e
any
cannot be acc e p te d f o r such
A d is c u ss io n w i l l follow
n itrate,
sp o rad ic” .
cases of cereb ral
su p p o rte d by c l i n i c a l
a n d s om e o f h i s
’’ c a r r i e r s ” o r ” c o n t a g i o n ” a r e
o f my o b s e r v a t i o n s .
are
He n o t e d t h e
t h a t ” contag io u sn ess
conclusion
in th e
even in h e a l t h he s a id t h a t
and o n ly l i v e s w i t h
said
is
no a d u l t m o u th o r t h r o a t
organism
b o d y and h e
and t h a t t h e y
c iv il life
activ ity .
d elicate
The w r i t e r n o t e d
s ta te m e n ts w hich d i f f e r
m ight fa v o u r s p i r o c h a e ta l
is very
organism s
and p u t r e f a c t i o n .
and c a s e s
power such as
looked
o f men w i t h w h i c h t h i s
”th e
c o m m u n ity ” and a l s o
if
th e
in th e ir h a b its
c o n c l u s i o n s W i n g r a v e made s e v e r a l
slig h tly
he
rath e r
stap h y lo co cci,
or fances
th e
zone,
pyocaneus e t c ..
The a r t i c l e
is
somewhat
th e n e c ro tic
a s s o c i a t e d w i t h m ixed i n f e c t i o n by s t r e p t o c o c c i ,
B.
W ingrave
organism s had b een d em o n strated
in V in c e n t’ s angina but lim ite d
su g g ests th a t
a re m entioned
fen ic
He a d v o c a t e d
chloride
date.
and p h e n o l ,
5^ t r i k r e s o l
in
alco h o l,
I
I p ain ted
on th e
u lc e r o r fo rm alin
He m a d e n o m e n t i o n
of th e
d ilu ted
average tim e
i n t h e f o r m o f ’’ l y s o f o r m ” .
req u ired
to
cure
a m ild o r
6.
m o d erate
case, w hich i s
essen tial
presence
part
is
th e
fact
th a t
th e
its
fact
if
At t h e
th e
im p o rtan ce w a rra n te d .
th e
th e
o f tim e H arp er (16)
He,
co n stitu tio n al
on d i f f e r e n t
accu rately
form s
clin ica l
appearances o f th e
receiv ed
th e
l i k e W ingrave,
and a l s o
th at
the
He t o o
aspects
and t h e
of th e le s io n s
organism b u t th o u g h t t h a t
the
A fte r d isc u ssin g th e
succeeded.
d ip h th eria
nam ely t h e te n d e n c y o f t h e
f o r weeks
and t o
re c u r u n less
recurrence
th at
eith er
may be u s e d
is
At t h i s
im p o rtan ce.
were
and o f t e n
s till
present
and e i t h e r
lia b le
th e
to
If
in
say
o r com bined,
a week, th e n t h e
I f the
recur.
of
success
H is b e s t r e s u l t s w ere
silv e r n itrate
(30 g r .
t r e a t m e n t was sto p p e d
th e
to
o r s p i r i l l a w ere
t h r o a t was p a i n t e d
He c o n c l u d e d t h a t
at th e
and s u l p h a t e
once w ith l/lO O m ercury
o r g a n is m was p r e s e n t ,
co n d itio n ,
th e presence
he
again w ith
in
a week
s t a t e d , was
of e ith e r of
end o f a week m ight be c o n s id e r e d t o be
proof of th e
no m e n tio n i n t h e
Three
part
iodine
e i th e r fu sifo rm b a c i l l i
so lu tio n .
organism s
a p o sitiv e
th e
and th e n p a i n tin g w ith
d aily .
p erch lo rid e
I m ight
c a u t e r y had l i t t l e
ag g rav ated m a tte r s .
o b tain ed by p a in tin g
o z.)
prevent
success.
C a u te ris in g w ith th e g alv an ic
th e
(A f u l l
He ma de n o m e n t i o n o f g e n e r a l
R em edies he had t r i e d
p erch lo rid e
p o in t
p ersist
and t h a t H a r p e r f a v o u r e d l o c a l t r e a t m e n t w h ic h he
z in c w hich had o n ly had l i m i t e d
eith er
to
co n sid er- ad equate tre a tm e n t to
l o c a l o r g e n e ra l tre a tm e n t, alone
s t a t e d was o f f i r s t
trea tm e n t.
a very
disease
ad eq u ately tr e a te d .
given l a t e r ) .
describ ed
d iffere n tial
and s y p h i l i s he m e n tio n e d
p o in t,
th is
been
th e n ,w h ereas V e illo n
im p o rtan t
of what I
to
b acteria
and Zuber (8 )
d ia g n o sis w ith
poin ted
d is e a s e m ight
cu ltu re
had
atten tio n
in d iffe re n t p a tie n ts .
till
go
stressed
symptom s h a d h i t h e r t o
h ad n e v e r b e e n grow n i n p u re
d escrip tio n
an
o f w ork o n b o ard h a s to
angina had n o t
o v e r l o o k e d b y many w r i t e r s
ta k e
ro u tin e
same p e r i o d
th a t V in c e n t's
th a t
a s i c k ma n i s
o f a te a m i n s a y a m i n e s w e e p e r and w h e re h i s
req u ired
on s m o o t h l y .
most im p o r ta n t w here
contin u an ce
article
c a se s w ere d e s c rib e d
of th e
of th e
in fectio n .
p o ssib ility
i n w hich th e
T h e re was
o f gum i n f e c t i o n .
t h r o a t was i n f e c t e d .
The f i r s t
two w e r e t r e a t e d w i t h l o c a l f o r m a l i n
and m e rc u ry p e r c h l o r i d e ,
Case h o .
su p p u rativ e
3 had
and w e re
straig h tfo rw a rd
a superim posed
ad en itis
stap h y lo co ccal
o f th e neck r e q u ir in g
cure
cu rettag e
carb o lic
and had
of th e
acid .
p erch lo rid e
w ith
silv e r
serio u s
carb o lic
(17)
th ro a t u lcers
(60 g r .
abscesses
en tire
per o z.)
t h e m alady
can
become i f n e g l e c t e d .
The l a t t e r
in terestin g
of the
teeth
caused
case
of
and
it
d isease
in
in fec tio n
of th e
The a p p l i c a t i o n o f
a f t e r th e use
g in g iv itis
to
en titled
V in c e n t's
an u lc e ro -m e m b ra n o u s
A nother
in 1916.
sto m a titis
use
of
cure
salvarsitfi
of the
in fec tio n s
th ro at w ill
in
and r e p o r t e d
in the
th e
m ouths
co n trib u ted
oh th e
treat
o rganism s p r e s e n t
and w h ich
had o fte n
a n d gum l e s i o n s .
in fected
average tim e f o r th e
all
gums,
from th e
th e
o th erw ise
in 95 out of
the
gums. M c K in s try
literatu re
durin g th e
days,
cases p re s e n tin g w ith
of fu sifo rm b a c i l l i
recru its
th ro at
a n d gu m s w a s s e v e n t e e n
gum s i n
again to
incidence
of h ealth y
the
a u t h o r s w e r e k e e n on t h e
and t h e
of th ro at
exam ine t h e
and t o
These
r e l a x from r e - i n f e c t i o n
1917 l a t e r
sa m e p a t i e n t
how t h e y h a d f o u n d t h a t
lo c ally
in fec tio n
Thejr w a r n u s t o
th ro at
in th e
co-existed.
ap p lied
double
in
of p eri-d e n tal
organism s. L a te r w r ite r s
T a y l o r and M c K in s try d e s c r i b e d
o ften
gum l e s i o n s
and an u lc e ro -m e m b ra n o u s
a s s o c i a t i o n betw een t h r o a t
a n d gum l e s i o n s
amount o f
A ngina” . V in c e n t h im s e lf had d e s c rib e d
b o th m ight have th e t y p i c a l
th e
th e
"The r e l a t i o n
g i n g i v i t i s w h ich m ight b o th be
overlo o k ed
o f phenol.
c e r v i x u t e r i was r e p o r t e d
now d r e w a t t e n t i o n t o
a paper
days f o r
s h o w s how
T a y l o r a n d M c K i n s t r y ( 1 9 ) who h a v e d o n e a l a r g e
field
neck,
swabbed w i t h p u re
a gangrene o f th e t h r o a t .
from A m erica by M cC onnell (18)
work i n t h i s
a
have b een w id e ly d o n e , f o r in 1915 B erg ero n
a c a s e w h ic h ended f a t a l l y
had
in th e
and on a l t e r n a t e
caries
rep o rted
The t h r o a t
and e a c h d a y f o r two w e e k s
had
seems to
and
p h a r y n x w as swabbed
case
acid
in fec tio n
T his case took
and t h e i r b a s e s
o f m ercury (l/lO O )
n itrate
T his
of th e
Two d a y s l a t e r t h e
w ith
a m onth.
in cisio n s
cases.
in cisio n .
c o n d i t i o n h a d b e e n p r e s e n t f o r 15 m o n th s .
m onth t o
and g l y c e r i n e ,
on t h e
and
(20)
su b ject
sp iro ch aetes
G r e a t vVar. He f o u n d
230 h e a l t h y men.
In th e
sa me
y e a r M cK enzie
no
(21)
in
d iscu ssin g
"Trench T hroat"
co n n ec tio n w h atev er w ith tre n c h l i f e ,
d i s s e m i n a t i o n w as f a v o u r e d by t h e
num bers o f young men. He,
too,
t h e w a r and he blam ed t h i s
lik e
previous w r ite r s ,
he
said
really
th a t
sin ce
should
in
ca m p l i f e
in
p riv ate
feeding
be
its
overcrow ding.
to
i t was an i n f e c t i o u s
iso la te d
and he s a i d
life
w here th e
co n tag io u sn ess
to
as
p atien t
h im self.
a facto r
easily
in fec tin g
treatm en ts
used w ere,
e v id e n t by th e f a c t
in te rn a lly .
quote
I
up th e
ex ten t
u lc ers
as
and
"I
o ften
Eor th e
s u f f e r e r 's
as th e
but
p atien ce,
p e rsisten t,
in d u cin g
for
but
as lo n g
a n y t h i n g more
of d isco m fo rt".
co n sid ered
and
th e
p atien t
seg reg atio n
elsew here
keep h is
if
own
in
io d id e
th e
g iven
sh ow how u n c e r t a i n
th e
d isease
only to
is
do i s
of
self-
to
subdue th e
r e s t we may h a v e t o
d isease
a s when
t h a t M cKenzie
a l l we n e e d t o
as p o s s ib le
odour th e y d if f u s e .
to
suspect th a t
d u ratio n
common
and s y p h i l i s ,
J u s t how v a r i e d
in p o tassiu m
fo llo w in g lin e s
a cure th o se w orkers w ere.
in
statem ent.
He b e l i e v e d
th e
had become
o t h e r s >w h i c h w a s i n d i r e c t
(15)
m ethod.
its
stric t
t o W i n g r a v e Ts
m entioned h i s
th a t
Thus M cK enzie b e l i e v e d
in
had
camps o f l a r g e
d isease
o p p o sitio n
is
hut
d ip h th eria
th a t
could
it
A fte r m entioning,
was e s s e n t i a l b u t n o t n e c e s s a r i l y
u ten sils
lim ited
in
s e e n how i t
resem blance
th a t
such,
co llectio n
had
w ith
as
said
clean
ap p allin g
sup p o rt the
may d r a g o n a n d o n ,
slu g g ish
as a c o u p le o f m onths w ith o u t however
s e rio u s th a n
He a d m i t t e d t h a t
t h e i r p ro p o rtio n
a little
pain
and a good d e a l
t h e r e w ere f a t a l
to
be
o r grave
cases
so low t h a t t h e y w e r e n o t
w orthy o f th o u g h t.
E arly le s io n s ,
of
stated ,
co uld be
a b o rte d by th e
silv e r n itra te
cry stals
o r o f pure phenol
He d e s c r i b e d
stubborn
and r e s i s t a n t
u lc eratio n
He s a i d
o f m o u th s and t h r o a t s
th a t
confinem ent
pow erful
to
and p e r s o n a l
to
he
be
th at
arisin g
it
is
ap p lied to
the
a n d w i t h t y p i c a l gum i n f e c t i o n .
10 o f p o t a s s i u m
to
m outh t o i l e t .
th e y harbour in f e c tio n .
from th e
b e tte r to
sp o ts.
cases w ith ex te n siv e
c a u s t i c s w ere u n w ise f o r them b u t he
gr.
atten tio n
rem oved a s
abscesses
th in k
bed,
ap p licatio n
ex tra ctio n
iodide th re e
tim es
advocated
a day
A ll c a r i o u s t e e t h were
( I have seen
of te eth
in
alv eo lar
such c ases
tem p orise w ith th e te e th
if
th ey
and
are not
d ead ,b y th e
th e
ap p licatio n
in fec tio n
ex tracted
in th e
of
a carb o lised
to o th
cav ity .
If
n e c e ssa ry th e to o th
hydrogen p ero x id e
freq u en tly
th e
best
m y r r h . He m e n t i o n e d t i n c t u r e
w ater as being
B outy (22)
had
in th e
tro o p s
of th ro at
a B ritish
2 3 fo. T h i s
aetio lo g y .
of io d in e
in France
at th at
in
in V in c e n t's
p a s t tw o y e a r s .
2 to
He s t a t e d
3fo o f
i n t h e F r e n c h Army. R e c e n t
showed t h e
symptom s o f t h e
all
sta tistic s
p r o p o r t i o n now t o
be
p ro b lem was becom ing.
disease
tim e b e lie v e d t h a t
and d i s c u s s e d
its
frien d
e x c e s s o f sm o k in g was
c h i e f p r e d is p o s in g f a c t o r , p lu s th e p re se n c e o f decay in g
o rg an ic m a tte r
and
from e x p lo d in g
sh ells.
any i r r i t a n t
was n o rm a lly p r e s e n t
th o u g h t
types
it
favoured
of d isease,
i n th e m ouths o f h e a l t h y
irrita te d
and i t
strep to co ccal
in fec tio n
o ften
lis t
cerv ical
alv eo laris,
case s w ith
3.
arte ry
g lan d s,
Two
and a "pseudo-m em ­
th at
serio u s
secondary
co m p licatio n s.
com piled from p r e v io u s
and t h e y i n c lu d e d , 1 . p a i n f u l a d e n i t i s
nearly
sto m atitis
and
of th e
(V in cen t),
vocal
i n d i v i d u a l s he
alw ays p r e s e n t ,
and g i n g i v i t i s ,
2.
pyorrhoea
4. g a s tr o - e n t e r it is
a b u n d a n t V i n c e n t ' s o r g a n is m s p o s t mortem ( V i n c e n t ) ,
n ep h ritis
u lceratio n
caused
organism
o f th e m ucosa.
was s t r e s s e d
o f co m p licatio n s
d e s c r i p t i o n s was g iv e n
of th e
co n d itio n s
nam ely an " u l c e r a t i v e "
describ ed
An e x c e l l e n t
fum es su ch as th o s e g iv e n o f f
Though B o u ty a d m itt e d t h a t t h e
branous" w ere
th e
in the
in crease
s h o w s u s how s e r i o u s t h e
th e
of
silv er n itra te
He h a d b e e n d i s c u s s i n g t h e m a t t e r w i t h h i s
V i n c e n t who
5.
or
and f o ll o w e d
and t i n c t u r e
angina c o n s titu te d
M ilita ry H o sp ital
article
ch lo rate
by 1917 n o t e d t h e
com p lain ts
B outy d e s c r ib e d
th e
also
s o l u t i o n was
agents.
in p eacetim e V in c e n t's
cases
in
good l o c a l
clean sin g
s p r a y e d on t h e u l c e r s
b y a m outh w ash c o n t a i n i n g p o ta s s iu m
th a t
can be
la te r).
M c K e n z i e now m e n t i o n e d t h a t
angina
d r e s s i n g w hich w i l l k i l l
cords,
en d o ca rd itis,
9. V in c e n t's
8.
a lb u m in u ria (B outy q u o te s a c a s e ) ,
pharynx w ith p e r f o r a tio n
7. b r o n c h itis ,
p leu risy ,
o f the
6.
caro tid
la r y n g itis w ith u lc e ra tio n
empyema, o t i t i s
m edia,
of
c a c h e x i a and
g a n g re n e o f t h e v u lv a and p e rin e u m ( S p i l l m a n ) ,
o rganism s
co m p licatin g
a sy p h ilitic
chancre
of
phagedaenic
tendency
(L aim ois),
10. t h r o m b o s i s o f t h e
saphenous v e in w ith gangrenous u l c e r a t i o n
11.
o steo m y elitis
asso ciated
(G ilb erti)
p ern icio u s
of th e
le ft
leg
and 1 2 . M ayer o b s e rv e d
(G u in sb erg ),
an
anaem ia.
D eaths from V in c e n t’ s d is e a s e
had o c c u r r e d by t h i s
tim e
in
French h o s p ita ls .
S till
in
more t r e a t m e n t s w ere m e n tio n e d by B o u ty .
rep eated
th a t
th e
he
sm all doses;
co n sid ered
th a t
p a t i e n t was n o t
arsen ic
and
ch lo rate
b lu e
for
of
com bined w i t h
(1
in
500)
and n e o - s a l v a r s a n
2 o r 3 days)
so d iu m -salicy late
trea tm e n t to
a f te r w ell
be
d ip h th eritic
o r powder a p p lie d
tim e f in d in g
a tam pon t o
serum was s a i d t o
m ethylene
lo c ally
of h o t hydrogen p e ro x id e .
th e most e f f i c a c i o u s
a th o ro u g h p a i n tin g w ith
scru b b in g w ith
as w ere m ercury
silv e r n itra te ,
and f r e q u e n t g a r g l e s
V in c e n t h i m s e l f was a t t h i s
of
and p o ta s s iu m
t o n i c s w ere used t o o ,
(so lu tio n
c o n d i t i o n when
Local a p p lic a tio n s
in g ly c e rin e ,
calom el
inform ed th e w r i t e r
m ercury a g g ra v a te d th e
a sy p h ilitic.
a m ix tu re
p erch lo rid e
b u t V in c e n t had
e.g .
6$ t i n c t u r e
of iodine
remove t h e mem brane. A n t i -
have been of b e n e fit
in
some
cases.
I t was
im p o rtan t
sid e
to
"one
dose o f
th e
as
prevent
d isease
it
its
E ag leto n ,
the B r itis h
part
T his
and I , i n c l u d e
in th e
it
statem ent
stated
a n g in a and had n o te d
now,
th a t
its
cond itio n of th e
of th e ir
days w h ile
th e
around th e
te eth ;
cases th e
im portant
co n d itio n
I have ad o p ted .
in
an a r t i c l e
th e y had read
prevalence
gums i n
th is
in
article s
in th e tro o p s
swabbed c a s e s b u t t h a t t h e y w ere s u r p r i s e d
several
is
as in trav en o u s
treatm en t
M e rc e r and Hudson (2 6 )
no m e n t i o n o f t h e
to m odify
began to be used f o r th e
M edical J o u r n a l,
on V i n c e n t 's
and had
ro u te
a b ig
the unaffected
H is f i n a l w ords were
and p r e v e n t r e c u r r e n c e " .
p lay s
treat
in trav en o u sly has been said
shows when a r s e n i c a l s
arsen ic
B outy t o
o u tb reak th e r e .
salv arsan
by th e p a r e n t e r a l
In
acco rd in g to
to
see
in fec tio n .
t h r o a t had c le a re d up in 8 to
o rg a n ism s had e a s i l y b een d e m o n stra te d
an d v i c e v e r s a #i n more t h a n one c a s e
p atien t
h a d come u p f o r t r e a t m e n t f o r
angina)
and t h e y h ad fo u n d t h e
a sore th ro a t
organism
10
in pus
the
(? V i n c e n t 's
in p e r i- d e n ta l pus
in
great
q u a n t i t y w h e n e v e r a swab f r o m t h e
in d © te rm in a te • These w o rk ers s tr e s s e d
for
den tal tro u b le
again st
in
d isch arg in g
all
in
sore th ro a t
get
1918 an i n t e r e s t i n g
M cK instry
cred it
(23)
episode
field
f o r t h e i r v iew s on th e
p u b lish ed
ex p ressin g
in
an a r t i c l e
o f V in c e n t's
su b ject.
in rep ly
in th e v a rio u s
overseas
sectio n
and M c K i n s t r y
and p u b l i s h e d
They a ls o
in
in
th e
th a t
a fu rth er
th e
V in c e n t's
d escrib ed
and
a rtic le s
angina"
read
u n its
o f t h e gums i n t h i s
to
th e fa c t
"Fuso-
b efo re the
o d o n to lo g ical
th e
sm ears o f 1,3 2 0
so ld ie rs
m ilitary
gums w as f u l l y
d ealt
of p eri-d en tal
above s e r v e to
in v e stig ated .
and fo u n d t h e
On e x a m i n i n g t h e
life
date.
T his paper has been
f u r t h e r exam ined f o r
i n 32 o r 2 . 4 3 ^ .
in
(19).
be f u l l y
su b ject
of th e S o ciety of th a t
"The r e l a t i o n
such as th e
d i s e a s e was b e g i n n i n g t o
me n n o t y e t
who
home s e r v i c e
drew a t t e n t i o n
c o n d itio n of th e
paper e n title d
to
o rganism s
(26)
on V i n c e n t ' s
a paper e n title d
"P ro ceed in g s"
g in g iv itis
th ro at
one by
R o y a l S o c i e t y o f M e d ic i n e on N ovember 2 7 t h 1916
stated
in v e stig a tin g
the
article s
and i n t h e
(23)
p e ri-d e n ta l g in g iv itis"
of th e
T a y l o r and
R.A.M .C.
cond itio n
th e y had n o te d th e m a tte r in
sp irilla ry
w ith
th a t
no m e n tio n o f t h e
T aylor
to
d isease
B r i t i s h M e d ic a l J o u r n a l on J a n u a r y 5 t h 1918
our tro p p s
could f in d
in fec tio n .
th a t
th e
su rp rise
an g in a b o th
th ey
to
and t h e y w a rn ed
o c c u r r e d w h ic h shows
C a p t a i n s E a g l e t o n , M e rc e r a n d 'H u d so n o f t h e
had w r i t t e n
of lo oking
t e e t h was n e g a t i v e .
how e a g e r s o m e o f t h e w o r k e r s i n t h e
w ere to
im portance
a p a t i e n t who h a d h a d a s o r e t h r o a t t i l l
a swab fro m a ro u n d t h e
E arly
cases of
th e
t o n s i l had been
he found t h a t
sh ow how t h e
M cK instry
(24)
organism s th e
fu so -sp irillary
gu ms o f 2 3 0 h e a l t h y
95 w e re p o s i t i v e
i.e .
4 1 .3 $ .
Co I y e r
(27)
w h ile n o tin g
to V in c e n t’s d isease
War d e p r e c a t e d
d isease
had
th e
d isco v ered
recognised
th e
fam ous work on t h e
sectio n
th e
lack
o f th e
id ea th a t
i n 1918 t h a t
gums a n d t o n s i l s
co n d itio n fo r
on " s c u r v y o f t h e
th e
20 y e a r s
th at
it
was a
dental
and t h a t
surgeons
in John H u n te r's
c o n d i t i o n was w e l l d e s c r i b e d
gums"
of vitam in th e o ry ,
R estated
had b e e n drawn
during th e g r e a t
som e w r i t e r s h a d t h a t
d u rin g th e w ar.
teeth
atten tio n
(th is
is
as a c a u s e ).
th e
first
in th e
reference
C olyer th e n
stated
to
12 *
th at
J.
S.
M a r s h a l l o f C hicago
d escrib in g
th e
w riters
draw
to
d escrip tio n
th e
real
was t o
cond itio n
cause
and f o r
a tte n tio n to
was q u o te d
th e
co n stan t
T h i s was p r o b a b ly B o u ty (22)
around b a d ly
to
th e
in
have found
tow ards th e
of drugs
th is
to
irrig atio n
co n sid ered
to
He m a d e a s t a t e m e n t
p rep aratio n s
areas th a t
an i n q u i r y
occurring
and th e
in
salien t
was p r e s e n t
to
th e
te eth
th e
in
ex ten t
th at
and t h e l o c a l
in to
Army.
th at
a sp ecific
irrig a te d
article s
should be e r a d i c a t e d .
disease
a.
and D ig b y (2 8 )
in v ariab ly
of c lin ica l
th a t
c.
present
g in g iv itis
ages and c a t e g o r i e s
ad m issio n s,
satisfac to ry ,
b.
th at
fu sifo rm b a c i l l i
in la rg e
from V in c e n t’ s d is e a s e
p atien ts
w ith fu sifo rm
in
b acilli
acute u lc e r a ti v e ,
cases o f N o .l.
w ere
2.
d.
of fu sifo rm
d i d n o t mean
and,
convalescent
e.
th a t
p atien ts’
in t h e i r m ouths.
o f ’’V i n c e n t ’ s d i s e a s e ” w a s g i v e n
O nly t h r e e
num bers i n
symptoms t h e p r e s e n c e
s e r u m and
th u s:-
so ld ie rs’
o f t h e m o u th and t h r o a t ,
am b ocep tors w ere p r e s e n t
classified
That
on t h e gum s, m outh o r t h r o a t
su fferin g
1.
co n tin u ed
C om m ittee o f t h e War
of a ll
B .fu sifo rm is
A d efin itio n
th a t
and V i n c e n t ’ s d i s e a s e
date,
so ld ie rs
o f 12$ o f h o s p i t a l
sp iro ch aetes
in
arsen ic al
They b ro u g h t p r e v io u s r e p o r t s t o g e t h e r
t h e Army i n
a p e r s o n was
org anism .
He b e l i e v e d
on t h e
g in g iv itis
ap p licatio n
a c t i o n on t h e
over io d in e.
f e a t u r e s w ere to
absence
and
w h ere t h e r e was s t a g n a t i o n .
p o ckets
and V i n c e n t ’ s d i s e a s e
in th e
b acilli
e.g .
f o r the P ath o lo g ical
and s p i r o c h a e t e s w ere
occurred
of th e
c o n d itio n s w ere n o t
g in g iv itis
o ften
deep pocket p o s te r io r
I n 1919 Sem ple, P r i c e - J o n e s
O ffice
of
it
disease
H is t r e a t m e n t was d i r e c t e d
co u ld n o t be e a s i l y
a report
C o l y e r 1s
He n o t e d t h a t t h e
t h a t he had n o t fo u n d t h a t
p u b lish ed
it
of p u tre sc e n t m atter.
be t r u e ) .
have
fin d
any p o s i t i o n w h ere t h e r e was
had any ad vantag e
be p u b l i s h e d .
thatw w e had y e t t o
in h alatio n
d isease
T h e w a r w a s now o v e r , b u t
to
recent
M arsh all’ s c lin ic a l
t o whom h e r e f e r r e d .
m olar or in
for
one w r i t e r h a d s u g g e s t e d
crow ns and i n t h e
p erio d o n tal
cred it
one o f t h e
a c l e a n m outh and t h a t
fittin g
low er t h i r d
p reex istin g
(I
stated
makes one im p o r ta n t p o in t..
was seldom fo u n d
th e
su b ject.
and C o l y e r
in th e
get
being th e
and m e n t i o n e d t h a t
be fo un d
article
should
and
i t was
su b -acu te,
and 3 .
seen du rin g the
ch ro n ic.
in v e s tig a t io n w hile
13.
th e
m ajo rity
w ere found
inflam ed
of
c a s e s were
in th e
cases of th e
some t i m e ,
3.
co n d itio n ,
w ith pyorrhoea or th e
all
co n d itio n s
sw ollen
gum s b l e e d
in
and
read ily
on
for
p a t i e n t was o f t e n
4 . t h e r e was a f r e q u e n t
asso ciatio n
o f pus from th e t e e t h
t e e t h w ere p o s s i b l e
im portant r e p o rt
i.e .
so ck ets,
clean
and
of the
p ercen tag es
In one u n i t o f 3 ,0 0 0
and a n o t h e r u n i t had 2 9 .5 $ .
L a r g e n u m b e r s o f me n w e r e
ex am in ed and t h e
and V i n c e n t ’ s a g in a f o u n d .
p ercen tag es
Thus i n 184 w ith
u n c le a n m ouths V i n c e n t ’ s o rg an ism s w ere p r e s e n t
and g i n g i v i t i s
fu sifo rm
and
o f haw ing b l e d e a s i l y
t h e t r o o p s was g i v e n .
men 3 3 $ h a d g i n g i v i t i s
75.5$
signs
and d e c a y e d .
An i n t e r e s t i n g
of g in g iv itis
1.
and t h e
d ischarge
of the
h ealth y or d ir ty
of g in g iv itis
2.
o r had a h i s t o r y
p a i n was v a r i a b l e
unaw are o f h i s
The f o l l o w i n g
series:-
gums ( l o c a l a n d g e n e r a l ) ,
to u ch o r p re ssu re
5.
i n 2 and 3 .
b acilli
in
59 o r 3 2 $ .
In
all
i n 139 o r
th o se w ith g i n g i v i t i s ,
and s p i r o c h a e t e s w ere p r e s e n t
in la rg e
num bers.
The w o r k e r s
to
35 y e a r s
found
in
took
at
and upw ards
r a n d o m 5 1 2 me n o f a l l
in h o s p ita l.
a g e s f r o m 18
F u sifo rm b a c i l l i
w ere
the
g u m s o f 4 89 m e n o r 9 5 . 5 $ .
S p i r o c h a e t e s were
fou nd on th e
gums o f 488 men o r 9 5 . 3 $ .
G i n g i v i t i s was p r e s e n t
i n 1 2 8 men o r 2 5 $ .
exam ined t o o ,
78 o r 3 3 . 3 $
f u s i f o r m b a c i l l i w ere fo u n d on t h e
a n d s p i r o c h a e t e s w e r e f o u n d on t h e
108 men o r 4 6 . 1 $ .
bearing
( I m ention th o se f i g u r e s
o n my i n v e s t i g a t i o n w h i c h w i l l
h isto ric a l
o u tlin e).
account of th e
for
O f 2 3 4 o f t h e me n w h o s e t o n s i l s w e r e
a com plem ent f i x a t i o n
fin d in g s
in t h i s
suggest th a t
te st
are
o rganism s
te st.
o f im m u n e b o d i e s ,
is
h is
greatest
as
of
of
as th e y have a
gave
end o f t h i s
a d etailed
and a s u g g e s t e d m e th o d
T h e ir e x a c t w ords re
in te re stin g
a man’ s r e s i s t a n c e ,
to n sils
come a t t h e
The C om m ittee f i n a l l y
grow ing o f th e
to n sils
i.e .
"These f a c t s
in d icate d
safeguard
th e
by th e
presence
ag ain st th e
disease
T h i s r e p o r t w h ic h b r i n g s t h e w ork o f V i n c e n t ’ s d i s e a s e
Army u p t o
as
date
a p o ssib le
in
1 9 1 9 , m ak es no r e f e r e n c e
to
d ie tary
.
in th e
d eficien cy
cause.
M ost o f t h e w ork on t h e
illn ess
had h i t h e r t o
been co n fin ed
to
th e
Army.
th e
d isease
cases
th e
in
I n 1919
as
it
a depot
c lin ica l
a N a v a l s u r g e o n , W,N. P i c k l e s
affected
sh ip
aspects
in
sailo rs.
He h a d
of the c o n d itio n
a f f e c t i o n s w ere
th e m a jo rity
specim ens
and he
d eb ilitated .
in clin ed
to
for
treatm en t;
th at
co n d itio n
in
and on t h e
of th e
all
he n o t e d ,
w ith
its
atrophied
th a t
he th o u g h t
in v ariab le
th a t
H is t r e a t m e n t
in
L ater
for
th e
in stead
by t h i s
of great
th e
s ic k bay
d isease
in
could
o rganism
im p o rtan ce
and t h a t
affected.
c o -e x is t w ith pyorrhoea a lv e o la ris
b u t he
again
stressed
th e f a c t
a' m o u t h w a s h o f p o t a s s i u m
v in .ip ec ac,
o f c o t to n wool
he u s e d
a so lu tio n
and g l y c e r i n e / s i m i l a r t o
On t h i s
ch lo rate
d r y w o o l and p a i n t e d w i t h t i n c t u r e
of iodine
tre a tm e n t th e
b leeding
of liq u o r
th at
described
and t e n d e r n e s s
w e e k s b u t two m o n t h s w as t h e
av erag e tim e
organism s to
v a n is h from sm ears. W ith th e
tre a tm e n t used
average
tim e ta k e n f o r
p a t i e n t s w ere
co n fin ed
d escrib ed
tw o
cases
discu ssed
th e
d iffere n tial
p rev io u s w r it e r s .
tim e f o r
th e
th ree
b y me t h e
of
to
c a s e s b u t he was
carious to o th
cleaned w ith p le d g e ts
of
i n two t o
one s i n g l e
in fec tio n
of
t h e n mopped w i t h
went
in h a lf h is
itse lf
of V in cen t’s d isease.
co n sisted
(51).
co n fin e
an u n h e a l t h y m outh w as f a r from b e i n g t h e
m oistened,
by Beaum ont
seen w ere h e a l th y
c le a n m ouths w ere f r e q u e n t l y
could
The gums w e r e
arsen ic alis,
in view o f th e
o t h e r hand he had s e e n t h e
gum p a p i l l a e
anteced en t
io d in e.
did n o t
d eterm in e what
p a t i e n t s who came t o
s o i l was n o t
in d iv id u a ls w ith
The d i s e a s e ,
he had
lite ra tu re .
t h e r e w as a q u e s t i o n w h e t h e r t h e r e was
He t h o u g h t t h a t
preparedness
t.d .s ..
it
f o r m ouths w here n o t
be f o u n d .
health y
p atien ts
concluded t h a t
th in k
a sim ilar
cared
of th e
was d i f f i c u l t t o
O r a l s e p s i s was p r e s e n t
not
w ell
causes of th e
d escribed
and re v ie w e d p a s t
th e
th a t
num bers o f
t h e p r e v i o u s m o n th s and he t o o
it
fact
described,
seen la rg e
H i s own o b s e r v a t i o n s w e r e t h a t
p red isp o sin g
(29)
to
of the
acute
and more c h r o n i c t y p e s
d iag n o sis
of th e
d isease
He f o u n d t h a t w i t h t h r o a t
and h e s t r e s s e d
th e
relap ses
th ro at
th an t h i s
but
th e
bed a s w ill* be d e s c r i b e d . P i c k l e s
c u re was a f o r t n i g h t
of th e
c u re was l e s s
im portance
le sio n ,
(it
i s much l e s s
of trea tin g
lik e
and
on th e
cases h is
lin es
average
i n my e x p e r i e n c e )
t h e gu ms t o
prevent
T a y l o r and M c K in s tr y ( 1 9 ) ,
E ag leto n , M ercer
and H udson (2 6 )
reference
to
d ie t
d eficien cy
co n d itio n
and I w i l l
d isease,
He b e l i e v e d
of the
w ere
su p p ly
m ess
i.e .
th at
caterers.
F .C .B .
tim e
canteen
( I m ention t h i s
to-day
in
sm all
o f lim e
ju ice
"M erely
a p leasan t
and s t a t e d
th a t
surgeon’s
n o t m entioning
(31).
the
overcooking
green v eg etab les
su b ject to
onboard
th e law s o f
demand w a s n o t made b y t h e
because th e
sh ip s).
made no
cause of th e
on s c u r v y ,
and w e r e
(29)
o f an o th e r Naval
S ittin g s
i n many c a s e s t h e
p rev ail
a p o ssib le
and he n o t e d t h a t
by t h e
and dem and;
at th is
P ick les
s c u r v y on s h i p b o a r d w a s d u e t o
m eat and fo o d
su p p lied
as b e in g
in clu d e here n o te s
w ork w h ic h was p u b l i s h e d
V in c e n t's
and o t h e r s .
S ittin g s
in th e
s am e c o n d i t i o n s
d e a lt w ith th e
q u an tity
su p p lied
q u estio n
it
was
s u m m e r d r i n k , n o t h i n g m o r e " . ( S e e my l a t e r
w o rk ).
At t h e
su ggested
is,
I
s am e t i m e
i n 1919 H a m ilto n
im proved d i e t
th in k ,
of l i t t l e
very
stro n g
o r no v a l u e
The i m p o r t a n t
of tru e
and I h a v e
in th e se
references
is
ju ice
is
th at S ittin g s
(31)
o f s c u r v y m a k e s no m e n t i o n w h a t e v e r o f
t h e m ouths o f t h e
cases.
(I
d escrib e
one
and a n o t h e r c a s e
s aw a t D u r b a n a n d w h i c h h a d no
in th is
h isto rical
endeavoured to
su b ject
w a s Ait t h a t
stu d ied
and I w i l l
(subscurvy).
H is
of
s i g n s o f gum o r
The s u b s c u r v y p a t i e n t s ,
stam in a,
I n more
and g e n e r a l
serio u s
stag e
in
was e n t i t l e d
he s a i d ,
h ealth
or slig h tly
in
th e
m acrocytic
( W h i l e my c o n t e n t i o n
cau sin g th e le s i o n ,
is
th a t
be w id e l y
(32)
of
a p e r s o n w i t h h y p o v i t amino s i s
"Scurvy p a s t
and p r e s e n t " .
s u f f e r from w e a k n e ss,
and had a s a l l o w
c a s e s haem orrhages w ere
There w ere vague p a in s
o u r know ledge o f t h e
a d e s c r i p t i o n by A .P . H ess
ex isted
ill
in th e p o st-w ar perio d
The v i t a m i n s b e g a n t o
no w i n c l u d e
article
o u tlin e,
show a t w h a t
p erio d .
sym ptom s h e b e l i e v e d
c y tic
"There
in fec tio n ).
We a r e n o w ,
th e
said
th e N aval lim e
scurvy w ith V in c e n t’s d isease
sc u rv y w hich I
to n sil
in
a
an a n t i - s c o r b u t i c " .
cases
V in cen t’s in fe c tio n
d e a lin g w ith
In d ies S ta tio n
evidence t h a t
as
p o in t
w h ile he d e sc rib e d
case
on t h e E a s t
(30)
jo in ts
in type)
severe
lack
of
com plexion.
and o f t e n
extensive.
and l i m b s and a n a e m ia (n o rm o was alw ay s a s a l i e n t
subscurvy p la y s
a larg e p a rt
along w ith o th e r n e c e s s a ry f a c t o r s ,
featu re.
in
I have n o t
16.
found th e
subscurvy
state
to
have
such a d e f i n i t e
clin ical
form
as Hess d e s c r i b e s ) .
G .H. M O r r i s ( 3 3 )
V in cen t’ s
i n 1921 d i s c u s s e d
d ie t
a n g i n a a n d m a d e s e v e r a l n ew o b s e r v a t i o n s .
t h a t V i n c e n t ’ s a n g i n a w as an a f f l i c t i o n
civ il
life
was most
c o m m o n ly f o u n d
s o c i e t y was d i r e c t l y
th a t
esp ecially
selec ted ” .
d iet
d eficien cy
f u r t h e r noted
larg e
nIn
o p p o site to
who s t a t e d
of
c iv il life
is
th a t
W hile r a r e l y
seen in
prone to
solu b le"
of d ie t
th e
far
d efic ien cy
w riters,
we h a v e
its
G oodall
d w ellin g
classes
in
close
s am e r a t i o n s .
it
was d a i l y
look f o r
affected
was i n t h e
seen
and t h o s e
d ie ts.
The
T h e w r i t e r b y no m e a n s c l a i m e d t h a t t h e
a n g i n a w a s ma de p o s s i b l e
th a t
th is
ex isted
to
s o le ly because
call
atten tio n
to
d i s e a s e was m o st p r e v a l e n t w h ere
and he e x p r e s s e d t h e b e l i e f t h a t
p reven tio n .
oral
a p ro p e rly balanced
Thus,
to
sep sis,
th e
d i e t w o u l d go
th eo ries
lack
of p revious
o f am boceptors,
and a h o s t
of oth ers
a new t h e o r y b y M o r r i s .
very
same j o u r n a l
(34) w ro te
th e m ilita r y
em p h atically
th e
th e
o d o u rs from p u tr e s c e n t m a tte r
added
M orris
was p r e v a l e n t w here
on t h e
d iffere n ce
and m a in te n a n c e o f
In th e
to
it
d en tal p ractice
in
th a t the
o f bad t e e t h ,
o ffen siv e
J.B .
serv ice
d iscu ssio n .
d e f i c i e n c y b u t he m e re ly d e s ir e d
tow ards
(15)
or poor is
su rg eo n . M orris proceeded to
of V in c e n t's
co rrectio n
of
b e a f f e c t e d l a c k e d t h e f o o d w i t h t h e ”w a t e r
o b vious f a c t
d iet
the
and s u b s i s t i n g
a s do e x i s t
v itam in s.
in fec tio n
classes
s ta t e m e n t o f W ingrave
assem bled t o g e t h e r ,
civ ilian
dental
and h e o b s e r v e d
class
in to
in M ilita ry
each o th e r
such d if f e r e n c e s
poorer
no c o m m u n i t y r i c h
creeping
n u m b e r s o f men w e r e
by th e M i l i t a r y
H is s ta te m e n t
o f t h e m a s s e s and i n
am ong t h e
the
in
I t w i l l be a p p r e c i a t e d t h a t t h e f a c t o r
p ro x im ity to
not
d eficien cy
at the
sa m e d a t e
ab o u t N a v a l c a s e s he had s e e n
o n e s d e s c r ib e d by M o r r is .
said
"th e
as M o rris,
d iet
G oodall m oreover
d o e s n o t seem t o
a e t i o l o g y ” . As a l l my c a s e s
are
as opposed
sailo rs
p lay
th is
any p a r t
is
in
an im p o rta n t
statem en t.
The a r t i c l e
stressed
th at
co n fin ed
to
d escrib ed
th e le s io n s
th e th ro a t
th e
ty p ical
of V in c e n t's
b u t m ight
also
clin ical
p ictu re
and
o rgan ism s w ere n ot e n t i r e l y
affect
the
gu m s a n d b u c c a l
m ucosa
and t h a t
th e
in th e
fo ld s
jaw and
more on t h e l i n e s
of cu rettag e,
w ith
as c a r r ie d
all
an d 3 .
the
out
stag e
crev ices,
in
tw ice
pain t
d escrib ed
by Beaumont
of " s c a lin g ” th e
d ie t
d eficien cy
ap p lied
(90)
and
tendency to
i n more
(51)
lo c ally .
c o n sid e r to
i n 1921 w ere
i n R o u m a n i a an d w e r e
lab elled
d istrib u ted .d u rin g
the
su p erv en tio n
food.
sym biosis p lu s th e
in
d iag n o sis
any one f i e l d .
alm ost
As w i l l
ceased
to
is
There
strain s,
all
rich but
presence
h ealth y
in
1.
co u rse w here th e
started
o ften
acute
(15)
(27)
etc.
of th e
to n sil
rap id
gums w e r e
round th e
adm it t h a t
in su fficien t
fusoof
criterio n
of
o f many V i n c e n t ’ s o r g a n i s m s
develop
and h a d no o v e r s t r a i n
and o t h e r s ) ,
20 d a y s 12 c a s e s
t h e m ucous membrane
C olyer
th e
th an
and t h i s
com monplace f l o r a
la te r,
a
ca m e a t i m e w h e n u l c e r o - m e m b r a n o u s l e s i o n s
D avid and H e c q u e t c l a s s i f i e d
and d e s c r i b e d
could not
sa w s h o w e d V i n c e n t ' s
com panies began to
( c . v . W ingrave
n o u ris h e d . Yet
th ey
as
was b e t t e r
o c c u r i n t h e R o u m a n i a n Army a n d t h e
p o p u la tio n ,b u t French
t r o o p s w ere
th a t
w h ich '
coin cid ed
scurvy ran r i o t
be d e s c r i b e d
th e
"scurvy"
o r g a n is m s was due to
gum c a s e s t h e y
m outh s a t r o p h y t e s .
a p o sitiv e
th e w rite rs
o f V in c e n t's
M ost o f t h e
sp irilla ry
t h e m onths t h a t
lin es
l a r g e num bers
m embranous l e s i o n s
th at
to
arsen ic
They s t a t e d
a v e ry u n s u b s t a n t i a l n o u rish m e n t though i t
so e v i d e n t
c a s e s he
by th e
w ith
f a c t was
recurrence
T h e r e w a s no m e n t i o n
stru ck
be due to V i n c e n t ’ s s p i r i l l u m .
th a t V in c e n t’ s u lcero
cu retted
a l s o w o r k i n g on t h e
turned
ru le
chronic
teeth
be' m o s t e s s e n t i a l .
bucco-pharyngeal le s io n s
general
to th e
gu ms w e r e t h o r o u g h l y
of u lc e ra tiv e
o u t •t o
ex cep tio n
spray w ith
a week f o r 3 w eek s p l u s t h e
t e e t h w hich I
D av id and H e c q u e t
w ith th e
an tisep tic
salv arsan
d i s e a s e was e r a d i c a t e d
salv arsan
of
a good
low er
H is t r e a t m e n t was
e x c a v a t o r . He n o t e d t h e
in jected
as
1.
2.
on t h e
i n my s e r i e s ,
3 o r 4 days th e
a spear-shaped
u n less
behind th e l a s t m o la r.
and was
an a t o m i s e r t o
and g u m s ,
l e s i o n s w ere more f r e q u e n t
o r p r e v io u s m orbid
a n d who w e r e w e l l
t h e m alady i n t o
cases,
affected.
They n o te d t h a t
in ter-d en ta l
in cid en ce
appeared.
tw o g r o u p s
and 2 , fo rm s r u n n i n g
th e
a slow er
tro u b le
and s p r e a d to w a r d s
lin e
. They m e n tio n ed t o o , t h e
and t h e h ig h
These French
of V in cen t’s d isease
l o w e r w isdom t o o t h
in th e
it.
civ il
as d id G oodall
great
lo ss
(34),
o f substance
in w hich th e u p p e r p o le
of th e
18.
t o n s i l was a f f e c t e d *
had e x c e l l e n t t e e t h
Some o f t h e i r
c a s e s h a d "bad t e e t h
as was s i m i l a r l y
an d o t h e r s
f o u n d "by 3 a m p l e , P r i c e
Jones
and D igby ( 2 8 ) .
D avid
lo c ally
and H e c q u e t f a v o u r e d
and d id
was l e s s
not
favour in te rn a l
effic acio u s
t h e m outh w i t h
i n 12 to
in
As a g e n e r a l
in th e
w ar and r e s e a r c h e s
su b ject
observed
he
a sim ilarity
and V i n c e n t 's
2 cases of
succedded
recovery of th e
A p o sto lid es
o f th e
d isease
to
scarified
in p roducing u lc e rs
That
su b jectjb ein g
ch iefly
w ere p r e s e n t
same y e a r K e i l t y
in terested
in
ro le
of fu sifo rm
invaders
w o rk in g on t h e
(36)
in fo c a l
I n tw o
in fec tio n
of
as
in stan ces
b acilli
and
on t h e
a cause
study of th e
gums.
an d s p i r o c h a e t e s
( 3 7 ) , who h a s d o n e
organism s^observed th e
and s p i r o c h a e t e s
in pulm onary c o n d i t i o n s .
a vast
organism s
in
( 3 8 ) made a n e x h a u s t i v e
and w e n t i n t o
They succeeded
th e ir
in
lung c a v i t i e s
and p u lm o n a ry t u b e r c u l o s i s .
(39)
i n w hich t h e
p ractically
1922,
of tro p ical
c o n t i n u e d to r k
In 1924 D avis a n d - P i l o t
b acilli
of b ro n ch iectasis
site s
in
o f pseudo-m em brane
d e m o n stra tin g t y p i c a l V in c e n t's organism s in th e
N ichols
of th e
alm ost ev ery c a se .
o f work on V i n c e n t ' s
as
p assin g
p ictu re
an e x h a u s t i v e b a c t e r i o l o g i c a l
norm al t o n s i l .
stu d y
took p la ce
co n tain in g fu sifo rm b a c i l l i
The f o l l o w i n g y e a r T u n n i c l i f f
the
p atien ts
sk in .
I n 2 0 0 p a t i e n t s whom h e e x a m i n e d f u s i f o r m
amount
of
o f sodium
fre s h h o sts
in th e b a c te r io lo g ic a l
angina over th e
conducted
(35)
a n g i n a and b a n d ag e d p i e c e s
sp iro ch aetes.
and h e
and g a r g l e s
did n o t fa d e w ith th e
co n tinued.
experim ental tran sm issio n
from
cleansed
20 d a y s .
In tere st
u lc er
They f i r s t
and a lw a y s rem oved t h e f a l s e
a m ilk d i e t
ru le
ap p lied
a r s e n o b e n z o l w hich t h e y found
a few d a y s and f o u n d p e r m a n e n t l o s s
They a d v o c a te d
b icarb o n ate.
and g l y c e r i n e
th an th e lo c a l tr e a tm e n t.
10^ s i l v e r n i t r a t e
t o n s i l l a r membrane
substance.
arsenobenzol
in th a t
s am e y e a r w a s c o n c e r n e d w i t h t h e
org an ism s e x is te d
alw ays be d e m o n strated
and showed t h a t
in
th e
th e y
su b -g in g iv al
could
crevices
a p p a re n tly h e a lth y m ouths.
L ike D avis
p u b lish ed
in fec tio n .
and P i l o t
an a c c o u n t
V in c e n t's
o f two
(38),
cases
C h e v a lie r Jack so n (40)
i n 1924
i n w hich t h e r e was b r o n c h i a l
o rg a n ism s w ere
dem onstrated to
be p r e s e n t
19.
and t h e
th e
in terestin g
lesio n s
p o in t
actu ally
In 1925 G oodall
i s t h a t t h e b r o n c h o s c o p e was u s e d
and
view ed.
(41)
d escrib ed
a case w ith
extension to
the
lary n x .
I n 1927 P . V arn ey
b a c illi
them
and a p p r o a c h e d t h e
site s
rep o rts
m ou th and t h r o a t ,
abscesses,
concluded th a t
q u ick ly
o rg a n ism s had b een o b ta in e d
noma,
ero siv e
c o n d itio n s m ight
a rap id ly
sero lo g ical
attack
but th e
and m o r p h o l o g i c a l
lo g ical
safely
te sts.
fu sifo rm
id en tified
He
a lm o st any o rg a n o f th e
of fu sifo rm b a c i l l i
four d iffere n t
b acilli
upon c u l t u r a l
He i s o l a t e d
th a t
R. T u n n i c l i f f
(64)
b eliev es
are
stag es
d ifferen t
The n e x t
(43)
in
appearances
in
on a d i e t
rich
opinion th a t
a classificatio n
and m o r p h o l o g i c a l g r o u n d s o n l y ,
a wavy t y p e
to
th a t fu sifo rm b a c i l l i
life
h isto ry
in th e
a tru e
analogous to
noma.
o f 10 n o r m a l a n i m a l s w i t h
d efic ien cy
come n e a r e r t h e
comes t o
present
date
should
form s
organism .
d i s e a s e was by D .T ,
in fec tio n .
i n v i t a m i n C and i n o c u l a t e d
organism s,
betw een th e
c h e e k . The r e s u l t w as a s p r e a d i n g
O nly l o c a l
sim ilar
of
sp irillu m .
and s p i r i l l a
of a sin g le
stu d y o f th e
d efic ien t
of the
and
of fu sifo rm b a c illu s but
in f u s o - s p i r i l l a r y
cutaneous la y e rs
alone
size
1 9 3 2 , when w o r k in g on e x p e r i m e n t a l V i n c e n t ' s
them w i t h m a t e r i a l
gangrene
step
types 3
from each o th e r o n ly by s e r o ­
had any r e l a t i o n s h i p
in th e
im p o rtan t
guin ea p ig s
mucous and
it
t y p e s by
He c o n s i d e r e d t h a t
by m o r p h o lo g ic a l
d iffere n tiated
h e h a d no e v i d e n c e
v itam in
and
a t t a c k e d m ucous membranes
cu ltu res
stu d ies.
V a rn e y was o f t h e
attem pted.
He f e d
and p y o r r h o e a ,
o r g a n is m s o f t y p e s 1 and 2 w h ic h v a r y g r e a t l y
could be
S m ith
te e th
ad v an c in g n e c r o s i s w hich u n l e s s
a n d how h e h a d i d e n t i f i e d
and 4 c o u l d o f t e n b e
n o t be
in c lu d in g th e norm al
cheeked m ight te r m in a te f a t a l l y .
iso la ted
shape
of the
pulm onary a b s c e s s e s
f u s if o r m b a c i l l i m ost o f te n
pro d u cin g
a short h isto ry
and g a n g r e n o u s b a l a n i t i s .
T h e n h e d e s c r i b e d how 1 8 p u r e
w ere
carious
a n tru m o f H ighm ore,
and i n
but under sp ecial
body o f t e n
in tro d u c tio n w ith
o r g a n i s m s and he g a v e a l i s t
angina c a se s,
th e
b ro n ch iectasis,
in h is
on V i n c e n t ' s
i n w hich t h e
study of fu sifo rm
p r o b l e m f r o m a new a n g l e b y c l a s s i f y i n g
s e r o l o g i c a l l y . He d e a l t
of early
leg
(42) was c o n c e rn e d w i t h t h e
abscesses
in jectio n s.
b e m e n t i o n e d more
developed
I t w i l l be
and m ore
a n d how a d e f i c i e n c y
in 8 out
s e e n how
as th e
article s
of p ra c tic a lly
all
20.
th e
v itam in s
is
are
ev id en tly
blam ed by s u b se q u e n t w r i t e r s
tru e
fo r th e
p articu la r
part
and t h e i r f i n d i n g s
o f th e w orld
in w hich
t h e i r w o rk was d o n e .
S m ith
th at
did
th e
not
(44) w r i t i n g
in travenous
produce
m easures
again in th e
use o f arsphenam ine
good r e s u l t s
u n less
it
in
1933,
said
c h r o n i c t r e n c h m outh
w as s u p p le m e n te d by d i e t a r y
and t h o r o u g h d e n t a l t r e a t m e n t .
Two y e a r s
la te r
in 1935,
s t o m a t i t i s w as w e l l known t o
trau m atized
by c h r o n ic
resto ratio n s
scurvy,
fo llo w in g y e a r,
or
most o f te n
epidem ics
or
Gay ( 4 5 )
stated
th a t V in cen t’s
occur p a r tic u la r ly
irrita n ts
in m ouths
such as t a r t a r
accom panying n u t r i t i o n a l
or fau lty
d istu rb an ces
in to x icatio n s
such as m e rc u r ia l p o is o n in g .
in
in stitu tio n s,
c h ild re n 's
of exanthem atous fe v e r s
esp ecially
o r o th erw ise
dental
such as
IToma o c c u r r e d
fo llo w in g
in u n d ern o u rish ed
c h ild ren .
So f a r
-o n ly
S m ith
w ith, t h e
in
d ietary
(43)
com plex in
larg e
in h is
evidence
e x p e rim e n ta l w ork.
concerning th e
a p a p e r on t h e
treatm en t
num bers o f f u s o - s p i r o c h a e t a l
p ellag ro u s
sto m a titis
im proved w ith
subscurvy
the
state
D alld o rf
” su b -clin ical
1935 on t h e
resistan ce
ex ists
(80),
v itam in
effect
at le a st
do a l s o
acid
and o t h e r s
b eliev e
showed
T his th e y
a m arked
concluded,
acid,
is
to
p ellag ra
state
If
b eliev e
those
in
it.
so -called
I n an a r t i c l e
in
on c a p i l l a r y
to
and p ro m p t r i s e
showed t h a t
a
t o o , an d
eleven
in m ates
and two 3 o t h e r s
in
v i t a m i n C d e f i c i e n c y was p r a c t i c a l l y
reference
as th e
th at
in jectio n s
of asco rb ic
in
v i t a m i n B com plex.
how t h e y g a v e i n t r a v e n o u s l y ,
1 0 0 mg .
14 p a t i e n t s
cleared
d eficien cy s ta te s ” e x is t.
of asco rb ic
th ey t e l l
resistan ce.
(47)
(46)
He s h o w e d how
o rg an ism s w ere found
M cL ester (70)
S pies
of th e vitam in B
of p e lla g ra .
lesio n s
and
co n n ectio n
However T.D .
t h e r e may b e a s u b p e l l a g r a
and R u s s e l l
a c o u n ty home,
A ll th e
a n d how t h e
in
im p licatio n
a d m in istra tio n of th e
many w o r k e r s , K in g
of
as a w hole h a s b een m e n tio n e d
m entioned v ita m in C s p e c i f i c a l l y
d isease,
1935 gave
d eficien cy
in
50 mg.
cap illary
one i n s t i t u t i o n
u n i v e r s a l . ( This
s h o w how s u b - c l i n i c a l f o r m s o f v i t a m i n
deficien cy
can e x i s t ).
I n 1936 t h e
in fec tio n s
by th e
A u s t r a l i a C lem ents
fusifo rm
b acillu s
(49)
produced
and t h e
evidence th a t
sp irillu m
o f V incent
21.
w ere p r e d is p o s e d
the
d ie t.
feeding
of
by a d e f i c i e n c y
in
H is w ork was e x p e r i m e n t a l
rats
on a d i e t
in o c u latin g
organism s,,
d eficien t
t h e v i t a m i n B com plex in
in nature
in
and c o n s i s t e d
of
t h e v i t a m i n B c o m p le x and
them w i t h f u s o - s p i r i l l a r y m a t e r i a l u n d e r d i f f e r e n t
circu m stan ces.
as w e ll .
to
C u ta n eo u s u l c e r s from w hich he
only
resu lted
recovered
th e
a f t e r th e p a r t had b een tra u m a tiz e d
He c o n s i d e r e d t h e
l a c k o f t h e v i t a m i n B com plex t o
be
v ita l.
That
s am e y e a r 1 9 3 6 May M e l l a n b y
developed
A, w h i l e
read ily
in
on s i m i l a r
(50)
showed t h a t
dogs whose d i e t s w e re d e f i c i e n t
d ie ts w ith th i s
v itam in
pyorrhoea
in vitam in
a d d e d t h e gu m s
rem ained n o rm al.
S in clair
(65)
in f u s o - s p i r i l l a r y
h im self b e lie v e s
in fec tio n
A and B.
p erio d ,
" T re n c h M outh",
angina p ro p e r,
Beaumont
ic alis
a com bined d e f i c i e n c y
(51)
current
cancrum o r i s
advised p a in tin g
(1^- d r a c h m s ) ,
to
1937,
is
v itam in
d eficien cy .
th at
scalin g
show l a t e r
as
In
(52)
th e
th a t
te eth
(34)
sig n s.
and g l y c e r i n e
question of th e re
F o r cancrum o r i s
being
th e
r a t s w ere
d en tin e
in tra­
so lu tio n s
and
and rem oving t a r t a r w h ich I w i l l
in the
treatm en t.
a n o t h e r v i t a m i n was m e n tio n e d by Lee and S u re
t h e r e was a p o s s i b i l i t y
d en tally .
th a t
a d iet
d efic ien t
They w orked on a lb in o
d efic ien t
v i t a m i n Bq t h e n t h e m o s t r e g u l a r a n d m a r k e d d e g e n e r a t i o n
m y e lin was fo u n d
is
an
he a d v is e d
arsen ic
and f o u n d t h a t when a n i m a l s w e r e on a d i e t
of d eg en eratio n
arsen-
and many e a r l i e r w r i t e r s .
as any o t h e r f a c t o r
i n v i t a m i n Bq m i g h t b e r e f l e c t e d
rats
drachm s)
Local trea tm e n t w ith
im p o rtan t
1937 a l s o ,
who s a i d
o r w ith V in c e n t's
common c l i n i c a l
(l^
d ealin g
Beaum ont m e n tio n s f o r t r e n c h m outh and he makes
no m e n t i o n o f
is
o f m edicine
a m o u th w a s h o f M i l t o n . The a r s e n i c a l p a i n t
t h a t u s e d by G o o d a ll
all
o r noma,
t i n c t . ip ecac.
m uscular su lp h a rse n o l.
M ilto n
of vitam ins
of th e u lc e rs w ith liq u o r
B e a u m o n t m a k e s no m e n t i o n o f t h e
asso ciated
tex t-b o o k s
m e re ly m entioned th e
(1 drachm ;) p l u s
sim ilar
p red isp o sin g fa c to r
•
At t h i s
w ith
is
th a t the
in the trig e m in a l
corresponded
and s c i a t i c
in most
on th e
d efic ien t
d ie t.
became u n d u ly
sen sitiv e
to
cases to
nerves.
in
of
The d e g r e e
t h e number o f days
The s o f t p a r t s
in stru m en tatio n .
and t h e
I n humans to o
22.
it
is
claim ed t h a t
d en tine
to
sen sitiv e
in stru m en tatio n
to
se n sitiv ity
It
several
and
th e
hypoderm ic n e e d le ,
v itam in s
fu so -sp irillary
S em ple, P r ic e
Jones
and many o t h e r s )
mash t h e
is
my p r i v i l e g e
im portant
s t u d y o f gum l e s i o n s
in
are
th e
in m ost m ouths,
N ich o ls
" t r e n c h mouth"
T his is
seafaring
of
(B outy ( 2 2 ) ,
( 3 9 ) , V arney (42)
co u ld be s t a r t e d
one o f th e
class
deficien cy
lin es
an d
on w h ic h I
a m o n g s t whom i t
a r e many i n s t a n c e s o f w o r k e r s f i n d i n g
th e y had
Thus J e g h e r s
B oston w ith
v i t a m i n B]_.
has been
to w ork.
There
of persons
undue
th a t
and D ig b y ( 2 8 ) ,
b a s e my s t u d y o f t h e
a n d who a r e u n d u l y
can o f te n have t h i s
organism s
lesio n .
of th e
above r e f e r e n c e s
how e a s i l y
o rig in al
sen sitiv ity
changes
doses of th e
s e e n from th e
of the
extrem e
and t h e r m a l
cu red by la r g e
is
sin ce
p e r s o n s who h a v e
(53)
exam ined w ere d e f i c i e n t
in
in
1937 ex am in ed 162 m e d i c a l
th a t
classes
a certain
students
v itam in .
at
a s p e c i a l p h o t o m e t e r and f o u n d 55 o r 34^ d e f i c i e n t
i n v i t a m i n A.
I n 1937
an u p - t o - d a t e
th e
th ro at
here
in
found
days
le sio n
is
detach ab le
it
rest
slig h tly
u lc erated
grey,
its
membrane
forceps
tissu e
it
b leed in g
base,
is
and i s
surface
On t h e f i r s t
on t h e
seen.
I
in clu d e
date.
ex p elled
th ird
u lcer.
co lour.
It
is
When p i c k e d
an i n f r a c t u o u s ,
eroded
a re a d o tte d w ith
The u l c e r h a s
are
an i r r e g u l a r ,
and h e a l s
over.
and
up w i t h
(c.v .
W ingrave
sm all
in d o len t,
abrupt or slo p in g .
re-form
a
Th e s o -
soft
to r n fragm ents
ceased to
and f o u r t h
sim p ly form ed by th e
easily
pseudo-m em brane
shows an
o r sw allow ed, le a v in g
of th e
in
it
"The l o c a l
day one t o n s i l
and on t h e
speak in g ,
surface
of
T h e m e m b r a n e may b e c o m e
may be r e d d e n e d o r o e d e m a t o u s .
clean
d escrip tio n
s e c o n d d a y t h i s membrane i s
surface;
or greenish
ed g es o f w hich
p u b lish ed
o n w h i c h mew m e m b r a n e ' f o r m s .
co rrectly
from th e
I have
(55)
soft
p o in ts.
th e
tissu e
g ets
edges
and t h e i r
f e a t u r e s up to
and s o f t e r .
com es away i n
leav in g
salien t
ty p ical.
yello w ish grey
(15))
th e
becom es t h i c k e r
n ecro tic
co n d itio n
on an u l c e r a t e d
at
Thomson and N e g u s
one o f t h e b e s t
ex u d atio n ;
detached
called
C lair,
on th e
b rin g
are f a i r l y
to
S t.
a rtic le
o rd e r to
featu res
easily
also ,
flatten e d
The s u r r o u n d i n g
A fter 4 to
10 d a y s t h e
and t h e u l c e r a t e d
But i n more p ro n o u n c e d
surface
cases
th e
soon
tissu es
23.
are
in v o l v e d m ore
to n sil,
th e
deeply
and t h e p r o c e s s
ad jo in in g fa u c ia l p illa r s
sid e
of th e pharynx.
The d e s t r u c t i o n
days
afte r
of th e
th e
onset
The a u t h o r s
V in c e n t's
all
noted
extends
a n d gum s a n d r a r e l y
of tissu e
th e
occurs 3 or 4
d isea se .”
th a t
in the
a n g in a was a u n i l a t e r a l
g reat m ajo rity of cases
affectio n .
They sum m arised
p r e v i o u s m e t h o d s o f t r e a t m e n t w h i c h h a v e "been p r e v i o u s l y
m entioned b u t
salv arsan
th e
consid ered
lesio n ,
or b etter
of
C ecil
in 1940,
not
t h a t t h e b e s t m ethod was to
pow der on a t h r o a t
in jectio n s
(72)
S t,
swab m o i s t e n e d w i t h
s till
to
give
T his
is
the
arsen ic .
p articu la rly
and o t h e r s .
who t h i n k s
effic acio u s,
C la ir,
in trav en o u s
o p p o site
th at
and d i s i n f e c t i o n
and t o n i c
treatm en t.
(55)
o f th e m outh, w ith
teeth
p u rg in g
and t o n i c s
p rep aratio n
p a rt w ith
u n til
th e
as e u s o l . They
a rticle
p ain t
w orked o r
in
seen
in san itary
in th e
f r e q u e n c y was n o te d
a clin ic
was 7 w h i l e
A gain
in
in Prague
1919 t h i s
d eficien cy .
said
was w e l l
it
p atien ts
w ere
system
ch iefly
system ,
in
c.
certain
sought f o r th o se
to
a.
air
to
u lcerated
(51).
There
i t was an up
th a t
the
th e
said
fact
ou tsid e
it
th at
disease
was b u t
in crease
th e war a re a .
number o f c a s e s
to
trea ted
57.
on t h e m i l d d e g r e e s
of
reg ard in g vitam in B d e fic ie n c y
th ro u g h th e
prolonged
stu d y of
o f known c o m p o s i t i o n t h a t
o f m ild v ita m in B d e f ic ie n c y .
th e g a s tr o - in t e s tin a l
th e
rest,
some s u c h
of th e
and t h e y
coun tries
had in c r e a s e d
on a d i e t
to
fresh
s u b j e c t s w ho.w ere o v e r ­
stressed
i n 1914 t h e
estab lish ed
sym ptom s and s i g n s
nervous
in
is
in 1921,
was u n w ise
how ever,
d eb ilitated
Elsom (5 6 )
su b sistin g
referab le
They s a i d ,
i n 1937 more w ork was done
v itam in
it
t h i s w ork a l th o u g h
The w r i t e r s
(27),
advocated
rest,
treatm en t
surro u n d in g s;
co n tag io u s.
in
in
in
feeb ly
Thus
also
as d e s c r i b e d by Beaumont
o th erw ise.
was m ost f r e q u e n t l y
(90)
th e m outh w i t h
advocated
w a s ' no m e n t i o n o f v i t a m i n s
date
arsphenam ine
g e n e r a l c o n d i t i o n had im proved w i t h
an d c l e a n s i n g
arsen ic al
to
t h a t when t h e u l c e r a t e d
g i n g i v i t i s k n o w n a s " t r e n c h m o u t h ” <o c c u r r e d
ex tract
g ly c erin e
o p in io n o f C olyer
D avid and H e c q u e t
They b e l i e v e d
apply
or in tram u scu lar
in trav en o u s
T h o m s o n an d N e g u s
clean sin g
to
o v e r "the w h o l e
b lo o d and d .
circu m stan ces.
to
the
trac t,
in
T hese w ere
b,
th e
card io -v ascu lar
I m ention t h i s
s y m p t o m s i n my c a s e s
th ere
because
an e n d e a v o u r t o
I have
fin d
a
24.
sh o rtag e
oi v ita m in B in th e
A lso
i n 1937 S m ith , P e r s o n s
study
th e
ty p es
of b lack
that
id e n tity
of the
tongue
and H a rv e y
so -called
in dogs.
of v ita m in B in
fu so -sp iro ch aetal
in fectio n
w ere v e r y d e f i n i t e
T h e i r w ork l e d
on t h e
the
po in t
and
appearance
reliab le
of
value
of certain
led
of th e n u tr i tio n a l
th a t
develop
of b la c k to n g u e.
con fid en ce
th a t
in
'T'hey
’’D o g s
assay in g
su b stan ces because
secondary fu s o -s p iro c h a e ta l in f e c tio n
in d icato r
conclude
them t o
even s t a t e d
G o l d b e r g e r d i e t ma y b e u s e d w i t h
p ellag ra-cu rativ e
them t o
and f u r t h e r m o r e
dog’s d ie ts
in each ty p e
about t h i s
(5 7 ) worked t o
" G o l d b e r g e r ” a n d ’’U n d e r h i l l ”
v i t a m i n B d e f i c i e n c y was r e s p o n s i b l e
a d eficien cy
th e
p atien ts.
is
th e
a
s t a t u s ” . T his i s
a very
im p o rta n t pronouncem ent.
I n 1938 S t i t t ,
co n n ectio n w ith
c o u ld be found
and V i n c e n t ' s
ty p e s
T his
th e
site s
th at
to
organism s
H arper
sto m a titis
be e x p e c te d
it
was to
not m ention t h a t
T.W.
T he f i r s t
(21)
d iffere n tiate
th e y could
(62)
and w i t h
’’f u a d i n " .
was v e r y t o x i c
V in c e n t's
asp ects
to
B o s e b u r y a n d G. F o l e y
rem ained
because
stressed
how
c o n d itio n s , b u t did
research
in fectio n .
into
th e
su g g ested
they
in tram u scu larly but
th a t,
of the
and h e n ce
it
o c c u r w i t h no w a r n i n g .
(63) w orked on e x p e r i m e n t a l
stated
th a t
i n many o f
o rganism s to
its
cases
of
fresh h o sts.
and t h e w o r k e r s th o u g h t t h a t t h e n e g a t i v e
w h ile
a m ix tu re
o f members o f t h e f u s o -
s p i r o c h a e t a l f l o r a m ight be p a t h o g e n ic ?i t s
th e
su b ject,
a n ”o b s c u r e p r o b l e m ” a n d t h e y e i t e d
F a i l u r e s w ere m entioned
n o t h ig h
of the
a n tim o n y and p o ta s s iu m
T h is was a d m in is te r e d
successful trah sp lan tatio n
fin d in g s
presence
c o -e k is t w ith a V in c e n t's
in 1938 c o n tin u e d t h e
o th er
o r carcinom a.
on t h e
th ree
angina
an a n t im o n y compound u s e d f o r b i l h a r z i a s i s
in fe c tio n
it
w riters
th o se
and d e a t h was l i a b l e
I n 1939 T.
sy p h ilis
and many o t h e r s ,
and a d v o c a te d t r e a t m e n t w i t h
ta rtra te
called
Hoss
o rganism s
in V in c e n t's
in view o f th e u n i v e r s a l
in m ost m ouths.
im p o rtan t
in
b u t t h a t th e y m ight co m p lic a te
such as d ip h t h e r ia ,
( 1 6 ) , M cK enzie
d isease
i n w hich f u s o - s p i r i l l a r y
th e y w ere v e r y num erous
of u lc eratio n
is
C loug h and C lou gh (5 8 ) m e n tio n e d
co n d itio n s
in excess
v i r u l e n c e was o r d i n a r i l y
o f sim ple t r a n s f e r
i n f e c t i o u s m ix tu r e m ight be r e q u ir e d f o r
of
a successful re s u lt.
( T h i s w a s my own i d e a
a n d my c h i e f w o r k w a s t o
a c o n d i t i o n w h ic h was l a y i n g th e
in fec tio n
by t h e
lu n n icliff
had
scillaren -B
tran sp lan t
m ic r o b e s .)
induced
Many c a s e s w e r e
been s u c c e s s fu lly
H ennessy
th e y no ted
used to
rarity
th e
te eth .
them to
co m paratively
in
(91))
a sm all
th e
and b . f u s i f o r m
(On r e a d i n g
of th is
d isease.
asso ciatio n
o f th e
and F o l e y ’ s work
in fe c tio n ,as
th e
The g r e a t
study of p re d isp o sin g
o f view ,
as th e y
co n flictin g
along w ith
in g u in ea p ig s
flo ra
in
the
O ther ex p erim en ts w ith
and to
ad m in istratio n
appeared
actinom yces w ith
value of ex p erim en tal
in
the
o p p o rtu n ity
o r m odifying f a c t o r s
th e
on i t s
efficacy
the
fo llo w ed
im p o rtan t
o f n e o —a r s p h e n -
in fectio n .
le ssen
cause
effect
They t o o ,
of the
a g re a t d im inution of the
in to
th e
le sio n .
and t h e y c o n c lu d e d t h a t
o f neo-^arsphenam ine u n d e r t h e
e x p e r i m e n t s was i n e f f e c t i v e
c h a r a c te r o f ex p e rim e n ta l V in c e n t's
cited
in the d is e a s e .
d ischarg e
d i s c h a r g e when i n j e c t e d
it
an aero b ic
an e x p e r im e n t w h ic h i s
stu d ied
rep o rts
e.g .
G uinea p ig s w ere c h i e f l y
t h e y -saw i t , l a y
They c a rrie d , out
in man,
th at
as th e y had f u s o - s p i r i l l a r y
A r s p h e n a m i n e 1s c h i e f v a l u e w a s t o
in trav en o u s
a
as th e " v ib r io
strep to th rix
am ine on e x p e r i m e n t a l f u s o - s p i r o c h a e t a l
a number o f
h a n d s on
m ixture th e p a r a l l e l
actinom ycetum c o m ita n s ).
gave f o r
of th ese
b acilli
an i n a d e q u a t e l y d e f i n e d
f r o m my p o i n t
and
in
o rganism s have
and d .
be th e
V in c e n t's
th e ir
of M iller
fu so -sp iro ch aetal
le sio n s
in ju red
organism re g a rd e d
in R osebury
th e
in fec tio n
m o tile
b acillu s
o rganism s.
teeth
produce le s io n s
o rg a n is m s i n t h e i r m ouths i n h e a l t h .
in
got
activ ely
strep to co ccu s.
it
of th e
n ew i d e a w a s e v i d e n t f r o m t h e i r w o r k v i z .
c.
th a t
a successful
o r a blow on t h e
conclude t h a t
treponem a m icro d en tiu m
used
get
i n f e c t i o n h a d f o l l o w e d human b i t e s
number o f tim e s th e y
a.
the
in dogs by
such c a se s.
aid th e tr a n s p la n t
com plex m i x t u r e s w e re n e c e s s a r y to
t o me t o
open to
low v i r u l e n c e .
An e n t i r e l y
v irid an s"
was to
w ith w hich d e n t i s t s
com parison w ith
T his le d
such
q u o te d w here m e c h a n ic a l t r a u m a t i z a t i o n had
and F l e t c h e r
th e
of in to x ic a tio n
organism s
C ases w ere m e n tio n e d where
(c.v .
fin d
gum s o f t h e p a t i e n t s
a n d how e a s y i t
of V in c e n t's
to
Th e a u t h o r s m e n t i o n e d how R.
a state
in jectio n s
try
in
alterin g
th e
although
co n d itio n s
course or
i n f e c t i o n , when t h e
same d r u g
was a p p l i e d
in
am elio ra tiv e
d irect
th a t
t h e r e was
'e x a lta tio n
th a t
R osebury
and F o l e y .
1939
in terest
gave
"passage"
as o f te n
th ere
th e
le sio n s.
w a s no m e n t i o n o f v i t a m i n s
A m erican w o rk e rs
seem t o
r e p o r t on t h e
organism s.
evidence
of
and th e
It w ill
i n th e w ork o f
have ta k e n
i n f e c t i o n f o r R.
m o rp h o lo g y and .t h e m a n n ers o f c u l t u r i n g
Her s t r o n g e s t
and
o f v i r u l e n c e " . No i m m u n i t y w a s
in f u s o - s p i r ill a r y
a m asterly
was
a s 20 t i m e s
on g u i n e a p i g s by r e c o v e r y fro m t h e
be n o ted
In
t h e r e was a d i s t i n c t
im p o r ta n t d is c o v e r y was t h a t
th ro u g h v a rio u s g u in ea p ig s
conferred
flo ra
effect.
A nother v e ry
p o ssib le
c o n ta c t w ith th e
a new
T u n n icliff
She d e s c r i b e d
(64)
th e ir
them a n a e r o b i c a l l y .
an a e t i o l o g i c a l r e l a t i o n b e tw e e n
fu sifo rm
b acilli
asso ciated
s p i r a l organism
n ecro tic
p r o c e s s e s w i t h w h ic h t h e y w e re a s s o c i a t e d was f u r n i s h e d
by t h e i r
presence,
unm ixed w i t h o t h e r b a c t e r i a ,
and t h e
in th e
area of
advancing n e c r o s is .
The m a in them e
w hether th e fu sifo rm
o f h e r work was on t h e
o r g a n i s m s and t h e
organism s
o r w h e th e r th e y w ere p a r t s
org an ism .
(She b e l i e v e d
in
1927 t h a t
conclude t h a t
authors w ritin g
th e
cy cle.
of the
th a t
le sio n
she
in to x ic a te d w ith
th ey
developed
of th e ir
conducted
etc.
(42)
in jectio n s
who d i d f e e d i n g
th o u g h t
He h a d no e v i d e n c e
related .
of th e
V arious
as b e lie v in g
same l i f e
evidence m ostly.
o f t i s s u e s was n e c e s s a r y
experim ents
o f one
She
to
cause
on dog s w h ic h sh e
an d t h e n f o u n d
organism s.
th at
She q u o te d
experim ents to
cause
by r e d u c i n g t h e v i t a m i n B com plex com ponent
d ie ts.
D udley B u x to n
deep t i s s u e
thfet
stag es
in f e c tio n s w ith V in c e n t's
ton g u e
cycle
V arney
o th erw ise
on c u l t u r a l
scillaren -B
t h e w ork o f M i l l e r
dog b l a c k
organism s.
d iffere n t
im paired v i t a l i t y
and
th eo ry ).
life
org an ism s m ention T u n n i c li f f
two o r g a n i s m s a r e
as to
s p i r i l l a w e r e two d i s t i n c t
o f th e
th e y w ere
Her view s w ere based
th o u g h t
th e
la tte r
th e y w ere d i s t i n c t
w ith w hich to
th at
the
q u estio n
lay ers
same y e a r ,
in v e stig ated
(97)
and t h e
1939,
said
th a t
th e
B fu sifo rm is
spirochaete
is
on t h e
a n o t h e r A m erican w o rk e r J .A .
v i t a m i n A and B d e f i c i e n c y
is
in th e
s u r f a c e j and
S in clair
(65)
as an a e t i o l o g i c a l f a c t o r
in
acute,
at f i r s t
th a t
su b -acu te
w ere
conducted
e p ith elial
on d o g s and o t h e r a n i m a l s .
g r o w th was s t i m u l a t e d
could
nappen
in
illfittin g
crow ns
and c a lc a r e o u s
n o n —h e a l i n g
th a t
o th ers.
p erso n s through i r r i t a t i o n
d ep o sits
such k e n a tin is a tio n
He n o t e d
along w ith
in
p ellag ro u s lesio n s
S pies
a fte r n ic o tin ic
o f t h e m u c o u s membrane l e s i o n s ,
of th e
c u t a n e o u s l e s i o n s when p r e s e n t
retu rn
o f norm al g a s t r o - i n t e s t i n a l f u n c tio n .
th e
m outh,
th ro at
strik in g
and to n g u e
red n ess-an d th e V in c e n t's
h o w e v e r, was w i t h
vitam in
He t h o u g h t t o o ,
and B w o u ld e f f e c t
eyes
cures,
a m inor m a t t e r ,
S in clair
d isease
and i n t h e
(65)
m outh w i t h
sm ooth,
vu lv a,
scrotum
th esis
to
or
co n sid er l a t e r
p articu la r
class
im p o rtan t e i t h e r
o sis).
t h e r e was
of the
ery th em a
The a b n o r m a l
o r com bined a s
a p o ly -
in f e c tio n s to a r i s e .
lack
describ ed
(day -b lin d n ess)
as i t
is
p o in ts w ith re fe re n c e
to
sore
of th e
im p o rtan t
in
th is
th e
I h av e o b s e r v e d . From S i n c l a i r s
t h a t v i t a m i n A and B d e f i c i e n c y
alone o r
the
o f th e w o rld and
and excem ato u s l e s i o n s
I m ention t h i s
th o se
o f v i t a m i n s A a n d B.
as having
dim ness of v i s i o n
of p atien ts
c o n c l u s i o n s we s e e
acid,
H is m ain w o rk ,
in v a rio u s p a rts
g la z e d tongue
anus.
i n 1935 and
b u t v i t a m i n C d e f i c i e n c y was i n h i s
com pared w ith t h e
in
(46)
U su ally w ith in
rectum .
alone
q u o te d E . J . W right
itse lf
occurred
C g iven along w ith th e v ita m in s A
w hich had been r e p o r te d
w hich e x p r e s s e d
o f gums f r o m
e x p e r i m e n t s c o n v in c e d him t h a t
eith er
v itam in
here
changes in th e m ucosa o f
cause fu s o .-s p irilla ry
th a t
/
and a t e n d e n c y t o w a r d s t h e
in fe c tio n vanished.
A and B d e f i c i e n c y
a v i t a m i n o s i s w ould
b lanching
ob jectiv e
do g s and h i s
a slow ,
very fre q u e n tly
fad in g
th e r e w ere
in
( I may s t a t e
sectio n s
as h ad T.D.
o b s e r v e d how,
by f i l l i n g s ,
resu ltin g
th a t V in cen t’ s in fe c tio n
S in clair
24 h o u r s
He c o n c l u d e d
by m e c h a n ic a l i r r i t a t i o n .
o r re c u rrin g V in cen t’s in fe c tio n .
X n o t e d no
cases).
H is ex p erim en t
ch an g es developed w ith v ita m in A d e f ic ie n c y
when e p i t h e l i a l
T his
and c h r o n i c V i n c e n t ’ s i n f e c t i o n .
as a com bined d e f i c i e n c y
H is e v i d e n c e was b ack e d by t h e i i n d i n g s
is
esp ecially
(p o ly -av itam in -
of K irk p atrick
( 6 6 ).
In
a fie ld
2 ,0 0 0 n a t i v e s
survey
i n Hew G u i n e a , K i r k p a t r i c k
and a n a ly s e d t h e
exam ined
about
d a t a o b ta in e d by s t a t i s t i c a l m ethods
The f i n d i n g s
in d icated
p erio d o n titis
to o ,
th a t V in cen t’s in fe c tio n
w ere
asso ciated w ith
and s u p p u r a t i v e
a p a rtial
d eficien cy
o f v i t a m i n s A and B.
The m a j o r i t y
V in cen t
p lay
s in fectio n
a part
in
be f o r g o t t e n
tim e;
for
th u s
th ere
it
since
had been p o s t u l a t e d
h is
o f vague
I t must n o t
be f a l s e
diseases
ju st
as
at
d iffere n t
tim es
w ith
the la p se
of
was th e vogue f o r d ia g n o s in g
accu rate
"co litis"
symptom s a s i s
and
d escrib ed
by
" S to r y o f Sans M ic h e le " .
chem ical
such c o n d itio n s
been v ery
in fec tio n .
few y e a r s v i t a m i n d e f i c i e n c y
proved to
on a h o s t
A xel M unthe i n
a r e m ore
d iseases
of
d e f ic ie n c y m ight
ca u sin g dozens o f d i f f e r e n t
and h a v e
blam ing
stu d y
as
in th e f i e l d
v itam in
a person to
t h a t w ith in th e l a s t
causes fo r
fo rm ally
and w o r k e r s
now b e l i e v e d t h a t
p red isp o sin g
h a s b e e n blam ed
o th er
of w riters
and c l i n i c a l
Now h o w e v e r , t h e r e
•
*
t e s t s w ith w hich to
and th e v i t a m i n d e f i c i e n c y
scien tific ally
stu d ied
an
o f how f a r t h i s
th eo ry has
and c o n c l u s i o n s
are
ju stifiab ly
made.
As
q u estio n
who
in
a rich
in sta n ce
h a s become g e n e r a l l y
h is
up t o
d ie t,
date
esp ecially
are m entioned.
th e
u lcer.
one r i c h
i n 1940 a d v o c a t e s
in v itam in s.
in
g ly cerin e.
arsphenam ine
is
not
book
b u t he
in th e
presence
No s p e c i a l v i t a m i n s
lo c a l tre a tm e n t w ith
a f t e r hydrogen p e ro x id e had been a p p lie d
arsphenam ine
au th o rities
book o f m e d ic in e
Copper s u lp h a te
T id y (69)
asp ect ofth e
re c o g n ise d I quote C e c il (72)
T h e t r e a t m e n t he- a d v o c a t e s i s
10 $ c h r o m i c a c i d ' ,
to
te x t
v itam in
did
a ls o m entioned
He c o n s i d e r s
p articu larly
th a t
of th e f a c to r ,
th a t
as i s
in trav en o u s
d eficien cy
neo-
in h is
tex t
d eb ility .
ag ran u lo cy to sis
He s a i d
th at
some
and o t h e r b l o o d
th e
changes
evidence
in co n clu siv e.
The b lo o d p i c t u r e
in
neo-
l e s i o n s w erep ro b a b ly o n ly p roduced
c o u ld be p ro d u ced by V i n c e n t ’ s i n f e c t i o n b u t t h a t
was
1 0 fo
efficacio u s.
not m ention v ita m in
co n sid ered th a t
b eliev ed
is
first
Ju ly
on 128
1940 D .G .
cases.
of p ictu res
S tin e
had n o t been th o ro u g h ly
(73) w orking
The c h a n g e s
in th e blood p re s e n te d
in V in c e n t’s d ise a se
w as no u n i f o r m i t y
in
in A m erica,
in v e stig ated
gave h is
leu co cy te
report
a great v arie ty
o f t h e mouth and t h r o a t .
e ith e r th e to t a l
and
counts nor
There
in th e
d iffe re n tia l
counts
count,
th e
in th e
d u ratio n
of about
w i t h no
a n d t h e r e w a s no r e l a t i o n b e t w e e n t o t a l
d iffere n tial
th e
count
of th e
same
and t h e
illn ess.
age,
degree
A ll h is
of feb rile
leu co cy te
reactio n
or
p a t i e n t s w ere young a d u l t s
and a l l w ere u n i v e r s i t y
students
and re c o v e re d
co m p licatio n s.
The h i g h e s t
and t h e
h ig h est
was 3 , 4 5 0
per
to ta l
neu tro p h il
c.
mm.
T h e r e w as no
and t h e
leu co cy te
n eu tro p h il
The h i g h e s t
c o u n t was 9 3 $ . The l o w e s t l e u c o c y t e
and t h e
rela tio n
c o u n t was 4 0 ,0 0 0 p e r c u b i c m i l l i m e t r e
low est n e u tr o p h il
betw een th e h e ig h t
count
co u n t was 12 $ .
of the
le u co cy te
count
count.
c o u n t w a s 88 $ . F i v e
lym phocyte
cases,
on ly ,
showed
a s m a ll number o f m y e lo c y te s .
R ed c e l l
per c.
mm.
counts, v a r ie d
and t h e
betw een 2 ,5 6 0 ,0 0 0
p er e.
haem oglobin e s tim a tio n v a r ie d
mm.
an d 6 , 0 0 0 , 0 0 0
b e t w e e n 58$ and
115$.
He c o n c l u d e d
a d iag n o sis
th a t
b l o o d p i c t u r e w a s o f no h e l p
of V in cen t’ s in fe c tio n
th e w ide v a r i a t i o n s
blood p i c t u r e
an gina,
th e
p o ssib le
m ight le a d
"m onocytic
to
angina"
occur.
O ther c l i n i c a l
co n d itio n s
In
e v id e n c e had to
and a s
arsen ic
su g g ested t h a t
in fec tio n .
th ese
blood p i c t u r e
a rap id
in h is
are found
im provem ent i n
all
o f w hich
l e s i o n s m ight
exclude th e l a t t e r
(92)
i n 1941
At t h a t
o f V in c e n t’ s organism s
th ree
i l l n e s s was n b t
opinion,
rep eated ly
in undoubted
o f them he
fo r th e
th ro at
attrib u tab le
f o r he s ta te d
The P a u l B u n n e l l t e s t w as p o s i t i v e
to
a
th a t V in cen t’s
cases of g lan d u lar
i n m ost o f t h i s
series
m onocytosis.
tim e
too,
S tu art-B arb er
g la n d u la r f e v e r w hich had to
mem brane^
F u lle r
organism s w ere r e s p o n s ib le
However t h e w hole
in fe c tio n
its
of
o n ly .
c a se s had a heavy i n f e c t i o n
caused
t h e r e was a s l i g h t
w ith
be used to
type
5 c a s e s w h ic h r e s e m b le d t h e anginose. tjrpe o f g l a n d u l a r
Four of th e
fever.
in the n e c ro tic
In f a c t
ag ran u lo cy tic
and a l e u k a e m i c l e u k a e m i a i n
from V in c e n t’ s i n f e c t i o n
fever.
organism s
o f any d e f i n i t e
co n fu sio n w ith leu k aem ias,
co n n ectio n w ith th e
p u b lish ed
th ro at
o f t h e m ou th and t h r o a t .
and t h e l a c k
a su perim posed V in c e n t’ s i n f e c t i o n
i n m aking
m ore s e v e r e
d escrib ed
be d i f f e r e n t i a t e d
c o n stitu tio n al
leu co cy to sis
(93)
sym ptom s,
and t h e p re s e n c e
anginose
from d ip h th e r ia
d efin ite
pseudo­
of K leb s-L o effler b a c i l l i
and
30.
from t r u e
blo o d
V in c e n t's
changes
sm ear,
stead y
said
th at
o f g l a n d u l a r f e v e r and t h e
sp irilla
Perusal
its
”it
was v e ry p ro b ab le t h a t
of
(92)
a n g in a w ere n o th in g e l s e
le av es
one
in doubt
a d irect
(94) as having
a g r e a t many o f t h e
so -called
th a n m onocytic
t h e w o r k s o f t h e l a s t two w o r k e r s ,
and P u l l e r
in
t y p i c a l blood p i c t u r e
d o w n w a r d c o u r s e . He q u o t e d A. L e m i e r r e
of V in cen t’s
tru ly
absence of c h a r a c te r i s t ic
and fro m ly m p h a tic le u k a e m ia w ith
and
cases
angina w ith th e
angina” .
( 9.3 )
S tu art-B arb er
as to w hether th e
c a s e s were
"m ononucleosis” a f f l i c t i o n s .
As l a t e
fu rth er
as 1940 B re a z e a le
in v estig atio n
fu sifo rm
b acilli
done b e f o r e
in
in to
th e
th ro at
( 74) carried
and G re e n e
in cid en ce
of
a n d gum s m e a r s
by many w o rk e rs
e.g .
out
sp iro ch aetes
although
Sem ple, P r i c e
it
a
and
had been
J o n e s and D igby ( 2 8 ) ,
M cK instry
( 2 0 ) and o t h e r s .
B reazeale
organism s
in
i n th e m ouths o f m ost n o rm al a d u l t s
esp ecially
s m a l l num bers
a r o u n d gum m a r g i n s
quoted R o s e n a u 's f in d i n g s
all
swabs ta k e n from th e
and i n t o n s i l l a r
diseased
te eth
from t h r o a t
fix in g
b a c illi
in
th ro ats
of tro o p s
and s p i r i l l a
a den tal
in
They
c lin ic.
50 n o r m a l i n d i v i d u a l s
B reazeale
s t a i n e d them w ith
50$ o f
a t B ram shott, U .S .A .,
i n 90$ o f a l l
a n d gum s m e a r s o f d i f f e r e n t
them w i t h h e a t
cry p ts.
o f a few V i n c e n t ’ s o r g a n is m s i n
O th e r w o r k e r s fo u n d o n ly one c a r r i e r
but fu sifo rm
and G re e n e o b s e r v e d b o t h
sm ears from
and G re e n e made s l i d e s
groups o f p a t i e n t s
c ry stal v io let
and a f t e r
and
am m on iu m o x a l a t e .
P o sitiv e
one o r no
sm ears
re su lts
organism s p e r f i e l d
o n ly
44 o r
w ere p o s i t i v e ,
The l o w e s t
so cial
meant s e v e r a l organism s
meant
6$ w e r e p o s i t i v e ,
and i n b o th
in cid en ce
and f i n a n c i a l
a n eg ativ e
In d ian s
at
a b o ard in g
and m a le
o c c u rre d from
w h ile th e
school c h ild re n
h ig h est
of su p erio r
i n c i d e n c e was from
and e c o n o m ic l e v e l s .
in 41$ o f a g ro u p o f c o lo u re d
ch ild ren
and
sch o o l.
27$ p o s i t i v e ,
co lleg e
In th r o a t
s m e a rs 83 o r 11$ w e re p o s i t i v e .
le v els,
Among y o u n g a d u l t s ,
G uard w ere
resu lt.
w h ile
i n gum s m e a r s o n l y 1 2 7 o r 1 8 $
M e x ic a n c h i l d r e n f r o m homes o f low s o c i a l
O rganism s w ere fo u n d
in a f ie ld ,
en listed
co lleg e
men i n t h e A r i z o n a N a t i o n a l
stu d en ts
(g irls)
s t u d e n t s w ere 36$ p o s i t i v e .
were 25$ p o s i t i v e
The r e s u l t s
in d icated
th a t
among s c h o o l
to
fin d
in
ap p ro x im ately
ch ild ren
sig n ifican t
num bers o f s p i r o c h a e t e s
35$ of th r o a t
No h i s t o r i c a l
th at
to
o u tlin e
h a s been done
1936
rem ed iab le
was
on t h e
p ublished
d ecid ed to
fin d
p h y sic a l d isease
A fter
course
m outh o r t h r o a t w i t h
sp iro ch aetes
in
th e
f o r one y e a r
and by t h e
lesio n s
stain ed
th erap eu tic
o f chrom ic
acid
got
C in ta k e .
th at
th e
It
created
oases
n o ted
th a t
is
co n d itio n .
ap p lied
citru s
th a t
and t h a t
scurvy
hydrogen p e ro x id e ,
in th is
and pow dered
and a 10$
salad s
in v ario u s
of V in c e n t's
p atien ts
d isease
B ennett noted
reje ct
degrees
in fec tio n .
prev io u sly fre e
ex isted
state
of th e
B en n ett gave
a h ig h v itam in C in tak e
in th e h o sp ita l
foods ric h
and to m a t o e s e t c ,
an u lc e r a te d
a f a v o u r a b l e medium f o r
series
a h ig h v itam in
series.
tended to
by p ro d u c in g
ap p licatio n s
5$ s i l v e r n i t r a t e ,
A sm all c o n tro l
foods,
stu d y
The gamut o f
in trav en o u sly
lo c ally .
to
in clu d ed lo c a l
of io d in e,
N .A .B . was g iv a n
p ro b ab le
and
of these
of in te r e s t
8$ z i n c c h l o r i d e s o l u t i o n ,
C such as th e
it
demon­
s m e a r s on two c o n s e c u t i v e
sa d iu m b i c a r b o n a t e m outh w ash es p l u s
p atien ts
gums i t
all
apart.
p a tie n ts w ith V in cen t’ s d isease
and t h o u g h t
in
by th e h e a l in g
of n eg ativ e
No i m p r o v e m e n t w a s n o t e d
in v itam in
in clu d ed th e
o f t h e m ucous membrane o f t h e
tin ctu re
in g ly cerin e
alk alin e
u lcero ­
2$ so d iu m p e r b o r a t e ,
o f B enzoin,
so lu tio n
i t was d e c id e d t h a t
of rem ediable d is e a s e s .
in t r e a tin g th e
(5$),
copper su lp h a te .
d isease
a g e n t s w as r u n and t h i s
F ow ler’s s o lu tio n ,
tin ctu re
of th is
sm ear.
24 h o u r s
B e n n e tt’ s ex periences
oral
m ethods f o r
the fin d in g of both fu sifo rm b a c i l l i
fin d in g
ex am in atio n s ta k e n
effects
d iag n o sis
H is ” c u r e ” was c o n s t i t u t e d
lesio n s
T h ere was to be
p atien t.
of a p o sitiv e
of u lc erativ e
i n May
recu rrin g
d etectio n ,
of the p o ssib le
m em branous s t o m a t i t i s h ead ed th e l i s t
stra tio n
a reference
th e most f r e q u e n t l y
n o t e d on a d m i s s i o n .
of th e
o b serv atio n
B en n ett’s c r i t e r i a
and t h e w ork
in 1940, A re c e p tio n
on w ays o f e a r l y
and d e t e r m i n a t i o n
m en tal
a n d gum s m e a r s e x a m i n e d .
a t th e Creedm oor S t a t e H o s p i t a l
p relim in ary o b serv atio n
co n tro l
and f u s i f o r m b a c i l l i
of V in c e n t’s d isease
(75)
was e s t a b l i s h e d
and i t
one m ig h t e x p e c t
on i t w ould be c o m p le te w i t h o u t
t h e w ork o f B e n n e t t
serv ice
and y o u n g a d u l t s
b u t he
from V in cen t
32.
in fec tio n
su p p lied
had d ev elo p ed
in th e
reference
it
form o f
from th e
w h ile u n d er
co n cen trates.
p o in t
o f view o f
In tre a tm e n t B e n n e tt’ s b e st
sy p h ilitic
venously
scaled
rem edy "M aph ersen " .
and t h e
as
o th er h a lf
determ ined.
D ifficu lty
The
pain ted
rate
of the
on t h e
as
soon
d o se was g i v e n
gums.
intra­
T h e t e e t h were
in p a tie n ts
reac tio n
larly
reg arding
group,
to
fo rtify
sym ptom o f t h i s
very o ften
V in cen t’s d isease
lo ad
of p ellag ra.
given
to
h isto rical
q u estio n
If
acute
as im provem ent
in
s im ila r to
fin d in g
th e
An i m p o r t a n t
of h is
sev erely
B en n ett noted th e
tendency
esp ecially
th a t
in
the
system ,
p articu ­
refusal
of food
When p a i n f u l o r a l
am elio rated
o u t l i n e we s e e
lesio n s
or depressed
th e
fresh
aspect
o th er
the
effects
of
or relap sed
o f w ork
H ightow er
acid
on
a c id w ere
p e l l a g r a t h e r e was s t r i k i n g
asso ciated -w ith
sym ptom s o f t h e d i s e a s e .
m entioned to
(65)
it
a s well
T his is
and many o t h e r s .
w as done by J .D .
K ing
(83).
A
him t h a t t h e H y a s a la n d n a t i v e s
P e l l a g r a w a s common i n
two m a l a d i e s w e r e b e l i e v e d
facto r.
asso ciatio n
of n ic o tin ic
am ounts o f n i c o t i n i c
of S in clair
p iece
in
cro p p e d up a g a i n when S p i e s ,
from V in c e n t’ s d i s e a s e .
and t h e
of th e P .P .
and
s u b sited
He s a i d
im provem ent o f t h e V i n c e n t ’ s i n f e c t i o n
reg io n
of
The d e l u s i o n s
delusional
group.
One c a s e
in h o s p ita l
o f V in c e n t’ s organism s
ad eq u ate
persons w ith
m edical f r ie n d
began e a tin g
t e n s i o n was l e s s e n e d .
in v estig ated
cases
th e
7,
had s u b s id e d .
d e l u s i o n s w ere
w i t h v i t a m i n Bg d e f i c i e n c y
(79)
save
feeding
in m en tal h o s p ita ls .
In 1940 t h e
and H u b b a r d
th e
p o is o n in g by fo o d .
th is
e i t h e r tube
w ith V in cen t’ s d ise a se ,
p a tie n t’s to ta l
Thus in
in fec tio n
o f t h e m outh a f f e c t i o n .
•was a n i m p o r t a n t
were r e l i e v e d
req u ired
she was b e in g p o is o n e d .
afflicte d
tren d
i n 92 o f 121 p o s i t i v e V i n c e n t ’ s
co n tracted V in cen t’s disease
th a t
a fte r treatm en t
a d m i s s i o n s w a s 6 - 5 (p .
A ll p a t i e n t s ,
as th e
p sy ch o sis
had a d e l u s i o n
lack
an ti­
o f V i n c e n t ’ s d i s e a s e were
of a ll
and 85 o f t h e s e
spoon f e e d in g .
affectiv e
the
an im p o rta n t
r e s u l t s w ere w ith th e
H alf
o f f e e d i n g was n o te d
v o lu n tarily
suffered
is
aetio lo g y .
rela tio n sh ip s
in cid en t
ad m itted ,
or fo rc e d
and t h e
T his
d iet
a ro u tin e.
The p s y c h o m a t i c
p atien ts
a h ig h v itam in
th ere
to
be due t o
K ing
in v e s tig a te d V in cen t’s d isease
co n c lu d e d ,th a t
ru led
in
out
1938,
not
as
in tru e
”p re -p e lla g ro u s
th e
sk in
th e
d eficien cy
cases.
also
and s t o m a t i t i s
in w hat th e y term ed th e
in tem perate
f a c t o r shows i t s e l f
desquam ation o f th e
to n g u e
by s t o m a t i t i s ,
and c h r o n ic
o v er 34 cases w ith nicotinfc a c id
o f 4 o f them i n h i s f i r s t
paper.
O nly v e r y l i g h t
lo c a l treatm en t
in th e form o f g a r g le s
nicotinic acid
p red isp o sin g
as the
He a l s o
attem p ted
in ju red
h is
th at
to
in o cu late
gums b e f o r e
a n eg ativ e
facto rs
in ju red
h is
resu lt.
d eficien cy of
cause o f V in c e n t’s D isease.
own gu ms b u t f a i l e d .
ap p ly in g th e
o th e r th an th e
m ech an ically
and p u b lis h e d
i n w a t e r d a i l y b y m o u t h f o r 10 d a y s a n d c u r e d
K ing f i r m l y b e l i e v e d i n t h e
s till
d iarrh o ea.
He g a v e 2 5 0 m g .
and p a i n t s w as u s e d .
was
clim ates
o f p e l l a g r a do n o t b e c o m e a p p a r e n t b u t t h a t
of n ico tin ic acid
th e
and
v i t a m i n C, t h a t . t h a t
of g lo s s itis
s t a t e ” . They s a i d t h a t
trea ted
resu lts
angle
K ing l i k e M a n s o n -B a h r and R a n s f o r d
th e presence
o f th e P .P .
ch ara cteristic
th e
in
o rig in .
p e lla g ra but
lesio n s
K ing h a s
d id n o t respond to
a sco rb u tic
b eliev ed
only
it
from t h i s
in fectiv e
m aterial
He c o n c l u d e d t h a t
it
before V in cen t’s g in g iv itis
or sto m a titis
p r e v i o u s l y u n i n f e c t e d m outh. K ing q u o te d
and t h e r e
w ould a p p e a r
passage of in fe c te d m a te ria l
t i s s u e s may i n ma n a t l e a s t
He
into
be n e c e s s a ry
can be in d u c ed
in
a
s e v e ra l form er w r ite r s .
M c K i n s t r y i n 1918 h a d f o u n d no a s s o c i a t i o n w i t h
scurvy o r o th e r
d ie te tic
errors.
oral f i l t h
not
oral
s e p s i s was th e m ain p r e d i s p o s i n g
lead
or
zin c,
la te r.).
G riev es
could
w ent on d i e t a r y
in creased
sm okers.
so lu b le
cause
C lew er th o u g h t
s c u rv y m ight be th e
(1919) m en tio n ed t h a t
sim ilar le sio n s
in
i n 1919 and 1923 t h a t
cause
in
h isto ries.
ex cretio n
cause
so ld iers
H arris
and t h a t m e rc u ry ,
some c a s e s ,
(see
a m ild form o f
on a c t i v e
serv ice.
a n d Ray m ond ( 6 7 )
of n ico tin ic acid
and
in th e u rin e
He o n l y
found
o f heavy
Goadby i n 1923 blam ed d e f i c i e n c y , i n v i t a m i n C o r o f f a t
v itam in s
ment o f th e
K ing
A and D as
co n trib u to ry fa c to rs
to th e
estab lish ­
d isease.
(83)
said
show t h a t
t h a t no
forw ard
to
in tru e
b a c illi
and s p i r o c h a e t e s
c o n v in c in g ev id en ce had been b ro u g h t
s c u rv y t h e num bers o f f u s i f o r m
i n t h e human m o u th a r e u n d u l y i n c r e a s e d .
K ing
(80)
in
a s u rv e y o f 1,530
L ew is f o u n d o n ly 1 0 $ f r e e
w ere
cases
tak en .
R off
situ a ted
d iv id ed
them .
clin ica l
into
(R o ff was t h e
sp ecia list
in
th e
d en tal
of H arris
and A bbasy ( 5 4 ) .
acid
tim e.
ship
The b o y s t h e r e w e re
e x p e rim e n ts w ere
They f o u n d ' t h a t
in th e u rin e .
G lazebrook
conducted
those
in
cases
showed a
T h ey ' u s e d t h e m e t h o d
i n f o r m s me t h a t
up v e r y w e ll w ith a s c o r b ic
n e c e ssa rily V in cen t’s in fec tio n s
o rd in ary
a naval train in g
and g i n g i v o - s t o m a t i t i s
of asco rb ic
cleared
swabs
s u r g e o n and G la z e b ro o k t h e m e d i c a l
estab lish m en t).
d eficien cy
cases
a ll th e
and c o n t r o l l e d
w ith m arginal g in g i v iti s
of
T h e r e w e r e no
s e e n i n L e w is b u t no
(82) worked i n
one l o c a l i t y
groups
isle
e v id e n c e was u s e d .
and G la z e b r o o k
in the
in th e
c h i ld r e n w ere f r e e .
o f V in c e n t’ s D isease
O n ly
ch ild ren
from g i n g i v i t i s w h ereas about 20$ o f
470 L o n d o n and S h e f f i e l d
d efin ite
school
acid.
those
They w e r e 'n o t
but th e g re a te s t
m a jo r ity w ere
g i n g i v i t i s w i t h s w o l l e n , b l e e d i n g gums and n o t
cases
o f t r e n c h m outh.
C a t h c a r t , M u rray and B e v e rid g e
d iet
of th e
aspect.
of th e
They fou n d t h a t
low er th a n
sp ecial
in h a b itan ts
th is
i n many o t h e r p a r t s
reference
us of th e
in
isle
(81)
islan d
t h e v i t a m i n C i n t a k e was
of G reat B r ita in .
to V in c e n t’ s D isease how ever,
rela tio n sh ip
by th e
o rg an ism s.
of the
th ro at
d escrib ed
c a u s e d m ore harm t o
in v o lv ed .
in
be p a id
ju stify
a lo t
o f w ork
and p u lm o n ary i n f e c t i o n
to
th an th o se u s u a lly
He h a d o b s e r v e d t h e
and s t r e s s e d
larg e
t h a t many o f them
t h a n g o o d . He t h o u g h t ■t h a t
th e g e n e ra l treatm en t
to
f in d what
of th e
more
p atien t,
co n d itio n s p erm itted
o rg a n ism s w hich w ere o r d i n a r i l y
become i n v a s i v e .
some m o re v i r u l e n t
seem t o
did
d isease.
and d e n t a l m e a s u r e s , w here.gum s a r e
He e n d e a v o u r e d
sap ro p h y tes to
treatm en t
th e tis s u e s
n u tritio n
fu so -sp irilla ry
w ere
severe
and w h ic h w e re o f t e n m i s s e d .
p a rticu la rly
(84)
of th e d ise a se
and l u n g s much l e s s
should
so d o e s n o t t e l l
He n o t i c e d t h a t t h e r e w e r e g r a d e s o f i n f e c t i o n
num bers o f d ru g s u sed
atten tio n
T h e w o r k m a d e no
of vitam in C d e fic ie n c y to th e
co n n ectio n w ith tre a tm e n t
th e
o f Lew is fro m a q u a n t i t a t i v e
I n 1 9 4 0 a n o t h e r A m e r i c a n , H. F i e l d
in
i n 1940 s t u d i e d
strain s
in fectio u s
He t h o u g h t t h a t
th an
o th ers
the
harm less
p o ssib ly th e re
and t h a t t h i s w ould
p r e c a u t i o n s w h ic h w ould n o t o t h e r w i s e
<
be
in d icate d .
how ever.
He w a s n o t
F i e l d was
neoplasm s,
S titt,
C lo u g h and
such
ap lastic
anaem ia.,
w ere
to
apt
by D .G .
be
acute
th e
in fec tio n s
was
leu k aem ias
in
antecedent
and
eith er
F ield
to
ch ro n ic
Thus v i t a m i n C was
blood
g in g iv al
a deficien cy
resu lt
evidence
tissu e s
in
In
(W. N o r d e n m a r k
asco rb ic
and t h e
F u so -sp irilla ry
b lack -to n g u e.
doubt
to
to
F ield ,
about th e
g iv e
and c l i n i c a l
th ree v ita m in s,
th o se
fin d in g
m ain ten an ce
dose
three
3.
vitam in s.
th e m outh o rg a n is m s
2.
cured th e
by n o tin g
in
cap illa ry
by th e f in d in g
o f low
in p a t ie n ts w ith g in g i v iti s
(96)),
(S m ith
and 4 . by o b s e r v a t i o n s
One w a s
o th e r req u ired
in fectio n
how ever,
alw ays
in dogs •
c u r e d b y t h e v i t a m i n Bg
v ita m in A as w e ll to
cure
a r o s e when a dog d e v e l o p e d
concluded t h a t
o f th em am ounting to
in tre a tm e n t.
on
(43)).
w hole q u e s t i o n o f v it a m i n s
su pplem ents
in fectio n s.
(H ess (3 2 ))
acid
of,
v ery im portant
and c a p i l l a r y f r a g i l i t y
(95))
ex ist.
acute
in tak e
in f u s o - s p i r i l l a r y
asco rb ic
acid
in
co n n ectio n w ith ex p erim en tal black -to n g u e
2 ty p e s w ere found
it.
o f any one o f
in crim in atin g
a l r e a d y m entioned
com plex a lo n e
stated
d eriv ativ es
occurred
experim ental
scurvy,
( W e i s b e r g e r , Young and M orse
g u in ea p ig s
blood
d i s e a s e s was b e c a u s e t h e r e
i n c r i m i n a t e d by 1 .
and by n o t i n g t h a t
of
as i s
or i t s
F i e l d made a s t a t e m e n t ,
betw een g i n g i v i t i s
le v els
certain
a g a i n b y F i e l d who c o n s i d e r e d
t h i s w ork, t h a t
showed t h a t
fra g ility ,
of
such in f e c tio n .
d eb ilitatin g
cases.
sum m arised t h e
ch ild ren
th a t
req u irem en t for, or a decreased
in th o se
co rrelatio n
entry
, aleukaem ic leu k aem ia,
th a t V in cen t’s in fe c tio n
A, B o r C, m i g h t
in v ad in g
the
an d o t h e r s .
co n n ectio n w ith
evidence
said
from heavy m etals b enzine
an i n c r e a s e d
v itam in s
tu b e rc u lo sis,
g r a n u l o c y t o p e n i a and i n f e c t i o u s m o n o n u c le o s is
(73)
reason
p o in t
( a s had b e en o b se rv e d by
( 5 8 ) ) . He a l s o
V ita m in s w ere d is c u s s e d
th a t
lik e
c o m p lic a te d by V i n c e n t ’ s i n f e c t i o n
P o iso n in g
be t h e
lo c al lesio n s
on t h i s
o r d i p h t h e r i a m ight f a c i l i t a t e
C lough
as
S tin e
d efin ite
/in c e n t’s in fectio n
disease©
m ight
aw are t h a t
sy p n ilis
a superim posed
abso lu tely
A great
t h e r e was
s till
and deemed i t
at le a s t
w ise
a d aily
d e a l o f F i e l d ’ s work
a
a
•3 6 .
on t r e a t m e n t c o v e r e d g r o u n d w h i c h h a s a l r e a d y been f u l l y
m e n t i o n e d . One i m p o r t a n t
is
not
th at
a sp ecific
it
is
of f i e l d
th o u g h t
w ere
th a t
sy p h ilis
e.g .
to
tissu es
co m p licatio n s
of
so lu tio n
usin g
a b lu n t p o inted
th e
its
th e
in B ish o p ’ s P a la c e
u lcerativ e
and h a l f
th e
D ealing w ith
any t h a t
have
t h e m o s t commonly
th e
lung
im portance
of
its
and t r e a t m e n t .
same t i m e
as
ep idem iology
The f i r s t
tim e
a g a i n s t t h e d i s e a s e w ere ta k e n was by O l i v e r
i n M a n i l a i n 1 9 0 2 . An o u t b r e a k o f e p i d e m i c
g in g iv itis
occurred
o f 85 men w e r e
afflic te d
sub­
and n u t r i t i o n .
and d e s c r i b e d
course
He
arsen icals
the
(85) w o rk in g a t th e
d isease
Most
He a d v o c a t e d '
to
sy rin g e.
stressed
t,he t e e t h
L eigh
clin ica l
q u a ra n tin e m easures
of acriflav in e
and he
degree
fu so -sp irillary
i n f e c t i o n was p u lm o n a ry i . e .
A n o th er A m erican,
in A m erica,
on t h e
F ie ld found t h a t
a tte n d in g to
in v estig ated
Local
d i s e a s e he d id n o t m e n tio n
before.
the
g in g iv itis.
in g ly c e rin e .
o f 1$
and b r o n c h i e c t a s i s
p r o p h y l a x i s by
F ield
actio n
to
fo r m alaria.
resistan c e.
a sp ecific
fu so -sp irillary
abscesses
is
c a s e s had f u s o - s p i r i l l a r y
have
not been m entioned
serio u s
qu in in e
10^ neoarsphenam ine
in tro d u ctio n
g in g iv al
or th a t
sm oking lo w ered l o c a l
co n sid ered
arsphenam ine
rem edy f o r f u s o - s p i r o c h a e t o s i s
s pulm onary
organism s
th e
for
p ro n o u n cem en t was t h a t
w ere
in h e ad q u a rters tro o p s th e re
affected .
q u aran tin ed
The e p i d e m i c o n l y c e a s e d when
and t h e . i n d i v i d u a l c o o k in g u t e n s i l s
w ere b o i l e d .
L e ig h was e m p h atic t h a t
th at
th e
sp irillu m
was a l a t e
T u n n i c l i f f ’ s (64)
form er claim
phase
c y c l e o f B.
f u s i f o r m i s w as no l o n g e r t e n a b l e
in ju red
th e
tissu es
o ften
in
and
and t h e
th e l i f e
also
t h a t traum a o r in f e c t i o n
o rg an ism s w ere seco n d ary
in v ad ers.
The d i s e a s e
1914 -18; l a t e n t
and
it
was n o t
spread.
carry
had o c c u rre d
cases
clear
alw ays e x i s t
to
of p ro p ag atio n .
epidem ic form from
i n many p a r t s
of th e
L eigh j u s t what caused th e
He o b s e r v e d t h a t
in fec tio n
in A m erica i n
and t h a t
any a r t i c l e
epidem ic
c o n ta m in a te d by s a l i v a
" k i s s i n g ” was th e m ost p o s i t i v e
He t h o u g h t t h i s m i g h t b e t h e b a s i s
o f "V incent’ s i n f e c t i o n
country
as th e
to
could
mode
o f speaking
" fo u rth v en ereal disease
.
37.
H is f i n d i n g s
in
r e g a r d t o t r e a t m e n t do n o t
w ith th o se
I have
describ ed
subsidence
of a ll
acute
la ter.
Thus he w a ite d t i l l
sym ptom s b e f o r e
scalin g
a c id m ight have
g in g iv ae| i t s
use
th is
I used
because
w i t h no
ill
and i d e a l
effects.
as
agents
advocated
in
th e
gums.
is
as w ell,
th e
acute
w ere u se d by L e ig h was t h a t
by s t i m u l a t i n g
the
b acterial
the
d isco n tin u ed ".
a means o f t r e a t m e n t
I have found
However t h i s
th e ra p eu tic
w ere
it
it
to
th a t
"w hile
in
I
quote
a l l my gum c a s e s
be an e x c e l l e n t l o c a l rem edy
L eigh sa id
n o t noted
stated
H is
a c t i o n on t h e u l c e r a t i n g
sh o u ld be p o s i t i v e l y
fo r firm in g
the t e e t h .
a th erap eu tic
en tirely
th e
th e te e th .
o th e r l o c a l m e a s u re s have been m entioned b u t he
chrom ic
co in cid e
in
th a t
its
use
d eca lcifies
a case tr e a te d w ith o th er
a s w i l l be d e s c r i b e d .
C itru s f r u it s
stag e
reaso n th ey
a t le ast, but
th ey lo c a lly
s a l i v a r y flow
th e
prevented
and t h u s t h e y
saliv ary
in d irectly
stasis
reduced
count.
CONCLUSION.
In th e
t h a t w hich
I
set
p reced in g h is to r i c a l
out
to
do,
nam ely to
o u tlin e
I have accom plished
cover the
ground
o n th e most
im portant
asp ects
o f t h e w o rk w h ic h h a s b e e n done on Y i n c e n t ’ s
D isease.
P erusal
of th e
view s
on t h e
century,
su b ject
how i t
above h i s t o r i c a l
have changed
has been tre a te d
sin ce
There
to
o f w h i c h •H r i s
read
I have
view s
all
in
th e
on t h e
are
above
lite ra lly
to
im p o ssib le w h ile
s h o w how t h e
end o f ' th e n i n e t e e n t h
t i m e s and
its
above a l l
rela tio n
hundreds of a r t i c l e s
summary t a k e n
su b ject.
th e
at d ifferen t
the u n c e r t a i n t y w hich e x i s t s w ith re g a rd
d eficien cy .
o u tlin e w ill
on a c t i v e
to
on t h e
v itam in
co n d itio n ,
serv ice,
a sam ple r e p r e s e n t a t i v e
but
of a ll
IV .
GENERAL LINES ON THE INVESTIGATION.
A ll t h e w ork
of th e
gums and
classes.
the
tim es
from s m a ll
u n d e r w hich th e
in w ar.
a s m a l l R.N.
w ith
k in d
evident
on b o a rd
sailo rs
liv e
i.e .
up w ere t r e a t e d
noted
am ongst t h e
(15),
M cK instry
sailo rs
by P ic k le s
To p r o v e
it
as o u t- p a tie n ts
h o sp ital
d isease
as f a r
back
to n sillitis,
b eri-b eri
tab le
A.
(27)
(21),
and many o t h e r s ,
I noted
and p e l l a g r a
shows t h e
th e
in
th e t o t a l
number o f
o ut.
is
D uring th e
th erefo re
p ercen tag e
q u arter
scurvy,
th e
it
had been
of
q u arter.
resu lt
serv ice
no d i s e a s e s
and g i n g i Y i t i s ,
not
th e
all
and gum s,
of th e
o u t.
I noted
December
cases,
of
an d o f s c u r v y ,
The a c c o m p a n y i n g
each q u a rte r of V in c e n t’s
p ellag ra,
to ta l
of
and a l l
d iseases
number o f bed c a s e s
I f we s t u d y t a b l e
aflo a t
of th e
la tter
in
afte r
q u a rte r A p ril to
of th o se
I h u n te d th ro u g h the
num bers o f
b eri-b eri,
cases rose
the n a tu ra l
consequences
as
and am o n g st t h e
each q u a rte r.
p ercen tag e
and gums r e s p e c t i v e l y ^ t o
th e
etc,
sm all
resu lts.
of te e th
T his
s aw
in th e
num bers o f bed c a s e s
of th e te e th
ad m itted
shows t h e
du rin g
in crease
to tal
to n sillitis,
h o sp ita l
as
a s ” i n - p a t i e n t s ” e a c h q u a r t e r up t o
D isease,
the
and I
B outy ( 2 2 ) , E a g l e to n , M ercer
and found t h e
and o f d i s e a s e s
T a b le B.
"in ­
personnel of the
a s A p r i l 1939 b e f o r e t h e w a r b ro k e
th e num bers a d m itte d
ad d itio n
in th is
m inesw eepers,
r e a l l y w as on th e
of th e
In
up w e re a l l
(29).
records
1940.
in
d u r in g th e w ar o f 1914-18 by W ingrave
M cK enzie
C olyer
both
seen
o f S u r g e o n - C o m m a n d e r (D) P a t t e r s o n , R . N .
d rifters,
so ld iers
(20),
and H u d so n ( 2 6 ) ,
and w ork,
me t h a t V i n c e n t ’ s D i s e a s e
d estro y ers,
and h a v e
e x c e p tio n o f 3 c a s e s w hich I m e n tio n .
l a s t w a r w as b e c o m in g commoner am o n g st t h e
sh ip s,
sh ip
seafarin g
b a se h o s p i t a l , where p a t i e n t s w ere m o s tly
perm ission
to
am ongst th e
The c a s e s w r i t t e n
th e
not w ritten
them w i t h t h e
I t became
and
sh ip s,
Many c a s e s ,
co n d itio n of V in c e n t’ s d isease
ex p erien ced th e l i f e
of peace
p a tie n ts ” in
d one on t h e
t h r o a t has been conducted
I have
co n d itio n s
I have
B . we s e e t h a t
S e p te m b e r 1939 when w a r - b r o k e
an i n c r e a s e d N a v a l s t r e n g t h
and i s
and
to be exp ected .
J u n e 1 9 3 9 t h e r e w a s no d e n t i s t
te eth
in
a n d gums w e r e
treated .
and
The
d is e a s e s has r i s e n w ith each ensuing
classed
as V in c e n t’ s d is e a s e ,
has been
39 .
common i n t h i s
class.
that
Q u arters
o h o s e two
w ere t h e
tw o
Q u arters
As r e g a r d s t o n s i l l i t i s
i n w h ic h , i t
was a t
b efo re war broke
o u t.
it
its
w i l l be
h ig h est
There
seen
percentage
i s no Q u e s t i o n
o f missed. V i n c e n t ’ s d i s e a s e i n t h o s e f i g u r e s f o r my f r i e n d D r .
G l a z e b r o o k was- i n
th e
charge
of th e w ards
at th a t
tim e
and a liv e
to
co n d itio n .
ALL
CASES
TO N SI L L I T I S .. !
!A p r il to
iJ u n e 1939
141
16
0
!
iJu ly to
; S e p t .1939
253
25
1
|
586
22
14
TABLE A,
iO c t. to
iD ec. 1939
i
IJ a n . to
IM a rc h ,1940
|
I
0
0
0
I
756
26
32
I 0
\t
A p ril to
June 1940
!
j 700
Ju ly to
S e p t . 1940
i
| 758
i
O ct.
Dec.
DISEASES 5 VINCENT’ Si SCURVY BERI«
OP TEETH; DISEAS E.
i BERI OR !
AND GUMS.
; PELLAGRA
j
,
20
31
23
49
35
47
j
0
19
i
i
tO
|
1940
it
j 0
; 899
i
! o
27
? VS'Vv<.
TABLE B.
iA p ril to
!
June 1939 !
;
|
Ju ly to
;
S e p t. 1939
I
|
;
I
EASES OF
TEETH AND
GUMS
V IN CENT ’ S
DISEASE
H BEEISCURVY! BERI OR
I PELLAGRA
-a,.-.
0
0
0
9 .9
0.4
0
0
0
3 .8
2 .4
0
0
0
4 .2
3 .4
0.93
0.1 3
0
2.9
4 .4
1 .3
0.7
0
758
3 .1
6 .5
2 .5
0.26
0
899
3.9
5.2
3 .0
0.1
0
253
j
11.3
i
586
I
j
Jan. to
h
M arch, 1940^756
f
A p ril to
!
June 1940
700
|
!
t
I
| J u ly to
j S e p t . 194C
% DIS­
0
141
;
O c t . tO
;
Dec. 1939 i
!
:
:
:
;
TON­
SILLITIS
ALL
CASES
j
j
j O ct. to
I Dec.
1940
40.
T o n s i l l i t i s p e r c e n ta g e s rose s l i g h t l y in th e f i r s t w i n te r
of
war t o f a l l i n t h e summer of 1 9 4 0 . Then th e y showed a s l i g h t
r i s e a g a in l a s t w i n t e r . This i s to be expected. T o n s i l l i t i s i s
common i n s h ip o companies i n very cold w eather when e v e ry th in g
i s b a t t e n e d down and t h e bulk-heads "sweat" and the s a i l o r s and
o f f i c e r s t u r n on e l e c t r i c h e a t e r s t o t r y to h e a t th e mess-decks
and ward-rooms a l i k e . The dryness of th e confined atmosphere i s
extrem e, d r o p l e t i n f e c t i o n abounds, and the n a s a l and t h r o a t
mucous membranes s u f f e r as a r e s u l t .
The f o u r t h
a stead y
rise
c a se s w ere
had b een
for
th e
(70)
of
in
and th e
the
ev id en t
percen tag e
in th e
body to
be
th a t
com plete o r
scurvy
alm ost
sm all
the
of th e
V s c u rv y was fo und
th e
endeavour to
show l a t e r .
due t o
w h ile
th e
in fec tio n
th ere
th a t
in V in c e n t's
by th e
a f t e r 2 .to
on.
T his
is
scurvy is
d isease
in creased
of th e
v iru len ce
th ere
of fresh
is
in the
in
is
sailo rs
t o my k n o w l e d g e .
of in crease
o f V in c e n t's
colum n 5 b e a r s
any l a c k
sm all s h ip s .
no m e r e
out th is
of v itam in C
The f i r s t
co in cid en ce
th a t
the
case
of
th ere
is
the
p ercen tag e
of v iru len ce
L eigh (85)
as I w ill
i s # i n my o p i n i o n ^
d eficien cy
alone,
ad d itio n al fa c to r
organism .
case
scurvy percen tag e has
caused by d i e t
In s u ita b le
of th is
of
h o sts
organism ,
and o t h e r s ) .
o r g a n is m w ould c a u s e
Such an
an i n c r e a s i n g
t h e r e w as an ab u n d a n c e o f s u i t a b l e " s o i l ’ .
s c u r v y num bers w ere g r e a t e s t
th a t
rate
The f a c t
(63),
year,
period
same q u a r t e r o f t h e y e a r a s t h e f i r s t
(R o s e b u ry and F o le y
I The
i
if
4 m onths
o f v i t a m i n G. T h i s f a c t
T ab le B.
fu so -sp irillary
if
th e tim e ta k e n
ad u lts
can be an e x a l t a t i o n
number o f c a s e s
a f t e r th e war
appears in
th e V in cen t’ s in fe c tio n
fact
is
The f i r s t
o f v i t a m i n C. M c L e s t e r
crew s o f th e
in
T h e y show
sto res
(70)
D isease.
lik e
i.e .
h a s n o t b een m entioned b e fo re
of V in c e n t's
risen
T his
com ing on a t t h i s
o f M cL ester
d ie t
us.
of its
com plete la c k
as th e war goes
statem en t
not
q u arter,
ac c o m p a n y in g g r a p h shows t h e
d isease
in
sh ip s
in terest
of V in cen t’ s d isease.
fo u rth
d ep leted
of V in cen t’s d isease
The
colum ns
in p r o g r e s s f o r f o u r m onths.
states
of our
fifth
a fte r
v eg etab les.
in
th e
second q u a r te r of th e
t h e w i n t e r m onths w i t h t h e i r
atten d an t
lack
41.
GRAPH SHOWING THE RATE OP INCREASE IN CASES OP VINCENT’ S
DISEASE AS THE WAR GOES ON.
It
beri
w ill
be
seen th a t th e re
or p ellag ra.
If
com plex had b e e n
deal
those
a d e f i c i e n c y o f v i t a m i n Bp o r t h e Bg
concerned
one w ould h a v e
h a v e b e e n no c a s e s o f b e r i ­
in the
expected
sailo r
at le ast
d iseases
to
crop up.
can p r e d is p o s e
to
V in c e n t’ s d isease
been v e r y w e l l p r o v e d
Persons
and H a rv e y
H i g h t o w e r and H u b b a rd
But
short
of
is
of th e
clin ica l
sig n s
u rin ary
te st
by H a r r i s
acid
cases
of
for
on s e v e r a l
d isease,
A. A u r i n a r y
I
th e
by me,
ex cretio n
te st
p red isp o sin g
th e
does
q u e s t i o n a n d A,
in
th e
out th e
th e u rin e
effect
of v itam in
qu estio n
In
sought
la te st
a s done
of n ic o tin ic
th e
and A bbasy ( 5 4 ) ,
or in
asco rb ic
facto r
I
to
a c i d w as done on th e
scu rv y w ere sought f o r
B. t h e
D.
in
a c i d was m a in ta in e d
to
th e
sig n s
in each case,
on each c a s e ,
ad d itio n
d ie t h isto ry
o u tset
C d eficien cy
along th e fo llo w in g l i n e s : -
of asco rb ic
t e s t ” was p erfo rm e d
trea tm e n t
At th e
"p re-p ellag ro u s
state
carried
a n d C. t r i e d
u sed by H a r r is
a s a tu r a tio n w ith
and E.
and B.
S pies,
and o t h e r s .
and many o t h e r s .
th is
relatio n sh ip
approach th e
a ’’t o u r n i q u e t
form of
in to
(65),
cases of V in cen t’s d isease.
or su b -clin ical
sole
(84)
so -called
Elsom (5 6 )
Sm ith,
S in clair
F ield
acid e x c re tio n
(67),
of scurvy
cases
(64),
such a c l i n i c a l
I looked
of th a t
th e
That
(83),
p rin cip le
C.
o r two o f
( 49 ),
C lem ents
T u n n icliff
n ic o tin ic
As r e g a r d s
th e
(46),
such a s t a t e ,
and Raymond
case
some c o m m u n i t i e s h a s
a c tu a l p e lla g ra th e
shown b y K in g
my s t u d y
in
( 7 9 ) , K ing ( 8 3 ) ,
s t a t e ” m ig h t be p r e s e n t .
ex ist
a m ild
T h a t v i t a m i n Bp o r Bg d e f i c i e n c i e s
by S p i e s
(57),
c l a s s w ith w hich I
some o f
as the
r o u t i n e m ethod u se d
o f e a c h c a se was t a k e n .
thought t h a t
p e r h a p s a n ae m ia was t h e
and a c c o r d i n g l y d i d
a fu ll
b l o o d c o u n t when
p a t i e n t was a d m itte d .
The t e m p e r a t u r e
as a ro u tin e
and t h e
F in ally
treatm en t w ith
th e
I
and p u l s e
rate
o f e a c h p a t i e n t was ta k e n
u r i n e was t e s t e d .
endeavoured to
rem edies
fin d
a t hand.
out th e
These
b e s t m ethod o f
i n c l u d e d Beaumont s
43.
paint
(51)
a l r e a d y m e n tio n e d , N .A .B .
w ith w a te r),
hydrogen pero x id e,
perm an g an ate
and p o ta ss iu m
A sco rb ic
acid
What
I found
to
A h isto lo g ica l
g arg les
acid w ere
be t h e
Eusol
(l
4
in
10 ^ c h r o m i c a c i d , p o t a s s i u m
ch lo rate
and n i c o t i n i c
in je c tio n s,
also
a n d M. & B .
at hand.
b est treatm en t
s t u d y o f n o r m a l gum,
693.
is
describ ed l a t e r .
a gum f r o m a c a s e
of
a n d o n e f r o m a p a t i e n t w i t h V i n c e n t 1s D i s e a s e w a s
sub-scurvy
made.
In
sm all
sh ip s
from d u ty th ro w s
it
is
im p o rtan t
to
d isch arg e
e x t r a w ork on t h o s e
to
be
them a s
in v estig atio n s w ill
A ll
th e
diagnosed
from th e
th e
eye
r e m a i n i n g on b o a r d ,
th o se
soon as p o s s i b l e .
c a s e s w ere bed
cases q uick ly
Th e r e s u l t s
c a s e s when a d m i t t e d ,
a ’’p o s i t i v e
’’p o s i t i v e
in
each f ie ld
T h i s was t h e
and G reen e
absence
hence
and
of th o se
and w e re
swab” .
sw ab” m eant t h a t when a s l i d e
straig h taw ay , i .e .
I
treat
a t e a m and h i s
gum o r t o n s i l l e s i o n s w a s e x a m i n e d ,
organism s
made.
able to
of
be g i v e n .
by h a v in g
T his
e a c h ma n i s p a r t
th e
o f a sm ear
o rg a n ism s met
t h e r e w e r e many f u s o - s p i r i l l a r y
and a m in u te h u n t f o r
criterio n
for
a p o sitiv e
them had n o t t o
be
d i a g n o s i s by B r e a z e a l e
(74).
stain ed
th e
s l i d e s , a f t e r f i x i n g w i t h h e a t , w i t h 1 i n 10
carbol fu ch sin f o r fiv e
m in u tes,
th e n th e y w ere washed in w a te r
a nd d r i e d ,
than th e
give
lhe
fusifo rm
sp irilla .
a su fficien t
o r g a n i s m s a l w a y s s t a i n m ore v i v i d l y
S t a i n i n g by l
i n 10 c a r b o l f u c h s i n d i d n o t
c o n t r a s t f o r p h o t o g r a p h y so e x p e r i m e n t s w e r e
made w i t h t h e f e w
sim ple s t a i n s a v a i l a b l e .
I t was f o u n d t h a t
t h e b e s t m e t h o d o f s t a i n i n g was t o u s e G r a m ’ s c r y s t a l v i o l e t
stain
f o r th re e m inutes,
m inutes
allow
and t h e n t o w ash t h e
to
as t h e
th en to
dry.
add L u g o l ’ s i o d i n e f o r t h r e e
slid es
l i g h t l y w i t h w a t e r and t o
B o t h t h e o r g a n i s m s s t a n d o u t w e l l by t h i s m e t h o d
p r e c e d i n g p h o t o g r a p h o f a ’’p o s i t i v e
swab” shows.
( F ilm 1000X).
B efore
.that th e
concluding t h i s
atten d an ces
i n t r o d u c t o r y c h a p te r I w i l l m ention
a t th e , d e n t a l o u t - p a t i e n t
each q u a r t e r w ere as no ted in ta b l e
departm ent
in
C.
$ VINCENT
TABLE C.
VINCENT’ S DISEASE
TOTAL ATTENDANCES
DISEASE
t
Jan. t o
M arch 1940
368
17
4 .6 2
'
A p ril to
June 1940
1
581
18
3 .1
Ju ly to
S e p t. 1940
j
|
460
15
3 .6 2
O ct.
Dec.
;
j
462
40
1
to
1940
.
*
T o tal fo r
a ll q u arters:
90
1871
I
The b i g g e s t
w i n t e r m onths
percen tag e
B. w ere
( 22)),
H o sp ital
o f th e w ar by
Naval
etc
d en tal
th e f ig u r e s
tow ards th e
fig u re
end o f t h e
be due t o
in th e l a s t
recent
d a te from th e
have n o t had tim e to
serv ice
A. my
in
war in 1917,
g iven n e a r th e
(B outy
end
(28).
fig u res
area t
a
o n s e t o f w a r and d i e t a r y
operate p ro p erly ,
has fu n ctio n ed
q u arter.
o f 2 3 i n aB r i t i s h
la st
and D igby
th e fa c t th a t
in th e
f o r th e bedc a se s
o f 3 zf> i n o n e u n i t ,
Sem ple, P r ic e Jones
T h i s may
co m p arativ ely
nor
rise
anyw here n e a r th e h ig h f i g u r e
or of th e
facto rs
fig u re
*
of V in cen t’s d iseases f e l l
and t h e r e w as a s t r i k i n g
N eith er th is
M ilitary
4.81
[
'
T able
8 .6 6
j
e ffic ien tly
and B. t h e
f o r many y e a r s p a s t .
V.
HISTOLOGICAL STUDY TO GET IDEAS FOR TREATMENT.
At th e
th o u g h t
o u tset
th at
it
of th is
w ould be
n o r m a l gum a n d o f
and © t a i n
th ese
c a se s w ere
lo cal
in
th e
an e x c e l l e n t
R.N. b a s e h o s p i t a l
plan to
fix
a p iece
gum i n 10 $ f o r m a l i n a n d t o
d iseased
o rd er to
com pare th e m .
and
w ould be i n j e c t e d
in to
a sm a ll Y -shaped p e ic e
B ard-Parker k n ife .
In th e
case
a p o rtio n
b u t w h i c h h a d no
obvious u l c e r a t i o n
tissu es
to be
a
a piece
o f gum w h i c h w a s s w o l l e n a n d r e d
T his l a t t e r
D o b e l l ’ s m ethod f o r
th e
no
o f gum w a s e x c i s e d w i t h
o r w h i t e membrane o v e r i t .
A n o th e r p i e c e w as rem oved fro m a p a r t
membrane on i t .
of
prepare
so t h a t
of V in cen t’s disease
was rem oved fro m
I
Th e gums i n t h e s e
a n a e s th e tis e d by a lin g u a l nerve block
an ae sth etic
rem oved,
stu d y in
p iece
sp irilla ,
of th e
gum w i t h w h i t e
o f t i s s u e was s t a i n e d by
a s an o r d i n a r y r o u t i n e . sm ear was
’’ p o s i t i v e ” .
D o b ell’s is
en m asse
a b u lk m ethod,
as fo llo w s .
The t i s s u e
th e n th o ro u g h ly washed in
i n .60,
i.e .
is
t h e w hole t i s s u e
first
d istille d
w ater.
It
i s washed th o ro u g h ly
24 h o u r s .
dark, in
It
is
now p l a c e d
an in c u b a to r
thoroughly
24 h o u r s
the
dark.
th e h ydroquinone
&nd d e h y d r a t e d
a lco h o l.
f o r 12 h o u r s
in
N o r m a l gum
o b v io u sly
It
is
th en p la c e d
It
cleared
p araffin ,
and t h e
d iseased
hours
d istille d
is
fin a lly
in
each.
w ater f o r
3$ s i l v e r n i t r a t e
days.
in
Then i t
in
the
i s washed
i n 1$ h y d r o q u i n o n e f o r
m ust be t h o r o u g h l y w ashed b e f o r e
ascending grades of
is
in
w a t e r and p l a c e d
so lu tio n .
in
Then i t
in 1 .9 $ to
at 37° f o r th re e
in d is tille d
in
and l e f t
stain ed
i n 1CYfo f o r m a l i n ,
80 and 90 $ a l c o h o l r e s p e c t i v e l y f o r t h r e e
Then i t
th o ro u g h ly washed
a l c o h o l up to
en terin g
again
ab so lu te
chloroform f o r 4 h o u rs,
placed
embedded and c u t .
tissu e
from th e
s u r f a c e w ere f i x e d
w i t h haem alum and e o s i n . P h o t o g r a p h s
m a de .
fix ed
is
red
s w o l l e n gum w i t h no
and s t a i n e d
of the
th ree
i n t h e u s u a l w ay
s e c tio n s w ere
46.
1 . N o r m a l gum.
L .P .
The s u r f a c e
w ith p a p illa e
There i s
ep ith eliu m
is
100X
s im ila r to t h a t of the
skin
b u t no g l a n d s a n d no h a i r f o l l i c l e s .
no i n f l a m m a t i o n i n t h e
e p ith e lia l lay er is
2. H . P .
H.& E .
deep l a y e r s
not d iseased .
S w o l l e n gum w i t h no m e m b r a n e o v e r i t .
H.& E .
25 0 X .
and t h e
sub-
The l a y e r
w ith
an X in
graphed.
are
of tissu e
th e
d isten d ed w ith
is
ev id en t.
num bers
in
th e
th e
are
la rg e
how ever.
T his
th e
sig n s of acute
in g re a t
absen t,
o f num bers o f p o ly m o rp h o n u c le a r l e u c o c y t e s
arte rio le s
or c a p i lla r ie s w ith th ese
(c.)
s w o l l e n gum l i a b l e
sim ilar
to
t h a t found
D iseased
The c a p i l l a r i e s
inflam m ation are
of
3.
and p h o t o ­
(a . ) a cap illa ry
are fre e
type
is
a r e a m arked
and h a v e e s c a p e d b y r h e x i s f r o m t h e
num bers o f h i s t i o c y t e s
frictio n
H .P .
i.e .
once e v id e n t.
and a t one p o i n t
(b .)
The t y p i c a l
presence
at
Re d b l o o d c o r p u s c l e s
tissu es
pavem enting o f th e
There
changes are
blood
ru p tu re
i.e .
ep ith eliu m
p r e c e d i n g p h o to g r a p h , was f o c u s s e d
P ath o lo g ical
cap illa ries.
beneath th e
tissu e
in
in
to
th e
or
cells.
tissu es
bleed
on t h e
le ast
scurvy.
1000 X
s t a i n e d by D o b e l l ’ s m ethod.
V
♦
D udley B uxton
surface
la y ers
A lth o u g h th e
(97) says
and t h a t
ro u tin e
s p i r i l l a w ere fo u n d
was p r e s e n t
w ere
on t h e
evident
p ho to g rap h
ex cisio n
in
in
it.
the
th a t th e
fusifo rm b a c i lli
sp irilla
are
s wa b w a s s t r o n g l y
in the
deep l a y e r s .
ti s s u e ’s surface
One ( a . )
is
in th e
p o sitiv e
are
on t h e
deeper la y e rs.
in th is
case
However a n e c r o t i c
no
area
and a few f u s i f o r m b a c i l l i
shown i n t h e
th e m idst o f th e n e c r o tic
of th e
i
accom panying
surface
lay ers.
In th e
gums and d u r i n g s u b s e q u e n t p r e p a r a t i o n m o s t o f
th e
s u r f a c e m em brane h a s b e e n rem oved.
I had hoped t h a t
tissu es
Tags rem ain a t p l a c e s .
s p i r o c h a e t e s m i g h t be f o u n d d eep i n t h e
b u t t h e y e v i d e n t l y l a c k t h e p e n e t r a t i n g power o f
t r e p o n e m a p a l l i d u m . My f i n d i n g s a g r e e w i t h t h o s e o f D u d l e y
B uxton (9 7 )
th at
as re g a rd s fu sifo rm b a c i l l i .
in treatm en t
it
However i t was f e l t
would be l o g i c a l t o g i v e
intravenous
arsenic
in p re fe re n c e to lo c a l a p p lic a tio n as th e
patien t
au to m atically lic k s
a lo cal
drug as soon as i t
m edicam ent t h e
tongue of th e
r o u n d t h e gums a nd r e m o v e s m o s t o f
is
applied.
Also w i t h an i n t r a v e n o u s
d ru g would be slo w ly r e l e a s e d
in to
the t i s s u e s
shown b y t h e p r e v i o u s p h o t o g r a p h s t o b e s w o l l e n a n d h y p e r a e m i c
and t h e r e v.7o u l d b e a c o n c e n t r a t i o n o f i t
surface la y e r
lo cally
exuding a t th e
da maged
and a v a i l a b l e f o r a l o n g e r p e r i o d t h a n i f
i t were
ap p lied .
to b e a r out t h i s
R e s u l t s w i t h g e n e r a l and l o c a l N . A . B .
t h e o r y a s w i l l be shown l a t e r , b u t l o c a l
treatm ent, not n e c e s s a rily
R o s e b u r y and F o l e y
arsen ic,
(63),
is
required in a d d itio n .
an d o t h e r s , b e l i e v e d t h a t
i n t r a v e n o u s a rs p h e n a m in e was n o t v e r y e f f i c a c i o u s .
many c a s e s ,
I have seen
r e s i s t a n t t o l o c a l m e a s u r e s , w h ich c l e a r e d up w i t h
in tr a v e n o u s H .A .B ..
affectio n s.
seem
This i s
e sp e c ially true
of to n s illa r
V I , THE URINE TEST EMPLOYED FOR VITAMIN C.
V itam in C i s
and i n
th e
ju ic e
Szent G yorgyi
of fresh
acid
acid
id e n tic a l w ith
is
and he
said th e
acid
in th e
ta b le ts,
I n 1928
c o rte x had in i t
a
form
th e
of
sh o u ld be
s u b s ta n c e was p r o b a b ly
experim ents
i n v i t a m i n C. I t
is
acid
agent.
(C ow ard and M organ ( 4 8 ) ) . G y o r g y i ’ s
is
on a n i m a l s w h o se
now d e f i n i t e l y
a c tu a l vitam in.
a c id w hose f o r m u la i s
so ld
in o ran g es.
be a p o w e rfu l re d u c in g
drawn from f e e d in g
d efic ien t
asco rb ic
A sco rb ic
suprarenal
anim al t i s s u e s
sug g ested th a t hex u ro n ic
v i t a m i n C.
c o n c lu s io n s w ere
th at
esp ecially
and w as fo u n d to
asco rb ic
d ie ts w ere
the
found in
d e r i v a t i v e w i t h t h e f o r m u l a C6 H8 Og. T h i s w a s
In 1932 S z e n t G y o rg y i
named
and i s
fru it
showed t h a t
carbohydrate
h ex u ro n ic
w a te r soluble
accep ted
CHgOH
shown
J h OH
I
C
H
sm allw h ite
I
each ta b le tco n tain in g
■
C-OH
I
50 m g m s . .
|
I•
0
C-OH
I
CO —
H arris
and Abbasy (54)
procedure
fo r th e
m ethod t o
the
D ecem ber 10t h
i n 1937 d e s c r i b e d
v itam in C u rin e t e s t
B iochem ical S o c ie ty a t
1937.
a sim p lified
and com m unicated t h e
t h e B irm ingham m e e tin g on
The m ethod p r e v i o u s l y
d e s c r ib e d by them f o r
th e m easurem ent o f v ita m in C u n d e r - n u tr i tio n had in v o lv ed
co llectio n
’’r e s t i n g
It
is
o f a 24 h o u r s
o f e x c r e t i o n ” and 2 . t h e
le v el
o ften
in c o n v en ien t to
exam ining la r g e
tra tio n
on t h e
specim en o f u r i n e
w ere n o t
groups
of
d iscard ed .
th e
1,
th e
response
after te st
24 h o u r s
specim en i n
doses.
su b je c ts; M e a su re m e n ts o f m ere c o n c e n ­
resu lt
o f th e u rin e .
depended to o
They t h e r e f o r e
p atien t
em ptied t h e
b lad d er.
T h e r e w a s no m ore u r i n a t i o n t i l l
sp ecim en was t a k e n
asco rb ic
determ ine
larg e ly
began th e
procedure.
At 9 a.m .
and t h i r d
the
recom m ended s i n c e t h e
degree of d ilu tio n
fo llo w in g
co llect
to
days.
acid
aftern o o n th e
and t i t r a t e d .
Then a t 10 a.m .
p e r sto n e
12 n o o n when a
T h is was r e p e a t e d
on t h e
fo llo w in g
on l a r g e
at 2 -
5 p.m .
on t h e
second
d a y 70 m g , o f
o f body w e ig h t were g iv e n
u r i n e was c o l l e c t e d
C o n tro l t e s t s
T h is u r i n e was
and t h a t
same
and t i t r a t e d .
num bers o f v o l u n t e e r s have p ro v e d
50.
th at
on g r a d e d l e y e l s
rep resen ts
eth .
o f i n t a k e t h e t h r e e h o u rs m orning specim en
o f t h e t o t a l d a y ’ s e x c r e t i o n and i s t h e r e f o r e
record of th e " r e s ti n g
th a t th e
co llectio n
adequate to
to th e
day’s te s t
d o s e s . Th e m o r n i n g p e r i o d i s
"re stin g lev el"
since
it
a s viell a s t h e
rep resen ts
response to the
" re stin g lev el"
standard t e s t
in p ro p o rtio n to th e p a st in ta k e .
an d i t
dose a re c l o s e l y
The c o n s u m p t i o n o f
g e n e r a l l y on t h e
The f i r m
stone of
c a u s e s t h e e x c r e t i o n a t e q u i l i b r i u m o f 13 mg.
p e r day ( r e s t i n g l e v e l )
dye,
approxi­
of excretion
r e p u t e d m i n i m a l o p t i m u m o f v i t a m i n C i s 25 mg. p e r t e n
body 7 /e ig h t
chosen
f a s t i n g . v a l u e . W o r k i n g on s e v e r a l h u n d r e d s o f c o n t r o l s ,
a n d A b b a s y h a d shown t h a t t h e
graded
and Abbasy (54) m a i n t a i n
o f t h e 2 o r 3 h o u rs a f t e r n o o n specim en i s
f o r m easurem ent o f t h e
H arris
H arris
show w h e t h e r o r n o t t h e r e h a s b e e n a n y m a r k e d r e s p o n s e
su ccessiv e
m ately th e
lev el".
a
first
and a r e s p o n s e t o t h e
standard t e s t
dose
and c e r t a i n l y on t h e sec o n d day.
o f Roche P r o d u c t s L t d .
(86) have b ro u g h t out a
d i c h l o r o p h e n o l - in d o p h e n o l , w hich i s used as th e i n d i c a t o r
in t e s t i n g
for
ascorbic
acid in u rin e
T h e i r m ethod f o r t h e
q u an titativ e
aqueous s o lu tio n s
as fo llo w s .
is
One i n d i c a t o r t a b l e t
5 c .c.
o f th e blue
is p ip etted
acid i s
in to
so lu tio n
is
e stim atio n of vitam in C in
d i s s o l v e d i n 50 c . c .
b u rette
in to the
a s m a l l b e a k e r and a b o u t 1 c . c .
red.
r u n d i r e c t l y fro m an o r d i n a r y
dye s o l u t i o n t i l l
the
i f u c .c.
colour i s
of the liq u id
ju s t discharged .
analysed are
d isch arg e the 5 c .c .
c o n t a i n 0 . 1 mg. o f v i t a m i n C.
o f dye s o l u t i o n t h e n u c . c .
0.1
100 c . c . w i l l c o n t a i n
u
xQO mg.
I n o t h e r w o rd s 10 d i v i d e d by u w i l l g i v e t n e
i n m. g
of g la cial: acb tic
t o Tde a n a l y s e d i s
In c a lc u la tin g ,
re q u ire d to
o f w a t e r and
( e q u i v a l e n t t o 0 . 1 mg. o f v i t a m i n C)
a d d e d . Th e c o l o u r c h a n g e s t o
The l i q u i d
a nd o t h e r w a t e r y s o l u t i o n s .
ascoroic
acid c o n ten t
.
T h i s a n a l y t i c a l m e t h o d o f R o c h e ( 8 6 ) d e p e n d s on t h e f a c t
th at
the
dye d i c h l o r o p h e n o l - i n d o p h e n o l i s t r a n s x o r m e d t o
c o l o u r l e s s l e u c o - d e r i v a t i v e by th e
its
reducing a c tio n of a sc o rb ic
( v i t a m i n C ). O th e r r e d u c in g s u b s ta n c e s found i n norm al u r i n e
d e c o lo u rise the
in d icato r,
acid
also
b u t i f t h e method i s u s e d i n c o n j u n c t i o n
51.
w ith t e s t
doses o f asco rb ic
d ia g n o s is . thus
P h y sician s
passed
acid
3 to
is
is
tak en
is
g iv en .
5 hours
afte r
and f r o m t h e
are draw n,
i.e .
is
fig u re
im probable
correct
i n mg .
it,
but
or
or
at
so
(b)
asco rb ic
th e
intake
i n mg. i
te sts
o f th e u rin e
te st
dose i s
altern ativ es
to
can have
5 mg.
th at
is
te st
case d efic ien cy
dose
su fficed
of the u rin e
of th e
in
po in t
s a t u r a t i o n w hich
P em berton
by t h e
th a t
at
35 mg.
by u r i n a r y
supplem ents o f v ita m in C are
an e x i s t i n g
4 to
is
thus p o s sib le
co in cid es w ith th e
of th e
p rin cip le
of schoolboys
to
40 mg.
co rrectio n
by h is
d id .
C in
respond
Pem berton
to
(77)
a w e ll n o urished
8 h o u rs.o f
ad m in isterin g
the
(31)
r e c e i v e d 3 5 mg. o f
in tak e
te st
found t h a t
su b ject
a te st
of th e
experim ents w ith
th o se
dose.
in
another
of v itam in C i s
a day by P e m b e rto n . The b o y s w i t h
not
th e
red u ctio n value of th e u rin e .
6 3 mg . T h e m i n i m u m d a i l y
a day d id
prom ptly
recognise
C p e r head p e r day in t h e i r f o o d , w h ile
o f 63 m g .
vitam in
It
sudden r i s e
One g r o u p
group r e c e iv e d
put
u rin e.
( 77) proved t h i s
scho o lb o y s.
v itam in
th e
te st
v itam in C d e fic ie n c y .
and a r e n o t e x c r e t e d u n t i l
ex creted
to
expressed
ad m in istratio n
f o r diagn o sing v itam in C le v e ls
system
double th e
h a s n o t been doubled as
found b e fo re
th ere
r is e n to
In t h i s
a sin g le
p e r 1 00 c . c . ,
depend on t h e f a c t
d eficien cy ,
now
conclusions
d e f i c i e n c y h a s b e e n made g o o d , w h e r e u p o n an e x c e s s i s
of
of
o f 3 0 0 mg . o f a s c o r b i c
of the
re d u c tio n value
fig u re
A ll
sto red .b y th e
dose
two p o s s i b l e
slig h t
acid
case
an aly sis
red u ctio n value
The r e d u c t i o n v a l u e
le ast
th e
In th is
the
A te st
p e r 1 00 c . c . ,
acid
com pared w i t h t h e
dose.
accu rate fo r
(a), t h e r e d u c t i o n v a l u e o f t h e u r i n e , e x p r e s s e d
asco rb ic
in itia l
and i t s
d eterm in ed .
d eterm ined
i n mg.
su fficien tly
recommend t h e f o l l o w i n g p r o c e d u r e
(6 t a b l e t s )
acid
is
i n d i a g n o s i n g v i t a m i n C d e f i c i e n c y Roch e P r o d u c t s
O rdinary u rin e
asco rb ic
acid i t
an in t a k e
o f only
Those w ith an in t a k e
th e u rin a ry e x c re tio n
of
showed a s h a r p r i s e w i t h i n
d o s e o f 50 m g . p e r s t o n e
of
body w e i g h t .
The t e s t
used
b y me i s
P em b erto n , b u t most w o rk ers
too
sm all
an amount f o r
based
on t h e one b y Roche and
a g r e e t h a t 3 0 0 mg .
a te st
dose,
of asco rb ic
so 700 m gs.
are g iv en .
acid
D r.
is
T hom pson o f t h e K o y a l I n f i r m a r y , E d i n b u r g h ,
is the
that
d o s e now u s e d
a n d my r e s u l t s
i n f o r m e me t h a t
700 mg.
a r e c a l c u l a t e d a s t h e y do i n
in stitu tio n .
The a p p a r a t u s
1. Three
required
i s in th e
accom panying p h o to g ra p h s .
dark sto p p e re d b o t t l e s to hold th e u rin e
2. B o ttle
of g lacial
3. B u rette
acetic
acid.
s t a n d w i t h 25 c . c .
4. Sm all w h ite
titratin g
sam ples.
b u rette.
bowl and s t i r r i n g
rod.
5. C o n i c a l f l a s k f o r i n d o p h e n o l s o l u t i o n a n d 10 c . c .
graduated
p ip ette
in c .c .s .
6. Tube o f d i c h l o r o p h e n o l - i n d o p h e n o l t a b l e t s .
7. B o ttle
of ascorbic
8. M icro sco p e
and 9 . t h r o a t
f o r diagnosing the
It
used in
is
acid t a b l e t s .
s w a b . ( T h e l a t t e r tw o a r t i c l e s
are
co n d itio n .)
e s s e n t i a l t o h a v e s t r i c t u n i f o r m i t y i n t h e method
each t e s t .
A cco rd in g ly I adopted th e fo llo w in g procedure
in each c a se .
The
em ptied h i s
p a t i e n t w as i n b e d a n d o n b e i n g a w a k e n e d a t 6 a . m .
b l a d d e r a nd d i s c a r d e d t h e u r i n e .
was e m p t i e d i n t o
700 mg.
a dark sto p p ered b o t t l e .
of ascorbic
acid
(14 t a b l e t s )
At 9 a . m . t h e b l a d d e r
Im m ediately a fte rw a r d s
were g iv e n w ith a d r i n k o f
w a t e r a n d no m o r e u r i n e w a s p a s s e d u n t i l 12 n o o n . The b l a d d e r w a s
now e m p t i e d
a th ird
and t h e u r i n e p u t i n a s to p p e r e d b o t t l e .
em ptying o f
t h e b l a d d e r w a s d o n e and
At 3 t o
5 p.
t h e u r i n e was a g a i n
put
in to
a dark
stoppered
of u rin e
passed
10% o f g l a c i a l a c e t i c
T his
and th e
acid
from b e in g
la b o ra to ry
dark
50 c . c . s
5 c .c .s
acid
in to
a c id was added.
o th e rw ise th e
the, dye
blue
Sach
sp ecim en was t i t r a t e d
The s o l u t i o n
so lu tio n
of d y e.)
m in u tes
dose
of
e ssen tial
and to
during fh e
in
3 tim es
and t h e
a b u rette
dayo f th e
asco rb ic
resu lt
to
of it
d efic ien t
is
to
the te s t
red
be a n a l y s e d
colour
th e
u se d was n o t e d .
as
a ru le;.
(86).
and w i t h i n two
same am ount o f f l u i d s
before
th e
te st
The 3 h o u r s s p e c i m e n c a n
acid or over th e re
is
d iet
d o s e . P e r s o n s b e l o w 8 m g .fo a r e
in
In
body i s
does
I la ck ed
the
th e
a person d e fic ie n t
sto red
th e
th e
o th er
re stin g le v el
overflow
necessary
in
showed t h a t
of asco rb ic
i n v ita m in C any e x t r a
to
taken
Only when t h e b o d y h a s
the u rin e .
ap p ara tu s to
do b l o o d e s t i m a t i o n s
c o n n e c t i o n w i t h my c a s e s ,
in stitu tio n s.
norm al
a t e s t dose only s l i g h t l y
up by th e t i s s u e s .
excess
shows t h a t t h e
o f p la sm a . U ngley (59)
p la s m a and t h a t
and when any a r e m e n tio n e d
in
in v e stig atio n
of v itam in C causes
it.
su ffic ie n t
acid
p e r 100 c c . s
b e low
w ere done
till
rap id ly
s h o w s 8 m g . fo o f a s c o r b i c
asco rb ic
1 mg .
th e
goes
i n v i t a m i n C.
in creases
in to
flask
a v e r a g e was t a k e n .
specim en,
low .
at
6 h o u r s sp ecim en i s t h e im p o r ta n t one and i f
8 0 m g .fo a f t e r
a d eficien cy
acid
u su ally
resu lted .
M an y p e r s o n s who h a v e b e e n o n a r i c h f r u i t
The b lo o d
lev el
is
The f i r s t
in
bowl and 1 c . c .
do 3 t i t r a t i o n s
do t h e t i t r a t i o n
te st.
acid,
th e
no d e f i c i e n c y .
show 50 t o
to
th e
became r e d
of d rin e
k e e p e a c h p a t i e n t on t h e
be ig n o r e d b u t
th e
down t o
The u r i n e t o
b u rette
The num bers o f c . c . s
enough u r in e
is
asco rb ic
a f t e r m easuring
in th e
C a l c u l a t i o n w as made a s a d v o c a t e d b y R oche
It
th e
so lu tio n
titratin g
s o l u t i o n from th e
became
is
clear.
th e
A blue
to wash th e p i p e t t e
ju st
(Thre
sam ples
as fo llo w s.
conical f la s k .
w ere p i p e t t e d
im p o rtan t
in to
prevented
kach sp e c im e n was t a k e n
w h e n 'n e x t m e a su rin g o u t 5 c . c . s
was r u n
th ree
a c i d was add ed i m m e d i a t e l y .
b o ttle
and a n a l y s e d
in the
ace tic
is
To e a c h o f t h e
o f d i c h l o r o p h e n o l —i n d o p h e n o l w a s d i s s o l v e d
of th is
(It
acetic
o x id ised ,
of w ater
of g la c ia l
once.
c o lo u r o f th e
im m ed iately
One t a b l e t
b o ttle.
th ey
To s e e
how q u i c k l y v i t a m i n C d e t e r i o r a t e d
fo llo w in g t e s t s
acid
in
w ere
done.
in u rin e
I put c le a r u rin e
(S .G .
the
1015
reac tio n ,
album in, b i l e
blood »
\
,
oxooa and s u g a r - m l . ) i n t o
T h i s u r i n e was r i c h i n v i t a m i n C and r e p r e s e n t e d
3 sam ples.
th e u r in e
of
a h e a l t h y p e r s o n who h a d b e e n s a t u r a t e d w i t h v i t a m i n
C a n d who h a d ,
700 mg.
5 hours
o f v itam in
p rev io u s to
co llectin g
the
sam ple,
taken
C.
Sam ple 1 . w as p la c e d
in
an o r d i n a r y ,
c le a r u rin e
jar
in the
dark.
Sam ple 2 . was p la c e d
co n tain ed
in
hydrogen pero x id e
a dark b o t t l e w hich had r e c e n t l y
a n d i n w h i c h t h e r e w a s a damp p i e c e
o f co rk w hich had b een f l o a t i n g
Sam ple 3 .
of g la c ia l
ace tic
The t h r e e
are
in
a b lack ,
hydrogen p e ro x id e .
sto p p ered b o t t l e
a n d 10/C
a c id was added.
sa m p le s w ere t e s t e d
shown i n t h e
at
in terv als
and t h e
resu lts
a c c o m p a n y i n g t a b l e D.
TABLE D.
SAMPLE 1 .
SAMPLE 2
SAMPLE 3
TIME OP TE ST IN G .
m gs.$ v it a m i n C
mgs. $ v i t . C
m gs.$ v i t
50
50
50
a.m .
33 .3
33 .3
50
p.m .
3 3 .3
16.67
50
p.m .
3 3 .3
9 .3
50
5 p.m .
33 .3
1.19
50
7 p.m .
3 3 .3
0 .9 5
50
p.m .
28.3
0 .5
50
25
0 .4 "
50
9 a.m .
1—1
iH
i
!
I
ii
was p la c e d
in th e
1
3
9
(u rin e
passed)
9 a.m .
(next
day)
F o u rteen days l a t e r
4 .2 m g s. $ o f a s c o r b i c
th is
vitam in
th ere
th is
C rose
th e
35 m gs.$ a s c o r b i c
d uring
700 m gs.
acid ,
th e
of
show ing t h a t
body.
A ll
( m y s e l f ) w as on a d i e t w h ic h was p o o r i n
v itam in
C and c o n t a in e d
kept
th e
in
afte r
no d e f i c i e n c y o f v i t a m i n C i n
su b ject
contained
none o f w hich had been ta k e n
specim en o f u r i n e
however to
was r e a l l y
tim e
acid,
The 6 h o u r s
p erio d .
a random sam p le o f u r i n e
no f r e s h v e g e t a b l e s .
d a r k b o t t l e w i t h 10 $ g l a c i a l
Sample N o. 3 was
ace tic
acid
in
it
and
on t h e 1 4 t h d a y c o n t a i n e d 2 5 $ o f a s c o r b i c a c i d . T h e s e r e s u l t s
show t h a t
asco rb ic
a c id slow ly d e t e r i o r a t e s in o rd in a ry u r in e
t h e d a r k . When s t o p p e r e d
acetic
a nd k e p t i n t h e
a c id added^the d e t e r i o r a t i o n
n o t on t h e
first
in
d a r k w i t h 10$ g l a c i a l
i s n o t so m a r k e d a n d c e r t a i n l y
day.
D irty re c e p ta c le s
i.e .
the hydrogen p e ro x id e
cork in i t , cause
a ra p id o x id a tio n o f the
v itam in
C content
resu lts
also
even i f
the b o t t l e
is
dark in c o lo u r.
j u s t i f y my c o l l e c t i n g o f u r i n e
a d d itio n o f 10$ g l a c i a l
acetic
the b o ttle w ith
Th e
in dark b o t t l e s ,
a c i d a nd t h e t e s t i n g
the
of i t
i m m e d i a t e l y a s a m p le was o b t a i n e d .
Y II.
THE METHOD USED TO DETERMINE THE LEVEL OF
VITAMIN Bg IN .T H E BODY.
Many w o r k e r s ,
.o u tlin e ,
believed th a t
w a s r e s p ’o n s i b l e
S pies
a s h a s b e e n shown i n t h e
(46),
T u n n icliff
(64),
among t h i s
lot.
i n some l o c a l i t i e s v i t a m i n Bg d e f i c i e n c y
f o r the
C lem ents
is
co mm en cem en t o f V i n c e n t ’ s d i s e a s e .
(49),
S m ith,P ersons
K ing ( S 3 ) ,
F ield
(84)
a nd H a r v e y ( 5 7 ) ,
a n d many o t h e r s w e r e
suggested t h a t
the
a n t i b e r i - b e r i v i t a m i n an d w h i l e
alco h o lic
n e u ritic
it
(Coward and
i s w e l l know n t h a t v i t a m i n Bg h a s no a n t i -
p r o p e r t i e s . V i t a m i n Bg w a s know n t o p r o t e c t
p e lla g ra w ith i t s
g a s tro -in te s tin a l u p sets,
be i d e n t i c a l w i t h l a c t o f l a v i n
egg-album in,
a nd t o b e p r e s e n t - i n w h e y ,
s u b j e c t s how s t h a t ” v i t a m i n Bg
a com plex o f a t l e a s t t h r e e f a c t o r s ,
B6 t h e
iso latio n
e g g - y o l k and l i v e r .
Th e l a t e s t w o r k on t h e
is
ag ainst
severe d e rm a titis
and c h r o n i c d e m e n t i a and v i t a m i n B^ w a s a f t e r i t s
found to
so -called
" ra t p e lla g ra facto r"
i.e.
lacto flav in ,
and P . P .
v itam in
t h e human p e l l a g r a
and c a n i n e b l a c k - t o n g u e f a c t o r .
The m o st r e c e n t w o rk i n d i c a t e s t h a t t h e P . £ .
related
to
.
and o t h e r f o r m s o f n e u r i t i s
a r e p r e d i s p o s e d t o by d e f i c i e n c y o f v i t a m i n Bp.
Morgan ( 4 8 ) )
.
'
W h i l e ' v i t a m i n Bp i s
it
in itia l h isto rical
or id e n tic a l w ith n ic o tin ic
(L eslie H arris
(60)).
acid
facto r is
( • Cg H 5 N O g . )
It
is
now e s t a b l i s h e d
p rev en tio n
v itam in
of p e lla g ra .
B in to
a d eficien cy
it
1912,
d isease
1926 ow ing t o
believ ed
A short h is to ry
is
concerned
of th e
was
d iscu ssin g p e lla g ra ,
th e
d octrine
due t o
d eficien cy
sp littin g
th o u g h t
of G o ld b erg er,
in
poor q u ality
d isease,
co rin g
p ro tein
realised
At t h i s
th a t
tim e
concluded th a t
" v i t a m i n B" h a d t w o f a c t o r s
facto r
at le ast
to
be b o t h
ex cellen t
a facto r
them ,
an ti-n eu ritic
su p p lem en t.
an ti-p ellag ra
p ro p erties.
th e
dual n atu re
Thus to
la b ile ,
in th e
facto r.
of
an ti-n eu ritic
p rin cip le
it
th e
old
afte r
s till
had
som e m a i z e m e a l
v itam in but poor in
on dogs and c a t s
to b e .
th e
confirm ed
be
sp lit
into
a heat-
component o r
T his h e a t- s ta b le
com plex
p ro p erties
I t p revented p e lla g ra
2.
I t p re v en ted b lack -to n g u e
i n man.
in
dogs (a
d isease
ap p aren tly
same a s p e l l a g r a ) .
3 .
I t was n e c e s s a r y
4.
I t prevented a p e lla g ra -lik e
G o ld b erg er w rongly
im p o rtan t to
be p a r t
in
a r a t ’s d ie t fo r
assumed t h a t t h e
th e "p ellag ra-p rev en tin g
know t o
1.
of
rem edy and an
and a h e a t - s t a b l e
1.
is
p rep aratio n s
though i t
diate v i t a m i n B w as f o u n d t o
had f o u r d i s t i n c t i v e
It
s im ila r to
i.e .
A ls o he n o t e d t h a t
F u rth er te s ts
c o m p l e x a s we no w b e l i e v e
to
the f a c t o r
" v i t a m i n B" .
an ti-n eu ritic
th e
However
called
Y east how ever,
a u t o c l a v i n g w a s no l o n g e r a n t i - n e u r i t i c
e x t r a c t s w ere r i c h
d ie t.
p e l l a g r a was a
o rd in ary
in
fro m 1916
c o n c l u s i o n s was t h a t y e a s t w as
an e x c e l l e n t
an ti-p ellag ra
an ti-p ellag ra
m ig h t be
and tw o t h e new a n t i - p e l l a g r a v i t a m i n .
One r e a s o n f o r G o l d b e r g e r * s
found
it
in the
p e l l a g r a had a d i s t r i b u t i o n
" v ita m in B ". G old b erg er
an ti-n eu ritic
of
a n A m e r i c a n , who
" v i t a m i n B" w a s k n o w n a n d G o l d b e r g e r , s h o w e d t h a t
concerned
in th e
b u t h i s view s w ere n o t re c o g n is e d
by 1926 G o ld b e r g e r had h im s e l f
v itam in
acid
Bp a n d Bg w i l l n o t b e o u t o f p l a c e .
Funk i n
to
th a t n ico tin ic
g r o w th and h e a l t h .
d erm atitis
in r a ts .
f o u r p r o p e r t i e s w ere
all
due
facto r".
note th a t
o f t h e Bg c o m p l e x i s
n ic o tin ic
a c i d w h i c h we now
h eat-stab le.
N ico tin ic
acid
acco rd in g to
is th e
M cL ester (70)
b eta-m o n o carb o x y lic
from t h e
w ithout
p o in t
lo ss
one h o u r k i l l s
so lu b le
on t h e
ex cretio n
th e ir n ic o tin ic
per day i s
te st
(67)
7 m g s.,
th a t
it
can be b o i l e d
C w i t h w h i c h 6 0 ° C.
for
A l s o v i t a m i n C,
by a l k a l i s
and d r y i n g .
have done, a g r e a t d e a l o f work
estim atio n s
elab o rated .
4 to
d estro y ed
and
The i m p o r t a n t t h i n g
(T idy ( 6 9 ) ) .
fo r n ic o tin ic
acid
is
u n lik e v itam in
rap id ly
an d Raymond
w orkers have
th e sis
80$ o f th e v ita m in .
in w ater, i s
H arris
acid of p y rid in e .
o f view o f t h i s
o f po ten cy ,
f o r m u l a C 5 H4 N (COOH)
has th e
acid .
Some o f my c a s e s h a d
done by t h e m ethod t h e s e
The n o rm a l n i c o t i n i c
w ith th e
average
acid
ex cretio n
e x c r e t i o n p e r day as
6 m g s .. The f i g u r e
rises
exam ined w h e re t h e
p e r s o n s w ere v e r y h e a v y s m o k e rs . The o u t p u t
w ith
was 7 t o
13 m g s.
per
to
th a t
a general
th in k
in r a i s i n g
as
th e
o u tp u t
These w orkers
and f o u n d
cases
day,
th a t
a h ig h meat d i e t .
but H arris
ru le,
a n d Raymond w e r e i n c l i n e d
sm oking had v e r y l i t t l e
of n ic o tin ic
of p ellag ra,
o f m y asth en ia g ra v is
effect
acid.
exam ined p e r s o n s d e f i c i e n t
cases
Some c a s e s w e r e
persons
in n ic o tin ic
on low d i e t s ,
acid
and
had 2 o r under, mgs. p e r day, o f
an
o u tp u t.
The t e s t
has
been proved to
be r e l i a b l e
o f e x p e r i m e n t a l work w i t h g u in e a p i g s .
o n e-fifth
ex creted
of
in
expect th a t
d aily
in
a perso n ’s to ta l'd a ily
th e
25 t o
th e
35 m g s . o f n i c o t i n i c
average
In do in g th e
w ard, w ere p u t
off
As a g e n e r a l r u l e
in tak e
u r i n e . W o r k in g on t h i s
from a v a s t
of
a v itam in
general
ru le
amount
about
is
one w ould
a c id w ould be i n g e s t e d
case.
te st
a l l the
s u b j e c t s , who w e r e k e p t
sm oking f o r 3 d a y s p r e v i o u s l y .
sp e cim en o f u r i n e was t a k e n
and t h e
in
th e
A 24 h o u r s
amount m e a s u re d . The t e s t
as f o l l o w s : ” 25 m l.
hy d ro x id e
of u rin e
so lu tio n
f o r 30 m in u te s
4$ sod iu m b i c a r b o n a t e
carefu lly
are h eated w ith
so lu tio n
n e u tra lis e d w ith
pH 6 - b r o m o - t h y m o l b l u e
w hole
is
q u an titativ ely
is
in
are
5 m l .o f 20$ sodium
a steam b a t h .
added and t h e
2 m l. o f
so lu tio n
co n ce n trate d h y d ro ch lo ric
used as
tran sferred
acid to
an e x t e r n a l
in d icato r.
to
graduated
a 50 m l .
is
The
is
and made up t o
50 m l . w i t h d i s t i l l e d w a t e r . F o u r l a b e l l e d 15 m l .
v olum etric f l a s k s
are prepared
in to th e th ir d
a n d f o u r t h 20 / u g .
and 40 yug. of nicotinic acid are pipetted accurately, using a
standard solution containing lOOyug.
To a l l
of the
f l a s k s 10 m l. o f t h e n e u t r a l i z e d u r i n e
the. c o n c e n tr a te d
flask s
is
nicotinic acid per ml.
n ico tin ic
acid s o lu tio n
in the th ir d
are
and f o u r t h
c a r e f u l l y w a s h e d down w i t h t h e u r i n e . The f l a s k s
immersed i n
s o l u t i o n o f cyanogen brom ide
d a i l y by a d d in g a 10$ aqueous p o ta s s iu m c y an id e s o l u t i o n
by d r o p t o
a satu rated
added t o
a t 8 0 ° C. f o r
lig h t
acid
all
brom ine w a t e r u n t i l
except the f i r s t
4 m inutes.
in
is
ju st
drop
decolourized
m i x by r o t a t i o n
and k e e p
a c o l d w a t e r b a t h i n dim
Add 0 . 2 m l .
of p-am inoaceto-phenone
50 m l .
) to
a ll four f la s k s ,
a d a r k c u p b o a r d f o r 15 m i n u t e s .
th a n added 0 . 4 m l.
t o l6 m l .
it
(made
( 5 gm. p - a m i n o a c e t o - p h e n o n e , 14 m l . o f . 1 0 $ h y d r o c h l o r i c
a nd d i s t i l l e d w a t e r t o
and l e a v e
flask ,
Remove t o
and c o o l f o r 4 m in u te s .
so lu tio n
are
a n o p a q u e s i d e d w a t e r b a t h a t 8 0 ° C. f o r t e n m i n u t e s ;
2 m l. of a f r e s h ly prepared
are
added;
and t h e
o f 10$ h y d r o c h l o r i c
flask s
acid
mix
To e a c h f l a s k i s
so lu tio n
and w a t e r
are r e tu r n e d to th e dark cupboard f o r
15 m i n u t e s . The c o l o u r i s m e a s u r e d i n a P u l f r i c h p h o t o m e t e r .
If
a turbidity develops at any stage it should be removed by
centrifugation before proceeding.
Urines may be preserved with
sulphur-free redistilled toluene. n
In the photometer we use the blue rilter S47. xhe purple
one,
S 43,1s too dark.
PULFRICH PHOTOMETER.
i.Tv'0 ■-> cm.
c-lls
are used
in the
in stru m en t.
One c a l l e d
has th^ u r i n e w i t - a no c y a n o g e n b r o m i d e n o r n i c o t i n i c
and it i s
placed i n the l e f t h a n d c o m p a r t m e n t .
compartment the o t h e r c e l l s
scale
is
set
(a.)
at
Just
( b . ) 0 .2
are p la c e d ,
100 m a r k .
th e
one a t
of n ic o tin ic
rig h t
a tim e,
These o th e r c e l l s
cyanogen brom ide
c.c.
In th e
acid,
hand
and t h e
have:-
(0).
acid
p lu s
cyanogen brom ide
( ,1t h e
acid
p lu s
cyanogen brom ide
("th e
20 c e l l " ) .
(c) 0 .4
c.c.
of n ico tin ic
40 c e l l " ) .
. i.e.
tim e,
we p u t
in to
readings
th e
a fte r
Suppose th e
the
rig h t
0,
20 and 40 m i c r o g r a m c e l l s
hand
s id e , w ith th e
b alan cin g th e
read in g s
are
drum a t
co lo u rs w ith
82 w i t h
"0",
in ,
one
at
a
100 a n d t a k e t h e
"x".
44 w i t h " 2 0 ” and 25 w i t h
"40” .
H arris
th e
a n d R a ym on d c a l c u l a t e d
ex tin ctio n
co efficien t
o b tain in g
a straig h t
abscissae
gave th e
against
th e ir
th e
resu lts
n ic o tin ic
l i n e w h ic h when p r o d u c e d t o
co n cen tratio n of n ic o tin ic
by p l o t t i n g
acid
a d d e d and
tran sect
th e
acid
in yug.
of
F o r e a sy com parison th e
resu lts
are
the u r i n e .
I w ork
it
w ritten
0 at
X = 44 w i t h
20 a t
X = 25 w i t h
40 a t 1 0 0 .
th e
i.e.
th ey
are
100
1 .9138,
each of th ese
0 .3 5 6 5
from th e
100
lo g a rith m s o f th e
readings
1.6435
82,
44 and 25 by a l o g -
and 1 .3 9 7 9 .
from 2 to
get
it
to
a decim al i . e .
and 0 .6 0 2 1 .
Now s u b t r a c t t h e
it)
fo llo w s.
X = 82 w i t h
Now s u b t r a c t
0.0862,
as
as:-
How t a k e
ta b le.
out
0.0862
(i.e.
th e
o t h e r two r e a d i n g s
c e l l w i t h no n i c o t i n i c
(i.e.
acid
in
t h e 20 and 40 m i c r o g r a m
cells).
The r e s u l t s a r e 0 . 2 7 0 3 ( f o r th e ” 20 ” c e l l ) a n d 0 . 5 1 5 9 ( f o r t h e ” 4 0 ”
cell).
Now m u l t i p l y 0 . 0 8 6 2 ( t h e c e l l w ith no n i c o t i n i c ac id ) by 20 and
d iv id e by 0 . 2 7 0 3 .
Also m u l t i p l y
These two
resu lts
" 20 " h a d
is
0.0 8 6 2
6.378
b y 40 m i c r o g r a m s
are
expressed
and t h e
and d i v i d e by 0 .5 1 5 9 ,
as m icrogram s p e r 5 c . c .
"40"- h a d 6 . 6 8 3 .
The a v e r a g e
is
i.e.
taken
and
6.53 m icro g ram s p e r 5 c . c .
Now we c a l c u l a t e
th e
p ercen tag e
and t h e
to ta l
amount e x c r e t e d
per day.
FINDINGS FROM THE CASES OF VINCENT 1S DISEASE.
V III.
H aving d e s c r i b e d
t h e ways i n w h ich I have
p r o b l e m o f V i n c e n t 1s D i s e a s e
the
actu al
cases.
A b rief
approached th e
l e t u s now t u r n t o
d escrip tio n
of
th e fin d in g s
each case
is
in
g iv en l a t e r .
VITAMIN B DEFICIENCY.
Let us
co n sid er th e ,q u e stio n
p red isp o sin g f a c to r
S p ies
(46),
in t h i s
C lem ents
T u n n icliff
(64),
S in clair
K ing
F ield
(84)
(83),
lo c a lities
K ing
cause
it
is
i n v a s i o n by th e
(83)
em p h atically
th at
tru e
ch ara cterise d
co n stan t
accom panim ent.
and a
in
th e
of th e
absent
all
state
th a t
th a t
th e
organism .
is
not
the
s t a t e " . F urtherm ore
in tem perate
agree th a t
clim es
and t h a t
A ll w r ite r s
d iarrh o ea is
O f my 5 5 c a s e s n o t o n e h a d t h i s
on
a
com p laint,
b e c o n s t i p a t e d 1. O t h e r f i n d i n g s w h i c h a r e
p re-p ellag ro u s
in
state
certain
and l a y s
C deficien cy
"p re-p ellag ro u s
can e x i s t
in
state
are
sto m atitis
and, g l o s s i t i s
d e s q u a m a tio n o f t h e t o n g u e . The l a t t e r
all
of the
55 c a s e s .
S to m a titis
is
two
a sig n
m alady i t s e l f .
E lsom (56)
that
to
ch ara cteristic
sig n s w ere
states
(57),
H ig h to w e r and H u b b a rd ( 7 9 ) ,
fu so -sp irillary
p re-p ellag ro u s
22 t e n d e d
S p ies,
and H a r v e y
by an a b se n c e o f s k i n l e s i o n s .
or th e
d escrib ed
th e
p ellag ra
p ellag ra
indeed,
(65),
S m ith, P e rso n s
o f v i t a m i n s B]_ o r Bg e x i s t s
and ev en d e s c r i b e s
he s t a t e s
(49),
as a
of p atien t.
and many o t h e r s
a d eficien cy
gums o p e n t o
class
of v itam in B d e fic ie n c y
its
ta lk in g
of v itam in
B d eficien cy
sym ptom s and s i g n s w e re r e f e r a b l e
to
(a.)
in g e n e ra l,
th e g a s tr o -
stated
61.
in testin a l
(d.)
to
trac t,
th e
M cL ester
(b.)
th e
card io -v ascu lar
(70)
co n firm s
th is
t h e r e w as no d i a r r h o e a
and o n e h a d
g astritis
feelin g
a h isto ry
co n sisted
th e gums.
in
of
co n stan t
certain
fu lly .
has
an d p a i n s
any o f t h e
and t h e r e
was no
cases
and a
a p e rfo rated pep tic u lc e r
or vague
d eficien cy .
aches
The b lo o d
o f vitam in B d e fic ie n c y
of dropsy o r m y o c a rd itis.
evidence
B.
An o u t b r e a k
s e v e r a l hundred
appears in th e
cases
in p r is o n
camps on t h e
i t . None o f t h e
The O b s e r v e r s
of tru e
(25).
p e lla g ra occurred
l a s t w ar.
Germans
s am e r a t i o n s e s c a p e d b e c a u s e t h e y
co n su late
B ritish
and su p p le m e n te d t h e i r
tro o p s
or h o sp ital
o rd erlies
co n clu d ed from th e w e a lth of c l i n i c a l
m aterial
av ailab le,
fo r 4 to
6 m o n th s and t h a t t h e r e e n s u e s a c l i n i c a l l y p r e - p e l l a g r o u s
stag e
the
d u r in g w hich
extrem e l i m i t
ex p en d itu re
th e
and
p recario u s
th a t
J o u r n a l o f t h e R.A.M .C.
camps d u r i n g t h e
e x t r a money fro m t h e i r
it.
so -called
and f o u l m a t e r i a l fro m
s e e n t h e r e w as no c l i n i c a l
report
ra tio n s w ith
and h e a r t b u r n
ch ara cteristic
evidence
An i n t e r e s t i n g
in n e ig h b o u rin g
on a d m i s s i o n . T h i s
in vitam in
and n o t
clin ica l
in T u rk is h p r i s o n e r s
P o u r h a d " g a s t r i t i s 11
cases.
a f t e r m e a ls and c o u l d hav e b e e n a c c o u n t e d
one g e ts
of v itam in
of
circum stances.
c a s e s had p e r i p h e r a l n e u r i t i s
Thus from th e
of a la c k
and
be a c c o u n te d f o r .
of th e
such as
th e b lood,
a l r e a d y b e e n shown t h a t
ascending f la tu le n c e
p ic tu r e s w ere v a r i a b l e
took
It
One c a s e w a s a d m i t t e d w i t h
No o n e
(c.)
system i n
sw allow ing o f pus
w hich c o u l d l i k e w i s e
receiv ed
system ,
of "in d ig estio n "
of d isco m fo rt
fo r by th e
nervous
the
causes of p e lla g ra are
ap p aren tly health y
of p o ssib le
persons g rad u ally
derangem ent r a p i d l y
e.g.
approach
a d ju stm en t betw een norm al energy
abnorm al m a l n u t r i t i o n .
b alan ce,
in o p eratio n
Soon any d i s t u r b a n c e
by e x t r a w ork o r f u r t h e r
converts th e
su b ject
in to
of
d ig estiv e
a c lin ica lly
d efin ite
p ellag rin .
L e t me a g a i n
t h e r e w e r e no
of p e lla g ra
of b e r i- b e r i
sig n s
itse lf
seen.
state
th a t
of the
in th e
sailo rs
p re-p ellag ro u s
ca m e i n t o
th e h o s p ita l.
of th e
state
sm all
sh ip s
a n d no c a s e s
Nor w ere t h e r e
cases
62,
In th e
R.A.M.C.
the b a c t e r i o l o g i c a l
sectio n ,
s e c t i o n who c a r r i e d
the f i n d i n g s
"There
is
ch aetal
w ith
Indeed
no
to
this
cases
it
to
Thus i t
sectio n
w ill
th e
also
be
said
of
it
in v asio n
th is
acid
in
n atu rally
in y e a s t,
it
is
in
is
of p o ten cy .
is
not
accom panim ent
of
of th e
th e
d iet
of th e
sailo rs
against p e lla g ra ,
(M cL ester
C.
(70)),
t h e way
by t h e V i n c e n t ’ s o r g a n i s m s .
G rant,
have dem onstrated th e
liv er,
l e a n meat
g astric
and m i l k ,
u n u su ally h e a t-s ta b le
is
is
th e presence
(M cL ester ( 7 0 ) ) .
A lthough
i n them a l l
There i s
M oreover M cL ester
of
i s found
and i t
even in
from p e rs o n a l e x p e rie n c e .
Thus t h e r e
S p ies,
effectiv en ess
The a c i d
trac t
and s t o m a t i t i s
the N aval d ie ts .
acid
of p e llag ra,
h a s b e e n c h i e f l y blam ed f o r l a y i n g
from th e
can v o uch f o r t h i s
cause
case h ere.
d i e t s w e re m o n o to n o u s, m eat was p l e n t i f u l
in th o se
aelio lo g ical
co n n ectio n w ith v ita m in
p rev en tin g p e lla g ra .
o f V iolent- g a s t r i t i s
lo ss
sp iro -
blood p i c t u r e s
not th e
tu rn s to
la ter
guards
(61)
n ic o tin ic
absorbed
of
acid
a co n stan t
A study of th e
show t h a t
and .M c L e ste r
n ic o tin ic
in
th a t
show u s t h a t V i n c e n t ’ s d i s e a s e
One n a t u r a l l y
an d d e f i c i e n c y
in
m ention
could n o t
states
organism s ta n d in g
a n a e m ia was
N ico tin ic
of meat
to
o f p e l l a g r a by any m eans.
of p e lla g ra .
and m o re w i l l
q u ick ly
failed
o f i n f e c t i o n by any p r o t o z o a l ,
serves
THE D I E T .
open t o
all
in fec tio n .
th e p ro to zo a lo g ic al
accom panim ent
55 s a i l o r s
s e c t i o n and o f t h e
c o m m itte e was h u n t i n g f o r t h e
C h lo ro tic
th e
post-m ortem s
of
p ellag ra."
n ev erth eless
a co n stan t
p ro to zo al
rep o rts
any c o n s t a n c y o r i t w o u ld h a v e b e e n
evidence
R h ile
S tone
out the
or u ltra-m icro sco p ic
rela tio n
th o se
of th e
of f u s o -s p irilla ry
have b e e n t h e r e
m entioned.
(25) . i n v e s t i g a t i o n ,v e r y f u l l
(70)
and I
no l a c k
states, th a t
and c a n be b o i l e d w i t h o u t
n o 1d e f i c i e n c y o f n i c o t i n i c
acid
s a ilo r s ’ d iets.
CHEMICAL T E S T S .
of r e s u l t s
The n e x t t h i n g to
o b ta in e d from th e
of n ic o tin ic
acid.
As i t
is
an aly sis
consid er is
th e ta b le
of the u rin a ry e x c re tio n
a long p ro c e s s
and tim e
is
lim ited
23 o f t h e
55 o a s e s w e r e e x a m in e d t h u s .
The r e s u l t s
are
shown i n
tab le S.
j TABLE E .
M illig ram s of N ico tin ic
I- ......................
'e x c r e t e d p e r d a v
! C4.SB NO. 1
1.
|
|
j(
8.8
1
. -
13.13
9 ,6
■
8 *34
_
i .
! :
No
i
I
i
No
No
1
I
•
No
'j
8.75
11.
No
8 .2
;
■
No
12.
]
6.3
j
No
13.
j
5.1
j
No
j
No
14.
4.14
i
15.
I
j
8.0
i
18.
■
6.3
•
2.87
19 .
21 .
j
5. 0
23.
:
24.
i
40.
!
46.
I
'
'
No
■,
D oubtful d e f ic ie n c y '
No
6.38
|
No
4.75
\s
I
No
. 5.1 4
1
No
\
\
‘
'
4.35
ex creted
low d i e t h a v e
the v a lu e
and
per
Raymond
day i s
a value
o f 2 , 8 7 mg.
4 mg. f i g u r e .
4 to
No
.j
No
state
t h a t th e norm al n i c o t i n i c
7 m g.. P e l l a g r i n s
and p eo p le
o f 2 o r u n d e r . W h i l e two o f t h e
ex creted
cases
(8 2 .6 $ )
on a
c a s e s have
p e r d a y o n l y two o t h e r s
The m a j o r i t y o f t h e
th e norm al li m i t s
N igh v a l u e s .
(67)
J
j
3.4 2
H arris
w ith in
No
t
j
{
I
1
57.
th e
No
11.1 5
10.
acid
D oubtful d e f ic ie n c y
I
{
i
. i
No•
\
*
I
.
No
1
3.83
7.
9
j.
j
-
:
8
No
|
.
5.
6.
I' . •
2.87
1
D e f i c i e n t nr
, e jic ie n c y or
o th erw ise.
|
9 .3
3.
4.
-
6,31
f
2.
A cid
a r e below
are w ell
a n d some ( c a s e s 9 a n d 6 ) show v e r y
64.
From t h e s e r e s u l t s we may ta k e i t t h a t the s a i l o r s
of t h e sm all s h i p s have ample v ita m in Bg in t h e i r d i e t s and
th a t in t h i s c l a s s o f men d e f i c i e n c y of n i c o t i n i c acid can he
ruled out as a p r e d i s p o s i n g f a c t o r in V i n c e n t ’ s Disease.
The r e s u l t s
be d e s c r i b e d
la te r
not
d isease
cure
th e
trea tm e n t,
of cure
is
in
of u sin g n ic o tin ic
but here
if
it
used
w ill
alone
acid
su ffice
in
the
in treatm en t w ill
to
say th a t
d irec t
co n trast
acid
to
in th is
th e
class
fin d in g s
does
absence of lo c a l
and t h a t w i t h l o c a l t r e a t m e n t t h e r e
u sin g n ic o tin ic
it
is
no a c c e l e r a t i o n
of p a tie n t.
o f K ing
T his
(83).
VITAMINS A AND D.
In th e
ex p o rted most
th em selv es
S r e a t W ar o f 1 9 1 4 -1 8 t h e D anes and Swedes
of
short
t h e i r b u t t e r t o b e l l i g e r e n t p o w e rs and l e f t
of th a t food.
As a r e s u l t t h e r e w e r e
o f x e r o p h t h a l m i a and k e r a t o m a l a c i a i n
the d is e a s e
known t h a t
rap id ly
d eficien cy
eyes and I have
man w h o s e
it
healed
of th e
and-he
is w ell
refle cted
in the
a case
of a
lo cal
rem edies.
He w a s o n a s h o r e
On t h e
o t h e r hand none
55 c a s e s w r i t t e n up h a d any s i g n s o f ey e t r o u b l e .
d ie ts
adm ixture
b u tter,
and i n
too
as
d ie t
are
has
all
abundance
of
be m a n u f a c tu r e d
supposing t h a t
occurrence
se e n ,b u tte r
a d d i t i o n m a n y o f t h e men h a d f i s h
on t h e m e a t.
C arro ts are
rich
th e ir
in
common
a g r e e . E ven now, w i t h
an
in th e
s u f f i c i e n t v i t a m i n s A a n d D. C a r r o t s ,
sun in
in
c a s e s were
( w h i c h c o n t a i n s v i t a m i n s A a n d D)
fats
i n v i t a m i n A (B eaum ont and Dodds ( 6 8 ) ) .
Indeed w ith th e
fo r th e
tim e when t h e
any s a i l o r w i l l
o f m argarine
th e
and b u t t e r
at th e
and t h e r e was f a t
on s h i p b o a r d
for
It
and
c l e a r e d u p w i t h nA d e x o l i n n , t h o u g h
h a d no V i n c e n t ’ s D i s e a s e .
was v e r y p l e n t i f u l
th e
is
s e e n i n t h e West C o a s t,
to
F urtherm ore
th e ir
o n g i v i n g v i t a m i n A.
corneal u lc e ra tio n
had been r e s i s t a n t
statio n
c h i ld r e n ’ s schools
of th o se v itam in s
recen tly
o u tbreaks
open a i r l i f e
the
summer m o n t h s ,
b o d ies.
sh o rtag e
th e
There i s
s a ilo rs lead
am ple v i t a m i n D w ould
d efin itely
no c a u s e
o f v i t a m i n s A and D was t h e
of V in c e n t’s d isease
and
reason
on o u r s m a l l s h i p s
as
is
c la im e d by F i e l d
o th ers
th at
in
it
o th e r
is
(84),
com m unities.
p o ssib le
vitam in A b u t
Indeed
fo r d ifferen t
th is
classes
true
first
cases
w ere a l l
p lace
of
tu rn
it
to
is
th e
sm all
q u estio n
scurvy
th ey
( 5 3 ) h a s shown u s
lack
case.
of v itam in C d e fic ie n c y .
sig n ifican t th a t
th e h o s p i t a l had 9
D e c e m b e r 1 9 4 0 . T h o s e men
s h i p s w i t h w h i c h I am d e a l i n g
doubt t h e r e m ust have been o th e r c a s e s
of v itam in C as
and
’
sc u rv y from Jan u a ry to
from th e
(65),
of people to
h a s no b e a r i n g on t h i s
L e t u s no w
S in clair
Jeghers
"VITAMIN C.
In t h e
( 66),
K irk p atrick
on b o a r d
o f n e c e s s i t y w e re on t h e
in
and beyond
a low s t a t e
s am e d i e t s
as th e
cases.
My n e x t
p o in t
is
th a t th ere
’’s u b s c o r b u t i c
s t a t e ” w ith
for c a p illa ry
fra g ility
(h esp erid in ),
although B e ll,
raised
p etech ia l
Of t h e
55 c a s e s
of v ita m in
counts
co n stan t
is
concerned w ith v itam in P
L a z a r u s a n d M u nr o
th o u g h alm o st
u rin ary
only 7 had a ” p o s i t i v e
clin ica l
(76)
reduced
e i g h t w e e k s w i t h d o s e s o f v i t a m i n C.
I m ention,
C by th e
no r e a l ,
sym ptom s. The t o u r n i q u e t t e s t
p robably
in
is
ex cretio n
all
te st
to u rn iq u et t e s t ” .
showed a d e f i c i e n c y
p rev io u sly d escrib ed ,
T his t e s t
i s o f no
^
^
....
Vr r *
subsco rb u tic s t a t e , fo r
- .............................
value
i n my o p i n i o n ,
other p a t ie n ts
for
asco rb ic
w ith
acid
in
estim atin g the
neg ativ e t e s t s
ex cretio n
as th e
had th e
"p o sitiv e s” .
The f i g u r e s fro m t h e u r i n a r y
46 o u t
o f 55 c a s e s w e re d e f i n i t e l y
adm ission.
Of t h e
acid
before
However a t
the
o u tset
acid
qu arters
and w e r e
were n o t
26,
values
34
d efic ien t
S')
in ,
i
/
w ereld eficien t)in
.26
18, 24,
33,
and w e re t r e a t e d w i t h ,
th e y w ere r e a l l y
41
ascorbic
d e f i c i e n t when s e e n by me.
d e f i c i e n t becau se th e blood
o f c a s e s 33 and 41 w e r e d o n e a t
and
sh ow t h a t
i n v i t a m i n C on
num bers 1 0 ,
a d m is s io n and t h u s w ere n o t
asco rb ic
Only c a s e s
d eficien t
ex cretio n te s t s
d eficien t
rem aining 9 c a se s,
and 47 h a d b e e n f o u n d
sa m e o r l o w e r f i g u r e s
another sick
. 2 1 mg./£> r e s p e c t i v e l y .
and 45 h a d no p r e v i o u s v i t a m i n C a d m i n i s t e r e d
on a d m is sio n .
T h u s o f 55 c a s e s ,
and
52 o r 9 4 . 55 /0 ,
y
v ita m in C by th e u rin a ry e x c re tio n t e s t s
and o f
th ese
th e
low f o r
state
values
of v itam in
the m ost p a r t
C In th e
th a t th e re
in w hich th e p a t i e n t s
Hov/ever t h e m a t t e r
not be t h a t
C to be
It is
it
is
th e
so low i n
rate
of
cases?
occurred due t o
Indeed
v itam in
Cam pbell
th o se
(98),
26, 3 4 a n d 4-5, w h e r e
of t h e
oral
sep sis
caries
and t a r t a r
the o r g a n i s m s
to
developed;
respond
to
Is
b u t w here
has
itse lf
on t h e
th en
to
on a
see
th e
th ere
only, h a s
was no q u e s t i o n
th e
v itam in
(H. G o rd o n -
cases,
as w itn ess
of v ita n in
traum a in
the
in itia l
sep sis
th e
C in
form
lesio n
sp ite
of
w hich a llo w s
does n o t alw ays
o u t-p atien ts
num bers
l o w e r - th e
w ith V in c e n t’s
D i s e a s e wh o h a v e h a d a l o w l e v e l
of v itam in
sepsis h a d b e e n a b o l is h e d by th e
10 $ c h r o m i c a c i d a n d i n t r a v e n o u s
N .A .B . t r e a t m e n t ,
in v i t a m i n
went back
C tw o o r
concerned i n
since t h e r e
DIET.
th is
three
class
The d i e t a r y
connection.
on b o a r d
P erusal
the a r t i c l e s
o f p a t i e n t wTi t h
to d e p le te
h isto ry
of th e
d ie ts
a know ledge
C is
diets
d estro y ed .
soon
h ig h
larg ely
and were s t i l l
a tru e
the
d iet
v itam in
of th e
cases
o rig in ally
G.
Mid e x p o s u r e
k i l l s 80 % o f
to
lig h t.
v itam in
C afte r
Some d i e t s
aboard is
in th ese
M cL ester
d isru p tio n
d eficien cy
of c e ll
T idy
(69)
states
(70)
G and
th a t
it
is
in
th is
ap p aren tly
says
60° c .
rap id ly
appear
necessary
stru ctu re
th a t
trea tm e n t.
shows t h a t many l a c k
d e s tr o y e d by c o n t a c t w ith h eav y m e ta ls ,
te m p eratu res,
d eficien t
of param ount im p o rtan ce
of co n d itio n s
see t h a t ' w h a t v i t a m i n
C is e a s i l y
is
C a n d who, when a l l
T h i s s h o w s t h a t we a r e
o f fo o d w hich c o n t a in v ita m in
p len tifu l b u t
is
ship
weeks l a t e r .
i ' s now n o s e p s i s
C
( 8 2 ) W e i s b e r g e r , Y oung a n d Morse
caused
A lso I h av e s e e n
!’n o ” .
o th e r hand
v itam in C o n ly .
lo c al
Thus o r a l
is
v itam in
o b serv atio n
C and
no d e f i c i e n c y
th e
C ould i t
th e
answer
and w here t h e r e
a g a i n we d o s e e
th ere
en ter.
vitam in C l e v e l .
th e
s u p e r i m p o s e d iferhich m i g h t l o w e r
T hei v
so
sub-scurvy
th a t causes
of v ita m in
C d eficien cy
cases
were
so l i g h t l y .
a person under
R o ff and G lazeb ro o k
(9 6) a n d o t h e r s ) .
the
d e s c r ib e d w here tr u e g i n g i v i t i s
of V i n c e n t ’s D is e a s e
le v e l.
In fectio n
to have
of ex cretio n
cases
of
I n my o p i n i o n
r e s u l t when V i n c e n t ’ s i n f e c t i o n
are many o t h e r
no d oubt
cannot be d ism isse d
ob v io u sly d i f f i c u l t
constant d a ily
is
specim ens
w ere.
presence
th o se
u rin e
th at
to
good
v itam in
exposure
to
a lk u lin ity
for
one h o u r
d e stro y e d by
alk alis
and d r y i n g .
I n most s h i p s t h e m id -d ay meal
im m ediately
a fte r breakfast
s ev e ra l hours b efo re
and i s
it
is
end i s
is
prepared
kept
at
a h igh tem p eratu re
serv ed . U sually th e food is
s e r v e d u p so h o t t h a t
it
o f t h e m onotony o f t h e
d iet
sea in a sm all ship
a s a r u l e . As a r e s u l t
ap p etites fla g
a n d t h e maximum a m o u n t o f b e n e f i t
from t h e
It
food.
i s u s u a l t o be a b le t o
t h e r e w i l l be p o r k f o r d i n n e r ; ' o r t o - d a y
tin n ed h e rrin g f o r b r e a k f a s t" .
food,
and l i t t l e
v ariatio n ,
In
ship to o ,
a sm all
i s not derived
say " t h i s
is
i s W ednesday,
try to
is
one u s u a l l y f i n d s
a s y s t e m kn o w n a s
say l / 8 d . p er
canteen.
l i m i t e d . N a t u r a l l y t h e members o f t h e m ess
save from th e
as 1 0 s .
th e re ’s
g e t s v e r y m onotonous.
day a n d o n e o f t h e M e s s C o m m i t t e e b u y s t h e f o o d a t t h e
choice
Sunday,
T his r e g u la r it y , w ith lim ite d
" c a n t e e n m e s s i n g " . E a c h man i n t h e m e s s s u b s c r i b e s
O ften h i s
overcooked
is un eatab le.
Any p e r s o n who h a s b e e n many w e e k s a t
w ill t e l l
end cooked
"m essing"
p e r head, p e r m onth.
a n d some m e s s e s e a c h s a v e a s much
O b v i o u s l y t h e more t h e y s a v e t h e l e s s
food t h e y g e t .
Then a g a in w ith t h i s
a re good a t t h e i r
take i t
in tu rn to
s y s t e m t h e r e may b e r e g u l a r c o o k s who
j o b s b u t v e r y o f t e n t h e members o f t h e m ess
do t h e
cooking f o r t h e i r
the s a y in g o f c a s e number 2 5 , " I f
make a d u f f ,
to g e t
apples or oranges
s how t o w h a t e x t e n t t h e y
c a p a b ilitie s to
S in c e November 1940 i t
get
a g o o d 'm e a l.
has been in c re a s in g ly d i f f i c u l t
a nd i n d e e d f r u i t
o f any k in d was r a r e l y
eaten by th e r a t i n g s u n l e s s th e y w ere s u p e r v is e d .
get an i s s u e
o f l i m e j u i c e , H am ilton (30)
c arrie d ou t experim ents w ith g uinea p ig s
A ll h i s
I quote
a f e l l o w was good enough t o
t h e r e was a d u f f , " t o
d ep en d ed on e a c h o t h e r ' s
shipm ates.
Some s h i p s
a s l o n g ago a s 1919
and N a v a l l i m e j u i c e .
c o n t r o l g u i n e a p i g s f e d on b r a n and h e a t e d m i l k o n l y ,
died o f s c u r v y i n
j u s t u n d e r SO d a y s ,
and h e a t e d m i l k p l u s 1 e . o ,
G u in e a p i g s f e d on b r a n
o f N aval lim e ju ic e
died o f scurvy
i n a n a v e r a g e o f j u s t o v e r 50 days,,. T h e same a p p l i e d t o g u i n e a
pigs f e d
on b r a n a n d h e a t e d m i l k p l u s 1 o , o ,
T ran sp o rt"
lim eju io e
one y e a r o l d .
o f " S u p p l y and
Guinea p i g s f e d
on b r a n ,
h e a te d m ilk
lim ejuice
at le a s t
70 d a y s a n d t w o l i v e d t o
on t h e
liv ed
84th day.
evidence t h a t
and f r e s h l y
H am ilton s a id "T here
th e Naval lim e ju ic e
is
is
p re p a re d , pure
and w e r e w e l l
I th in k , very
of l i t t l e
strong
o r no v a l u e
a s an
an ti-sco rb u tic".
G ittin g s
(31)
supplied o n b o ard ,
His r e m a r k s t o o ,
i n 1919
th a t
often th e
apply t o - d a y
q u an tity
sum mer d r i n k .
g r e e n v e g e t a b l e s o n b o a rd w ere s u p p l i e d by
su b je c t to
th e law s of
s u p p l y a nd d e m an d
de m an d w a s n o t ma de b y t h e m e s s c a t e r e r s ,
at
all.
I took s e v e r a l
it
sam ples o f N aval lim e ju ic e
ag ain st
5 c .c .
th e u r i n a r y e x c r e t i o n
not
onboard
of d ic h lo ro p h e n o l-in d o p h e n o l as in
n ece ssa ry to
Thus N aval l i m e j u i c e
acid, w h ic h i s
as su p p lie d
test.
The a v e r a g e n u m b e r o f c . c . s
was 2 3 .
the
a s h a s b e e n s h o w n a b o v e . He w a s n o t c o n s i d e r i n g
V incent’ s D ise a se
and t e s t e d
stated th a t,in
l i m e j u i c e was m e r e l y a p l e a s a n t
th e c a n t e e n a n d w e r e
and t h a t
also
su fficen t
co n tain s
in th e
disch arg e th e
red
colour
a b o u t 0 . 4 3 mg.4 o f a s c o r b i c
am ounts o f l i m e j u i c e
'
tak en .
P e rh a p s t h e most im p o rta n t f a c t o r i n lo w e rin g th e v ita m in C
content o f t h e
mid-day m e a l ,
d iets
th e manner o f c o o k in g .
t h e m ain meal o f t h e
after b r e a k f a s t
se r v e d u p .
is
and i s
kept hot fo r
Som etim es t h e fo o d i s
for th e n e x t d a y ’ s m e a l .
(3 1) ) a nd i s
still
day,
is
even cooked o v e r n ig h t
T h is custom p r e v a i l e d
It
sm all
is
i n 191 9
a nd r e h e a t e d
(G ittin g s
ev id en t to -d ay .
a lo n g tim e b e fo re u s e .
in many o f t h e
cooked im m e d ia te ly
about th r e e hours b e fo re being
T h e n a g a i n man y o f t h e v e g e t a b l e s
h e a te d f o r
In most s h i p s th e
ships th is
rare
too
are tinned
Even t i n n e d f r u i t
is
are
have l a r g e l y
dried
(Tidy ( 6 9 ) ) .
The n u t r i t i o n
vitamin C d e t e r i o r a t e s w i t h
of s c u r v y c r o p p e d ' u p
all
i s u s e d and
G reens,
such as
o f t e n tw o w e e k s o r s o o l d w h e n c o o k e d
up, t h u s f u r t h e r
T aking i t
all
a b s e n t on m o s t d a y s .
t o g e t f r e s h m i l k on s h i p b o a r d .
cabbage s a n d s p r o u t s ,
a nd a r e
im pairing
t h e i r v i t a m i n Cc o n t e n t .
in fo rm atio n b u lle tin
storage
and
(99)
s t r e s s e s how
and d r y i n g o f v e g e t a b l e s .
o v e r and on c o n s i d e r i n g t h a t 9 t r u e
in th e h o s p i t a l ) i t
cases
i s c e r t a i n t h a t many o f
the s m a l l s h i p s ’ c o m p a n i e s l a c k t h e n e c e s s a r y s u p e r v i s i o n o f t h e i r
d ie ts
and
tratio n .
in
consequence
Indeed
I have
gums w h i c h r e s p o n d e d
and i n
th ose
cases
cases,
In c o n t r a s t
to
no d e f i c i e n c y
th e ir
(78)
d ie t was
the m a jo rity
sw o llen ,
a m atter of
bleed in g
2 weeks
of V in cen t’s d isease.
c a s e s numbers 2 6 ,
C. T h e l a t t e r
C concen­
(98)
have
seen
3 4 and 45 showed
two h a d m e a ls
ashore
of
A ll had f r u i t
th e
as w i l l be
cases.
seen l a t e r
and
operated
d isease.
(below
35 s c h o o l b o y s f r o m
14 to
a d aily
severe
ship c a s e s .
Cases
26,
homes w h e r e t h e
in tak e
good,
to
34
of
lack
p ro p erly
stan d ard
40 t o
none o f th e
show t h e
at
to
an d 45 c o r r e s p o n d t o
th e
good
g u id ed
d iet
as i s
good.
is
of v itam in
F ive
showed
a ho me w h e r e
29 b o y s
p arallel
by t h e t e s t
lev el
50 m g . ) .
By c o n t r a s t ,
d i e t was e x c e p t i o n a l l y
sh ip s
a poor d is tr i c t
be below t h e
d eficien cy .
th is
are
of
O ther f a c t o r s
quote
When t h e y
in
a n d H. G o r d o n C a m p b e l l
th an
exam ined
sm all
o n ly ,
m a jo rity
I
in t h e
acid
th e
ex cep tio n ally
standard.
of v itam in
a n d men w i t h
f o r m e r on s h i p b o a r d .
diets.
a re la tiv e ly
o ffice rs
state
the
dose m e t h o d a n d f o u n d
C n u tritio n
a low
asco rb ic
(82),
d iets
in c a u s i n g t h e
H arris
to
of v itam in
a ll had f u l l e r
too, i n
seen
in
t h e r e w a s no q u e s t i o n
Roff and G la z e b r o o k
sim ilar
are
exam ined was below
my e x p e r i e n c e
th e
shown l a t e r ,
of
29 b o y s f r o m
The r e a s o n t h e
larg ely
th e
th ro u g h
sailo rs
ig n o ran ce.
th e y rem ain
h ealth y .
BLOOD P I C T U R E .
TABLE F .
HIGHEST COURT
1. R.B.C.
2.
5 ,2 5 0 ,0 0 0 p e r
c mm.
1 6,0 0 0 p e r
3. W.B.C.
LOWEST COURT
j
3 ,2 8 0 ,0 0 0
p e r c mm.
64
103
H B$
j
c mm
3,200 p e r
c mm.
40$
4. P o l y m o r p h s .
5. M o n o c y te s
6. Lym phocytes
11$
7. E o s i n o p h i l s
0$
8. B aso p h ils
0$
J
I w ill
sta te
b riefly
th a t
I f o u n d no c o n s t a n t f e a t u r e
in
70.
the blood counts of my cases which might be classed as a cause
or as an effect of the disease. Stine (73) had similar findings.
Table F shows the upper and lower limits of the various counts.
W hile
some o f t h e
g reat m ajo rity
no c o n s t a n t
c o u ld n o t be s a i d t o
callin g fo rth
A gain i t w i l l be
type
c a s e s had a s l i g h t
be a n a e m i c . A l s o , t h e r e was
of leu co cy tes
seen t h a t
the
d e g re e o f anaem ia th e
in t h i s
type
c a s e s were n o t t h o s e
o f g l a n d u l a r f e v e r d e s c r i b e d by F u l l e r
(92)
of in fe c tio n .
of the
anginost
o r S tu 'a rt-B a rb e r
(93) .
OTHER ST A T IS T IC S.
In each of th e
or n o t t h e y h a d c a r i e s
c a s e s a c a r e f u l n o t e was t a k e n
or ta r ta r ,
im portant b e a r i n g on t h e
a s i n my o p i n i o n t h i s
of w hether
h a s a .very
cause.
Table G s h o w s t h e
TABLE 0 .
i
re su lts.
i
TARTAR. | CARIES.
17
......... ~..
” 1!..STAIHIHG".......I
STAINING
.................
: TARTAR + CARIES ; ORLY.
! TOTAL.
10
■T
27
The c a s e m arked " s t a i n i n g
o n l y ” had a d a rk b r o w n ,b a s a l
[i s t a i n i n g a s s o c i a t e d w i t h u n b r u s h e d t e e t h .
be s e e n f r o m t h e
and d e n t u r e s .
case h i s t o r i e s ,
Thus t a r t a r
picture form a c o n s t a n t
It
infection.
12
Many o f t h o s e
smoke a nd d r i n k
crowded t e e t h ,
a s we s e e f r o m t h e
above
of th e
sm o k ers and t h e
sp irits.
DRINKER
12
clo sely
as w ill
sm oking p r e d i s p o s e s t o V i n c e n t ’ s
T able HP g iv e s th e f i g u r e s
TABLE H. ; SMOKER
cases
accom panim ent o f o u r s e r i e s .
h as boen s a id t h a t
drinkers o f b e e r o r
Many o f t h e
had f i l l i n g s ,
and c a r i e s
55
i
BOTH j NEITHER ; TOTAL j
26
!
5
j
55
c a s e s as w i l l be see n from t h e h i s t o r i e s ^
i n m o d e r a t i o n o n l y a n d i n my o p i n i o n t h e f i g u r e s
&re
aboute q u a l t o
the fig u re s
not
affected w ith V in cen t’s d isea se.
review ing t h e t a b l e
in th e
f o r saying t h a t
sam e
c la s s of
There i s
men who a r e
no g r o u n d a f t e r
smoking o r d r i n k i n g
p o s in g f a c t o r s w h e n , a s h a s b e e n s t a t e d ,
th is
is
are p re d is ­
only in m o d eratio n .
I X . PROBABLE MODE ON ONSET OF THE DISEASE.
H a v i n g o b s e r v e d t h e many o u t - p a t i e n t s who a r r i v e d w i t h
V in cen t’s d isease
and t h e
i n - p a t i e n t s w ith th e m alady,
c o n clu sio n s as to
how t h e
disease
started
in th is
I drew
class of
s e a f a r i n g men.
M cK instry
(24)
showed t h a t t h e V i n c e n t ’ s o r g a n i s m s w e re i n
the t h r o a t
sm ears o f 2 .4 3$ o f s o l d i e r s
of h e a l t h y
civ ilian s.
h o sp ital
gums o f 4 1 . 3 $
A gain M cK in stry (2 0 ) fo u n d t h e o rg a n is m s
in 95 o u t o f 230 h e a l t h y m e n , i . e .
S em ple, P r i c e
a nd i n t h e
Jones
4 1 .3 $ .
and D igby ( 2 8 ) fo u n d t h a t
i n random
c a s e s 9 5 .5 $ had f u s i f o r m b a c i l l i w h i l e 9 5 .3 $ had
s p ir o c h a e te s in t h e i r m ouths.
B reazeale
throat
and G re e n e
(74)
i n 1940 f o u n d t h e
a n d gum s m e a r s f r o m o r d i n a r y
I
o r g a n i s m s i n 35$ o f
in d iv id u als.
s w a b b e d t h e gums o f 1 0 0 r a n d o m p a t i e n t s ,
V incent’s d isea se
from t h e
sailo r
and n o t w i t h o r a l
numbers f o u n d i n
organism s
swab” b u t on c a r e f u l s e a r c h i n g
c o u l d be f o u n d
is
th a t th ese
in the
of s t r a i n s w i t h
o rg a n ism s c an n o t a l l be
(84)
of ex u ltatio n
C e rta in ly w ith o th e r organism s t h e r e
as a ru le
are o t h e r w i s e
stresses
in
the p o s s i b i l i t y
d i f f e r e n t v i r u l e n c e w h i l e R o s e b u r y a nd F o l e y ( 6 3 )
b e l l ere i n t h e p o s s i b i l i t y
no r e a s o n t o
one
oral d eb ris.
o t h e r w i s e t h e r e w o u l d be m o r e c a s e s o f t h e d i s e a s e
the com m unity a s a w h o l e . F i e l d
virulence
63$ h a d
These o f c o u rs e w ere n o t p r e s e n t in th e
a ’’p o s i t i v e
The n e x t p o i n t
v iru len t
t a k e n a t random
c l a s s w i t h w h i c h I d e a l and f o u n d t h a t
the o r g a n i s m s p r e s e n t .
o r tw o o f t h e
co n d itio n s,
not w ith
e.g .
o f v i r u l e n c e by p a s s a g e .
are varying
strep to co cci,
strain s
K .X .B . e t c . ;
of
so t h e r e
doubt t h a t organism s of th e f u s o - s p i r i l l a r y
is
class
p laced .
I n o n e t r a w l e r - m i n e s w e e p e r t h e r e w e r e 21 o u t - p a t i e n t s
w ith V in c e n t’ s d is e a s e w ith in th e
of th em w e re o f f i c e r s
in
s p a c e o f a few w e e k s . T h ree
a s e p a r a t e m e s s . The r a t i n g s
had one
cup b e t w e e n 40 m e n . The o t h e r c u p s h a d b e e n s t o l e n b y d o c k y a r d
w o rk e rs when t h e
s h i p was r e f i t t e d
o r had b een b ro k e n i n a c t i o n .
T h i s o n e c u p w a s p a s s e d r o u n d a nd o f t e n w a s n o t w a s h e d b e t w e e n
72.
in d iv id u al d rin k e rs.
,
Th e o i ' f i c e r s
s t e w a r d who c o n t r a c t e d t h e
had a l s o
d isease
in the
through t h e i r
r a t i n g s ’ m e s s a nd who
b e e n u s i n g t h e o f f l e e r s * u t e n s i l s . T h i s was an i d e a l
for ob serv atio n
were t o
became i n f e c t e d
get
and
the m e a su re s t a k e n t o
i n d i v i d u a l c u p s and t o
u t e n s i l s , w ere b o i l e d
before use.
stam p t h e d i s e a s e
ensure th a t th ese
case
out
and o t h e r
T h e n t h e men w e r e m u s t e r e d
t h r e e t i m e s a d a y a n d made t o g a r g l e w i t h p o t a s s i u m p e r m a n g a n a t e
and t o b r u s h t h e i r t e e t h ,
No f r e s h
cases
appeared.
under the
E x istin g
eye o f t h e F i r s t L i e u t e n a n t .
c a s e s w ere m eantim e v i g o r o u s l y
treated .
This was e v i d e n t l y
a case w here v i r u l e n t o rg an ism s a tta c k e d
su scep tib le persons
of t h e
co m p lain t.
and p r o v e s w i t h o u t
T h e r e may a l s o
a doubt th e
contagiousness
have been e x a l t a t i o n
of
v iru le n c e by p a s s a g e .
W ingrave
(15)
said th a t th e b e l i e f in
not s u p p o r t e d by c l i n i c a l
evidence
c o n t a g i o u s n e s s was
a lth o u g h L eig h (85)
stressed
c o n t a g i o u s n e s s b y f o m i t e s . Many s m a l l s h i p s n e v e r h a d a c a s e
the d i s e a s e
on b o a r d .
I n my c a s e s p a d d l e m i n e s w e e p e r (X) h a d t h r e e
m inesw eeper (Z)
cases,
traw ler
and so o n .
had t h r e e
cases,
(Z ) h a d two c a s e s ,
atten d in g
Thus a g a i n we s e e t h a t
d estro y er
(A) h a d t h r e e
And h e r e
h e a l t h y gums i n
le t
as o u t p a t i e n t s from each o f th o s e
some f a c t o r l i k e
me m e n t i o n t h a t
a h ealth y
ad u lt,
it
cases
sh ip s.
contagiousness of
it
s o i l s , must have b een
is
d ifficu lt
to
in fect
even w ith v i r u l e n t m a te ria l
from a c a s e o f V i n c e n t ’ s d i s e a s e .
One m i g h t a s k i f
paddle
sa m e t i m e t h e r e w e r e
s t r a i n s w h ich a c t e d on s u s c e p t i b l e
p resent.
cases,
p a d d l e m i n e s w e e p e r (Y) h a d t h r e e
T h ese w e re bed c a s e s and a t t h e
several cases
v iru len t
of
(Xing (8-3)).
w ere n o t p o s s i b l e
th at
a person
developed V i n c e n t ’ s d i s e a s e w h en ev er h i s v i t a m i n C l e v e l f e l l
e'7c- r r-t
below a c e r t a i n v a l u e .
I th in k the
answer i s
" n o ” b e c a u s e many
men w i t h l o w v i t a m i n C v a l u e s who h a v e t h e o r g a n i s m s i n t h e i r
mouths i n
sm all num bers,
do n o t d e v e l o p t h e m a l a d y . A l s o 3 o f
niy c a s e s h a v e n o d e f i c i e n c y o f v i t a m i n C. I n my e x p e r i e n c e
traum atizing f a c t o r ,
w ell.
I th in k
th at
such as c a r i e s
th e
ro le
or ta r ta r ,
a
i s n e c e s sa ry as
p la y e d by v i t a m i n C d e f i c i e n c y
i s to
make t h e
gums s w o l l e n
a nd t e n d e r a n d m o r e p r o n e t o
underm ine t h e p a t i e n t ’ s pow ers o f r e s i s t a n c e
T h e n a g a i n on a n o t h e r t r a w l e r ,
at t h e
same t i m e
as o u t- p a tie n ts .
Several o th e r s a i l o r s from t h i s
teeth or d e n tu re s
rep aired
a,nd t o h a v e o t h e r w i s e
infected under th e
and t o
g e n erally .
t h e r e w ere 5 c a s e s
atte n d in g
H e r e t h e r e w a s o n e c u p f o r 19 m e n .
ship
a tte n d e d to have f i l l i n g s
of
and w e re f o u n d t o he f r e e fr o m d i s e a s e
c le a n m ouths.
co n d itio n s
the
in ju ry ,
P resu m ab ly th e y had been
aboard b u t th e y had n o t t a k e n V i n c e n t ’ s
disease p r o p e r ,
i.e .
oth er fa c to rs
presence o f th e
o rg a n ism , w ere n o t t h e r e .
ate a n d b r u s h i n g u n d e r s u p e r v i s i o n ,
n ecessary b esid e s the
S i m i l a r use o f perm angan­
a s was done a b o v e , p r e v e n t e d
pew c a s e s .
H a v i n g g i v e n b y t h o s e tw o e x a m p l e s , o b v i o u s p r o o f t h a t
contagiousness i s
p resen t,
fa c to rs w hich o p e r a t e
in
l e t u s now c o n s i d e r w h a t a r e
a case,
since not
th e o th er
a l l ' on b o a r d t a k e
th e
disease.
A
survey of th e
namely s u b - s c u r v y
55 c a s e s h a s
and c a r i e s
shown tw o c o n s t a n t f a c t o r s , ,
or ta r ta r .
I f v ita m in C is la c k in g f o r 2 to
s cu r vy w i l l
clinical
develop
scurvy,
in
the
and
have s e e n t h o s e
to ilets
(4-7),
to
state
Short of a c tu a l,
can e x i s t .
and o t h e r s ) .
In t h i s
com pletely,,
(H ess
state
cases
an d w h e r e t h e . m o u t h s a r e
norm al in
co n d itio n w ill
ascorbic
about 2 .w eeks. T his statem e n t
(82)
I p erso n ally
c l e a n and t h e . d e n t a l
respond to
out b y t h e f i n d i n g s o f R o f f a n d G l a z e b r o o k
(32),
t h e gums
s w o l l e n a n d b l e e d ' e a s i l y on p r e s s u r e .
are thoro u g h ,' th e
and r e t u r n
(ivlcLester ( 7 0 ) ) .
su bscorbutic
T a l l d o r f and R u s s e l l
become t e n d e r
an a d u l t
4 m onths,
acid
is borne
a n d H. G o r d o n
Campbell ( 9 8 ) .
The p r e s e n c e
or o f a c a r i o u s
opinion.
of
to o th , a f f e c ts
F irstly
it
offers
often v i r u l e n t ,
abound
swollen, t e n d e r
gum a n d
organism s a r e
at
th e
te eth
of hard t a r t a r
the
one
causes
and s e c o n d ly
a breach of th e
d irectly
in to
can see
a hard
bases,
o v erlap p ed
th e
at
th e
to o th
bases
i n t w o w a y s i n my .
situ a tio n
a medium w h e r e t h e
and b r e e d ;
in tro d u ced
V in cen t’ s D isease
s mall)
a rin g
V in c e n t’ s o rganism s,
it
tra u m a tiz e s th e
s u r f a c e w here t h e ’
tissu es.
rin g
In m ost cases
of ta r ta r
by s w o lle n ,
(how ever
s p o n g y gum,
and
this tartar can be picked out from its pocket. In my mind I see
as a parallel the case of intestinal diverticulosis where a
diverticulum is harmless till it comes to contain a mass of
impacted faeces, pregnant with organisms.
This by pressure erodes
arld inflames the wall of the diverticulum, setting up a true
diverticulitis.
Alveolar abscesses form sites where the organisms of
Vincent's disease lodge,
as do overcrowded teeth or the crevices
connected with teeth fillings. The accompanying photographs were
taken from outpatients with the disease and show in what positions
the spirilla and fusiform organisms might lurk. Alveolar abscesses
with pus, capable of infecting tender gums, are shown, and fillings
with crevices which hide the organisms. The ordinary aerobic
organisms in an abscess will use up the available oxygen and
allow the anaerobic fuso-spirillary organisms to flourish till they
75.
get
a breach
of
gum s u r f a c e
and g a s - g a n g r e n e
in
th e
to
invade,
depths
of
(c.v.
su p p u ratin g ,
T h e c a s e s we s e e w h e r e n o c a r i e s
th e
trau m a a p p lie d
acc id en tal
in
stab b in g
or by a b ra sio n w ith
v iru len t
o th er fash io n s
of
o rg an ism s t o o ,
firm
in
of tetan u s
la cerated
w ounds).
ex ists,
have
exam ple by t h e
prong o f
to o th b ru sh ;an d
ad d itio n
onset
or ta rta r
as fo r
t h e gum w i t h t h e
a too
th e
a d in n er fo rk
th ese
to
being
th e
in
a state
can c a rry
la ceratin g
ag ents.
Then a g a i n many s a i l o r s
in w ar tim e
and t h i s
them p r o n e t o
helps
underm ine
a fu rth er
su b -sco rb u tic
gums and
my e x p e r i e n c e
of
"C lan F e r g u s o n "
I
for
at s e a .
in
bought c h e a p ly
caries
observed
eighth e n g in e e r,
We w e r e
in stan ce
sh ip b o ard .
crew had a l l
th e
at
the fo o d was
In
co n d itio n s
tro p ics
all
ex cep tio n
of the
s e a g o in g men,
alw ays
predom inant l o c a l f r u i t s
e.g.
papayas
to
the
p in eap p les
W ith th e
d ie t
The f r u i t
th e
a t M a u r i t i u s , mangoes
sailo rs
and r e f r i g e r a t e d
on t h e
Be t h a t
o r of sw ollen,
as
it
ro u tin e
may , t h e
tran sac tio n s
as
ex am in atio n
of th e
crew
P ills.
sy p h ilis
a t A ntw erp
s o r e . As t h e
arsen ic
He d e v e l o p e d
gums.
on b o a r d ,
a n d who a p p e a r e d
done
prevented
show ed no
(K a la M ia H . . . , . ,
a Lascar s a ilo r,
is
abundance of f r u i t
above, w as t h a t
th e re was no
th ere
b leed in g
The e x c e p t i o n a l
a p rim ary
sm all
l e t t u c e was e a t e n
e v i d e n c e o f V i n c e n t ’ s gum d i s e a s e .
bay w i t h
fru it
one e x c e p t i o n t o b e m e n tio n e d ,
made s o m e t h i n g on t h e
and th e
who c o n t r a c t e d
at
2s . 6d . p e r h ead , p e r d a y f o r f o o d and th e
The C o m p a n y a l l o w e d
of
each p o rt
ex cep tio n of t h i s
th at
of V in c e n t’s D isease,
in m ost l i n e s .
on b o a r d .
and a t
and w i t h
Stew ard p o s s i b l y
on T . S . S .
tim e
etc.
of
d escrib e
m ost o f th e
sim ilar
were no c a s e s
gum d i s e a s e
and m akes
I w ill
a f i v e m onths voyage
one y e a r and w ere
D akar,
on b o a rd
operate
b een on b o a r d , w ith th e
th e
cra ft have to - d a y .
by a l l
th e ir v ita lity
o f how t h o s e t w o f a c t o r s
or ta rta r
B eira in P o rtu g e s e E a st A f r ic a ,
and o r a n g e s
of nervous te n sio n
in fectio n .
To g i v e
The w h i t e
to
are
case m entioned
24 y e a r s )
at
n e x t p o r t w a s 28 d a y s
the
sick
away a n d a s
t r e a t m e n t was p u sh ed w i t h m e rc u ry
a m ercu rial g in g iv itis
and l a t e r
the
ty p ical
76.
w h ite m embrane o f V i n c e n t ’ s D i s e a s e
at
a h o sp ital
in
D urban.
appeared.
T his L ascar
T h i s was c o n f ir m e d
ate f r u i t
d aily
a n d h a d no
s u b - s c u r v y . H is p r e d i s p o s i n g l e s i o n was th e m e r c u r i a l g i n g i v i t i s
and t h e
o rg an ism s w ere p ro b a b ly lu r k i n g
was a b s e n t
and t a r t a r was s l i g h t
m ercury p o is o n in g
can p re d isp o se
At D urban a l s o
to s e e
am ount.
in
from t h e r e .
to t h e
one o f
to
in fec tio n
article s
till
and t h e
was a m e r e p i t t a n c e
worked t o
death
and t h a t
and fe d
pronounced s c u r v y , w i t h
sw ollen,
b leed in g
m ention t h i s
develop
in
to
scurvy
cases
ten d er,
it
d id
develop
co n d itio n s
and t h e
on a d e s t r o y e r
th e sis
ever present
U -boats,
aircraft
w eather.
T his
is
bound to
of
"crabs” o r
scab ies
co n su ltin g
conduct on s h o r e
the o p p o s i t e
as
or
d ie ts
and he
o u t.
I
does n o t
alw ays
(25).
at firs t
class
coupled w ith lo n g p a t r o l s
on t h e
t h e M.O.
of
and
o f men
from t h e menace o f m in e s,
to
h ealth
and t h e
and t h e i r
by e a tin g
and i t s
oranges,
rough
stressed
su sp icio n
ailm en t.
and t h e y w e re t o l d
scurvy
p o in ts
b o w els and t e e t h ,
on t h e f i r s t
alcohol
in
o f t h e men.
a g a i n s t V . D . . The d i e t w as gone
supplem ented t h e i r
lo o k
and o b s e rv e d t h e
atten tio n
regards
was
i n my s e r i e s , , j u s t
cases
any o th e r, s u s p ic io u s
m esses w ere to l d
and c l e a n
saw f o r n i n e m o n th s
and s t r a i n
te ll
s e x was g u id e d
of p r o p h y l a x i s
c a s e 38
re p e a te d ly g iven
clean lin ess,
q u arters,
T h ere was o v e rc ro w d in g o f n e c e s s i t y
and E - b o a ts
im portance
and a l l
d eals.
ten sio n
H ealth l e c t u r e s w ere
were b o d i l y
I
h i s wage
He h a d v e r y
I w as on t h e
in
any
sw o llen m u sc le s,
in p e lla g ra
I n th e w i n t e r o f 1939-40
w ith w h ic h t h i s
in m iserab le
t h a t V in c e n t's D isease
as
B ritain
him s i g n
on s c r a p s .
f o r w hich
show a g a i n
does n o t.a lw a y s
ha nd t h e
g e t h om e t o
gums. H is t e e t h w e re h e a l t h y
had n o V i n c e n t ’ s d i s e a s e
o rg an ism s.)
He w a s t o
He t h e n f o u n d t h a t
he l i v e d
purpura,
th a t
U n f o r tu n a te ly he was " g r e e n ”
o u t.
lite ra lly
states
a Seamen’ s M issio n
sh ip s.
G erm ans w o uld n o t l e t
he w as 24 h o u r s
caries
a p a s s a g e from W estern
Germany and h o p e d t o
th e w ar.
(45)
by V in c e n t's
in
th e H am burg-A m erika L in e
I t was b e f o r e
sea lif e
(Gay
I was c a l l e d by a p a d re
work h i s way b a c k t o
as i t
in
a n E n g l i s h m a n who h a d b e e n g i v e n
A u stralia
i n h i s m outh th o u g h
and t h e
of
Then t h e i r
r e la tio n s h ip w ith
o f th e
in to
dangers,
to m ato es
im portance
th o roughly
and
all
and o t h e r
fru it,
raw fro m t h e
a good
supply o f f r u i t .
W henever s c a b i e s
freq u en tly ,
th e
whose m a n a g e r was i n s t r u c t e d
or p e d ic u lo s is p u b is
th u s
im portance
of f r u it
in th e
ashore
teeth .
he had he was re p rim a n d e d
can c o n d i t i o n s
V in c e n t's
treatm en t.
be k e p t
boat"
guided
in
such m a tte r s
health
and becom e m ore
sailo rs
In
should
th ey
o n ly
conclu d in g
sm all
q u ick ly g e t
and
op eratin g
as above
hom es,
too w ill in g
th o se
are
to
are
to
general
sw o llen ,
due to
rush
in
th e
ashore
of
on t h e
an o rg y o f
be r e s t i n g .
v ast m ajo rity of
sh ip s,
or t a r t a r
Furtherm ore
w ill
in d u lg e
su sc ep tib le
up fro m d e c e n t
i n my o p i n i o n , t h e
on t h e
T h e r e w e r e no c a s e s
w in e,
I f th ey are
in to
not
a low s t a t e
any i l l n e s s
To-day th e v a s t m a jo r ity
and a r e
le ctu res,
gums on b o a r d .
and u s u a l l y
song when t h e y
are c a l l e d
tartar-cp v ered
and th e m a t t e r d e a l t w i t h .
a lo n g p a t r o l ,
women a n d
the r o u n d s .
s ic k bay
th o se w ith c a rie s
No m a n h a d f o u l ,
satisfac to ry .
of th e
in from
"lib e rty
and
b y c h a s i n g up t h e men and b y r e p e a t e d
d isease
S ailo rs
first
and t h a t was
d ie t.
d en tal parades
were s e n t
O nly t h u s ,
for
to keep
t o g e t h e r an o p p o r t u n i t y was t a k e n to
Then t h e r e w e r e p e r i o d i c
If
appeared,
e v e r y member o f t h e m ess w as e x am in ed i n t h e
a nd w h e n t h e y w e r e
stress
canteen,
th a t
o f y o u n g men i n
of
is
going
th e Forces
not hardened d ev il-m ay -care
tak e
ad vice
in
rem arks I w i l l
th e
th o se m a tte r s .
again
say th a t,
cases of V in c e n t's
facto rs
of tra u m a tisin g
t e n d e r gums f r o m l a c k
of v itam in
d escrib ed .
co n ta g io u sn e ss has been dem o n strated .
C,
D isease
caries
X.
TREATMENT.
I w ill
conclude w ith
a few p e r s o n a l
o b serv atio n s
on th e
-treatment.
It
to t h e
gums.
is
not
I have
su fficien t
4,
It is
th a t
tru e
adm ission to
d aily
some c a s e s
but
to
cases
daily
in n in e
as o u t- p a tie n ts
to ilet
reg u larly
o u t-p atien t,
bo
liab le
tack t o
to
h is
fact
use
it
is
reg u larly ;
A lso
it. is
p ro p erly tr e a te d .
req u ire
cure w h ile th e
cases receiv e
a b o ttle
to
den tal
th e
not
goes
re-in fected
d isch arg e
Cases re c u r u n le ss
is
th e ir
o u t-p atien t
and may g e t
average
T his
o f m outh w ash i s
and a g a i n t h e
no u s e
more
c a s e s w hich a tte n d e d
a day u n d er s u p e r v is io n ,w h ile
given
th e ir
duty q u ic k ly .
h o sp ita l
s h ip betw een tr e a tm e n ts
etc..
out of ten
(51.).
of
to w arrant
c a s e s was 11.07 p e r c a s e .
th a t
fo u r tim es
th o u g h he
from f o m i t e s
it i s
th e
severe
about 3 weeks to
numb er o f d a y s f o r h o s p i t a l
probably due to
cases
ap p licatio n
was soon e v id e n t t h a t
to o k
acid ,
o r B e a u m o n t's p a i n t .
su fficie n tly
g e t them b ack t o
Then a g a in i t
o f 10$ chrom ic
c l e a r up w i t h l o c a l
h o sp ita l w ill
vigorous tr e a tm e n t
D etto l,
rem edies
show ed no im p ro v e m e n t
ap p licatio n s
5$ c r y s t a l v i o l e t ,
m edicam ents a l o n e ,
apply lo c a l
s e e n many c a s e s w h ic h
and e v e n g o t w o r s e w i t h
Eusol 1 i n
to m erely
d aily
a case b e fo re
ad eq u ately tr e a te d
(H arper ( 1 6 ) ) .
I
h a v e m e n tio n e d m ore v i g o r o u s
mean a t h o r o u g h
From p e r s o n a l
experience
fewest p o s s i b l e
Smith ( 4 4 )
d e n ta l t o i l e t w ith th e
days
m entioned
all a c u te
sym ptom s w e re
cleaning p r o c e s s
the g r e a t e s t
method o f
used
adm itted t o
I w ill
all
my c a s e s
co n trib u to ry
clean in g
th e
h o sp ita l,
co-existed how ever,
L eigh
away.
in
fa c to r to
th e
acute sy m p to m s s u b s i d e d
te eth
ill
is
are
th e
(85)
ad v isab ility
did n a t
if
th e
achieved.
of
scale
as
th e
as
I b eliev e
th a t
ti ll
soon as th e
effects.
scalin g
it
c u re . F urth erm o re
If
an a l v e o l a r
of th e
rest
is
th is
p a t i e n t was
a t f a u l t w ere n o t p u ll e d
although
etc..
essen tial
to be
I
now m e n t i o n i n d e t a i l t h e
t e e t h was done
w ith no
it
case
am o n g o t h e r t h i n g s
thorough d e n t a l t r e a t m e n t w h i l e
By t h i s
rem oval o f d e b r is
I firm ly b eliev e
in h o s p ita l per
treatm en t.
abscess
till
of th e
the
te eth
was done
.
soon found
ro u tin e
If
th a t
a d iseased
th e
t o o t h was p u ll e d
c a v i t y was a p t t o
The f i r s t
p h o to g r a p h shows t h e
clean sin g
m ethod
straig h t
away i t
become i n f e c t e d .
in stru m en ts used
in th e
adopted.
(a)
A d en tal m irro r.
(b)
S calin g
(c)
R otary b ru sh e s,
tool.
(cup
and f l a t
shaped)
( d ) Spray a p p a r a tu s .
(e)
Swab a n d 1 0 $ c h r o m i c
P hotograph No.
1 shows
a ty p ic a l
acid.
case
was
of V in c e n t's
d isease.
80.
T he s w o l l e n g u m s a n d p r o m i n e n t
in te rd e n ta l p ap illae
are
ev id en t.
The w h i t e ,
f i l m y membrane on t h e gums c a n be made o u t g l i s t e n i n g
at p la c e s.
M oreover th e
sin ce
a p p e a r m ore w h i t e
th ey
clean sin g .
•base i s
At t h e
seen.
care fu lly
n o tin g
c o llar
gum.
very
th e
extent
is
to
of th e
to scale
I n many c a s e s
it
is
th e
T h is must
sta rt
th e
base
all
is
m irror to
see
cure
is
ro tary
stone and g l y c e r i n e .
brush
cru sted
it
is
is
used
m ass,
not
a to o th
th e
in d iv id u al
form ing
for
dip p ed
te e th
in
at
each p iece
and k e e p s up th e
process,
a
by s w o lle n
erad icated
behind th e
used,
w h ich th e
from th e
and o v e r l a p p e d
scalin g
is
area at
afte r
t h e m outh and t e e t h ,
ta rtar
len g th en ed ,
T his p o lis h e s
of ta r ta r
a cup-shaped
If
of ta rta r
brush
a s t h e y m ig h t be
p h o to g rap h s
in sp ect
organism s
2 shows t h e
h id d en f o c i
fin er p a r t i c l e s
clean
ensuing
th e
to o th
be rem o v e d .
team in g w ith
Next th e
as
d isease.
a hard,
of th e
tim e o f
P h o to g ra p h No.
or
th in g
is
round
not
in the
step
foul t a r t a r
flat
are
u p p e r r i g h t gum a n u l c e r a t e d
The f i r s t
The n e x t
teeth .
te eth
th e
of
in fectio n .
u sin g th e
d en tal
teeth .
pow dered pum ice
and rem oves th e
s c a le r m isses.
d e p e n d in g on th e
E ith er
reg io n
a
to
81.
w hich a c c e s s
is
no h a r m e n s u e s .
d esired .
b leed
at th is
stag e
but
( P h o t o g r a p h No. 3 ) .
U sing th e
retro -m o lar
su lci
as d e p i c t e d
in
If th ere
s till
is
T h e gu ms o f t e n
spray th e
te eth ,
a r e no w w e l l
p h o to g ra p h No.
b leed in g
th e
m outh,
la b io -g in g iv al
sprayed w ith 1 in
4 Eusol
and
so lu tio n
4.
p atien t
can r in s e
w ith a warm e f f e r v e s c i n g m o u th w ash w h i l e
s till
h i s m outh
on t h e
ch air.
The f i n a l
No 5 .
stag e
o f th e
in itia l
process
is
dep icted
on p h o to g r a p h
below .
T h e gums g e t
sw abbing w i t h
10 $ c h r o m i c a c i d .
dipped i n
at t h i s
a d aily
use
th e t e e t h .
of
chrom ic
(L eigh
if
it
(85)
Th is i s
so
of d a y s
i n my s e r i e s
is
has been le v e lle d
grounds t h a t
o v er 2 weeks b u t
was 1 1 .0 7
of
tro u b le
it
d eca lcifies
and i n t h i s
th e
p erio d
av era g e number
th ere
d e n t a l damage fro m t h e u s e o f
starts,
p ra c titio n e r g iv es
th e
m entioned t h o r o u g h
d en tal
for 2 o r 3 w e e k s
on t h e
criticism
and o t h e r s . )
used f o r
c e r t a i n l y no e v i d e n c e
acid. W here t h e
acid ,
A dverse
a p le d g e t o f c o tto n wool
i n my o p i n i o n ,
chrom ic
i s when t h e
chrom ic a c id w ith o u t p erfo rm in g
o r m ore
to ilet.
Then th e
and th e c h ro m ic
co n d itio n
acid
is
starts
th e
drags
to
act
above
on
on
th e t e e t h .
In
of E u s o l
ad d itio n
to
chrom ic
acid
d aily
th ere
a r e m outh w ash es
(1 i n 4) f o u r tim e s a d ay .
If
topped d r y
th ere
and
is
a decayed to o th ,
"stopped” w ith
it
is
a tem p o rary ,
sprayed w ith E u so l,
carb o lised
d ressin g .
T his
is
sh u ts
off
carried
th at
source
of in f e c tio n w h ile
th e
treatm en t
o u t.
Then again it is adviseable to order the patient to destroy
his old tooth brush, if he has one, when he returns to his ship.
I f he uses the old brush he is liable to re-infect himself as
I have repeatedly seen with out-patients.
I
n o ticed
wash 4 t i m e s
th a t
a day,
if
h y d r o g e n - p e r o x id e was u s e d
even when d i / l u t e d , i t
tended
as
in
a m outh
5 or
6 days
t o make t h e gums raw and r e d .
Eusol
its
It
was b e t t e r
(l
in
4).
o x id isin g
to
use
perm anganate
The p e r m a n g a n a te p r o b a b l y a c t s
p ro p erties.
I favoured Eusol because
of i t s
po tassiu m
chlo rin e
content
it
d isso lv es
ju st
f i l m y , w h i t e membrane seem s t o m e l t
spray
d irec ted
is not
is
h o sp ital
and
I
in
to
cure
early
sim ple
th o se
soon observed
in u n d e r 14 d a y s ,
a n empyema c a v i t y .
or
of
H ow ever,
in v irtu e
so lu tio n s
Indeed
the
away when t h e
Eusol
it.
no d o u b t t h a t
su fficie n t
anaerobes.
as c h lo rin e -c o n ta in in g
ty p ical,
against
in v irtu e
o f f t h e membrane
to
T here
fib rin
are
are u se d
is
d isso lv e
The o r g a n is m s
so lu tio n
ap p licatio n
c a s e s t h a t w ere
th a t
if
th e
of lo c al
ad m itted
cu re had to be
and m e tic u lo u s d e n t a l
to ilet,
agents
to
effected
as
above
d e s c r i b e d , was n e c e s s a r y .
On discovering that sub-scurvy was the predisposing
lesion I naturally thought that ascorbic acid should be tried.
A sco rb ic
3 tim es
acid,
e v e n when p u sh e d t o t h e
a day, w ill not
treatm en t.
Once t h e
or so u rc e
of
Cases 1 0 ,
18,
acid b e f o r e
had a s c o r b i c
cure
surface
alpne,
of th e
in th e
gum i s
ex ten t
of
7 0 0 mg .
absence of lo c a l
invaded th e t a r t a r
i n f e c t i o n m ust be rem oved.
24,
33,
adm ission
acid
for
41 and 47 w e r e a l l
tre a te d w ith
and w ere n o t d e f i c i e n t
in
it*
asco rb ic
Case N o .10
e l e v e n w e e k s w i t h no b e n e f i c i a l
resu lts.
The results with many out-patients were the same.
It
is
tem p tin g to
th in k
satu rated w ith v itam in
C it
case n o t
when l o c a l
so
satu rated ,
w ill
th a t
if
a case
is
first
c l e a r up q u ic k e r th a n
treatm en t
is
once
another
started .
84.
I did
not fin d
any a c c e l e r a t i o n
s a tu ra te d w ith v itam in
to
lo se
th e ir fie ry
have done w i t h o u t
in
C, H o w e v e r I n o t i c e d
red
look
prev io u s
u lc e r a tio n to o k th e
o f cure
a case p re v io u sly
th a t
th e
gums b e g a n
a day o r tw o s o o n e r t h a n t h e y w o u ld
v itam in
same tim e t o
C satu ratio n .
heal
as
The a c t u a l
a c a s e w h i c h h a d no
^
ex tra v itam in .
I have
p atien ts,
as N.A.B.
also
ch iefly
t h a t B eaum ontf s a r s e n i c
g iv en
in trav en o u sly
Indeed a t o n s i l l a r
clear by th e
case,
sev en th
in trav en o u sly ,
and
th ere
the
in fec tio n .
so lu tio n
is
not
( S e e my p r e v i o u s
day w ith 0 .4 5
else.
num bers o f o u t ­
so
efficacio u s
reaso n in g :
693 seem ed t o
At any r a t e
693 a l o n e
th e
Page
48).
w i l l u s u a l l y be
o f a gram o f N .A .B .
g iv en
O ccasio n a lly h aem o ly tic
su p e rim p o se d on a t o n s i l l a r V i n c e n t ! s
M. & B .
b u t M.& B .
in la rg e
w i t h n o gum l e s i o n s ,
and n o th i n g
s tr e p to c o c c i w ere
w ent,
n o ticed ,
get
rid
of th e
coccal p art
u v u l a r and f a u c i a l
h a d no e f f e c t
in fec tio n
of
redness u su ally
on th e V i n c e n t 's
D isease
proper.
A glan ce
at ta b le
the c a s e s w e r e t r e a t e d
w hich a l l
in
I w ill
ad d itio n
show t h e v a r i o u s w a y s i n w h i c h
to
th e th o ro u g h d e n ta l t o i l e t
had.
TABLE I
GENERAL LINES OF TREATMENT
TOTAL DAYS
ILL.
i. o f C a s e s
trea ted .
AVERAGE
DAYS TO
CURE.
12.
N.A.B. + s a tu rn , v i t . C
+ lo c a l treatm e n t.
127
1 0 .6
21.
N.A.B.+ lo c a l
222
1 0 .6
57
1 1 .4
90
11 .3
67
1 1 .2
treatm en t
5.
Local treatm en t
only
8.
N .A .B . + s a t u m .
acid .
n ico tin ic
6.
L ocal treatm en t*
v i t a m i n C.
2.
Local treatm en t + sa tu rn .
n ic o tin ic acid .
34
17
1.
S atu rn , vitam in
n ic o tin ic acid.
12
12
55
satu rn .
C + satu rn .
609
'
11.07
The 55 c a s e s r e p r e s e n te d 609 days o ff d u ty in a l l , and
averaged 1 1 .0 7 d a y s p er c a s e , o f f d u ty . I f we c o n s id e r t h a t th e
I did
not fin d
any a c c e l e r a t i o n
satu rated w iih v itam in
to l o s e
th e ir
fie ry
have don e w i t h o u t
in
a case p rev io u sly
C, H ow ever I n o t i c e d
red
lo o k
p rev io u s
u lc e ra tio n took th e
of cure
th a t the
gums b e g a n
a d ay o r two s o o n e r t h a n t h e y w o u ld
vitam in
same tim e t o
C satu ratio n .
heal
as
The a c t u a l
a c a s e w h i c h h a d no
extra v itam in .
.
I have
p atien ts,
as N . A . B .
also
g iv en
in trav en o u sly
Indeed a t o n s i l l a r
case,
sev en th
in trav en o u sly ,
ch iefly
so lu tio n
is
not
( S e e my p r e v i o u s
day w ith 0 .4 5
else.
num bers o f o u t ­
so e f f i c a c i o u s
reaso n in g :
t h e r e M. & B .
the
in fec tio n .
o f a gram o f N.A.B.
693 a l o n e
48).
g iv en
O ccasio n a lly h aem olytic
693 seem ed t o g e t
At any r a t e
Page
w i l l u s u a l l y be
s u p e rim p o se d on a t o n s i l l a r V i n c e n t ’ s
and
b u t M.& B .
in la rg e
w i t h n o gum l e s i o n s ,
and n o th i n g
s tre p to c o c c i w ere
went,
n o ticed ,
t h a t B eaum ont’ s a r s e n i c
clear by th e
^
rid
of th e
coccal p art
t h e u v u l a r and f a u c i a l
h a d no e f f e c t
in fec tio n
of
redness u su ally
on th e V i n c e n t f s D is e a s e
proper.
A glan ce
at ta b le
the c a s e s w e r e t r e a t e d
which a l l
in
I w ill
ad d itio n
show t h e v a r i o u s w a y s i n w h i c h
to
th e
thorough d e n ta l t o i l e t
had.
TABLE I
GENERAL LIN ES OF TREATMENT
TOTAL DAYS
ILL.
i. o f C a s e s
trea ted .
AVERAGE
DAYS TO
CURE.
12.
N.A.B. + s a tu rn . v i t . C
+ lo c a l treatm en t.
127
1 0 .6
21.
N.A.B.+ lo c a l trea tm e n t
222
1 0 .6
5.
L o cal tr e a tm e n t only
57
1 1 .4
8.
N.A.B.+
acid.
90
11.3
6.
L ocal treatm en t*
v i t a m i n C,
67
1 1 .2
2.
Local treatm en t + sa tu rn .
n ic o tin ic acid .
34
17
1.
S atu rn , vitam in
n ic o tin ic acid .
12
12
55
satu rn .
n ico tin ic
satu rn .
C + satu rn .
609
'
11.07
The 55 c a s e s r e p r e s e n te d 609 days o ff d u ty in a l l , and
averaged 1 1 .0 7 d a y s p er c a s e , o f f d u ty . I f we c o n s id e r t h a t th e
average
M.O.
o u t-p atien t
and
is
atten d in g
out o f 10 he
his
sh ip to
pays t o
run.
spends
th e
tak e
th e
forenoon o r
and back
into
sm all
again,
of th e
is
as a b a s i s
really
th e
’’ a v e r a g e
n o th in g
is
key to
eleventh day,
in te n
th e
fact had been
a fte r
is
seen t h a t
it
in th e
long
c l a s s h a v e n o M .O .
the r e s u l t s
acid .
m easure t o
sailo r
it
There
20 d a y s , P i c k l e s
M cK instry ( 1 9 )
-
o f 17 d a y s t o
h o sp ital
is
treatm en t t i l l
If th is
fig u re
acid ,
b u t my c a s e s
I
d id not g et
d id not
in g iv in g
it
d e a l and
as
as
its
expense
ad d itio n .
fig u re
o f 11.07
e a r l i e r w orkers
(29)
- 3 weeks to
etc.)
days p er
(D avid
(90)
-
T a y lo r and
above m e n tio n e d
sound.
c h a p te r by s t r e s s i n g
th at
or th e
a v aried
C lev el
off
and H e c q u e t
2 m onths,
we s e e t h a t t h e
case
the d i s e a s e : -
the v i t a m i n
a class
a ro u tin e
seem t o be n e c e s s a r y t o
cooked,
o f 17
o th er fig u re s
shipboard t h e f o l l o w i n g f a c t o r s
or l i g h t l y
th e
actu ally
t o i l e t e t c was b eg u n .
no p o i n t
L e t me c o n c l u d e t h i s
1.
cure,
and one w h ic h was
same c a t e g o r y a s t h e
is
in
17 d a y s ,
treatm en t
in
c l a s s w ith w hich I
fig u res of
and t h i s
I.
I f we c o m p a r e t h e
duty, w i t h t h e
den tal to ile t
w ould h a v e lo w e re d t h e
in the
p ractice
A ll m ethods have
a c i d o n l y . Thed i s e a s e
by K ing ( 8 3 ) ,
lack n i c o t i n i c
th is
another.
s a tu ra tin g w ith n ic o tin ic
claim ed
th e
in t h e v a r i o u s m ethods
an a v e ra g e
dental
colum n o f t a b l e
As r e g a r d s
routine
from
c u r e ” c o l u m n we s e e
The f o r m e r h a d no l o c a l
co n sid ered
days w hich
in t h e e n d
12 t o
in 9 cases
b est treatm en t.
but n ico tin ic
days
days to
th o ro u g h
c a s e s w hich to o k
in h o s p ita l.
p ro h ib its
w ill be
traw le r
com pared w i t h
co m p rise d a c a s e w h ic h w as 21 d a y s
to 1 1 . 5
a busy
afternoon g e ttin g
it
o u tstan d in g
above d e s c r ib e d ,
be th e
The tw o
cleared
see
and t h a t
h o sp ita l fo r treatm en t,
sh ip s
at th e
0f t r e a t m e n t w h e n o n e
13 d a y s
21 d a y s ,
to
on b o a r d .
th e re
seems t o
fo r about
an e n t i r e
cases
I f we g l a n c e
that
a b o u t 3o m i n u t e s w a i t i n g
d aily
d en tist
th o se
M ost o f
or d e n t i s t
spends
d ie t,
fre sh v eg etab les,
of th e
body w ith
ro u tin e
to
its
prevent
on
prevent
d ie t p lu s f r u i t s
a low ering
atten d an t
sw ellin g
of
of
th e
86.
gums. (c.v. My experiences on T.S.S. ’’Clan Ferguson” and on a
destroyer).
2 . Periodical dental parades and repeated health
lectures. 3. Proper washing and sufficiency of eating utensils.'^
4 . Segregation and treatment of cases if they arise, with
gargling and teeth brushing under supervision, of those
remaining on board in the presence of an epidemic.
There is great scope for preventive medicine on ship­
board, especially where the menace of Vincent’s Disease is
7
'
constantly present.
XI.
SUMMARY OF THESIS.
1 . The introduction states my intention to try to make some
contribution, however slight, to our knowledge of Vincent’s
Disease as it affects our sailors on the small ships. Those
sailors by virtue of their mode of living are in a class by .
themselves. It is stressed how opinions regarding the causation
of the disease differ widely.
2 . Acknowledgements are made to persons who have kindly
assisted me in various ways.
3. A full historical outline is given showing how views on
the subject and methods of treatment have altered. It is shown
how deficiency of different vitamins is the predisposing factor
in different communities.
4 . The general lines of the investigation are explained and
relevant statistics from the hospital are given. It is pointed
out that there is a rise in Vincentfs Disease with each
succeeding quarter and that it is common in small ships operating
in the North Sea. The first oases appeared when the war had been
in progress for four months, and two to four months is the time
taken for the bodily store of vitamin C to be used up.
Also the
first case of scurvy appeared in the same quarter of the year as
the first case of Vincent’s Disease.
The best method of staining the organisms for photography,
with simple stains, is described in this section.
5 . A histological study of the gums was made and it supported
the view that it was a condition of subscurvy that was originally
present in the sailor class. Photographs are shown.
6 . A full desciption of the urine test for the estimation of
vitamin C is given, with a short history of vitamin C and of the
test.
Some original tests were carried out with urine in dark and
other bottles to show the rate of deterioration of vitamin C.
A controlled test was done, to show how a random sample of
urine might appear low in vitamin C but how a test dose will raise
the value of vitamin C in the 6 hours specimen if the body is not
really deficient.
7 . The method used to determine the level of Bg in the body is
fully described and a short history of vitamin B is given.
8 . Findings from 55 cases of Vincent’s Disease are discussed.
There was no clinical evidence of vitamin B deficiency.
It was considered that the study of the diets showed no evidence
*
of lack of nicotinic acid.
The urine chemical tests showed no deficiency of nicotinic acid
in 82.6jof the cases done.
It was described how there was no clinical or dietary evidence of
shortage of vitamins A ar D.
It is shown how a deficiency of vitamin C is present in many small
ships’companies. Reasons for concluding this are given and a dis­
cussion is made on the subject on the lines that, (a) 9 true
cases of scurvy, from those small ships,were admitted to the
hospital between January and December 1940, (b) the dietary
study and the manner of the cooking on board shows a low level
of vitamin C or a destruction of vitamin C in the food, (e)
cases of gingivitis, with swollen bleeding gums, were seen, with no
88.
Vincent's infection, and which responded to ascorbic acid alone,
(d) urinary excretion tests showed the almost universal presence
of vitamin C deficiency in the diets (reasons are given why the
low level of vitamin C is not due merely to the infection) and
(e) the Naval lime juice and its ascorbic acid content is
commented on.
Blood counts of the cases were done to try to discover the
cause or the effects of the disease there.
The incidence of caries or tartar in the teeth of the patients,
and of smoking and drinking was considered.
9. The probable mode of onset of the disease is discussed as
it affects the small ships’ companies^and the mechanism by which
the gums are infected.
My observations on random cases, not of "Vincent’s Disease, show
that 63fo of sailors have the fuso-spirillary organism in their
mouths.
Examples showing that contagiousness exists are given and a
successful method of stamping out an epidemic on a small ship
is described.
The role that vitamin C deficiency plays in starting the infection
is given.
My experience with the disease on shipboard, when methods are
taken from the outset to prevent it, is described.
10. Some observations on treatment are appended.
Early,
routine scaling, brushing and spraying of the teeth is in my
opinion a necessity if the fewest possible days in hospital are
to be obtained. The use of large doses of vitamins does not
quicken the cure though with previous saturation with vitemin C,
the gums lose their fiery red appearance sooner than they would
do otherwise.
P h o to g ra p h s o f t h e s t a g e s o f t r e a t m e n t a r e a p p en d ed .
11. A bibliography is added.
12. A brief description of each case is given.
I have discussed the problem of Vincent’s Disease as I
found it in the small ships, and I hope I have contributed,
however slightly, to our knowledge of the condition there.
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Wolmar Nordennlark.
Skandinav. Arch. Physiol. 70:186.1934.
(Quoted Field).
96.
Weisberger, Young and Morse. J. Dent. Research. 17; 101-105.
April 1938 (quoted Field).
97.
J.L. Dudley Buxton. Dental Pathology (E, and S. Livingstone)
1937.
98.
H. Gordon Campbell. B.M.J. March 8 th, 1941. 360-361.
99.
Vitamins Limited. 23 Upper Mall, London. Nutrition
Information Bulletin. C5. March 1941.
CASE
NUMBER.
SITE OF
DISEASE.
1.
Gums
0
0
Absent
2.
Gums
0
0
Absent
3.
Gums and
tonsils
0
0
Absent
4.
Gums
0
0
Deficient
5.
Gums
0
0
Absent
6.
Gums and
tonsils
0
0
Absent
7.
Gums and
tonsils
0
0
Absent
8.
Gums
0
0
Absent
9.
Gums and
tonsils
0
0
Absent
10.
Gums
0
0
Absent
11.
Gums
0
0
Absent
12.
Tonsils and
gums
0
0
Absent
13.
Gums
0
0
Absent
14.
Gums
0
0
Absent
15.
Gums
0
0
Absent
16.
Gums and
tonsils
0
0
Not done
17.
Gums
0
0
Not done
18.
Gums
0
0
Absent
19.
Gums
0
0
Absent
20.
Gums
0
0
Not done
21.
Gums
0
0
Absent
22.
Gums
0
0
Not done
23.
Gums
0
0
Absent
24.
Gums
0
0
Absent
25.
Tonsils
and gums
0
0
Not done
26.
Tonsils
0
0
Not done
27.
Gums and
tonsils
■0
0
Not done
to
CO
Gums
0
0
Not done
•
93.
CLINICAL
SUB-PELLAGRA.
CLINICAL A.
DEFICIENCY
NICOTINIC ACID
DEFICIENCY.
29.
Gums
0
0
Not done
30.
Gums
0
0
Not done
94.
continued.
31.
Gums
0
0
Hot done
32.
Tonsils
0
0
Hot done
33.
Gums
0
0
Hot done
34.
Tonsils
0
0
Hot done
35.
Gums
0
0
Hot done
36,
Tonsils
and gums
0
0
Hot done
37.
Gums
0
0
Hot done
38.
Gums
0
0
Hot done
39.
Gums
0
0
Hot done
40.
Tonsils
and gums
0
0
Absent
41.
Gums
0
0 .
Hot done
42.
Tonsils
0
0
Hot done
43.
Gums
0
0
Hot done
44.
Tonsils
and gums.
0
0
Hot done
45 ;
Gums
0
0
Hot done
46.
Tonsils
and gums
0
0
Hot deficient
47.
Gums
0
0
Hot done
48.
Gums
0
0
Hot done
49.
Gums
0
0
Hot done
50.
Tonsils
and gums
0
0
Hot done
51.
Gums
0
0
Absent
52.
Hard palate
0
0
Hot done
53.
Gums
0
0
Hot done
54.
Tonsils
and gums
0
0
Hot done
Gums
0
0
Hot done
55.
95.
CASE
NUMBER
VITAMIN C
DEFICIENCY
TOURNIQUET TEST
CLINICAL B x DEFICIENCY
1.
Present
Negative
0
2.
Present
Negative
0
3*
Present
Negative
0
4.
Present
Negative
0
5.
Present
Negative
0
6•
Present
Negative
0
7.
Present
Negative
0
.
Present
Negative
0
9.
Present
Negative
0
10.
Absent when
seen
Negative
0
11.
Present
Negative
0
12.
Present
Negative
0
13.
Deficient
Negative
0
14.
Present
Positive
0
15.
Present
Positive
0
16.
Present
Positive
0
17.
Present
Negative
0
18.
None on
admission
Negative
0
19.
Present
Negative
0
20.
Present
Negative
0
21.
Present
Negative
0
22.
Present
Negative
Q
23.
Present
Negative
0
24.
Not on
admission
Negative
0
25.
Present
Positive
0
26.
Absent
Negative
0
27.
Present
Negative
0
28.
Present
Negative
0
29.
Present
Negative
0
30.
Present
Positive
0
31.
Present
Negative
0
8
96.
continued.
32.
Present
Negative
0
33.
Not on
admission
Negative
0
34.
Absent
Negative
0
35.
Present
Negative
0
36.
Present
Negative
0
37.
Present
Negative
0
38.
Scurvy
Positive
0
39.
Present
Negative
0
40.
Present
Negative
0
41.
Not on
admission
Negative
0
42.
Present
Negative
0
43.
Present
Negative
0
44.
Present
Negative
0
45.
Absent
Negative
0
46.
Slight
deficiency
Negative
0
Not on
admission
Negative
0
48.
Present
Negative
0
49.
Present
Negative
0
50.
Present
Negative
0
51.
Present
Negative
0
52.
Present
Negative
0
53.
Present
Positive
0
54.
Present
Negative
0
55.
Present
Negative
0
47.
97.
No. o f R . B . C . / C m m .
Case.
H .B .
<f>
C .I.
1.
4,820 ,0 0 0
84
0.87
2.
5, 1 0 0 ,0 0 0
92
3.
3,950 0 0 0
4.
T o tal
P o ly L eu co cy tes m orphs,
per c. mm.
Lymphocytes
-•
11 000
77
20
3
0
0
0.9
8 500
68
23
5
3
1
86
1 .1
9 500
78
20
2
0
0
4,200 00 0
80
0.91
13 000
67
28
4
1
0
5.
4,750 0 0 0
90
0.96
6 500
72
20
5
2
1
6.
3,650 000
64
0.89
12 000
75
20
5
0
0
7.
4,950 000
85
0 .8 6
13 750
62
34
2
2
0
8.
3,280 000
70
1.09
6 900
80
15
3
1
1
9.
5,100 0 0 0
94
0.92
10 500
77
21
2
0
0
10 .
3,840 0 0 0
78
1 .0 1
9 800
57
34
7
1
1
11 .
4,300 00 0
80
0.93
13 600
82
15
3
0
0
12 .
4,900 0 0 0
94
0.96
10 800
70
22
6
2
0
13.
4,250 0 0 0
86
1 .0 2
11 000
70
24
5
0
1
14.
4,000 0 0 0
78
0.975
7 800
70
27
3
0
0
15.
4,860 0 0 0
98
1 .0 2
9 800
65
28
6
1
0
16.
4,560 0 0 0
103
1.14
15 000
68
25
7
0
0
17.
5,200 0 0 0
96
0.92
15 500
82
18
0
0
0
18.
4,770 0 0 0
92
0.99
11 600
65
29
4
2
0
19.
4,360 000
95
1 .1
9 800
78
20
2
0
0
20 .
4,200 0 0 0
86
1 .0 2
9 500
72
24
4
0
0
21 .
3,560 000
64
0.91
5 400
55
38
5
2
0
22 .
4,900 000
86
0 .8 8
16 000
80
17
3
0
0
23.
-
-
-
-
24.
4,280 0 0 0
79
0.94
11 000
64
29
5
H
1
25.
4,480 0 0 0
90
1 .0 2
12 600
75
19
6
0
0
26.
5,150 0 0 0
97
0.95
8 800
71
25
4
0
0
27.
4,500 0 0 0
99
1 .1
6 800
75
22
2
1
0
28.
4,700 0 0 0
96
1 .0 2
11 000
73
25
2
0
0
29.
4,800 0 0 0
100
1.04
10 200
59
34
6
0
1
30.
3,860 00 0
68
0.89
13 400
78
19
3
0
0
31.
4,920 0 0 0
94
0.95
10 200
80
15
4
1
0
32.
4,300 0 0 0
95
1 .1
9 600
66
32
2
0
0
33.
4,860 0 0 0
98
1 .0 2
11,400
75
20
1
0
-
-
.
-
98*
continued.
34.
4 ,7 0 0 ,0 0 0
92
0 .9 8
5 ,000
40
53
6
1
0
35.
4 ,9 3 0 ,0 0 0
98
1 .0
6,800
71
25
4
0
0
36.
4 ,3 7 0 ,0 0 0
92
1.0 6
7,100
80
15
3
1
0
37.
4 ,7 5 0 ,0 0 0
95
1.0 1
11,800
77
20
3
0
0
38.
4 ,5 0 0 ,0 0 0
70
0.78
9 ,4 0 0
69
27
*
0
39.
4 ,1 5 0 ,0 0 0
87
1 .06
7,200
80
15
4
*
i
40.
4 ,3 6 0 ,0 0 0
96
1 .1
8,400
61
31
5
2
1
41.
4 ,8 5 0 ,0 0 0
98
1 .0 2
10,800
66
29
5
0
0
42.
5 ,0 0 0 ,0 0 0
95
0 .9 5
9,6 0 0
74
20
5
1
0
43.
-
-
-
-
-
-
44.
3 ,7 4 0 ,0 0 0
98
1 .3 2
3 ,200
86
11
3
0
45.
4 ,3 9 0 ,0 0 0
88
1.0 2
15,3 0 0
72
24
4
0
46.
4 ,9 6 0 ,0 0 0
100
1 .0 2
1 0,3 0 0
71
22
5
47.
4 ,4 5 0 ,0 0 0
96
1.0 9
8 ,400
66
29
4
1
-
-
-
-
-
-
48.
-
-
-
-
0
0
i
0
49.
3 ,8 7 0 ,0 0 0
70
0 .9 2
1 1,8 0 0
60
32
6
1
1
50,
4 ,6 8 0 ,0 0 0
98
1.0 6
1 0,0 0 0
72
25
3
0
0
51.
4 ,9 2 0 ,0 0 0
99
1 .0 1
9,600
78
19
3
0
0
52.
4 ,1 0 0 ,0 0 0
88
1 .0 7
1 3,600
80
15
44*
53.
3 ,8 6 0 ,0 0 0
72
0 .9 5
12,500
76
20
4
0
54.
4 ,9 8 0 ,0 0 0
98
1 .0
9,800
59
34
5
1
55.
5 ,2 5 0 ,0 0 0
98
0 .9 4
8,000
66
26
6
1*
0
■
©
1
1
Number
of case.
TYPE OP SHIP ANT)
DI
DURATION OP SERVICE.
JKER
SMOKER
TOOTH CONDITION
1.
Minesweeper. 9 months
Beer
Yes
Caries+tartar
2.
Yacht. 13 months
No.
Yes.
Caries.No tartar
3.
Paddle mineswasper. (X) 6 mths.
No.
Yes
No caries, tartar
Beer
++
Yes
Caries + tartar
Paddle sweeper (Y)
3 months
No
Yes ++
Caries, no tartar
6•
Minesweeper.9mths
Yes
Yes
No caries, tartar
7.
Paddle sweeper (Y)
5 months
Yes
Caries + tartar
8.
Drifter 4 mths
No
Mode­
rate .
Mode­
rate
9.
Minesweeper. 4 mths
Heavy
10.
Trawler, 1 yea:r.
Yes
Yes
No caries, tartar
11.
Patrol trawler,
4 months
Yes
Yes
Caries +
crevices
12.
Paddle sweeper (X)
5 months
No
No
Tartar, no caries
Paddle sweeper (X)
8 months
Heavy
Mode­
rate
Caries + tartar
Trawler (Z )
Heavy
Mode­
rate
Caries, no tartar
4.
5.
13.
14.
Paddle sweeper (Y)
5 months
io
mths
No
Caries, no tartar
Slight caries,
tartar
15,
Trawler (Z) 11 mths
No
No
Caries, no tartar
16.
Destroyer, 10 mths
Yes
No
Severe caries,
tart ar
17.
Destroyer (A) 6 mths
Yes
Yes
No caries, tartar
18.
Trawler (A) 8 mths
Yes
No
Caries + tartar
19.
Shore hutments 14 mths
No
Yes
Loose tooth.
No tartar
20.
Trawler-sweeper 8 mths
Yes
Yes
Tartar ++
Caries.
21.
Trawler 3 months
Yes
No
Caries + tartar
22.
Trawler (B) 10 mths
Yes
Yes
Tartar
23.
Drifter 9 months
No
Yes
Caries + tartar
24.
Paddle sweeper (Z)
9-J- months
No
No
Tartar
25.
French destroyer
4 months
Yes
Yes
Tartar
26.
Destroyer (A)
17 months
Yes
No
No caries
No tartar
100.
continued.
Destroyer 4-J- mths
28.
Trawler 8 mths
29.
Yes
Yes
Tartar + close
set teeth
No
Yes
Caries + tartar
Drifter 6 months
Yes
Yes
Caries + tartar
30.
Drifter 1 year
No
Yes
Tartar
31.
Sloop 4^- months
Yes
No
Caries + tartar
32.
Trawler (B) 8 mths
No
Yes
Caries, no tartar
33.
Drifter 10 months
Yes
Yes
Slight tartar
34.
Shore establishment
5 months
Yes
No
Caries only
35.
Sloop for 4 months
Yes
36.
Mineesweeper (S)
4 months
No
No
Caries + tartar
37.
Trawler i8 months
Yes
Yes
Caries + tartar
38.
Trawler 1 year
Yes
No
Tartar
39.
Trawler (A) 7 mths
Yes
No
Caries + tartar
40.
Battleship 2 weeks
Camp 10 weeks
No
Yes
Caries + tartar
41.
Motorboat 1 year
Yes
Yes
Caries + tartar
42.
Paddle sweeper 1 yr.
Yes
Yes
Tartar only
43.
Trawler (A) 15 months
Yes
No
Staining only
44.
Destroyer 8 months
Yes
No
Tartar + caries
45.
Motorboats 1 year
Yes
Yes
Tartar + +
46.
Trawler 5-J- months
No
Yes
Tartar + +
47.
Paddle sweeper (Z)
6 months
Yes
Yes
Tartar + caries
.
00
27.
Paddle sweeper (Z)
4 months
Yes
No
Caries + tartar
49.
Trawler 18 months
Yes
Yes
Tartar + +
50.
Drifter 5-g- months
Yes
Yes
Caries
51.
Destroyer 3-J- mths
Yes
Yes
Alveolar abscess
+ tsfctiar
52.
Destroyer 5 months
No
No
Tartar + caries
53.
Drifter 8-J- months
Yes
Yes
Tartar + caries
54.
Tanker 4 months
Yes
Yes
Caries + staining
55.
Destroyer (A)
7 months
No
Yes
Caries + tartar
Yes
Tartar + caries
101.
Number o f
Case.
SP ECIAL FEATURES
N . A . B . I N J E C T I O N S , ET C.
and S a tu r n .
3.
N .A .B .
on 1 s t
4.
N .A .B .
and S a t u r n .
5.
S atu ratio n v it.
6.
N .A .B .
day
v it.
8.
N .A .B .+ S atu rn .
9.
N .A .B .
10.
V it.
11.
N .A .B .+
12.
N .A .B .
13.
S atu ratio n V it.
v it.C
v it.C
v it.C
N .A .B .
15.
N .A .B .
16.
N .A .B ,
Epistaxis
Adenitis
v it
S atu rn v i t .
+ S atu rn v i t .
C
C
C
C
+ S atu rn v i t .
Alveolar abscess
Adenitis
11.
Alveolar abscess
Adenitis
9.
Gastritis
Adenitis
C + L o c a l N .A .B .
14.
12.
Adenitis
C
and S a t u r n ,
Adenitis
Adenitis
C
and S a t u r n .
S atu ratio n
V it.C
11.
C
17.
»
N .A .B .
Adenitis and
bronchitis
o
2*
7.
day
•
5 th
H
N .A .B .
NUMBER OF
DAYS IN
HOSPITAL.
o
1.
COMPLICATION
13.
Adenitis
7.
Adenitis
15.
Bronchitis
16.
Adenitis
10.
Bronchitis
Adenitis
9.
None
8.
Shotty adenitis
Adenitis
10.
9.
Perforation
10 days
with Vi:
cent's
N .A .B . s a t u r a t e d on ad­
m i s s i o n w i t h C.
S a tu ra te d w ith n ic o tin ic
acid
Adenitis
10.
Bronchitis
21.
20.
N .A .B .
Adenitis
12,
21.
N .A .B .
Adenitis
Bronchitis
10.
18 .
19.
22.
N .A .B .
Adenitis
Tonsillitis
10.
23.
N .A .B ,
Bronchitis
10.
24.
N .A .B . + P r e v io u s
S atu ratio n C
Shotty adenitis
10.
25.
N .A .B .
Adenitis
13.
26.
N .A .B .
Shotty adenitis
27 .
N .A .B .
Adenitis
Gastritis
8.
12,
102
continued.
28.
29.
30.
31.
32.
N.A.B.
-
Ascorbic acid
M.&B.693 + N.A.B.
5
Bronchitis
Adenitis
13
Adenitis
14
Gastritis
Bronchitis
Adenitis
12
Adenitis
Bronchitis
13
33.
Vit. C. First + N.A.B.
Adenitis
10
34.
M.&B.
Bronchitis
Adenitis
13
35.
36.
37.
38.
693 + N.A.B.
N.A.B.
” Indigestion”
Adenitis
N.A.B.
Saturation vit. C.
11
Nyctalopia
Adenitis
11
Adenitis
12
Anaemia
Nyctalopia
12
39.
N.A.B.
Adenitis
10
40.
N.A.B. (very ill)
Conjunctivitis
Bronchitis
Adenitis;
18
41.
N.A.B. + Saturn, vit. C
Adenitis
9
42.
N.A.B.
Post nasal discharge
Adenitis
7
8
43.
N.A.B.
Gastritis
44.
N.A.B.
Adenitis
13
45.
-
Adenitis
8
46.
N.A.B. + Saturn, nicotinic acid. Adenitis
10
47.
Saturation Vit. C. +
Saturation nicotinic acid
Adenitis
12
Saturation nicotinic acid
+ N.A.B.
Bronchitis
Adenitis
15
48.
49.
N.A.B. + Saturn, nicotinic acid. Adenitis
10
50.
N.A.B. + Saturn, nicotinic acid. Adenitis
11
51.
N.A.B. + Saturn, nicotinic acid. Bronchitis
Adenitis
12
52.
N.A.B. + Saturn, nicotinic acid.
-
53.
N.A.B. + Saturn. Nicotinic acid. Adenitis
Anaemia
8
12
103.
continued.
54.
N.A.B. plus saturn. nicotinic acid.
Adenitis
12.
55.
Nicotinic acid saturation first.
Adenitis
Bronchitis
13.
SUMMARY OF THE CASES OF VINCENT1S DISEASE.
As previously stated, the great majority of those cases
was confined to hed. All cases had a routine scaling of the
teeth, brushing with the rotary brush, and spraying with Eusol
solution at the outset.
The special methods of investigation have been described in
full previously. The tourniquet test was done, by the cuff of
a sphygmomanometer being placed round the bare arm and the
pressure of mercury being raised for 3 minutes to a huhdred
mms.
The cuff was then removed and ruptured capillaries and
petechiae sought for and counted.
The results are summarised in the preceding tables and
have been previously discussed. The complications are noted
in the tables.
All the cases had a "positive swab” as described earlier
and as illustrated by photograph.
Special attention from the outset was paid to the points
illustrated by the columns headings in the tables of summary.
This was done in an attempt to find some factor common to,
or predisposing to the condition in the sailors of our small
ships.
The cases are described in brief to conserve paper.
Case 1. P.B. Ordinary Seaman, 55 years.
On a minesweeper for 9 months.
On admission;-
Temp. 98.4°. Pulse 100 per min. Bowels open.
Tourniquet test - negative. Urine - pale straw colour, S.G. 1028,
acid; blood,sugar, bile and albumen - nil.
Gum and throat swabs
"positive” .
Blood count.
R.B.C. - 4,820,000 per c. mm. H.B.
- 84$. C.I.-0.87
W.B.C. - 11,000/c.mm. Polymorphs 77$, lymphocytes 20$, eosinophils
0$, monocytes 3$, Basophils 0$
Urinary vitamin C estimation.
First specimen - 1.1 mg.$, 3 hours
spec. - 3,3 mg. $, 6 hours spec. - 1.8 mg.$ (therefore vitamin
C. deficiency).
Nicotinic acid excreted per day equal to 6.31 mgs. in 42 ozs, urine
Complaint and history:-
This rating has lost 6 lbs of weight in
2 months, has a very bad mouth and complains of toothache and
sore, easily bleeding gums. Also has hoarseness, cough and slight
pain on breathing. Bad taste in mouth on rising. No diarrhoea
and generalised pains are absent. Does not suffer from night
blindness.
Smokes 20 cigarettes per day. Drinks beer heavily.
O.E. severe caries of teeth with tartar and brown staining. Gums
ulcerated and covered with whitish membrane especially behind
right lower molar tooth.
Breath bad. No glossitis. Tonsils clear.
Pulse shows occasional, extrasystoles, possibly from the oral
sepsis.
Tender shotty glands R. side pf neck. Complexion sallow.
Lungs - signs of bronchitis.
Heart - occasional extrasystoles, no murmers. C.N.S, - N.A.B.
No xerophthalmia.
X-ray of chest ”Right apex opaque from ? positioning; No
infiltration. Congestion and increased shadowing of right base” .
Sputa on 28/1/41, 29/l/41 and 3D/l/41 - no T.B. detected.
Course:- Day 1.
Had the routine scaling, rotary brush treatment
and spraying with Eusol solution. Gums painted daily with 10$
chromic acid and frequent mouth washes of Eusol 1 in 4. Also
hed, full diet and malt and cod liver oil.
105.
Day 4.
Complained of earache on R. side. No inflammation of
of tympanic membrane. Gums I.S.Q.
Chromic acid and Eusol
m.w. continued and G.A.C, ear drops given + 15 gr. aspirin
in the evening and mist. gent. alk. 1 oz. t.d.s. half an hour
before meals.
Day 5.
Earache gone and he felt better. The gums were still
red and spongy and had the whitish membrane present in the
morning. 0.45 gram N.A.B. was given intravenously and vigorous
local treatment continued.
Day 7.
Slight improvement detected. Gums less red. No pain in
neck glands. Chest clear of bronchitis.
Day. 8.
Membrane shows less tendency to reform. Less bleeding
and no pain in gums now.
Day 11.
Discharged from hospital.
This case began to improve after intravenous arsenic on the
5th day.
Diet. Breakfast:- tea,bread, butter ++, jam.
fried sausages, porridge.
Dinner:- Meat, pork, liver or
fish. Potatoes, tinned peas or carrots.
No fresh fruit for several months.
and jam.
Bacon and eggs,
Pudding twice a week.
Tea:- Tea, bread, butter
Supper:- Sausage and mash, or fish and chips.
Case 2. J.G. Able Seaman, 26 years. H.M. Yacht 13 months.
On admission:- temp. 98.2, pulse 85 per minute, bowels regular
once a day^ tourniquet test negative. Urine - clear, S.G. 1018,
acid; bile, blood, sugar and albumen - nil. Gum swab "positive” .
Blood count. R.B.C. - 5,100,000, Hb. 92$, C.I. 0.9.
W.B.C.
8,500/c.mm. Polymorphs 68$, lymphocytes 23$, monocytes 5$,
Eosinophils 3$, basophils, 1$.
Urinary vitamin C estimation. 1st specimen - 3.85 mg.$, 3 hours
spec/ 2.27 mg. $, 6 hours spec. 2.22 mg. $ (vitamin C deficiency).
Nicotinic acid excreted per day - 9.3 mg. in 23 ozs. tirine.
Complaint and history.
For the past three weeks his gftms
have bled when brushing his teeth. He brushes his teeth
regularly. There has been no pain whatever, but occasionally
a bad taste in his mouth, worse in the mornings. Appetite good.
No Tfindegestion" .
No bronchitis and has had no other illnesses.
No rheumatic pains.
Bowels regular once a day with no diarrhoea.
No other member of his Mess affected (7 in the Mess). Does not
drink alcohol. Smokes 20 cigs.a day and 2 ozs. tobacco a week.
O.E. Healthy looking, well nourishes patient. Mucosae red and
healthy. Gums - Swollen and red with prominent interdental
papillae. Bleed easily. Membrane and ulcer on palate behind
upper, central incisors.
Teeth - no tartar but two decayed
molars on left lower jaw.
False membrane and bleeding area
in front of upper jaw on either side of raph£ of upper lip
and extending over all the upper gums.
right and left. Tender left side.
Shotty adenitis
Bad breath.
No
glossitis but furred tongue. Tonsils clear. No xerophthalmia
or corneal ulceration.
Course.-
Heart, lungs, abdomen and C.N.S. -
N.A.B.
Day 1. Routine scaling, brushing, spraying and painting
with chromic acid. Decayed molars stopped with temporary
carbolised dressing. M.W. Eusol 1 in 4, t.d.s. Bed and full
diet.
0.45 gram N.A.B. intravenously. Saturate with 2,000 mgs.
ascorbic acid per day.
Day 4. Now saturated with ascorbic acid. Gums I.S.Q. Treatment
continued and ascorbic acid cut down to 300 mgs. per day. Day 6 .
swab still positive first thing in morning. Gums less red
and not bleeding so readily.
Day 8. Gums firmer, still some ulceration. Treatment continued.
No tenderness in neck.
Day 10. Ulceration confined to a small areia on R. side of upper
gum.
Day 1 2 .
Ready f o r
d isch arg e.
Diet.-
Not canteen messing.
Food apt to be overcooked. Breakfast,
bacon and tinned tomatoes, (well fried and overcooked), beans,
friefUbread and bacon; eggs two or three times a week. Bread,
butter + + and tea. No grape fruit or any other fruit.
Dinner-
boiled potatoes, roast meat, cabbage and dried peas soaked in
water, stew, cottage pie,
boiled pudding or pastry; tinned
pears twice a week, no oranges, apples or fresh fruit.
Tea-
107.
Scotch rarebit, scrambled eggs on toast, sausage and mash or
fresh fish two or three times a week. Supper - bread, butter,
cheese or jam, tea or coffee.
A diet, rich in all but vitamin C possibly, which would be killed
^y the food being overcooked as the patient described.
Case 3.
A.G. 36 years. Stoker,
Paddle minesweeper X for 6 mths.
On Admission. Temp.99.2°. Pulse 86 per min. Bowels - constipated
for 2 days. Tourniquet test negative.
Urine - straw coloured.
S.G. 1022. Albumen, bile, blood and sugar - nil. Throat and gum
swabs positive.
Blood count.
R.B.C. 3,950,000 / c.mm. Hb. 86$, C.I. 1.1
W.B.C. 9,500/c.mm.
Polymorphs. 78$, Lymphocytes 20$, monocytes
2$. Eosinophils 0$, basophils 0$.
Urinary vitamin C estimation. 1st spec, urine - 2,5 mg.$, 3 hours
spec. - 4.5 mg.$, 6 hours spec. 3,3 mg.$ (vitamin C deficiency)
Nicotinic acid excreted per day - 8.8 mg. in 47 ozs.
Complaint and history.-
Sore throat for 3 days and his gums
have been bleeding for this time also. Gums however have been
tender for 5 days. Sour taste in mouth in mornings lately.
Appetite good - wants to eat more than formerly. No bronchitis.
No rheumatism but has had stoker1s cramps in abdomen and arms
in hot weather. No nyctalopia. Constipated lately - usually
regular.
Smokes 20 cigs.a day and is a non-drinker.
O.E. T h i n p a t i e n t ,
rath e r p ale.
Left c e r v i c a l a d e n i t i s
+ + .
Breath heavy; pale mucosae of eyes; gums red, swollen and bleed
easily.
Shallow ulcers with greyish yellow sloughs at teeth
bases, Tartar and brown staining at teeth bases. Has a plate
above with 8 false teeth. Gums sore beneath the plate. No
Caries in remaining teeth, but tartar + + at bases. Tonsils exudate ofi Vincent*s Disease on left tonsil.
or corneal ulceration.
Course.-
Day 1.
No xerophthalmia
Heart, lungs, abdomen and C.N.S. - N.A.D.
Routine scaling, rotary brushing and spraying
of teeth with 1 in 4 Eusol. Gums painted with 10$ chromic acid*
0,45 gm. N.A.B. given intravenously.
M.W. of potassium perman­
ganate. Bed. Diet low with extras. Two vegetable laxative pills.
Day 4.
Membrane on left tonsil has not spread, is yellowish and
is peeling off at upper edges. Gums I.S.Q,.
Day 6.
Practically no membrane on tonsil now. M.W. permanganate
t.d.s. and daily chromic acid to gums continued.
Day 7. Tonsils clear, Gums becoming firmer and not so red and
swollen. Eusol 1 in 4 applied to gums.
Day 9.
Big improvement in gums.
Ulceration gone. Eusol and
chromic acid continued.
Day 10.
Disease is dead.
Diet.-
Canteen messing.
sausage or egg.
and no fruit.
Negative swabs.
Breakfast - Slice of bacon and
Bread, butter + +, tea and jam, no porridge
Dinner - Potatoes, meat and vegetables (carrots,
turnips, dried peas and cabbage), no pudding.
as he has never had any fruit in this ship*
jam and tea.
No fruit whatever
Tea - Bread, butter,
Supper - Tea and sandwich with meat or cheese.
A monotonous unvaried diet, with little vitamin C. He gets
plenty of the articles named.
Case 4,
T.K. 19 years. A.B. Paddle minesweeper Y for 5 months. '
On Admission.
slightly.
Temp. 98,4°. Pulse 92 per min. Bowels constipated
Tourniquet test negative. Urine - pale straw colour,
S.G. 1015.
Blood count.
Albumen, bile, blood and sugar - nil. Gum swab positive.
R.B.C. 4,200,000 per c.mm. Hb. 80$. C.I, 0.91.
W.B.C. 13,00§/c.mm.
Polymorphs. 67$. Lymphocytes 28$. Monocytes
456. Eosinophils 1$, basophils 0$. Urinary vitamin C estimation 1st spec, urine - 2.5 mg $. 3 hours spec. 1.8 mg.$, 6 hours spec.
2.63 mg.$ ( v i t a m i n C d e f i c i e n c y ) .
N i c o t in i c a c i d e x c r e t e d p e r day - 2.87 mg. i n 78 ozs.
Complaint and history.
Complains of bleeding and very tender gums
for a week. Does not brush his teeth as a rule. Very bad taste in
his mouth in the morning. Appetite is good. No vague pains,
bronchitis, nor "indegestion". He sleeps well and does not dream.
He has felt off colour and easily tired lately and has noticed a
slight loss of weight. History of epistaxis on occasion for the
Past week on blowing his nose. Drinks much beer. Smokes 20 cigs.
109 .
a day. No night blindness.
There are twenty men in the Mess
and for the past 5 weeks they have used 2 cups only. The other
cups were broken at sea.
0 #E.
Tartar at teeth bases.
Slight caries of lower molars
on right side. Mucosae of gums, swollen, red and easily bleeding.
Tonsils clear. Membrane and ulceration on lower gums. Ulcer
with whitish slough behind left lower molar. Heavy breath.
No glossitis. Shotty, non tender adenitis on left side of neck.
Lungs, C.N.S. heart and abdomen - N.A.D.
Course.-
No eye defects.
Day 1. Routine scaling, rotary brushing, Eusol spraying
and painting of gums with 10$ chromic acid. 0,45 gm. of N.A.B,
given intravenously.'2,lOOmg. ascorbic acid given daily to
saturate him.
Day 3. Gums I.S.Q,. and not painful. Random spec, of urine at 11 a.m.
showed 8.3 mg. $ of ascorbic acid - not quite saturated. Continue
700 mg. ascorbic acid per day.
Day 4. Now saturated with ascorbic acid. Put on 200 mg. per day.
Daily 10$ chromic acid to gums and 1 in 4 Eusol M.W. t.d.s. Gums
less swollen and red but whitish membrane still present.
Day 7. Great improvement in gum swelling. No bleeding. Still some
ulceration behind and around lower left molars but this is
healing.
Day 9. Fit for discharge.
Diet.-
He says the food is good in quality but he complains of its
monotony.
Breakfast - sausages, or bacon and many fried eggs,
bread, butter and tea, tinned milk. Liver and "mash” , tinned pork
and beans. Porridge available but not eaten by him.
Dinner -
Roast beef, roast potatoes and tinned peas or cabbage. Jam roll,
or jelly and rice. No tinned fruits. The only fruit he has seen
for three months was tinned apples on one occasion.
butter, jam and tea.
Tea - bread,
Supper - Egg and chips, or egg and beans.
Tea, bread and butter.
This i s t h e i n v a r i a b l e d i e t and i s n o t r i c h i n v i t a m i n C.
110.
Case 5.
J.T. 23 years. A.B, Paddle minesweeper Y. for 3 months.
and trawler previously for 3 months.
Temp 97. 8 °. Pulse 65 per min. Bowels regular 1 i.d.
On admission.
Tourniquet test negative. Urine - S.G. 1022. Acid. Bile, blood,
albumen and sugar - nil.
Gum swab positive.
Blood Count. R.B.C. 4,750,000 /c.mm. Hb. 90$. C.I. 0.96. W.B.C.
6,500/c,mm.
Polymorphs. 72$, Lymphocytes 20 $, Monocytes 5 $
Eosinophils 2$, basophils 1$.
Urinary vitamin C estimation -
1 st spec. 5 mg. $, 3 hours spec. 4.2 mg. $, 6 hours spec. 4.0 mg,$.
(Vitamin C deficiency).
Nicotinic acid excreted per day - 3.83 mg. in 44 ozs. urine.
Complaint and history.-
Complains of bleeding, tender gums
for 2 weeks. Aching like toothache all over, but was worse on
the left side to start with. He brushes his teeth twice a day.
His appetite is good, slight loss of weight lately. No diarrhoea,
bronchitis or recent indigestion.
He had "stomach trouble"
4 years ago. No history of rheaumatic pains and he sleeps well
with no dreams.
Has not been feeling up to the mark lately
and has had a bad breath and foul taste in his mouth. No
trouble with his eyesight at night.
Non drinker but a heavy
smoker.
O.E.
Thin patient, with seborrhoeic spots on face and shoulders.
He has 6 false teeth in the upper jaw in front.
The teeth in
the lower jaw have some caries in places but no gross tartar.
Some brown staining at the bases. There is some ulceration
and whitish membrane on both gums and on the palate behind the
upper central incisors. Tonsils are clear of infection. The
breath is heavy and the gpms swollen, and the interdental papillae
prominent.
A moderately severe case.
Tender a d e n i t i s
present
le ft
sid e
No defect in the eyes.
o f n e c k . Heart, l u n g s ,
abdomen
and C.N.S. - N.A.D.
Course.
Day 1.
Routine'scaling, rotary brushing, spraying
with Eusol 1 in 4 and daily painting of gums with 10 $ chromic
acid.
Saturate patient with ascorbic acid (700 mg. t.d.s.).
Day 2 . - Continue with 10 $ chromic acid + 700 mg. ascorbic acid
111.
t.i.d. + Eusol (l in 4) M.W.
Day 3. Random specimen urine shows 7.6 mg.$ ascorbic acid not yet saturated. Continue vitamin C.
Day 4. Saturated with ascorbic acid. Gums I.S.Q. Still pain in
left side of upper and lower jaws. Ascorbic acid - 200 mg. per day given.
Day 7. Less pain in gums. Interdental papillae less swollen and
less red. Ulceration vanishing. No tenderness in cervical glands,
but glands still enlarged.
Day 9. Gums practically healed.
Day 1 0 . Ready for discharge.
Diet - Same as case 4.
Case 6 . F.C. 26 years. Minesweeper for 9 months.
On admission. Temp.100.2°. Pulse 94/min. Bowels regular every day.
Tourniquet test negative. Urine - dark, straw colour. S.G. 1025.
Albumen, bile, blood and sugar - nil. Gum and throat swabs positive.
Blood count. R.B.C. 3,650,000 per c. mm. H b . 64$. C.I. 0.89.
W.B.C. 12,000/c.mm.
Polymorphs. 75$. Lymphocytes 20$, monocytes
5$. Eosinophils 0 $. Basophils 0 $.
Urinary vitamin C estimation. First spec. -3.4 mg.$, 3 hours spec.
3.8 mg.$, 6 hours spec. 4.5 mg.$ (vitamin C deficiency).
Nicotinic acid excreted per day - 13.13'mg. in 35 ozs. urine.
Complaint and history. -
Sore throat and difficulty in swallowing
for 4 days prior to admission. Gums have bled on cleaning for the
past week. He used to clean them every day till they started to
bleed. No bronchitis, nor rheumatism.
He sleeps soundly and
rarely dreams. No loss of weight nor "indigestion". Smokes 14-15
oigs per day. Drinks every week-end and gets "drunk" every Saturday
night.
O.E. Thin, pale subject. Teeth - no caries but tartar at the bases.
The crowns are clean. Alveolar abscess in left lower jaw.
Small ulcer in front of left anterior pillar of the fauces. White
spots on both tonsils.
Uums red, swollen and bleed easily on
pressure. Whitish membrane of Vincent 1 s disease on anterior aspect
°f upper and lower jaws.
Breath very offensive. No glossitis.
112.
Tender R. and L. cervical adenitis. Worse on left side.
No
xerophthalmia or corneal ulceration.
H eart,
lu n g s,
C o u rse,-
abdom en and C .N .S .
Day 1 .
Two t e e t h w i t h
- n il.
alv eo lar
abscess
at
ro o ts
removed. Routine scaling, brushing, spraying and painting daily
with 10$ chromic acid.
.45 gm. N.A.B. intravenously. Mist, ferri
et ammon. cit. and .45 gm. N.A.B. 700 mgs. vit. C. T.D.S.
Day 3. Now saturated with vitamin C. therefore put on 200 mg. daily.
Daily gums paints with chromic acid and M.W, 0f Eusol.
Gums I.S.Q. tender adenitis R. side less tender on L.
Day 4. Gums I.S.Q. but marked improvement in throat. No pains
in throat or neck, and spots almost gone.
Day 7. Throat clear. Alveolar abscess has stopped draining and is
healing in from below.
Gums less red and much firmer. Still some
membrane in the morning.
Day 9. Only a small ulcerated area on L. side of upper jaw. Neck
glands shotty but not paining. Eusol irritating gums therefore
used pot. permang. M.W. + daily chromic acid.
Day 1 1 .
Diet. -
Discharged.
Breakfast - Fish every morning, porridge, bread, toast,
butter and tea. No fruit whatever in diet. Last fruit was 3 apples
at Christmas, nine weeks previously and he canft remember any
before that.
Dinner - Meat, potatoes and greens or tinned peas,
sago, tinned plums or custard. Tea - Toast, jam, butter and tea.
Supper - Meat, potatoes and cabbage. Liver is available but he
does not like it.
Case. 7 .
M.P.
27 years. Paddle minesweeper Y for 5 months.
On admission. Temp. 99°. Pulse 90 per min. Bowels constipated.
Tourniquet test negative. Urine - S.G. 1035. Blood, bile, albumen
and sugar - nil. Gum end throat swabs positive.
Blood count. R.B.C. 4,950,000/c.mm. Hb. 89$. C.I. 0 .8 6 .
W.B.C.
13,75o/c.mm. Polymorphs. 62$. Lymphocytes 34$. Monocytes 2$.
Eosinophils 2 $. Basophils 0 $.
Brinary vit. C. estimation. First spec, urine 2.5 mg.$. 3 hours
spec, urine 3 . 3 3 mg.$.
deficiency).
6 hours spec. 3 .1 2 mg.$. (vitamin C
113.
D aily n i c o t i n i c
acid
e x c re tio n 9 .6
mg.
in
C o m p l a i n t a n d h i s t o r y . - H ad p a i n s l i k e
for
a week.
Gums b l e e d i n g
in m outh. P a in
la te ly .
th ro at
No d i a r r h o e a ,
tro u b le.
No u n d u e
m oderately.
O .E.
in
m olars.
red
of u p p e r L.
at
tim e
m uscular p a in s,
S m okes 10 c i g s .
T artar
th is
to o th ach e
for
and d y s p h a g ia f o r
d ifficu lty
gums s w o l l e n ,
in r e g io n
before
46 o z s .
and
in
in clin ed
m olars.
teeth
L.
3 days.
2 days.
to
gums
Bad t a s t e
C o n stip ated
nor
stom ach"
at n ig h t la te ly .
A p p etite
A lv eo lar
bases.
in h is
b ro n ch itis,
seein g
per day.
of u rin e.
b leed .
abscess
D rinks
good.
V ery s l i g h t
d isease
aro u n d u p p e r L.
te n d er c e rv ic a l a d e n itis
p resen t.
L. t o n s i l
g rossly
has w h ite
enlarged.
g r a n u la r p a tc h on u p p er p o le .
H eart,
lu n g s,
T o n sil not
abdomen and C .N .S .
- N .A .D .
No x e r o p h t h a l m i a .
This was
a v e ry m ild
ad m itted had
it
not
C o u r s e . - Day 1 . scalin g ,
ro tary
case
indeed
been f o r
and w ould n o t hav e b e e n
the
in itia l
D iseased u p p er L. m olars p u lle d .
b ru sh in g ,
d aily p a in tin g w ith
sp ray in g w ith Eusol
10$ c h ro m ic
acid.
E u s o l M.W. a n d g a r g l e s
g iven
4 i.d .
S atu rate w ith
acid ,
14 t a b s ,
asco rb ic
and c a s c a r a 2 d r .
of
- Temp, n o r m a l
Day 3 .
-S till
com plains o f
Day 4 .
-S till
u lc e r L.
w ith
(l
R o u tin e
in
4)
and
T h i s man r e f u s e d N . A . B .
t.d .s.,
liq u id
p araffin
each.
Day 2 .
Now s a t u r a t e d
p y rex ia of 99°.
all
day. G argle
pain
to n sil
asco rb ic
p o t.
4 i.d .
i n gums.
and t e n d e r
acid
ch lr.
at
L.c e r v i c a l a d e n i t i s .
5 p.m . T o o th s o c k e t
clean in g
up.
Day 5 .
- U lcer
and p a i n
on s w a llo w in g .
D aily c h ro m ic
Day 6 .
and w h ite
acid
C ontinue
asco rb ic
on L . t o n s i l
a c i d 300 mg.
/day.
a n d E u s o l M.W.
- P ractically
memb ran e o n t o n s i l
p a t c h o f membrane p e r s i s t
no
is
change
very
in
gums a n d t o n s i l s .
slig h tly
A rea o f
s m a l l e r t h a n when he w as
adm itted.
Tt i s
fe lt
th at
but h e
w ill
E&y 7 .
- S lig h t
th e
n o t have
c a s e w ould h a v e
cleared
b y now w i t h N .A . B .
it.
im provem ent
c o m m e n c in g i n gums
and s p o t
on to p
of
114.
L.
to n sil
p o t.
ch lo r.
acid,
-
Day 9 .
D iet
S h o tty
8 .-
cases
J.S .
on gums and a s c o r b i c
ad en itis
on t o p
o f L. t o n s i l
i n n e c k now. A l v e o l a r
n eg ativ e.
B lood c o u n t .
9 8 .2 °.
U rine
D rifter fo r
P u lse
- S .G .
1028,
E o sin o p h ils
C.
A cid.
B ow els o p e n .
T o urniquet
A lbum en, b l o o d ,
b ile
Gum s w a b p o s i t i v e .
/c.m m . Hb.
/c.m m . P o ly m o rp h s.
U rinary v i t .
4 m onths.
7 2 / m in.
R .B .C . 3 ,2 8 0 ,0 0 0 .
6,900
and r e a d y f o r d i s c h a r g e .
5 and 4.
24 y e a r s .
and s u g a r - n i l .
3$.
n o n -ten d er
Spot
- M embrane gone fro m t o n s i l ,
W .B.C.
G arg.
healed .
On a d m i s s i o n ; t e m p .
te st
acid p a in ts
o f t h r o a t now.
day.
- Same a s
Case
chrom ic
of rest
Gums now a p p e a r h e a l t h y .
sm all.
abscess
No i n j e c t i o n
D aily
300 m g ./
Day 8 .
very
sm aller.
1$.
80$.
70$.
C .I.
1 .0 9 .
Lym phocytes 1 5 $ . M o n o cy tes
B asophils 1$.
estim atio n .
F irst
spec,
u rin e
2.0 1 m g.$.
3
hours s p e c . 2 .6 m g.$.
6 h o u r s s p e c . 2 . 6 3 mg. $ . ( v i t a m i n C d e f i c . ) .
N i c o t i n i c a c i d e x c r e t e d p e r d a y 8 . 3 4 mg. i n 43 o z s . u r i n e .
C o m p la in t and h i s t o r y . T h r e e w e e k s ago w as i n a n o t h e r h o s p i t a l
w ith V i n c e n t f s d is e a s e
days l e a v e .
Now r e t u r n s
and b l e e d i n g
w ith p a i n
o f th e
gums.
w ith p ain ,
A p p etite
and f l a t u l e n c e
5-10 c i g s . p e r
day.
gums f o r
for
a week,
bad t a s t e
th e n w en t on 7
i n m outh, b ad b r e a t h
p o o r and h a s had g a s t r i c
5 w e e k s . N on d r i n k e r
No d i a r r h o e a a n d n o b r o n c h i t i s
tro u b le,
and o n l y
smokes
o r rh eu m atic
pains.
O .E . B a d b r e a t h
and lo w e r m o la r s
stum ps p r e s e n t .
M o d erately
t h e g u n s a n d R.
retro -m o lar
Abdomen -
some t e n d e r n e s s
g u arding.
C ourse.
No e y e
- Day 1 .
10 c h r o m i c
e t amraon.
Day 2 .
-
acid .
d efects.
R outine
14 t a b s .
on R.
severe
case
su lcu s.
in reg io n
sid e
v it.
and d e c a y e d
o f V in c e n tf s D isease
H eart,
lu n g s,
and C .N .S .
o f R. u p p e r r e c t u s
No g l o s s i t i s .
scalin g ,
lo o se
etc.
C. T . d . s .
No t a r t a r
of
- N .A .D .
and m u sc le
in te e th .
o f t e e t h . M.W. E u s o l a n d
M ilk d i e t
and m i s t ,
ferri
c i t ..
0 .4 5
grm . N .A .B .
com plains o f p a i n
in
in trav en o u sly .
C ontinued v i t .
u p p e r and lo w e r ja w s .
C. S t i l l
115.
Day 4 .
Temp.
-
C om plains o f h e a d a c h e
9 8 .4 °.
H eart
asco rb ic
acid
D ay 5 .
S till
Temp.
-
and
and l u n g s n i l .
(now s a t u r a t e d ) .
9 8 .4 °.
has
severe
in
- Temp.
firm in g
stum ps
o
alone
are
th e ir
p ain in g
of neck.
1.
M ist,
alba
had
50 m g . $
C. p e r d a y .
aches gone.
C.
b .i.d .
b rig h t
and a re
C h e s t N .A .D .
u rin e
c h r o m . , E u s o l M .W ., v i t .
. B ow els n o t o p e n .
up and l o s i n g
T h r o a t N .A .D .
sid es
99
over.
gums. G e n e ra l
acid
300 m g ./d a y and l u m in a l g r a i n s
Day 6 .
Random s p e c ,
all
C o n t i n u e 300 mg. v i t .
pain
C ontinue d a i ly
aching p a in s
Gums n o t
red
appearance.
are
Decayed
non t e n d e r g la n d s R.
(2 o z s .)
and
t o d a y un d er g a s .
ex tracted
S h o tty ,
so t e n d e r
and r o u t i n e
d aily
and L.
gum
trea tm e n t.
Day 7 .
- Face
but upper
jaw
sw o llen a f t e r
aching.
A scorbic
acid ,
etc.
Day 8 . -
Redness
places
on u p p e r
fairly
clean.
Day 1 0 .
-
in
Gums h a v e
t e e t h w ere rem oved.
C o n stip atio n p e r s is ts
co n tin u ed .
F u ll
S w ellin g
b etter.
slig h t
d ie t.
of face
le ss
No g a s t r i c
in fec tio n
C ontinue
F eels b e tte r
(enem a g i v e n ) .
gums m o s t l y g o n e t h o u g h
jaw .
F eels
stum p e x t r a c t i o n .
s till
and
acid ,
in
stum p s o c k e t s
co m p lain ts.
and a r e
chrom ic
membrane
sore
Eusol
B ow els o p e n .
o n ly w here
and a s c o r b i c
acid .
Day 1 2 .
- M uch b e t t e r .
Day 1 3 .
-
Ready f o r
D ie t.-
and p o r r i d g e ,
roast
tin n ed
w ith "b eans
bread,
or b o iled
carro ts.
Cup o f t e a ,
and p o r k " ,
- M.M.
On A d m i s s i o n .
per d ay .
tin n ed
sausages
p o ta to es,
and
jam .
meat
and e g g s . D in n e r
cabbage,
sp ro u ts,
and t h e n
-
tu rn ip
or
"plum d u f f " .
Supper a t n ig h t
and c h i p s ,
jam ,b a c o n
- L iver
fresh fish
Tea-
and b a c o n ,
and c h i p s ,
te a,
and c h e e s e .
29 y e a r s .
M inesw eeper f o r
Temp. 9 7 . 8 ° . P u l s e
T ourniquet t e s t
1030.
b re a d ,b u t t e r (ad l i b . ) ,
S w eet on S u n d ay s o n l y
and b r e a d
b u tter
Case 9 .
S.G .
d isch arg e.
B re a k fa st- Tea,
and e g g s
M eat,
S o ck etsalm ost h e a le d .
68/m in.
n eg ativ e.
A c i d . No b l o o d ,
b ile,
4 m onths.
B ow els r e g u l a r once
U rin e -
straw
co lo u red .
s u g a r o r album en. T h r o a t
and
116.
gum s w a b s p o s i t i v e .
B lood
count.
W .B .C .
R .B .C .
10 ,5 0 0 .
M onocytes 2 $.
U rin ary v i t .
spec.
/
E o sin o p h ils
C.
acid
per
c.mm. H . b .
c.mm. P o l y m o r p h s .
77$.
F irst
C .I.
0 .9 2 .
0$.
spec,
u rin e
6 h o u rs s p e c . 3 .1 8 m g.$.
ex creted
94$.
L ym phocytes 21 $ .
0$. B aso p h ils
estim atio n .
2 . 7 6 mg . $ .
N ico tin ic
5 ,1 0 0 ,0 0 0
p e r day e q u a l to
2 .5 m g.$.
3 hours
(D eficien cy of v i t . C . ) .
1 1 . 1 5 mg.
in
40 o z s .
u rin e.
C om plaint
sid e
and h i s t o r y . -
b leed in g .
A p p etite
days
No d i a r r h o e a ,
eye t r o u b l e
per
day.
O.E.
ten d er
ad en itis
L. t o n s i l
them and
in so m n ia,
g astric
S lig h t
lo o k s p a le ,
p resen t.
sig h tly
are
in fe c tio n ).
larg er
slig h tly
H eart,
th an
an d a p p l i c a t i o n
in trav en o u sly .
700 mg.
Temp.
T hroat
p o t.
L.
sh o tty
s till
L,
s till
red,
is
on u p p e r p o l e
R.
and L.
o f L.
cerv ical,
but not g ro ssly
C .N .S .
scalin g ,
and
sw o llen .
to
th e
4 i.d ..
and e a r l y
c a s e o f gum
e y e s - N .A .D .
b ru sh in g ,
acid
ch lo r.
of te e th
a v e ry m ild
abdomen,
in jecte d .
ad en itis
sore,
from th r o a t
to n sil
but
but
save
Eusol
gums.
sp ray in g
0 . 4 5 gm. N .A .B .
S a tu ra te w ith
asco rb ic
Sm all w h ite p a tc h p e r s i s t s
s till
to n sils
Gums a p p e a r h e a l t h y .
Diet. - Same as case 6.
sw o llen .
slig h t
pain
and r e d d e r t h a n R.
shows 45 m g.$ o f
and L.
s till
very
300 mg.
asco rb ic
asco rb ic
Throat b e t te r .
Day 7 . - F i t
on L.
ten d er.
e a s ie r th a n p re v io u sly .
still
larg er
and t e n d e r .
random s p e c , u r i n e
glands R.
it
t.d .s.
- No c o m p l a i n t s
of t h r o a t .
(th is
R outine
G arg.
down.
has v a n is h e d
Day 6 . -
vague p a in s ,
Smokes 2 c i g s .
dy sp h ag ia.
Some t a r t a r
o f 10$ chrom ic
Day 2 . - T o n s i l s
glands
a few
R. Gums h a v e w h i t i s h m e m b r a n e o n
sw o llen .
lu n g s,
Day 1 . -
C o u rse.-
Day 4 .
tro u b le ,
b re a th heavy.
T o n sils
o f lo w e r L. m o la rs
Day 3 .
on L.
p e r f e c tly w ell t i l l
U l c e r w i t h w h i t e membrane o v e r
caries
and t e n d e r n e s s
Heavy d r i n k e r .
P atien t
sid e.
th ro at
good and h a s f e l t
nor b ro n ch itis.
to n sil.
acid,
in
2 d a y s . No p a i n i n g u m s a n d t h e y h a v e n o t b e e n
of neck f o r
ago.
P ain
for
L.
M embrane
Gums I . S . Q .
in L.
sid e
cerv ical
fceid b t.d .s.
as
a
acid .
S h o tty non te n d e r
d isch arg e.
117.
Case 1 0 .
-
E .D .N .
35 y e a r s .
o f f Faroe
On a d m i s s i o n .
every day.
Temp.
b ile,
b lo o d ,
B lood
count.
9 8 .4 °.
sugar
R .B .C .
F irst
spec,
53 m g . $ .
ad m issio n ).
/c.m m . Hb.
3 hours,
acid
T his
p erio d
per
been ta k in g
in
retu rn
asco rb ic
poor.
on h i s
No h i s t o r y
b lindness n o r rh eu m atic
ounce p i p e
tobacco
and i n
clear.
red
but
p illo w .
in h is
to
H eart,
8 . 7 5 mg.
a year
fru it
in Faroe
or fresh
food
a t K ir k w a ll when t h e y
in
the
d ie t
5 days w ith
duty b e fo re
acid
P ain
c u r e was
reg u la rly
and h i s
sin ce
gums a r e
p ain s.
is
present
all
th en
in
gums.
over.
m outh i n t h e m o r n in g s .
of d iarrh o ea,
chest tro u b le,
D rinks h e a v ily ,
and b l e e d
no c a r i e s .
S h o tty ,
lu n g s,
easily .
n ig h t
smokes h a l f
an
on a n t e r i o r
B reath very f o u l.
non t e n d e r
abdomen,
Y ello w ish m a rg in a l u l c e r s .
Some e x u d a t e
bo th re tro -m o la r s u lc i .
but n o g l o s s i t i s .
spent
before
per day.
O.E. Gums s w o l l e n ,
T artar o f t e e t h
acid
He now c o m p l a i n s o f b l e e d i n g
an e x tre m e ly bad t a s t e
A ppetite
6 hours spec.
O c to v e r 1940 f o r
as b e fo re .
He h a s
estim atio n .
40 m g . $ .
called
the same c o n d i t i o n
blood
C.
day e q u a l to
h a d no l o c a l t r e a t m e n t
o ften
1 . 0 1 . W .B .C .
asco rb ic
(11 w e e k s ) . He h a s
is
1015.
alw ays t i n n e d .
h i s gum c o n d i t i o n b u t h e h a d t o
There
QI.
and b u t t e r w ere p l e n t i f u l
another h o s p ita l
He h a s
S .G .
Gum s w a b p o s i t i v e .
He h a d n o f r e s h
e x c e p t when t h e y
m eat. F is h
spec.
o ffic e r has
h o w e v e r. The m eat w as n e a r l y
com plete.
clear.
78$.
b u t h a s had
ex creted
on a t r a w l e r .
He w a s i n
U rine
L y m p h o c y t e s 3 4 $ . M o n o c y t e s 7$ .
57$.
C o m p la in t and h i s t o r y . -
o b tain ed f r e s h
B ow els open once
and album en - n i l .
20 m g .$ .
N ico tin ic
during t h a t
n eg ativ e.
s u b - s c u r v y now,
Islan d w aters
70 / m i n .
B aso p h ils 1$. U rin ary v i t .
u rin e
(no
P ulse
3 ,8 4 0 ,0 0 0
9 ,800/c.m m . P o ly m o rp h s.
E o sin o p h ils 1$.
R .N .Y .R . T ra w le r f o r 1 y e a r
Islan d s.
T ourniquet t e s t
A cid,
L t.
C .N .S .
ad en itis
R.
aspects
F u rre d tongue
and L.
T o n sils
and e y e s - N .A .D .
Course, - D ay 1 . Gums swabbed with N . A . B .
(.3
grm. in 1 5 c c . water)
after spraying with hydrogen peroxide (l part to water 3 parts)
Te e th n o t t o
Vit,
%
c.
7.
-
be brushed
250 mgs.
Gums s t i l l
/
at f ir s t.
M ist,
ferri
amm on .
cit.
1 o z. T .D .S .
day g iv e n .
slig h tly
sw o llen ,b lee d in g in
p laces
and
slig h tly
sore.
They lo o k e d
the m a rg in s.
rath er b e tte r but
He w a s m a d e t o
a fte r h is
n ic o tin ic
the
tim e
first
sto p
acid t e s t .
T eeth
ten d ern ess
ab norm ally
red
at
sm oking w h ic h he had resum ed
and m outh i r r i g a t e d
p e r o x id e was c a u s i n g
s till
scaled
and p o lis h e d f o r
w ith E u so l,
and r e d n e s s
as hydrogen
of th e
gums.
Some
b leed in g .
Day 1 0 . - No c h a n g e .
Day 1 4 . -
C on d itio n has
Day 1 5 .
- F it
D iet.
See h i s t o r y
-
Case 1 1 .
for
J.P .O .
On a d m i s s i o n .
d iarrh o ea.
A lbum en,
cleared .
d u ty .
of case.
35 y e a r s . P a t r o l
Temp.
9 7 .8 °. P u lse
T o urniquet t e s t
sugar,
sh ip
b ile
80/m in.
n eg ativ e.
and b lo o d
for
4 m onths.
B ow els o p e n ,
U rin e.
- n il.
A cid.
D ep o sit
no
S .G .
1024.
of u ra te s.
Gum
swab p o s i t i v e .
B lood c o u n t .
W .B.C.
R .B .C .
4 , 3 0 0 ,0 0 0 ,/c.m m .
1 3 , 6 0 0 . /c.m m .
M onocytes 3 $ .
U rin ary v i t .
3 hours
P oly m o rp h s.
E o sin o p h ils.
C.
spec.
estim atio n .
2 .4 m g.$.
N ico tin ic
acid
C om plaint
and h i s t o r y .
ex creted
b l e e d i n g gums f o r
B rushes t e e t h
per d ay .
D isch arg ed
sw eats.
82$.
2 4 .hours
- P ain
reg u la rly .
O.E. V i n c e n t 1 s D i s e a s e
g lo ssitis.
weeks
and t a s t e
or tro u b le w ith
and
Smokes 20 c i g s .
chest tro u b le
eyes.
co n fin ed
A nkles u se d to
P rom inent
No n i g h t
spaces.
sw ell but
in terd en ta l
No c o u g h .
not la te ly
C h e s t - H .M . v e s i c u l a r
rales
at bases
and b o t h
H eart,
abdomen and e y e s N .A .D .
apices.
all
p ap illae.
had b e e n rem oved and no d i s e a s e
ra th e r pale.
v it.C .)
i n m outh i n
1937 ow ing t o
in
in
8 . 2 mg.
Heavy d r i n k e r .
w ith s c a t t e r e d
C .N .S .,
(def.
o f gums - w h i t e m em brane v i s i b l e
B reath bad.
T o n sils
Thin p a t i e n t ,
ago.
0.93*
1 . 3 mg. $ .
i n gums f o r t h r e e
S u ffe rs from b r e a th le s s n e s s
Tongue f u r r e d .
equal to
fro m U .S . Navy i n
R heum atic f e v e r 9 y e a r s
u rin e
2 .2 m g.$.
Heavy b r e a t h
rheum atic p a in s ,
C .I.
L ym phocytes 1 5 $ .
spec,
6 hours spec.
in
80$,
B aso p h ils 0$.
F irst
one w eek.
m orning.
No d i a r r h o e a ,
0$.
Hb.
over.
No
of to n sil
in
all
B ales v e ry
beds
areas
scan ty .
Sane c a r ie s of b i c u s p i d s .
h is lower m olars had been f ille d , and sane
ah
of th e f i l l i n g s w r e o v e rla p p in g and form ing c re v ic e s betw een f i l l i n g s and
to o th .
X_r a ^r 0f c h e s t - a p i c e s
c le a r .
Some ev id en ce o f c h ro n ic b r o n c h itis
and i n c r e a s e d shadow ing o f b a s e s .
Ho sputum p ro d u c e d .
C ourse.
Day 1.
a c id p a i n t s .
R o u tin e s c a l i n g , r o t a r y b r u s h in g , E u s o l s p ra y and 10
c h r o n ic
S a tu r a t e w ith a s c o r b ic a c i d - 700 mgs. t . d. s .
Day 2. - LI. 17. E u so l an d u s u a l gum. tr e a tm e n t.
gay 3. - Gums I . S . Q .
.2S5 gm. N.A.B. in t r a v e n o u s ly .
to d a te an d i s s t i l l n o t s a t u r a t e d .
Has h ad 4200 mgs. v i t . C.
C o n tin u e IS ta b s . v i t .
t . d .s .
Day l-'f, -
G-ums i . E, q, an d a c h in g .
w ith v i t .
c . , t h e r e f o r e g iv e 300 m g s ./d a y and r o u t i n e E u s o l m.w. and ch ro m ic a c id ,
Day 3. -
Gums s t i l l te n d e r .
organism s o r E .L .B .
T h ro a t c l e a r and no cough*
How s a t u r a t e d
P a tc h on L. t o n s i l to d a y . Swab n eg , f o r V in c e n t’ s
T en d er L. c e r v i c a l a d e n i t i s .
Heavy b r e a t h . U su a l
tre a tm e n t + G-arg. P o t. c h i o r.
Day 6. - Temp. 99*8°. T h ro a t and uvula r e d . -s u p e rim p o s e d s t r e p t o c o c c a l
in f e c tio n ( s e v e r a l c a s e s i n w a rd .)
H and B 693 ’
fay 7* - Gums 1 . 3. Q. th o u g h s l i g h t l y l e s s r e d .
Shotty n o n - te n d e r c e r v i c a l a d e n i t i s .
2 ' t . d. s . + r o u t i n e tr e a tm e n t,
Temp,
n o rm al. T h ro a t b e t t e r .
LI an d B d is c o n tin u e d . C h e st h a s te m p o r a r ily
c le a re d w ith, r e s t an d w arm th.
Day 11. - V i s i b l e im provem ent i n gums b u t n o t y e t r e a d y f o r d is c h a r g e .
Day IQ.. - D is e a s e c o n f in e d t o s m a ll p a tc h on u p p e r jaw ’ s o u te r a s p e c t 'a t
canine t e e t h .
Day
R e s t o f gums f ir m an d pink*
26 - D is c h a rg e d .
Diet, - B r e a k f a s t .
Tea o r c o f f e e e , ti n n e d m ilk , s u g a r , b r e a d and b u t t e r ++•
fresh f i s h o r s a u s a g e s ( tin n e d ) o r b aco n and e g g s.
- w e d c a r r o t s o r cabbages.
D in n er - M eat, p o t a t o e s ,
Plum d u ff or r i c e pudding.
Supper - L iv e r and.
h e on, sa u sa g e s and mash, I r i s h stew o r k ip p e rs , p o ta to e s , b re a d , b u t t e r ,
jam and te a .
Case 12.
17. P. 22 y e a r s ,
p r e v io u s ly .
Or adm ission.
p ad d le minesweeper (x) f o r 3 m onths. D e stro y e r
Temp. 98.2f°. P u ls e 8 6 / min. Bowels open. T o u rn iq u et t e s t n e g a tiv e
Urine. 3.C . 1020. A cid. B ile , b lo o d , su g ar and albumen - n i l . Gum and th r o a t
^abs p o s i t i v e .
Blood co unt.
R .B.C . 4 ,9 0 0 ,0 0 0 /c . mm. Hb. 9 4 ^ 8 .1 .
.9 6 . Y7.B.C. 10,8 0 0 / c .111
Uolyraorphs. 7Q1. Lymphocytes 22j... M onocytes 6^7. E o s in o p h ils 2y, B a s o p h ils 0;
120.
U rin a ry vuc, 0 , e s ti m a t io n . F i r s t s p e c . 2 ,1 5 rag*4*
6 h r s . s p e c . 2 .2 rag.;;.
3 h r s . s p e c . 2 .4 5 mo.:..
( V it. C. d e f ic ie n c y ) .
N ic o tin ic a c i d e x c r e te d p e r day e q u a l t o 6 .3 rags, i n 39 o zs.
C om plaint a n d h i s t o r y . -
S ore t h r o a t f o r 8 d a y s.
Gums s o re f o r 4 m onths and
have b e e n b le e d in g on an d o f f s in c e th e n . ITo r h a s p a i n s i n th e gums.
A lso h a s p a i n
in R. s id e o f n e c k .
Ho
A p p e tite p o o r l a t e l j r and s l i g h t l o s s o f w e ig h t.
d ia rr h o e a , b r o n c h i t i s o r " rh e u m a tic ” p a i n s .
Ho 'tr o u b le w ith h i s e y e s ig h t . Uon~
smoker and. n o n - d r in k e r .
0.E*
B r e a th fo u l*
Tongue m o is t an d f u r r e d . G-ums s w o lle n , r e d .and te n d e r .
U lc e r a tio n a t t e e t h m a rg in s . T a r t a r on t e e t h b a s e s and. w h ite membrane on o u te r
a s p e c ts o f gums and b e h in d u p p e r c e n t r a l i n c i s s o r s .
II. t o n s i l r e d , sw o lle n
and u l c e r a t e d , w ith a w h i t i s h membrane i n th e c e n t r e . R. te n d e r ,
s u b m a x illa ry
a d e n itis .
H eart, lu n g s , abdomen en d e y e s - IT. A .D ..
Course. -
Day 1. S a tu ra t e w ith a s c o r b ic a c i d , 700 mgs. t . d. s . R o u tin e s c a li n g
etc, and 10
chrcm . a c i d d a i l y .
.4 5 gram. N. A.B. in tra v e n o u s ly *
Bay 3* ~ T h ro a t f r e e fro m p a in .
Membrane g e t t i n g y e llo w is h an d g r a n u la r , C-ums
1. S. Q.
Bay
5* T h ro a t r a p i d l y im p ro v in g .
C-ums l e s s r e d and f ir m in g .
on them i n th e m o rn in g s.
Bay 7* - T h ro a t b e t t e r .
C e r v ic a l g la n d s s h o t t y an d n o n - te n d e r .
S t i l l have w h i t i s h membrane o f V in c e n t’ s d is e a s e
On 300 mgs. a s c o r b ic a c i d d a i ly .
Curas im p ro v in g .
U lc e r a tio n c l e a r i n g ro u n d to o t h b a s e s .
Bay 9* - O nly one s m a ll, r e d te n d e r a r e a ro u n d b a s e o f L. lo w er b i c u s p i d
tooth. •
Bay 10. - G-ums h ealed .. Ready f o r d is c h a r g e .
Biet H is to r y .
Case 13.
Same a s c a s e 3*
M.Ii. 43 y e a r s .
to ad m issio n . .
diarrhoea.
Acid,
P a d d le sw eeper ( l ) f o r 8 m onths,
Temp. 97*2°.
P u ls e 72 p e r m in u te .
T o u rn iq u e t t e s t n e g a t iv e .
U rin e c l e a r and w a te ry , lo o k in g . S.G. 1010.
B i l e , b lo o d , album en, s u g a r - n i l .
Slood c o u n t.
P., B. C.
?°lyuorphs. 704.
Gum swab " p o s i t i v e " #
4 , 2 5 0 ,000/c.m ra. ITb. 86y .
ly m p h o c y te s 244.
Mnary v i t . 0 . e s ti m a t io n .
Bow els open b u t no
m o n ocy tes
C. I # 1 .0 2 . U.B.G.
1 1 ,0 0 0 /c.mm,
5y. E o s in o p h ils 05. B a s o p h ils 11.
F i r s t s p e c . , 8 rags. 4 .
3 hrs. s p e c , u r i n e •87)1.
^ hrs. s p e c . . 91 „ ( d e f . Of v i t . c . ) .
lic o tin ic a c i d e x c re te d , p e r day e q u a l t o 5 .1 rags.
fi® p la in t an d d u r a ti o n . -
l o r e gums f o r one m onth and b le e d in g on to p and b o tto m
gums*
C o n s u lte d a d e n t i s t th e day b e f o r e a d m is s io n t o hav e a. to o t h e x t r a c t e d
which w as done (trpner*
Ij.
b ic u s p id ) and th e c o n d i tio n was d is c o v e re d . Pie smokes
10 c i g s . x>er d ry an d d r in k s h e a v ily .
Has b e e n o u t o f s o r t s l a t e l y .
d ia rrh o e a , p a i n s i n lim b s o r-e y e tr o u b l e .
Ho
Has h a d a cough, l a t e l y and wheeze
at n i g h t s .
O.E.
B o th gums i n f e c t e d w ith V in cen t* s d is e a s e . S w o llen , te n d e r . P ro m in e n t
i n t e r d e n t a l p a p i l l a e an d membrane i n p_. r e tr o - m o la r s u lc u s .
g lo s s itis ,
B r e a th h eav y . Ho
t o n s i l s , r e d , b u t no u l c e r a t i o n o r membrane.
C e rv ic a l a d e n i t i s R. an d L,
C.N. S. -.• H .t.D .
C a r ie s and t a r t a r o f t e e t h .
Ho k e ra ta m a la fiu a .
H e a r t, abdomen end
Lungs - s l i g h t b r o n c h i t i s w ith v e s i c u l a r R.H.
and s c a t t e r e d r a l e s .
Course.
Day 1.
S a tu r a t e w ith a s c o r b ic a c i d . J00 mgs. t , I s .
F u ll d ie t.
R o u tin e
scalin g e t c . , end 10 , ch ro m ic a c i d a p p l ie d d a i l y . C a r b o lis e d d r e s s in g to c a r i ous
fight lo w e r m o la r.
l i s t e x p e c to r s n s t . d. s . ■
■
Day 4* ~
G-ums o n ly s l i g h t l y te n d e r . S t i l l san e membrane i n p la c e s on o u te r
aspects.
Red c o lo u r g e t t i n g l e s s in t e n s e .
S l i g h t cough .b u t c h e s t c l e a r .
Ascorbic a c i d - 300 m g ./d a y . 1 1. T v . R u so l. D a ily ch ro m ic a c i d p a i n t s .
Day 6.
th e o n ly te n d e r a r e a i s ro u n d a f i l l e d to o t h i n th e u p p e r l e k t
bicuspid area..
Only s l i g h t b le e d in g ; now.
R u so l M . T 7 .
e t c , and a s c o r b ic a c i d
continued.
’
Day 8. - Ho p a i n an d r e d n e s s gone.
•
-•
Day. 9* - D is c h a rg e d .
Diet.
Same a s c a s e 3*
.
Case 14. - A.Y/.R. 21 y r s . T ra w le r
On ad m issio n .
Temp. 97* 2 °.
Tourniquet t e s t p o s i t i v e .
ibumen.
.’
(z)
f o r 10 m o n th s.
P u ls e 6 6 /in in . .
Bow els open, b u t no d ia r r h o e a .
U rin e - S.G-. 1030.
A cid . Ho b i l e , b lo o d , s u g a r o r
G-um swab " p o s i t i v e . "
Blood count. - R .B .C / 4 ^ 0 0 0 ,0 0 0 /c.ium , Iib. 7 8 /.
C. I . .973* U .B .C . 7>800/c,m m .
Bolymorphs. 70,4 L ym phocytes. 27)4 H o n o cy tes 3/*
binary v i t . C.
estimation.
hrs, s p e c . 1 .6 m gs., .
-
E o s in o p h ils (14 B a s o p h ils
0;
F i r s t s p e c . 2 .3 m g s ./. 3 h r s . s p e c . J-.6 m g s ./,
( Y it. C. d e f ic ie n c y ) ,
'
^ c o tin ic a c i d e x c r e t e d p e r day e q u a l to 4 . I 4 mgs,
^ p l a i n t an d h i s t o i y . - , Gums b le e d in g on c l e a n in g
% ila r ly .
Ho p a in .
beer e v e r r n i d h t .
Smokes 12 c i g s . : p e r. day.
t e e t h f o r 3 d a y s.
G lean s t e e t h
’ F a i r l y heavy' d r i n k e r , 4 o r 3 p i n t s
A n o e ti’t e good. Ho l o s s o f w e ig h t. Ho p r e v io u s rheum atism , o r
122*
d ia r r h o e a . ITo c h e s t t r o u b l e s .
O.D.
lie h a s f e l t p e r f e c t l y f i t l a t e l y .
Ilo d .erate d e g ree o f clisea.se o f g u n s.
o f f e n s iv e .
C opious w h ite membrane a l l o v e r. B re a th
I n t e r d e n t a l p a p i l l a e p re m in e n t an d gums r e d .
No t a r t a r h u t brown
s t a i n a t b a s e o f t e e t h and a d eca y ed m o la r on th e l e f t s i d e . No a d e n i t i s .
t
No g l o s s i t i s .
L un g s, h e a r t , abdomen, C.N. S. an d e y e s . - N.A.D.
C ourse. Day 1 . r o u t i n e s c a l i n g , r o t a r y b ru s h in g and s p ra y in g w ith E u so l, D a ily
p a in tin g o f gums w ith 10.> ch ro m ic a c i d .
.4 5 grain. N.A.B. in tr a v e n o u s ly .
No. v i t . C.
Day 5. ~
L e s s fo r m a tio n o f membrane.
Day 8. -
G-ums f ir m and. h e a l th y .
D ie t H a s to ry . -
G-ums f ir m e r an d l e s s r e d . No b le e d in g .
No b le e d in g and n o u l c e r a t i o n .
D isc h a rg e d .
B re a k fa .s t - B aro n o r s a u s a g e s an d eggs e v e ry m o rn in g . Bread.,
b u t t e r an d tea..
D in n e r. -
or t i n n e d c a r r o t s ) .
l i e d an d p o ta to e s w ith one v e g e ta b le (cab b ag e
No f r e s h f r u i t , b u t tin n e d f r u i t m ost d ay s.
L iv er o r b a c o n and p o ta to e s ,
D ish and p o ta to e s .
S u p p er. -
C o ffe e , o r t e a , b r e a d , b u t t e r
■and c h e e s e .
P a ti e n t co m p la in e d o f th e m onotony o f th e d i e t w h ich was alw ays o v erco o k ed .
Case 1% . B.M.
27 y e a r s .
On a d m is sio n .
Temp. 97* 4°*
y
p o s iti v e .
T ra w le r (z ) f o r 11 m onths.
U rin e S.G-, 1020.
P u ls e JO/is&xi*
A c i d .»
C o n s tip a te d .
T o u rn iq u e t t e s t
No b i l e , blood, o r s u g a r .
Albumen - V.D. T.
C-um swab " p o s i t i v e 1'.
Blood c o u n t.
Polymorphs
1.13.C. 4 ,8 6 0 ,0 0 0 .
Lym phocytes 28,8.
U rinary v i t . C. e s ti m a t io n .
6. h r s . s p e c . 3 J 4 m g.y,
Hb. 98;;. C .I . 1 .0 2 . T7.B.C. 9*800 /c.m m .
ll o n o c y te s 6;4 E o s i n c ^ M l s Ifo* B a s o p h i l s oP.
F i r s t s p e c . 2 .1 3 m g .a,
3 h o u rs s p e c . 2 .3 6 mg.;
( v i t . C. d e f ic ie n c y ) .
N ic ito n ic a c i d e x c r e t e d p e r day e q u a l t o .8 .0 mg.
Complaint and h i s t o r y . - No s p e c i a l c o m p la in ts b u t h a s a b a d t a s t e i n h i s
mouth i n th e m o rn in g s. S een b y a d e n t i s t 4 d ay s ago f o r a " f i l l i n g " an d
c o n d itio n w as d is c o v e r e d .
He b r u s h e s h i s t e e t h r e g u l a r l y .
No b le e d in g r e c e n t l y
but he h a s h a d p e r io d s o f b le e d in g gums on a n d - o f f f o r s e v e r a l'w e e k s . A p p e tite
is good.
S l i g h t l o s s o f w e ig h t l a t e l y .
had d ia r r h o e a .
then.
0,3.
N on-sm oker and n o n - d r in k e r .
N ever h a s
5 m onths ago h a d c r a m p - lik e p a in s i n h i s le g s b u t none s in c e
No lu n g tr o u b l e .
T e e th v e r y c le a n and no t a r t a r ;
...one f i l l e d m o la rs one o f w h ic h was
fre s h ly r e p a i r e d and h a d h a d no f i l l i n g f o r san e w eeks.
A n o th er te n d e r , c a r i o u s
m o lar was p r e s e n t .
T o n s ils c l e a r ,
,.--light membrane, r e d n e s s an d s w e llin g o f th e gums.
G h o tty , n o n - te n d e r R. an d L. a d e n i t i s
abdomen,
C.H. S. and e y e s - N .A .D ..
C ourse.
Day 1. -
R o u tin e s c a l i n g , e t c .
D a ily
S a tu r a te w ith a s c o r b ic a c i d 700 rags. t . cl* s .
i n n eck .
H e a r t, lu n g s ,
p a i n t w ith 1 Ofa chrom ic
a c id .
Tem porary c a r b o l i s e d d r e s s in g
in one c a r i o u s m o la r.
Day 2. -
D a ily tr e a tm e n t + .4 5 gm. IT.A.B.
Day 4» S a tu ra te d , w ith a s c o r b ic a c id ,
G-ums- I. S. 0. '
Day 6.
G-ums f ir m e r an d l e s s membrane.
Day 8.
O nly s m a ll a r e a s o f d ise a .se l e f t .
Day 10. P i t f o r d u ty .
D iet. -
in t r a v e n o u s ly .
Ho b le e d in g .
D is e a s e stam ped o u t.
Game a s c a s e Id .
Case 16. - E. J.17. 33 y e a r s ..
D e s tr o y e r f o r 10 m onths.
On a d m is sio n .
P u ls e 100 p e r rain. Bowels open b u t no d ia rrh o e a *
Temp. 9 8 .4°#
T ourniquet t e s t p o s i t i v e (30 s p o ts i n 3 rain s.-).
Albumen, b i l e , b lo o d , s u g a r - n e g a t iv e .
U rin e . 3.C-. 1022 f a i n t l y a c id .
Gum and t h r o a t swabs - p o s i t i v e .
Blood c o u n t. - R .B .C . 4 * 5 6 0 ,0 0 0 /c.m tn. lib. 103;j, C .I . 1.14* T/.B.C. 15,000/c.rom .
Polymorphs. 684,
Lym phocytes 2^3. llo n o c y te s 7/4
Urinary v i t . C. e s ti m a t io n .
6 h r s . s p e c . 2 .3 5 rig. p .
F i r s t s p e c , u r i n e 1 .8 rag.;4
done.
G-ums spongy and p ro n e t o b le e d f o r severed, m onths. Bad
:aste i n m outh i n m o rn in g s.
A p p e tite good, and no " i n d i g e s t i o n ” .
e p ista x is and no p a i n s ’ i n j t s .
^&r on th e same d i e t .
3 h r s . s p e c . 2 .1 m g.t
( V it. C.. d e f i c i e n c y ) ,
n ic o tin ic a c i d e x c r e t i o n t e s t n o t
Complaint an d h i s t o r y .
E o s in o p h ils Cfo. B a s o p h ils OR*
o r lim bsp
Wo c h e s t tr o u b l e .
Wo a t t a c k s o f
Had. b e e n a t s e a s in c e o u tb r e a k o f
T h ro a t h a s b e e n s o r e f o r 3 d ay s.
Ion-smoker, b u t d r in k s when a s h o re .
I»E. W ell n o u r is h e d p a t i e n t .
H e a r t, lu n g s , abdomen, C.N. S. an d e y e s - W .A.D..
tonsils - f ilm y w h ite e x u d a te i n p a tc h e s on e a c h s id e and R. t o n s i l i s s w o lle n ,
'Ic e ra te d an d lia s a s lo u g h on i t .
7een th e t e e t h .
feeth S o c k e ts .
E x te n s iv e c a r i e s .
T e e th and gums - T a r t a r a t b a s e s and
G-ums s w o lle n 'a n d b le e d e a s i l y from th e
T y p ic a l f ilm y e x u d a te , on gums1 o u te r m a rg in s an d i n th e s u l c i
&ind th e lo w e r b a c k m o la rs .
S m all u l c e r an d w h ite p a tc h b e h in d u p p e r c e n t r a l
^ i s s o r s an d s m a ll u l c e r w ith w h i t i s h s lo u g h on p o s t e r i o r p a r t o f s o f t p a l a t e ,
h i s i n R. sub-im ucU .lary and R. i o n s i l a r g la n d s .
124*
C ourse.
Day 1.
F u l l d i e t . R o u tin e tr e a tm e n t w ith s c a l i n g , e t c . an d 1 0 /
ch ro n ic a c i d d a i l y .
S lo u g h on t o n s i l tr e e .te d w ith 1 0 / c a r b o l i c a c id .
4 h o u r ly m.w. o f Ii2 02 .
Day 3* -
*3 gPU H.A.B. in t r a v e n o u s ly .
Day 3. -
T o n s il s c l e a r ,
G-ums f ir m e r .
ITo e v id e n c e o f film y- OXlldiat e .
Day 9# ~ F i t f o r d is c h a r g e .
Diet h i s t o r y . -
C an teen M essin g .
B r e a k f a s t - B re a d , b u t t e r ++, t e a .
L iver, b a c o n , ti n n e d s a u s a g e s and e g g s.
and one v e g e ta b le .
P o r r id g e .
P u d d in g . T in n ed m ilk alw ay s.
but th e p a t i e n t n e v e r ta k e s i t .
D in n er - M eat, p o t a t o e s ,
F re s h f r u i t i s a v a i l a b l e
Tea - B re a d , b u t t e r en d jam w ith te a .
Supper - F is h , s a u s a g e an d m ash, l i v e r and p o ta to e s .
This i s a l i b e r a l d i e t b u t n e v e r v a rie d *
B read , b u t t e r an d te a .
The f a u l t was th e p a t i e n t s own; t h a t
he h ad n e v e r p a r ta k e n o f th e a v a i l a b l e f r u i t s in c e he d i s l i k e d f r u i t .
Case 17.
F. J .
On a d m issio n .
18 y e a r s .
D e s tr o y e r (a ) f o r 6 m onths.
Temp. 1 0 0 .6 ° .
P u ls e 9 6 / m in.
Tourniquet t e s t done on 4 t h day - n e g a tiv e .
blood, album en o r s u g a r.
Blood c o u n t. - R .B .C .
Polymorphs. 829..
U rin e - 8.G-. 1030.
Acid* Ho b i l e ,
Gum swab ’’p o s i t i v e " .
5 ,2 0 0 ,0 0 0 /c . ram.
Lym phocytes
184.
Eb. 9 6 /.
C .I .
M onocytes 0 / .
Urinary v i t . C, e s ti m a t io n (Done on 6 t h d a y ).
.7 m g ./.
Bow els - te n d t o b e c o n s ti p a te d .
6 h r s . s p e c . 4^ 55 mg., ;*
.9 2 .
U .B .C . 15*300.
E o s in o p h ils 0 / . B a s o p h ils Ch.
F i r s t s p e c . 1*8 m g ./
3 h r s . spec*
( V it. C. d e f i c i e n c y ) .
10 n i c o t i n i c a c i d e s ti m a t io n done.
Oarplaint and h i s t o r y .
P a t i e n t b r o u g h t t o s i c k b ay c / o s e v e r e ab d o m in al p a in
M ch came on a t 1 1 .1 5 a*n. (10 h o u rs p r e v io u s ly ) su d d e n ly .
licldle o f abdomen and d o u b led him- u p .
P a in w as a c r o s s
Bow els open p r e v io u s day an d he h a d h ad
nothing b y m outh s in c e P.M. y e s te r d a y .
Ho h is to r y o f p r e v io u s stom ach tr o u b l e .
coated*
3nokes an d d r in k s i n m o d e ra tio n .
Tongue
G-ums s w o lle n , spongy an d w ith V in c e n t’ s membrane a l l o v e r. Ho c a r i e s
tet t a r t a r o f t e e t h .
Abdomen h e l d r ig i d *
P a in on p r e s s u r e i n a l l a r e a s ,
abdom inal r e s p i r a t o r y movement and abdomen shows no movement on co u g h in g .
?.H. - H.A.D.
ITo v o m itin g .'
and accom m odation.
% b e r g ’ s s ig n + to o .
^ o ien u m
C h e st - H .A .P.
Knee j e r k s +.
T en d e rn ess i n e p ig a s tr iu m
P u p ils r e a c t to
an d i n R* I l i a c fo s s a -1- 4- •
T e n ta tiv e d ia g n o s is was a p e r f o r a t i o n o f p a r t 1 o f th e
w ith th e c o n t e n ts tr i c k li n g ; down th e R. p a r a - c o l i c g u t t e r .
125 .
I n v e s t i g a t i o n s d o n e :- H a lf h o u r ly p u ls e - r a t e r i s i n g ; L eu c o cy te c o u n t15, GOO /c.m m . ; X -ra y diaphragm - no g a s p o c k e t se e n .
U r in a ry r e p o r t - N.A.D.
abdcm en p r e p a r e d f o r o p e r a tio n an d 1 c . c. Omnopon and S c o p o lm in e
g iv e n . Abdcmen
in c is s io n .
opened u n d e r g a s , Op an d E th e r .
R e c tu s m u scle s p l i t .
Upper r i g h t p a ra m e d ia n
E scap e o f p u t r i d f l u i d on open in g abdomen.
P e r f o r a t i o n s e e n on a n t e r i o r w a ll o f duodenum a b o u t 1 i n s . d i s t a l to
p y lo r u s ,
r e r f o m , .about R i n s . i n d ia m e te r an d ed g es a lm o st c a r t i l a g i n o u s
in h a rd n e ss.
Ho s u t u r e
c o u ld be made t o s t a y i n ducsbnum e i t h e r w ith
L am b ert suturing'; o r p u r s e - s t r i n g .
After* r e p e a te d f u t i l e a tte m p ts to s u tu r e
tire p e r f o r a t i o n -a- p ie c e o f a d j a c e n t amentum was s u tu r e d i n p o s i t i o n o v e r i t .
Abdcmen m s f u r t h e r e x p lo re d an d l l o r r i s o n ’ s pouch and p e l v i s s e e n to be
f u l l o f g r e e n i s h f l u i d w h ich d id n o t s m e ll.
As much a s p o ssib 3 .e was mopped
o u t and a s u p r a - p u b i c s t a b d r a i n i n s e r t e d down i n t o th e p e l v i s . A f u r t h e r
d r a in was i n s e r t e d i n t o M o rris o n ’ s pouch a t th e u p p e r en d an d th e ab d o m in al
i n c i s i o n w as s u tu r e d i n i n t e r r u p t e d f a s h io n .
C o n d itio n o f p a t i e n t was s a t i s f a c t o r y th ro u g h o u t.
1. 8000 u n i t s A. G. G-,. S. given*
2. R e c t a l d r i p
in s titu te d .
3. LTil b y raouth.
4 * llo u th t o i l e t t . d, s.
3. F o w le r’ s p o s i t i o n 011 coming ro u n d .
6, M orphia g r . o n e - s ix t h on r e c o v e ry an d re p e a te d , s . o. s .
Lay 2 . Temp. 1 0 0 .6 ° .
p u ls e 1GA p e r m in,
R esp s.
P a in i n abdomen b u t g e n e r a l a p p ea ran ce q u i t e good.
.20/m in*
Sw eating* I s h a v in g
c o n tin u o u s r e c t a l d r ip s a l i n e s .
Lay 3 . Temp. 99*8°.
P u ls e 94/rdn*
R esp s. 26 p e r min*
S l i g h t cough. S l i g h t -pain i n R. hypochondrium p r o b a b ly due t o tu b e . G e n e ra l
a p p e a ra n c e i s good* Tubes s h o r te n e d 2 i n s . m o rn in g and e v e n in g .
Lay 4*
Im p ro v in g .
Lay 5.
Abdcmen s o f t and becom ing s l i g h t l y d is te n d e d i n lo w e r h a l f . Tubes
removed. U rin e shows v e r y f a i n t t r a c e o f album in* R e c t a l f l u i d s d is c o n tin u e d .
On day 2 d i e t .
S l i g h t d is c h a r g e from s ta b wound.
Enema given* No symptoms.
Seen b y d e n t a l s p e c i a l i s t who i n s t i t u t e d th e r o u t i n e s c a l i n g , b r u s h in g , e t c . ,
and d a i l y p a i n t i n g o f gums w ith 10/ c h r o n ic acid*
Dsy 7.
i . e . 3 r d day o f tr e a tm e n t f o r "V incent’ s c h s e a s e .
± n in c gums t/ic h
1 O^
a c i d chra.ii, and m , i t , E u s o l 1 i n 4 ,
Day 8. ho symptoms o f stom ach t r o u b l e , S l i g h t p u r u l e n t dischai*ge from c e n tr e
o f e p i g a s t r i c ro u n d . D a ily gum tr e a tm e n t.
E u s o l v e ry f r e q u e n t ly . 7 th day
d ie t.
Day 10.
S a tis fa c to ry .
Remove a l t e r n a t e s u t u r e s .
G-ums b e c a n in g p a l e r and
f ir m e r .
L e s s membrane i n th e m o rn in g s.
Day 12.
A l l s u t u r e s now rem oved. S l i g h t s in u s i n ab d cm in al wound. •- ap p ly
sulphonam ide powcler.
G-ums a lm o st h e a le d .
Day 14* Gums h e a le d .
S t i l l o o zin g from ab d cm in al s in u s .
Day 3.6. S in u s i s now c le a n .
C o n tin u e d a i l y c h r o n ic a c i d t o gums.
T r a n s f e r r e d t o m e d ic a l ward, f o r m e d ic a l
tr e a tm e n t o f p e p t i c u l c e r .
V in c e n t’ s D is e a s e was c l e a r e d w ith 10 days o f v ig o ro u s tr e a tm e n t.
I t was
a s l i g h t a tta c k .
D ie t h i s t o r y . and e g g s .
ITo f r e s h f r u i t on th e menu.
Bread^ b u t t e r , t e a o r co co a .
e v e ry day.
P o rk o n 'S u n d a y s.
B r e a k f a s t - B acon o r s te a k
D in n er - M eat, r o a s t e d o r stew ed ,
P o ta t o e s and ti n n e d p e a s u s u a ll y .
v e g e t a b le s t h r e e tim e s a w eek, cabbage and. swede.
d u f f e v e r y day.
T in n ed m ilk .
O th e r
R ic e p u d d in g o r plum
Tea - B re a d , b u tt e 'r
, t e a and jam .
S upper - P o rk and. b e a n s , s a u sa g e ( t i n n e d ) , f i s h o r l i v e r and p o t a t o e s .
C ocoa, b read , and c h e e se .
Case 18.
l. ?.
On a d m is s io n .
24 y e a r s .
T ra w le r (a ) f o r 8 m onths.
Temp. 98*4°.
P u ls e
68 p e r . m in.
T o u rn iq u e t t e s t n e g a tiv e .
U rin e - c l e a r .
b lo o d , s u g a r o r album en.
Gum swab " p o s i t i v e " .
B lood c o u n t.
p e r c . mm.
2;..
E .B .C . - 4 ^ 7 7 0 ,0 0 0 /c.ram. Hb.
P olym orphs.
63. ,
Bow els
3.G . 1018.
c o n s ti p a te d .
A cid , h o b i l e ,
3Zfa». 0 . 1. ,99* W.B.C. 1 1 , 6 C 0
Lym phocytes
k o n o c y te s 4 , E o s in o p h ils
B a s o p h ils Op.
U rin a r y v i t . G. e s tim a tio n .
2 0 .0 m g .k ;
P i r s t specim en 3*7 m g .; 3 h r s . sp ecim en
6 h r s . sp e c . 2 3 .0 mg.; .
Ho su b sc u rv y now.
N ic o t in ic a c i d e x c r e te d p e r day e q u a ls 6.3 mgs.
C o m p lain t an d h i s t o r y . m onth.
H is gums have b een p a i n f u l and a c h in g f o r one
He c o n s u lt e d a n e ig h b o u rin g " s i c k q u a r te r s " 10 d ay s ago w here u r i n e
and b lo o d t e s t s showed th e
p r e s e n c e o f s u b -s c u rv y .
300 rags, a s c o r b ic a c id p e r
day.
C.
S in c e th e n h e h a s h a d
On a d m issio n h e r e h e i s
s a t u r a t e d w ith v i t .
P o r th e u a s t 10 days he h a s a l s o h a d a n t i s e p t i c g a r g le s an d l o c a l a r s e n i c
127
p a in ts ( i T . A . B .
7 ~ k
■>
<
i n g l y c e r i n e ) • T here h a s b e e n no s c a li n g o r d e n t a l
t r e a h a e n t . He f e e l s no b e t t e r and h i s gums h av e n o t c e a s e d to b le e d f o r
a month* No cough. S l i g h t " in d i g e s t i o n '' f o r 3 t o k y e a r s , w o rs e ly l a t e l y . .
Bad t a s t e i n m outh i n m o rn in g s. No n y c t a l o p i a , d ia r r h o e a n o r a c h e s
end' p a in s i n h i s lim b s .
He d o es n o t smoke b u t d r in k s b e e r i n m o d e ra tio n .
T y p ic a l- u l c e r i n L. r e t r o m o la r s u lc u s .
)
O.K. Gums r e d end b le e d in g an d c o v e re d v /ith d e b r is . T e e th v e r y f o u l and
c o v e re d v /ith t a r t a r . Y e llo w is h s lo u g h s a t t e e t h b a n e s on th e gums. A la r g e
c a r i o u s -molar i s p r e s e n t on L. s i d e . B r e a th o f f e n s iv e .
and m o is t b u t ho g l o s s i t i s .
c le a r.
Toungue f u r r e d
. T en d er a d e n i t i s on L. s id e .
T o n s ils and f a u c e s
H e a r t, lu n g s , abdcm en, C .N .S . and e y e s - N.A.D.
P re v io u s l o c a l
tr e a tm e n t h a s b e e n of. no , a v a i l .
C o urse.
Day 1. Thorough s c a l i n g , r o t a r y b ru s h in g v /ith p u m ic e -s to n e ,
s p ra y in g v /ith N u so l ( 1 i n 4 ) an d d a i l y p a i n t i n g v /ith 10/o a c i d chrom.
*45 gm* N.A.B. g iv e n in t r a v e n o u s ly . C a r b o lis e d d r e s s in g to L. c a r i o u s m o la r.
Day 1;-. T e e th c l e a n . C o n tin u e d a i l y gum tr e a tm e n t. C a r b o lis e d d r e s s in g '
r e p la c e d a s i t h a d ccme o u t.
Day 6.
G u ru s-firm er. U lc e r b e h in d A. m o lar h e a lin g .
Day" 8.
L e s s membrane. G-ums p a l e r end more f ir m . No b le e d in g . Y ello w u l c e r s
a t t e e t h b a s e s a lm o s t a l l h e e le d . I n t e r d e n t a l p a p i l l a e sh ru n k en .
Day 10. P i t f o r d is c h a r g e .
D ie t h i s t o r y , ~ '
B re e d 'fa s t - B acon and. f r i e d tin n ed , tc m a to e s . S au sag e an d
egg o r f r i e d f i s h o r s a r d in e s . K ip p e rs , bread ., • b u t t e r and jam.
w h atev er on th e s h i p . p o ta to e s o r g r e e n s .
D in n e r, -
R o a s t b e e f,- m u tto n .
Tinned, p e a s ,
R ic e o r c u r r a n t p u d d in g s o c c a s i o n a ll y . .
or c h e e se or-ham o r b a c o n , e t c .
No f r u i t
T ea - T ea, f i s h
Supper - None a t n ig h t e x c e p t c h e e se o r
c o rn -b e e f end. t e a b e f o r e r e t i r i n g .
Case ID. V/.H. 52 y e a r s .
On a d m is sio n .
t e s t n e g a t iv e .
H u tm en ts-o n s h o re f o r 1A m onths. -
Temp. 9 8 .2 ° .
jh ils e 70/ n i n .
U rin e - 3. G. 1025.
Bcw/els open once a day. T o u rn iq u e t
A cid, B i l e , blood., album en an d s u g a r - n i l
Gum sv/ab p o s i t i v e .
Blood c o u n t. R .B .C . 4 , 3 ^ 0 , 000/c.mm . lib. 954» C .I . 1 .1 .
/.B .C . fjSO O /c.nm .
Polym orphs. 784. Lym phocytes 205. K o n o cy tes 2$. E o s in o p h ils Ojo. B a s o p h ils C^.
U rinary v i t . C. e s ti m a t io n - F i r s t s p e c . 2 .2 mg.5';
6 h r s . s p e c . 2 .6 5 m g .;.. ( V it. C. d e f i c i e n c y ) .
3 h o u rs s p e c . 2 .5 4 mg.p.;
■
12C.
N ic o tin ic a c i d e x c r e te d p e r 'd a y e q u a l to 2 .8 7 mgs.
C om plaint en d h i s t o r y . -
Curas te n d e r an d p ro n e to b le e d f o r 3 w eeks.
No
f' d ia rrh o e a . A p p e tite good and c o u ld e a t a n y th in g , c / o p a in i n u p p e r an d lo w e r
I
'
'
‘
*
| jaws on R . s id e b e h in d c e n t r a l i n c i s s o r s f o r 5 d ay s.
j
i
!'
No b a d t a s t e i n m outh.
No " i n d i g e s t i o n " , rh e u m a tism , eye t r o u b l e , n o r n y c t a lo p ia .
'
•
Has h ad s l i g h t
■
L " b ro n c h itis l a t e l y . N o n -d rin k e r .and smokes 15 c i g a r e t t e s p e r day.
]• th a t he b r u s h e s h i s t e e t h r e g u l a r l y e v e ry day.
v •
'
1
’
'
j h ern ia.
No p r e v io u s i l l n e s s e s e x c e p t
■"
•
~ *
’
j O.JA
T h in p a t i e n t v /ith su n k en c h e e k s.
He " s t a te s
'
T y p ic a l V in c e n t’ s 'D isease o f gums.
Y ello w ish v /h ite s lo u g h s a t b a s e •o f t e e t h from R. i n c i s s o r to II. b ic u s p i d t e e t h
above an d belov/.
G-ums s w o lle n and e a s y to make b l e e d . , No t a r t a r a t b a s e o f
te e th , b u t brow n s t a i n i n g a t t e e t h b a s e s .
gums and i n g i n g i v o - l a b i a l fu rro w .
\
V fh itish membrane o u te r m a rg in o f
Tongue c l e a n - no g l o s s i t i s .
•
. S h o tty
glands R. an d L. s id e o f n e c k . > L oose R. i n c i s s o r to o t h - te n d e r on p r e s s u r e .
B reath h eav y .
a ll a re a s .
C h e st - evidence" o f s l i g h t b r o n c h i t i s .
S c a t t e r e d r a l e s in .
H e a r t, abdomen, C.N. S. a n d e y e s - N.A.D.
Course.
Day 1.
Gums p a i n t e d once v /ith E u s o l.
per day
g iv e n i . e .
1 t a b l e t 5 tim e s a day.
N ic o t in ic a c i d 250 g r .
(A t f i r s t . h e to o k 2 ta b s ,
n ic o tin i c a c i d •a t once an d he had. a s e v e r e f lu s h in g o f h i s fa c e and c h e e k s .}
Day 7.
Day 11.
No change i n c o n d itio n .
N ic o t in ic acid, and E u s o l .m.vr. c o n tin u e d ,
T e e th and. gums show no ch an g e,
v /ith n i c o t i n i c a c i d and E u s o l. G-ums
s t i l l b le e d in g ev en on rubbing; v /ith c o t to n w ool. R o u tin e s c a l i n g , s p r a y in g , .
.■brushing, e t c . , o f t e e t h . T y p ic a l f a l s e membrane s t r e t c h i n g from f r a e n u i n
to E. c a n in e o f u p p e r jaw . H ollow t o o t h s to p p e d v /ith c a r b o lis e d . d r e s s in g .
Bowmont’ s. a r s e n i c a l s o l t n . p a i n t e d on d a i l y * d a i l y E u so l s p ra y .
Day 14.
L e s s membrane on rums i n th e m o rn in g s. S t i l l te n d e r .
Day 17.
Gums f ir m e r . L e s s p a in and b le e d in g on m a n ip u la tio n . C o n tin u e
a rs e n ic a l s o l u t i o n a p p l i c a t i o n .
Day 2C. i.Iouth a p p e a rs n o rm al.
Day, 21.
.,
d a ily
■
No membrane v i s i b l e .
D is c h a rg e d .
Diet h i s t o r y . -
B r e a k f a s t - Bacon an d eg g s p r s a u s a g e s or. l i v e r .
Margarine an d t e a .
H e r r in g , b r e a d ,
The o n ly f r u i t he h a s h a d i s cooked p r u n e s . . The l a s t f r e s h
f r u it was i n P a l e s t i n e i n J a n u a ry 1939.
D in n er - S t e w , - f r i e d s t e a k , '.'c o tta g e p i e ,
potatoes. ■No v e g e t a b le s o th e r th a n p o ta to e s .
P ru n e s o r c u s t a r d , r i c e , no
■finned f r u i t . T ea - B re a d , b u t t e r , jam en d c h e e se . Supper - C ocoa, so u p , b r e a d ,
fruiter and. jam .
129.
Case 2 0 .
J.A .
On a d m i s s i o n .
Temp.
T ourniquet t e s t
tra c e
of
B lood
count.
W .B.C.
4$.
1 0 1 .6 °.
n eg ativ e.
album en.
0$ .
E o sin o p h ils
G.
1 . 4 3 mg. $ .
B aso p h ils
Has
suffered
i n R.
T here
is
gum c o n d i t i o n
No b r o n c h i t i s ,
w ith h i s
O.E.
eyes
nor
or
eyes
cy stic,
of
cyst.
Course.
bad.
and c o n c u s s io n
th en
and
a
of th e
H is gums b l e e d
th e m ornings.
H is
and p a i n s .
alco h o l.
No t r o u b l e
at te eth bases.
p atien t.
appeared
of V in cen t’s
to
T o n sils f r e e .
gum l e v e l .
H eart,
evidence
s w e llin g w hich does n o t
T here
cy st.
W h itish film
Gums s w o l l e n w i t h p r o m i n e n t
a n t e r i o r b o r d e r o f R.
lungs.,
of
C .N .S .
cran ial
appear to
stern o -m asto id ,
in ju ry .
be
at lev el
b e no c o n n e c t i o n b e t w e e n t h e
H is p y r e x ia c o u ld be
accounted f o r
by th e
o f h i s m outh.
m uscle
spasm o r l i m i t a t i o n
o f movement o f
show s no P o t t ’ s d i s e a s e .
No c h o l e s t e r o l
10$.
slig h tly
clo u d y f l u i d w ere ta k e n from
c r y s t a l s w ere found
a b ro n ch ial
Day 1 . -
chromic a c i d
sin ce
ng i d d y " .
No e x t e r n a l
of y ello w ish g reen ,
D iagnosis o f
in ju ry
s t u m p s w o r n do w n t o
N .A .D ,
d efo rm ity ,
neck. X - r a y
15 c . c .
-
jaw .
co n d itio n
Ho p a i n ,
and u l c e r s
p ain less
in ju ry and th e
a head
aches
p alate.
a w e ll n o u rish ed
inflam m atory a t
of a n g l e
nor
and b r e a t h
Many d e c a y e d
abdomen a n d
D eficien cy .)
sto m ach .
in terd en tal p a p illa e
is
(V it.C .
3 hrs.
f o r 3 w e e k s . He s m o k e s a n d d r i n k s
D i s e a s e o n gums an d h a r d
O therw ise he
2 4 $ . M onocytes
2 .7 8 m g.$.
i n h i s m outh i n
d iarrh o ea,
Gums v e r y f o u l
Teeth f i l t h y .
had
He a l w a y s f e e l s
lasted
1 .0 2 .
of neck under upper th ir d
a bad t a s t e
has
spec.
from headache
sid e
C .I.
done.
P atien t
stern o -m a sto id m uscle.
easily .
not
F ain t
0$ .
3 . 4 mg. $ .
spec.
acid .
Gum s w a b p o s i t i v e .
L ym phocytes.
6 hrs.
and h i s t o r y . -
appeared
72$.
F irst
C om plaint
sw ellin g
1025. F a in tly
estim atio n .
estim atio n
one m o n t h a g o .
S .G .
B ow els n o t o p e n .
sugar - n il .
9 , 5 0 0 / c,mm. P o l y m o r p h s .
acid
d irty
U rine
96/m in.
4 , 2 0 0 , 0 0 0 / c . m m . H b . 86 $ .
N ico tin ic
Soft,
P ulse
B ile ,b lo o d ,
R .B .C .
U rinary v ita m in
spec.
T raw le r sw eeper 8 m onths.
26 y e a r s .
a n d f l u i d ’wa's s t e r i l e .
c y s t was m ade.
R outine
scalin g ,
E u s o l m.w .
(lin
e tc .,
4)
and d a i l y
th ree
p a in tin g w ith
or fo u r tim es
a day.
N .A .B ,
-
0 .4 5
gm.
Day 4 .
-
Gums s t i l l
Temp, n o r m a l .
in trav en o u sly .
b leed
M ist;
on p r e s s u r e .
a l b a one o z .
g iv en .
L e s s membrane
Stum ps rem oved u n d e r g a s .
i n m outh.
S ockets kept
clean
w i t h E u s o l m.w.
D ay 6 . te n d er
Gums l e s s
and b e c o m in g f i r m e r .
S till
slig h t
L.
a d en itis.
D ay 8 . -
In te rd e n ta l p ap illae
clean .
A d en itis
D ay 1 0 .
- D isease
areas
red
T eeth
so ck ets keeping
not ten d er.
rap id ly
re m a in on t h e
Day 1 2 .
- F it
D iet.
S im ila r to
-
sh rin k in g .
for
h ealin g .
gums.
O nly a v e r y few e r o d e d
D a il y 10$ chrom .
acid
contin u ed .
d isch arg e.
case
1.
He h a s h a d n o f r e s h
fru it
for
¥
s e v e r a l m onths
m ilk
is
and h i s
Temp.
T ourniquet t e s t
co lo u r.
9 8 .2 °.
P u lse
- n eg ativ e.
S.G .
0 .9 1 .
5,400/c.m m . P olym orphs.
W .B .C .
M onocytes
5$.
E o sin o p h ils
U rin ary v ita m in
C,
2 . 0 4 mg.$.
The
3 . 2 2 m g.$
and h i s t o r y .
in m outh
ex creted
sw o llen .
spec.
He d o e s n o t b r u s h h i s
and h e a v y b r e a t h .
Non s m o k e r ,
cough f o r
but
d rin k s.
2 .7 m g .$ .
A p p etite
No " w h e e z i n g "
d efic ien cy ).
5 mg.
th at h is
gums
d o c t o r on day 2 .
Gums
te eth
is
C .I.
3 hrs.
( V ita m in C.
ago h e n o t i c e d
C o n su lted h i s
64$.
sugar
L ym phocytes 3 8 $ .
spec.
p e r dayequal to
5 days
- P ale ,
0$.
6 hrs,
C om plaint
do n o t b l e e d .
B aso p h ils
F irst
acid
and
2$.
open.
b lo o d ,
3 , 5 6 0 ,0 0 0 /c .m m . Hb.
55$.
a D rifter
U rine
No b i l e ,
estim atio n .
N ico tin ic
aching
R .B .C .
acid.
B lood
and i n
B ow els n o t
Gum s w a b p o s i t i v e .
1028. F a in tly
count.
78/m in.
o r album en.
w ere
overcooked.
W . C . 27 y e a r s . T r a w l e r f o r 3 m o n t h s
f o r 6 m onths b e f o r e t h a t .
On A d m i s s i o n .
spec.
are
tin n ed .
Case 2 1 .
straw
green v e g e ta b le s
reg u larly .
Bad t a s t e
g o o d . No s t o m a c h t r o u b l e .
in
ch est,
but has had a
a w e e k . No d i a r r h o e a n o r " r h e u m a t i s m " . He s a y s h e
feels
fit.
O .E.
T all,
th in
Tender a d e n i t i s
p a t i e n t w ith p a le m ucosae. H is
R.
sid e
of neck.
colour
S h o tty g lands L ..
of f o r m e r o p e r a t i o n f o r t u b e r c u l a r g l a n d s
on R.
is
H ealth y
sid e
poor.
scar
of neck.
Some c a r i e s
of upper
The r e m a i n i n g t e e t h
Tongue f u r r e d
scattered
C .N .S .
chrom .
F erri
et
upper
-
Day 1 .
acid
show t a r t a r
begun.
F u ll
c it.
T em porary c a r b o l i s e d
Day 2 .
0 .3
Day 5 . No t e n d e r n e s s
Day 7 .
B reakfast
b u tter
-
in
ro o ts.
on R.
sid e.
H eart,
Chest
-
abdomen,
etc.
D a iljr tr e a t m e n t w i t h
(1
in
4)
t.i.d ..
10$
M ist.
t.d .s.
to m o lar.
in trav en o u sly .
gums.
S till
gums and i n
and l e s s
or r i c e
w hich th e
Sausages
u lceratio n
a n d s om e w h i t e
la b io -g in g iv a l furrow s.
red.
sausages
No f r u i t .
No g r e e n s .
p atien t
Im proving.
and b e a n s ,
o r bacon
D in n e r - S tew ,
and e g g s .
p o tato es,
p lu s
R o a s t o c c a s i o n a l l y . Plum p u d d in g
never ta k e s.
No t i n n e d
fru it.
o r c o r n e d m e a t o r h am a n d e g g s . B r e a d , b u t t e r
and t e a .
Supper -
week a g o .
T here
of th e m
random t o
at
T inned
and t e a .
or tu rn ip s.
and t o
th e
V in cen t’s in fe c tio n
au d ib le.
M.W. E u s o l
d ressin g
sid e
carrots
Tea -
are
at
D isch arg ed .
D ie t.B read,
rale s
scalin g
one o z .
Gums m u c h f i r m e r
Day 1 0 .
T o n sils f r e e .
d ie t.
g ram . N .A .B .
membrane on o u t e r
and brow n s t a i n i n g
m olar.
n il.
- R outine
am mon.
and u p p e r b a c k L.
and lo w e r m o l a r r e g i o n s
p o st-tu ssiv e
and e y e s
C ourse.
in c iso rs
- no g l o s s i t i s .
o f gums - u l c e r s
a few
cen tral
Cake and t e a .
a r e 16 men i n
go t o
th e v ic tu a llin g
Cheese f o r th e f i r s t
th e m ess
and t h e m a te t e l l s
th e N .A .A .F .I.
sto res
f o r m eat,
tim e
a
one
canteen f o r v ic tu a ls
etc.
This man b u y s w hat he can g e t and o f t e n no v e g e t a b l e s a r e a v a i l a b l e .
Case 2 2 .
W.M.
23 y e a r s .
On a d m i s s i o n .
Temp 9 7 . 6 ° . P u l s e
T ourniquet t e s t
n eg ativ e.
blood,
album en.
sugar or
Blood c o u n t .
R .B .C .
16,000/c.m m .
E irst
spec.
ng.$,
(V itam in
U rine
(B)
72/m in.
-
3 .1 2 m g.$.
acid
S .G .
4 ,9 0 0 ,0 0 0 /c .m m . Hb.
80$.
B ow els o p en .
1016.
A lk alin e.
3 hrs.
86 $ .
C .I.
L ym phocytes 1 7 $ .
B aso p h ils 0$.
C.
f o r 10 m o n t h s .
No b i l e ,
Gum s w a b p o s i t i v e .
P olym orphs.
E o sin o p h ils 0$.
Bo n i c o t i n i c
T raw ler
0 . 8 8 . W .B .C .
M onocytes 3 $ .
U r i n a r y v i t a m i n C.
spec.
d eficien cy ).
e stim a tio n done.
3 .3 m g.$.
estim atio n
6 hrs.
spec.
3 .7
-
C o m p lain t and h i s t o r y .
- A ching s t a r t e d
th a t
the t e e t h .
i n m o rn in g s fro m gums.
and n o " s t o m a c h "
tro u b le s.
are r e g u l a r o n c e
a day.
not done
so ow ing t o
and d r i n k s b e e r
fro n ts
th e
L ately he has n o tic e d
Bad t a s t e
th e
in
Is
prone
to
B rushes h is
ten d ern ess
in m o d eratio n .
and
of h is
tak e
gums 12 d a y s a g o .
gums b l e e d
No a c h e s
chest
on b r u s h in g
in
body,
co ld s.
B ow els
te eth
n o rm ally b u t l a t e l y
aching.
S m o k e s 20 c i g s .
No t r o u b l e w i t h h i s
has
a day
eyes o r ey esig h t
la tely .
O.E.
No g r o s s
caries
deep b r o w n s t a i n i n g
of te e th .
Some t a r t a r
o f th e m olar r o o t s .
at
te eth bases
Gums r e d
the i n t e r d e n t a l
p ap illae
p ro m in en t. W h itish f ilm
on o u t e r
of
and an u l c e r w i t h
present
aspect
in
the
upper c e n t r a l
right
sid e.
R,
S h o tty ,
and b r e a t h
H eart,
lu n g s,
N.A.B.
in
4)
su lcu s.
T o n sils
clear.
heavy,
R outine
scalin g ,
slough
sid e.
ex ists.
is
behind
on
Tongue i s
P a le m ucosae.
- N .A .D .
ro ta ry b ru sh in g ,
p a i n t i n g w i t h 10 $
and d a i l y
of V in c e n t’ s d ise ase
of p alate
on l e f t
and e y e s
and
Tender c e rv ic a l g lan d s,
b u t no g l o s s i t i s
C .N .S .
and s w o lle n
a w h ite
E ro sio n s
n o n -ten d e r g lands
abdomen,
C o u r s e . - D ay 1 .
(l
retro -m u lar
in ciso rs.
furred
Eusol
gums,
and
chrom .
sp ray in g w ith
acid.
0 . 4 5 gm .
in trav en o u sly .
Day 4 .
C om plains o f s o re
Temp.
99°.
S lig h t
O.E,
R edness o f
th ro at,
ear-ache
and p a i n
in
th e
neck.
cough.
soft
p alate
and R.
sid e
of fauces.
L ungs - N .A .D .
A superim posed t o n s i l l i t i s .
Garg. f e r r i
$ phenol
Day 7 .
per
in
ch lo r.
g ly cerin e
Fauces le s s
t.d .s.
+ M ist,
drops to
red.
S lig h t
R.
p ecto ralis
1 oz.
t.d .s.
e a r.,
ear-ache
Day 8 . No e a r - a c h e . T h roa t im p r o v e d .
la st
n ig h t.
No p y r e x i a .
Gums f e r e a t l y im p roved and
are n o t t e n d e r . More f i r m and l e s s i n c l i n e d t o b l e e d . No membrane
v isib le .
U l c e r i n R. r e t r o - m o l a r s u l c u s i n t h e l a s t
sta g e o f
h ealin g .
Day 1 0 .
Ready f o r d i s c h a r g e .
Diet. -
B reak fast.
B read,
Boast p o r k ( o n S u n d a y s ) ,
meat p i e .
Cooked t i n n e d
Bread o r r i c e
pu d d in g .
b u tter,
te a,
r o a s t m eat,
carro ts
or
b a co n and e g g s .
roast
or b o iled
p o tato es
so u p and h e a t e d t i n n e d
T e a .- B read,
b u tter,
D in n er -
jam and t e a .
or
to m ato es.
Supper -
Som ething f r i e d
or b aco n
every n ig h t.
and b e a n s .
B read,
L iver
b u tter
and t i n n e d
and t e a .
tom atoes
He e a t s
or fis h
much n u t
c h o c o la te betw een m e als.
Case 2 3 .
C.G.
28 y e a r s .
On a d m i s s i o n .
Temp 9 8 . 2 ° .
T ourniquet t e s t
A ci d
.
C.
N ico tin ic
b lo o d ,
acid
U rine
spec.
ex creted
C om plaint and h i s t o r y .
a m olar out th e n
per
day -
aches
20 c i g s .
does no t
and c a r i e s
evidence
easily .
H eart,
S lig h t
and e v i d e n c e
2 .1 3 m g.$.
th e
reg io n
3 hrs.
spec.
d eficien cy ).
6 w e e k s . He h a d
sin ce.
A week
ago
and t h e
on b r u s h i n g th e t e e t h .
He
i n h i s m outh and a b a d b r e a t h .
from b r o n c h i t i s
(2 w e e k s ).
an d no s t o m a c h t r o u b l e .
He d o e s n o t
o f anaem ia.
T o n sils
Smokes
s u f f e r from
clear.
Severe V in c e n t’ s i n f e c tio n
Some t a r t a r
o f gums w i t h
g in g iv o -la b ia l furrow .
B reath very heavy.
C .N .S .
of
in
d rin k .
n o n -ten d er sh o tty
abdomen,
done.
( V i t a m i n C.
and p a i n s
o v e r gums a n d i n
lower R . m o l a r s .
B lood co u n t n o t
eye t r o u b l e .
of te eth .
me mb ran e a l l
1028.
6 . 3 8 mg.
suffers
There a r e no g e n e r a l
O.E. No c l i n i c a l
S .G .
m o la rs rem oved f o r to o th a c h e
p o o r and he
nor
co lour,
- T r o u b l e d , w i t h gums f o r
a bad t a s t e
p e r day and
straw
spec.
u p . H i s gums b l e e d
has f o r 3 w e e k s h a d
night b l i n d n e s s
dark
F irst
and h a s h a d p a i n
pain n e v e r c l e a r e d
is
-
2 . 3 7 mg. $
he h a d 2 m o r e u p p e r r i g h t
His a p p e t i t e
7 8 /m in . B ow els n o t o p e n .
s u g a r o r album en.
e stim a tio n ..
6 hrs.
2.09 m g . $ .
P u lse
n eg ativ e.
No b i l e ,
U rinary v i t .
D r i f t e r f o r 9 m onths.
Gums r e d
ad en itis
and e y e s N .A .D .
U lc e r behind
and s w o lle n and b l e e d
on b o th
Lungs -
sid es
of neck.
scattered
rale s
slig h t b ro n ch itis.
Course. - Day 1 . S c a l e , r o t a r y b r u s h i n g u s i n g pum ice s t o n e d u s t
and E u s o l s p r a y . D a i l y p a i n t i n g o f gums w i t h 10 $ chrom. a c i d .
(1
Day 2 .
g m. N . A . B .
0 .5
in
4)
M.W. E u s o l
Day 5 . No p a i n
in
4 i.d .
F u ll
d ie t.
One N o . 9 p i l l .
g i v e n + d a i l y m.w.
gums.
S till
sw ellin g
and b le e d in g
Some membrane p e r s i s t s i n t h e m o r n in g s .
Day 7 .
and chrom .
acid .
on p r e s s u r e .
D a ily trea tm en t c o n tin u e d .
Gums much f i r m e r and l e s s r e d . I n e r d e n t a l p a p i l l a e s h r i n k i n g
Ulcer i n r e t r o - m o l a r s u l c u s h a s h e a l e d .
Day 9 . G r e a t
im provem ent
all
over.
C h est c l e a r .
D ay 1 0 . R e a d y f o r d i s c h a r g e .
D iet h i s t o r y . B reakfast
or fish
- Egg and b a c o n ,
rarely .
p o ta to e s 'o r
cabbages,
B read,
stew .
th e
cu stard .
meat
He h a s h a d n o f r e s h
la tte r
rarely .
T e a - M eat h a s h
tu rn in g
Case 24.
E .L .
in .-
b lo o d ,
to ast
Temp.
T ourniquet t e s t
n eg ativ e.
R .B .C .
E o sin o p h ils
!•£■$.
U rin ary v i t .
C.
16 .6 7 m g.$.
6 hrs.
acid
treatm en t.
n o th in g
spec,
d eficien cy
asco rb ic
of p a in
of
acid ,
and
U rine
F irst
- He n o t i c e d
on i t ,
For th e
la st
acid .
P r i o r to
th is,
asco rb ic
acid .
g arg les
a day.
1 0 1 7 . A c i d . No
C .I.
0 . 9 4 . W .B .C .
good,
5 .5 5 m g.$.
3
5$ .
h rs. spec.
v i t . C. d e f i c i e n c y
n o w .)
4 . 7 5 mg.
th at
h is
gums w e r e s o r e w h e n
d e n t i s t wh o p u l l e d
it.
Two
4 cario u s
He h a d n o s c a l i n g
o r o th er
t h r e e w eek s b u t one h e h a s been
(3 t a b s .
4 -h o u rly )
and h a s h ad
b lo o d and u r i n e t e s t s
D uring th e
and a r s e n ic
some b l e e d i n g
of th e
l a s t week h e h a s had
p ain ts
gums.
o n ly .
has
He s t i l l
com plains
He h a s n o c h e s t n o r
an d no a c h e s
s till
showed a
and p a i n s .
a bad t a s t e
H is
i n h i s m outh.
smokes n o r d r i n k s .
Gums b l e e d i n g ,
in
79$.
(No
acid o n ly .
though he
aspects,
f o r 9^- m o n t h s .
d id n o t b o th e r about
a p riv ate
ap p etite
O .E.
and t e a .
B ow els open once
S .G .
spec.
2 5 .0 m g,$.
No d i a r r h o e a ,
He n e i t h e r
clear.
p ie w ith
Gum s w a b p o s i t i v e .
stom ach t r o u b l e .
is
or
jam .
or cheese
8 4 / m in.
-
tu rn ip s
soups,
and
p e r day e q u a l to
chrom .
asco rb ic
else.
are
64$. Lym phocytes 29$. M onocytes
con su lted
lo c a l
co ld ),
b u tter
m o n th s ago b u t
ap p lied
tre a te d w ith
or
4 ,2 8 0 ,0 0 0 /c .m m . Hb.
ex creted
and
D in n e r - M eat and
e i t h e r plum p u d d in g o r
and d r i p p i n g ,
estim atio n .
te eth
-
sausage
B a s o p h i l s -J $ .
he w as on l e a v e
he
(hot
album en.
C o m p lain t and h i s t o r y .
weeks l a t e r
or tin n ed
P a d d le m in e s w e e p e r (Z)
l l , 000/c .m m . P o ly m o rp h s .
N ico tin ic
Sweet
9 8 .2 ° . P u lse
sugar or
B lood c o u n t .
steak ,
++ a n d t e a .
Tea, b read ,
26 y e a r s .
On a d m i s s i o n .
b ile,
b u tter
or
The o n l y v e g e t a b l e s g i v e n
and p o t a t o e s .
B efore
liv er
f o r 9 m onths.
fru it
esp ecially
th e
t e n d e r and
sw o llen . W h itish film
i n u p p e r gum.
on o u te r
L a rg e u l c e r w i t h w h i t e membrane
L. m a n d ib u lar r e g io n .
Tongue f u r r e d
b u t no
135.
g lo ssitis.
T o n sils
- N .A .D .
S h o tty
stain in g ,
and
C ourse.
at th e
sp ray in g
lu n g s,
and L .
abdomen,
T eeth
C .N .S .
show o l d
and eyes
stan d in g
bases.
and d a i l y
R outine
scalin g ,
p a i n t i n g w i t h 10$ chrom .
acid.
(1 i n 4) 4 i . d . .
Day 3 .
No p a i n .
Day 5 .
Gums l e s s
u lcer h ealin g .
Day 8 .
a d e n itis 'R .
ta rtar
Eusol
E u s o l m .w.
H eart,
1 . 0 , 3 gm . N .A .B . i n t r a v e n o u s l y .
Day
b ru sh in g ,
clear.
S t i l l w h i t e membrane and b l e e d i n g .
in ten sely
C ontinue
U lceratio n
red
d aily
alm ost
all
and
somewhat f i r m e r .
R etro -m alar
treatm en t.
gone.
Gums f i r m
and w h i t e r .
No b l e e d i n g .
Day 1 0 .
Ready f o r
D ie t.bread,
d isch arg e
B reakfastb u tter,
te a.
bread,
T his was t h e
were w ash ed
cups,
etc.
peas,
te a,
a p ail
kept
canteen.
o r tin n ed
from th e m ess.
T here
he had p r i o r
to
sailo rs
is
th e
sausages,
D inner -
occasions
R ice,
as these
and plum d u f f .
fish .
On a d m i s s i o n .
Supper -
C heese,
cooking u t e n s i l s
did n o t have t h e i r
of
own
a c a rrie r here.
a d m i s s i o n h a d b e e n o f no
av ail
and d e b r i s .
27 y e a r s . F r e n c h d e s t r o y e r f o r 4 m o n t h s a n d
f o r 4 m onths p r e v i o u s l y and d e s t r o y e r 20 m o n th s
th a t.
Temp, 9 7 . 4 ° .
T ourniquet t e s t
of
A ll
p o ssib ility
th o ro u g h rem oval of t a r t a r
F aint t r a c e
d ie t.
g r e e n s on r a r e
th e
liv e r
and t h e
ap art.
- G .H .F .
R .N .B .
before
reg u larly .
in
o n ly p a tie n t
in
w ith o u t th e
and t i n n e d
and t e a .
The t r e a t m e n t
Case 2 5 .
tin n ed
b u tter,
b u tter
or liv e r
No f r u i t w h a t e v e r i n t h e
alw ays a v a i l a b l e
Tea - B r e a d ,
du ty .
Eggs and b a c o n ,
Meat a n d p o t a t o e s ,
were n o t
to
album en.
P u lse
8 2 / m in. B ow els n o t
p o sitiv e.
No b i l e ,
U rine
blood
- S .G .
or sugar.
open
1022.
T hroat
A cid.
a n d gum
sw a bs p o s i t i v e .
Blood c o u n t .
R .B .C .
4 ,4 8 0 ,0 0 0 /c .m m . Hb. 9 0 $ .
W . B .C . 1 2 , 6 0 0 / c . m m . P o l y m o r p h s 7 5 $ .
6$ . E o s i n o p h i l s 0 $ . B a s o p h i l s 0 $ .
F irst
2 . 1 2 mg. $ .
spec.
2.7 m g . $ .
3 hrs.
Bo n i c o t i n i c
acid
e stim a tio n done.
1 .0 2 .
Lym phocytes 1 9 $ . M o n o cy tes
U rin ary v i t .
spec.
(V itam in C d e f ic ie n c y ) .
C .I.
C.
2 . 0 8 mg. $ .
estim atio n -
6 hrs.
spec.
136.
C om plaint
and h i s t o r y . -
H isto ry
in fec tio n
of
1 . A ttack
treated
Jan.
th ro at.
w i t h N .A .B .
1939,
"tab lets
L asted
th e
la sted
to
T his
d u r at i o n
in
the
pressure
to o ,
L.
h is
4th
sid e
and a r e
e a sily ,
th ro at.
T his
suffers.
and d id
so
in
p ain ts
+ th ro at
of
1940.
pain t
a week’s
H i s gums a r e b l e e d i n g
th ro at
but not
and d r i n k s
in
and
4 t h N ovem ber,
tro u b le
He h a s h a d m i l d
attack s
10 d a y s ,
attack
and he h a s p a in
severe
tro u b le
in body o r lim b s .
He s m o k e s
2 . M ild
in jectio n s
t h e M . O . He h a s no c h e s t
No a c h e s o r p a i n s
an ything.
A ttack
attack
of h is
on o c c a s i o n b e t w e e n t h e
him c o n s u l t
3.
of V in cen t’s
1938 l a s t e d
in H aslar.
ten d er.
from w hich he
Jan.
attack s
T reated w ith th r o a t
in H a sla r.
is
several
in
T r e a t e d w it h N .A .B ,
in H a sla r.
illn ess
5 days.
suck"
9 days.
in je c tio n s
of
is
sore
th e
o n ly
th ro ats
e n o u g h t o make
and no n y c t a l o p i a .
No n a s a l t r o u b l e
in m od eratio n .
a l s o w h i l e he w as on h i s
on
and
H is t e e t h
first
can e a t
b leed
d e stro y e r in
home w a t e r s .
O .E .
M arked r e t r a c t i o n
as w e ll
of th e
gums.
as m arked V i n c e n t ’ s d i s e a s e
u l c e r s b u t m em brane a l l
has p ro b ab ly
over.
(23)).
L.
upper pole
from t h e
case.
R. t o n s i l
sw ollen,
ten d er
cerv ical
ad en itis.
H eart,
show c a r i e s
lu n g s,
and t a r t a r
w ith 10$ chrom .
acid.
0 . 4 5 gm. N .A .B .
Day 5 .
Fauces fe e ls
tak e
is
sm all
gland
gums.
No a c t u a l
and m o u th .
and h a s
is
(T aylor
a g re y is h w h ite
a ch aracteristic
L.
C .N .S .
sid e
There
sm ell
is
a
and s h o t t y R.
and e y e s - N .A .D ..
T eeth
at bases.
scalin g ,
b ru sh in g
etc.
(1
4.
in trav en o u sly
b e t t e r and t h e r e
a fu ll
some p y o r r h o e a
and g r a n u l a r .
on t h e
M .w . E u s o l
Day 2 .
Now a b l e t o
and t h e r e
is
s t a n d i n g gum t r o u b l e
to n sils
sw ollen
abdomen,
Day 1 . R o u t i n e
C ourse.
h is
to n sil
membrane on i t s
o f th e
T h is lo n g
been re in fe c tin g
and M c K i n s t r y
There
d ie t.
in
4)
+ usual
is
D aily
p ain ts
i.d .
d aily treatm en t.
no p a i n
in
th e
gums.
U l c e r and m em brane r a p i d l y v a n i s h i n g
from t o n s i l .
Day 7 .
T hroat
chrom.
acid
Day 8 .
alm ost
C o n t i n u e E u s o l m.w.
4 i.d .
and
d aily .
No s p o t s
are f i r m ,
clear.
le ss
on L. t o n s i l .
red
but
s till
Less pain
in neck g la n d s.
s h o w s om e m e m b r a n e i n
th e
Gums
u p p e r jaw
137.
i n th e l a b i o - g i n g i v a l fu rro w .
Day 1 0 .
Gums r a p i d l y h e a l i n g . No b le e d in g o r p a i n .
Day 1 2 .
A lm ost b e t t e r .
Day 1 3 .
D isch arg ed
D iet.
-
to
The s y s te m
is
its
own f o o d f r o m t h e
are
2 4 me n i n
to
feed.
th e
d u ty .
th a t
o f can teen m essing.
canteen
m ess and
They u s u a l l y
Each m ess buys
a n d e a c h ma n s u b s c r i b e s .
each
sailo r
save 10s.
is
T here
allow ed l s . 7 d .
p e r man
p e r head p e r m onth.
B r e a k f a s t - Tea, bread o r r o l l s , b u t t e r and jam, ham and e g g s on
Sundays.
Dinner - D esc rib ed by him as "good" - p o t a t o e s , m eat,
g r e e n s , peas o r ru n n e r b e a n s. There i s n ev e r f r u i t a t any tim e .
E ac h man t a k e s
h is
tu rn
p uddings,
to use
enough to
make a d u f f ,
tin n ed
Tea liv e r,
th e
and h e a t e d
B read,
cook and a s r e g a r d s
r a t i n g ’ s own w o r d s ,
up,
b u tter,
bacon,
a t being th e
"If
t h e r e was a d u f f " .
even th e
A ll v e g e ta b le s
are
cabbages.
jam and t e a .
p o tato es
a f e l l o w was good
Supper -
Sausages o r
and t e a .
Case 2 6 .
G .T .
In
17 y e a r s .
a d iffere n t
On a d m i s s i o n .
trac e.
(A) f o r 17 m o n t h s .
m e ss f r o m c a s e s 17 an d
Tem p.9 8 ° .
T purniquet t e s t
fain t
D estro y er
P u lse
n eg ativ e.
S ugar,
b ile
55.
84/m in.
U rin e,
S .G .
and b lo o d
B ow els r e g u l a r o n c e
1015. A cid.
- n il.
a day.
A lbum en - v e r y
T hroat
swab p o s i t i v e ,
gum s w a b n e g a t i v e .
B lood
W .B .C .
4$.
count.
R .B .C .
8,800/c.m m .
E o sin o p h ils
U rin ary v i t .
spec.
P olym orphs 71$.
0$.
C.
5 ,1 5 0 ,0 0 0 /c .m m . Hb.
B aso p h ils
estim atio n .
6 hrs.
4 m g.$.
spec.
97$.
C .I.
0 .9 5 .
Lym phocytes 25$. M onocytes
0$.
F irst
spec.
10 mg . $ .
1.39
mg. $ .
(No v i t a m i n
G.
3 hrs.
d efic ien cy ).
No n i c o t i n i c a c id e s tim a tio n done.
C o m p lain t and h i s t o r y .
for 4 or
5 days.
an d s u f f e r e d
th ro at
before
first
if
He h a d
C om plains o f p a i n
a T .A .B .
from m a laise
he b r u s h e s h i s
a year
-
th is.
a bad h eadache.
ev ery day b ut
he o m its to
fcore t h r o a t .
in o cu latio n
reg io n
(.5
2 or 3 days.
No r h e u m a t i c p a i n s ,
2 days
ago
a sore
H i s gums a r e
th e y have b le d
c l e a n them f o r
of th ro at
c .c .)
a f t e r t h a t b u t he had f e l t
He h a s
te eth
in
h ealth y
on o c c a s i o n f o r
T his
chest tro u b le,
is
h is
n y ctalo p ia ,
if
He i s
O .E ,
a non-sm oker b u t d rin k s
cider
and w h isk y .
Good c o lo u r and n o c l i n i c a l evidence of anaemia. Gums are
v e ry s l i g h t l y sw o lle n a t s i d e s of upper jaw on th e o u te r a s p e c ts
b u t th e y a re n o t u l c e r a t e d and have no w h itis h f i l m on them.
No t a r t a r
rig h t
or caries
sid e
o n ly .
of te eth .
Fauces
S h o tty n o n -te n d e r
inflam ed.
R.
w ith
a w h i t e m e m b r a n e . No g l o s s i t i s .
eyes
and C .N .S ,
- N .A .
Day 1 .
C ourse.
Day 2 .
0 .3
of
3.
a gm.
Day 3 .
No s o r e n e s s
D ay 4 .
F u ll
Day 5 .
No r e d n e s s
H eart,
on
shows a s m a ll u l c e r
lu n g s,
abdom en,
D.
1 garg.
m o rn in g and e v e n i n g .
to n sil
ad en itis
p o t.
ch lo r.
therm o g en e t o
in trav en o u sly
4 i.d .
neck.
+ 1,
2 asp irin
g r a i n 15
Bed and lo w d i e t .
2 and 3 a b o v e .
in th r o a t.
d ie t.
of fauces.
U lcer ra p id ly
g ettin g
sm aller
on
to n sil.
Day 8 . ‘ D i s c h a r g e d .
D iet h i s t o r y .
co o k s.'
C anteen m essing b u t th e r e
B reakfast
or f is h .
-
D in n er -
{cabbage
and t i n n e d
(tin n ed
th e n
scarce
became
b u tter,
muc h n u t
bacon
w hich w i t h t h e
2 m o n th s ago
is
On a d m i s s i o n .
Tem p 9 9 ° .
blood
or
sugar.
Blood c o u n t .
W .B.C.
2$,
T hroat
R .B .C .
E o sin o p h ils
reg u la rly
P uddings
fru it
W ithout th e
2 m o n th s ago
till
sin ce.
Tea - B re a d ,
or bacon
T his
is
He e a t s
a d ie t
as he h a s h ad up t i l l
fru it
C,
and u n d e r th e
is
lack in g .
D e s tro y e r 4£ m onths.
P u lse
8 4 /m in.
S .G .
B ow els n o t
1020.
open.
A c i d . No a l b u m e n , b i l e ,
a n d gum s w a b s p o s i t i v e .
4 ,5 0 0 ,0 0 0 /c.m m .
polym orphs
1$.
eggs
rarely .
o r baco n and m ashed p o t a t o e s .
n e g a tiv e . U rin e.
6 ,8 0 0 '/c .m m .
or peas).
of a d e stro y e r th e v i t .
26 y e a r s .
reg u la r
and one v e g e t a b l e
Sa m e a s b r e a k f a s t ,
of a li ttl e
very f u l l .
G .K .
T ourniquet t e s t
m eat,
e v e ry day betw een m e a ls.
ad d itio n
cooking c o n d itio n s
Case 2 7 .
Supper -
th ree
and b u t t e r ++. B acon,
and he h a s had none
and l i v e r ,
ch o co late
tu rn ip s
and o r a n g e s )
jam o r t o a s t .
and e g g s ,
bread
R oast p o ta to e s ,
carro ts,
They g o t f r u i t
it
C offee,
are
75$.
B aso p h ils 0$.
Hb, 9 9 $ .
C .I.
1*1.
L y m p h o c y t e s 22 $ .
U rinary v i t .
M onocytes
C.
estim atio n .
F irst
spec.
3 .3 3 m g.$.
2.4 3
m g.$,
(V it.
No n i c o t i n i c
C.
acid
3 hrs.
spec.
2 .1
6 hrs.
m g.$.
spec.
d eficien cy ).
e s t i m a t i o n was d o n e .
W .R.
- n eg ativ e.
C o m p lain t and h i s t o r y , -
c/o p a i n s i n h i s t h r o a t , e a r s and gums.
H is gums h a v e p a i n e d
for
rem oved tw o w e e k s
th ro at
for
nor c h e s t
ago
and t h e
10 d a y s .
tro u b le
P ain
in
O .E .
T here
and c o n s u l t e d
ep ig astriu m
is
ad en itis
Yellow u l c e r s
R,
at
and a r e
close
central
in c iso rs
N .A .D .
set
g u ard in g
Day 1 .
brushing,
e tc .,
Day 2 .
T hroat
perm ang.
slo u g h
sick
on t h e
and L.
b erth
L a t e l y he h a s
atten d an t
one m onth
re lie v e d by a lk a lis ja n d
i.e .
and
are
sw ollen,
He s m o k e s -J- l b .
lo o se.
C .N .
S.
and
b etter.
Day 6 .
T o n sil
gums.
Day 8 * T o n s i l s
Day 1 0 .
morning.
C ontinue
or pain
clear.
chrom ic a c id
and u l c e r s
i n gums.
- N .A .D .
Abdomen,
No p a i n .
R outine
scalin g ,
chrom .
G .A .C ,
of
and f i r m e r .
d aily
S till
and m.w.
No d y s p h a g i a .
at bases
clear.
Some m e m b r a n e i n
in c iso r
in c iso r
so ck ets
in
th e
so ck ets.
f o r d is c h a r g e to d u ty .
— C anteen M essing.
Bacon a n d e g g s .
suet
B reakfast
D in n er - M eat,
Unned b e a n s o r p e a s ) .
then e i t h e r
-
Gums I . S . Q .
red
D aily tre a tm e n t + Eusol sp ray to
F it
2 lo w er
ear.
Gums l e s s
ap p ear norm al.
T eeth firm
Bo b l e e d i n g
clear.
of th e
bases
D a i l y t r e a t m e n t + m .w .
th e l e f t
U l c e r on t o n s i l b e g i n n in g t o
aching i n
eyes
at
E ars
gum p a i n t s w i t h 1 0 $ a c i d
to
B reath has
rem ain d er.
in trav en o u sly .
Day 4 ,
alm ost
m em brane.
in
of
and b le e d in g .
o v e r R. u p p e r r e c t u s .
slig h tly
and G .A .C .
appearance
The s o c k e t s
No c a r i e s
. 3 gm. N . A . B .
feels
te n d e r , red
T ender,
T e e t h h a v e much t a r t a r
in fected .
and d a i l y
to n sil.
and w h i t i s h
some a r e
Lungs,
le ft
T he gums show t h e
on p a l p a t i o n
Course.
Diet,
He h a s n o d i a r r h o e a
a heavy d rin k e r.
heavy odour.
H eart,
Day 12,
He h a s h a d a s o r e
No n y c t a l o p i a .
th e
not
canine b a se s
ch ara cteristic
pot.
sy p h ilis.
a f t e r m eals;
He i s
a larg e
V incent’ s in f e c tio n
slig h t
of
ache.
p e r m onth.
to n silla r
the
gu ms s t i l l
No h i s t o r y
ascending f l a t u l e n c e .
to b acco
2 m o n t h s . He h a d h i s t w o f r o n t i n c i s o r s
n o r vague p a i n s .
had " i n d i g e s t i o n "
ago.
him
or
p o ta to es
S w e e ts when t h e
currant
— Tea,
p uddings.
bread
and b u t t e r
end v e g e t a b l e
c o o k c a n make i t
T inned f r u i t
++.
(cabbages,
and u s u a l l y
and c u s t a r d
on
140.
Sundays.
Tea - B read,
sausages.
Fresh
to m ato es.
Tea,
Case 2 8 .
G .L .
No b i l e ,
2$ .
bread
and b u t t e r .
Temp.
R .B .C .
1 1 , 0 0 0 / c.mm.
U rin ary v i t .
C.
3 . 1 6 mg. $ .
6. hrs.
No n i c o t i n i c
acid
have
L, u p p e r
by t h e
spec.
-
spec.
3 . 2 7 mg. $
C arb o lised
Day 3 .
healed
- norm al.
2 . 4 8 mg$.
(V itam in
3 hrs.
spec.
C. d e f i c i e n c y . )
th a t
te eth .
fo r th e
p a s t week h i s
No p a i n .
Has h ad
No d i a r r h o e a ,
M ucosae hav e good
a
no
eyes.
colour.
Gums s h o w s o m e u l c e r a t i o n
th e re .
S w ollen
He
H eart,
lu n g s,
T o n sils
above
m olar re g io n .
in terd en ta l
Some t a r t a r
R outine
4.
Gums f i r m e r .
scalin g ,
at te eth
bases
on L.
V in cen t’s
p ap illae .
Large
o v erlapped
abdomen and C .N .S .
an d gums a r e
b ru sh in g
D aily p a in tin g
to
- N .A .D ,
and s p r a y in g o f t e e t h
o f gums w i t h 1 0 $ c h r o m i c
. 4 5 gm. N .A .B .
acid
in trav en o u sly .
ca rio u s m olar.
L e s s membrane on L.
"neg ativ e"
Same a s
upper
in th e m orning.
firm er
D isch arg ed to
-
1 .0 2 .
a n d no g l o s s i t i s .
d ressin g
D iet h i s t o r y .
C .I.
done.
(1 i n 4) 4 i . d .
Day 5 . S w a b i s
A lk alin e.
a n o n -d rin k er.
p atien t.
s w o lle n gums.
and m . w . E u s o l
96$.
h i s m outh l a t e l y .
is
c a rio u s m olar.
w ith E u s o l 1 i n
1024.
Lym phocytes 25$. M onocytes
Has n o t i c e d
in
but
present
Day 1 .
S .G .
a c h e s and p a in s n o r t r o u b l e w ith h i s
No k e r a t o m a l a c i a ,
Course.
B ow els o p e n b u t no
Gum s w a b " p o s i t i v e " .
fro m m edian l a b i o - g i n g i v a l ra p h e to
membrane i s
area.
U rin e.
on b r u s h in g t h e
O .E. W e l l n o u r i s h e d
side
n eg ativ e.
F irst
estim atio n
s m o k e s 20 c i g s / d a y
an d n e c k g l a n d s
70/m in*
B a s o p h i l s 0$ .
and t a s t e
stom ach t r o u b l e ,
tin n ed
8 m onths.
4 ,7 0 0 ,0 0 0 /c .m m . Hb.
and. h i s t o r y .
heavy b r e a th
and f r i e d
P u lse
album en.
estim atio n .
been b le e d in g
S upper - T inned
p o ta to es
Polym orphs 73$.
0$ .
E o sin o p h ils
C om plaint
9 8 ,2 °.
sugar or
-
jam .
T raw ler f o r
T o u rniquet t e s t
B lood c o u n t .
W .B.C.
or k ip p ers,
—
b lo o d ,
and
fish
29 y e a r s .
On a d m i s s i o n .
d iarrh o ea.
b u tter
and a r e
du ty .
c a s e 15*
jaw i n t h e
m orning.
E r o s i o n s on gums a r e
n o t prone
to
bleed
in
any
gums
141.
Case 2 9 .
J.W .
On a d m i s s i o n .
a day.
31 y e a r s .
— Temp.
B ile,
b lo o d ,
B lood
count.
R .B .C .
W .B.C.
spec.
No n i c o t i n i c
C om plaint
slig h tly
to b acco
and
‘a s p e c t s .
T o n sils
odour.
m olar.
Some t a r t a r .
Lungs
-
rales.
R.M.
H eart,
Gums b l e d
lax ativ e
4 m .w .
C
2 . 3 rag. $ .
d eficien cy ).
The gums a r e
in th e m orning
He s u f f e r s
Large te n d e r ,
a few
from s l i g h t
b ro n ch itis.
Gums a r e
and u l c e r s w i t h
'
heavy,
C aries
rig h t
o f o n e l o w e r R.
cerv ical
scattered ,
c h ara cteristic
ad en itis.
p o st-tu ssiv e
and e y e s - N .A .D .
scalin g ,
b ru sh in g
and s p r a y i n g
D a i l y p a i n t i n g w i t h 10 $
4 i.d .
nor d iarrh o ea.
W h i t i s h membrane o n o u t e r
B reath has th e
C .N .S .
in h i s m outh.
a ruddy com plexion.
bases.
bleed in g
in m oderation.
a n d no g l o s s i t i s .
th is.
M ist.
chrom ic
of te e th .
acid
t . d . s .,2
E x p ect.
and
v eg etab le
p ills.
Gums s t i l l
Day 7 . U l c e r a t e d
in t h e
clear.
R outine
1 .0 4 .
U rin ary v i t .
spec.
slo u g h in g m argins
th e te e th
abdomen,
afte r
Eusol 1 i n
him .
v e s ic u la r w ith
Day 1 .
Course.
3 hrs.
No " r h e u m a t i s m "
p a tie n t w ith
Tongue f u r r e d
C .I.
Lym phocytes 34$.
p e r m onth and d r i n k s
at
F ain tly
Gum s w a b " p o s i t i v e " .
B aso p h ils 1$.
C.
Bad t a s t e
sw o llen w ith
y ello w ish slo u g h s
1028.
done.
nor n y ctalo p ia.
W ell n o u ris h e d
te n d e r
S .G .
3 or 4 days.
does not tro u b le
Smokes -J- l b .
Day 4 .
la st
on p r e s s u r e .
H is t h r o a t
B ow els o p en once
c /o s o r e gums f o r t h e p a s t 4 w e e k s b u t
-
th e
59$.
0$.
(V it.
estim atio n
in
U rin e.
1.66 m g .$ .
spec.
and h i s t o r y .
No e y e t r o u b l e
red,
P olym orphs.
3 .3 3 m g.$.
p a in much w o rs e
8 2 /m in .
4 ,8 0 0 ,000/c.m m . Hb. 100$.
F irst
acid
P u lse
n eg ativ e.
E o sin o p h ils
estim atio n :-
6 hrs.
.
6 m onths.
s u g a r and album en a b s e n t .
1 0 , 2 0 0 / c.mm.
M o n o c y t e s 6$ .
O .E .
98
T ourniquet t e s t
acid.
D rifter fo r
sore
areas
and r e d .
C ontinue
at bases of te e th
m ornings on o u te r
a s p e c t s o f gums.
d aily
treatm en t.
clearin g .
B reath
L e s s m em brane
s till
o ffen siv e.
Ch es t c l e a r .
Day 9 .
Gums h a v e l o s t
In terd en tal p a p illa e
aspect o f R.
Day 11.
sid e
th e
fiery re d
back to
o f upper
norm al
jaw?.
C o n d itio n alm ost c l e a r .
c o lo u r th e y had p r e v io u s ly .
size.
Eusol
Some e r o s i o n
s p ra y + chrom ic
No a d e n i t i s .
on o u t e r
acid .
Tongue c l e a n .
142 .
Day 1 3 .
D ischarged
to
d u ty .
D iet h i s t o r y . -
B reakfast
and e g g s n e a r l y
e v e ry m orning.
D inner - U s u a lly
carro ts
(a ll
; He c a n n o t
apples
- P orrid g e
r o a s t m eat.
fresh).
a week.
b u t t e r ++,
P o tato es.
C u stard
Cabbage,
and o c c a s i o n a l l y
Ham, b a c o n
and t e a .
tu rn ip s
and
tin n ed f r u i t .
saw a n o r a n g e .
T ea - Bacon and eg g ,
jam , m a rm a la d e o r t r e a c l e .
j
B read,
rem em ber when he l a s t
a week.
tw ipe
He a v e r a g e s
p lu s te a ,
bread,
Supper - B read and c h e e s e ,
2
b u tter,
o nions
and c h e e s e .
! T his
is
a good d i e t
as
v eg etab les.
The f o o d
Case.
S .J,
30.
s u rv iv o r’ s leave
On a d m i s s i o n .
T ourniquet
sugar o r
3$.
2.6
E o sin o p h ils
C.
C om plaint
P u lse
U rine
estim atio n .
spec.
acid
80/m in.
S .G .
h is
life
on
p rev io u sly .
B ow els o p en .
1018.
A c i d . No b i l e ,
blo o d ,
1 .4 2 m g.$.
estim atio n
b lin d n e ss,
te eth
in th e
spec.
C .I.
2 .0 m g,$.
( V i t a m i n C.
.8 9 .
3 hrs.
spec.
d eficien cy ).
done.
He h a s h a d p a i n
n ig h t
does n o t b r u s h h i s
68 $ .
78 $ . Lym phocytes 19$. M onocytes
F irst
Bad t a s t e
nor te n d e r n e s s
all
and t h e n
B aso p h ils 0$.
a lo t.
rheum atism ,
and d r i f t e r
.P olym orphs.
and h i s t o r y .
Gums b l e e d
be o v e rc o o k e d h o w e v e r.
3 ,8 6 0 ,0 0 0 /c .m m . Hb.
' 0$.
6 hrs.
No n i c o t i n i c
to
Gum s w a b " p o s i t i v e " .
13,400/c.m m .
m g.$.
99*4°'.
p o sitiv e.
and c o n t e n t o f f r e s h
D r i f t e r f o r 3 m onths
2 w eeks,
for
R .B .C .
U rin ary v i t .
a ll lia b le
24 y e a r s .
album en.
B lood c o u n t .
W .B.C.
is
Temp.
te st
regards v a rie ty
in th e
gums f o r
i n m ou th and h e a v y b r e a t h .
nor ch est,
reg u larly .
4 w eeks.
No d i a r r h o e a ,
n o r stom ach t r o u b l e .
He h a s n e v e r h a d s o r e
neck.
He s m o k e s h e a v i l y
bases,
o v e rla p p e d by s w o lle n gums,
He
th ro ats
and d o es n o t
d rin k
alco h o l.
O.E.
T artar
at
te eth
brown s t a i n i n g .
O nly one
in c iso rs.
T o n sils
u lc erated
at bases
m olar s u l c u s .
C .N .S.
C ourse.
clear.
No g l o s s i t i s .
Day 1 . -
spot of
Gums s w o l l e n ,
of te eth ,
- N .A .D .
pumice d u s t
sm all
S h o tty ,
U lcer
b leed
and w h i t e
H eart,
lu n g s,
on t h e u p p e r
easily
slough
abdom en,
n o n -ten d er a d e n itis
Thorough r o u ti n e
and E u s o l
caries
sp ray in g .
scalin g ,
and
R.
ro tary
M.W. E u s o l 1 i n
cen tral
and
in
R.
eyes
re tro and
and L . .
b ru sh in g w ith
4 four
tim es
a day
143.
and d a i l y
10 $ c h r o m i c a c i d .
gum p a i n t s w i t h
D ay 3 .
Gums I . S . Q , .
Day 6 .
L e s s membrane on gum s.
and s h r i n k i n g .
Day 9 .
w h ite
U lcer
No b l e e d i n g
in
s till
O nly one
D ay 1 4 .
F it
for
retro -m o lar
on p r e s s u r e .
m arg arin e,
Soup.
carro ts.
"D uffs"
fru it.
Supper.
Case 3 1 .
or su g ar.
every
U rin e.
R .B .C .
U rin ary v i t .
c.
No n i c o t i n i c
jam .
p ick les
and t e a .
P ulse
1024.
acid
56/m in.
B u lly b e e f ,
once
eggs
a w eek.
T ourniquet
A c i d . No a l b u m e n , b i l e ,
spec.
80$.
blo o d
F irst
reg u la r
(V it.
chief
pain
Has " w h e e z e d "
at
He i s
n ig h t
p ains
spec.
d efic ien cy ).
and l a t e l y
4 days b efo re
and had
a non-sm oker,
had n o t i c e d
b lood
ad m issio n
co lic
d ia rrh o e a nor
red b lo o d .in
a n d no. e p i s t a x i s .
in h is
he was
and no n a u s e a th e n * .
and he h a s n e i t h e r
No v a g u e
C.
3 hrs.
c o m p la in t was t h a t
p a s t 3 w eeks he h a s had d i r t y ,
ago.
2 .0 6 m g.$.
done.
H is
No f a i n t i n g
.95.
L ym phocytes 15 $ .
spec.
2 .2 8 mg. $ .
estim atio n
C .I.
B aso p h ils 0$.
No v o m i t i n g w h e n o n s h o r e
are
2 w eeks.
tu rn ip s,
B ow els o p en .
4 ,9 2 0 ,0 0 0 /c.m m . H b. 94$.
Had e p i g a s t r i c
the m o rn in g s .
4 days
cabbages,
4^- m o n t h s .
sea-sick n ess h a b itu a lly
v o m it.
For th e
sausages.
3 tim e s a week.
Fresh f is h
S loop f o r
S .G .
and h i s t o r y * -
tro u b led w ith
bow els
o f R. l o w e r b i c u s p i d .
sausages.
b u tter,
estim atio n .
6 hrs.
2.35 m g .$ .
in t y p e .
s u l c u s now h e a l e d .
T i n n e d p e a r s b u t no f r e s h
salm on o r t i n n e d
M onocytes 4 $ . E o s i n o p h i l s 1 $ .
in th e
day.
1 0 ,2 0 0 /c.m m . P o ly m o rp h s.
C om plaint
s om e
Gum s w a b " p o s i t i v e " .
B lood c o u n t .
W .B.C.
or rice
Temp. 9 7 . 2 ° .
n eg ativ e.
and h e a l i n g .
- Bacon and eg g s o r t i n n e d
P o tato es,
21 y e a r s .
On a d m i s s i o n .
clean
a t base
Stew o r r o a s t .
bread,
S .R ,
area
P o rrid g e
T e a ,b re a d ,
C heese,
R etro -m o lar
jam and t e a .
Tea - T inned
and b a c o n .
su lcu s
red
R e d n e s s g o n e f r o m gums b u t
sm all u lc e ra te d
B reakfast
D inner -
p ap illae le s s
d isch arg e.
D iet h i s t o r y . B read,
heavy.
In terd e n tal
f i l m y membrane r e m a i n s .
D ay 1 1 .
te st
B reath
lim b s
-
H is
co n stip atio n .
h is.m o u th
A p p etite
good
in
till
a n d no e y e t r o u b l e s .
an i r r i t a t i n g
m orning cough f o r
but d rin k s h e a v ily w h ile
on s h o re .
144.
O .E,
He i s
a rath e r
4e a r t , C .N .S .
cerv ical
abdom en and
ad en itis.
severe
caries
spongy
and b le e d
of
10 $ a c i d
te eth .
No p a i n
R outine
Day 5 .
S lig h t
C ontinue
and no
scalin g ,
m.w.
cough.
Day 6 . A b d o m i n a l p a i n
gone.
Day 7 .
Eusol
S till
all
and
sw o llen
o v e r and u l c e r
and
i n R.
sp ray in g ,
etc.
D aily p a i n ts w ith
Bed.
d aily
i
T e n d e r R.
i s much t a r t a r
gums a r e v e r y r e d ,
Gums I . S . Q .
a b d o m in a l p a i n . M ist;.
chrom ic
it.
There
clear.
rale s.
B reath f o u l.
acid
w ith
The
Lungs- s c a tte r e d
T o n sils
W h ite membrane
su lcu s.
c h r o m . Ho 0
Day 3 .
su b ject.
e y e s - N .A .D .
easily .
Day 1 . -
pale
No g l o s s i t i s .
the
low er r e tr o - m o la r
C ourse,
th in ,
A scorbic
G ent, w ith
acid, ta b s
rh ei.
2.
tl.d .
K t . d . s .
a n d HgOg m o u t h w a s h e s .
HgOg d i s c o n t i n u e d
a s gums a r e
ten d er
(1 i n 4 ) .
in ste ad
some t e n d e r n e s s
i n gums.
C a rio u s stu m p s removed
under g as.
Day 9 .
Gums a r e
No u l c e r s
firm er
No p a i n
Day 1 2 .
D ischarged
D iet h i s t o r y .
in
gums n o r n e c k .
to
Chest
clear.
d u ty .
H is m eals v a ry
- B read,
or stew ed m eat.
acco rd in g
to
day.
b u t t e r ++, m arm alade
Roast
or
the
trip
T inned v e g e ta b le s
pudding once
Supper - Eggs o r
o r ham,
A tlan tic
B reakfast
bread
he i s
on.
or b e a n s
a fte r
being
h o t.
b u tter,
m arm alade
b u tter,
steak ,
statio n s.
jam and t e a .
liv er
th a t.
T inned f r u i t
Tea - B r e a d a n d b u t t e r ,
sausages or c h ip s.
and s y r u p .
and p o t a t o e s ,
C up o f t e a .
D in n e r — R o ast o r stew ed m e a t,
F resh greens f o r f i r s t
f i s h when i t
actio n
days).
- B read,
a fte r
or
th e
C o rn ed b e e f and
c lo s e d up a t
and c h i p s ,
Roast
and f r e s h g r e e n s
day 1.
Tea - B read,
D inner -
and b u t t e r .
trin (1 5
N othing e l s e
p o tato es.
p e r w eek .'
sausage
and t e a .
steam ed p o t a t o e s
p o t a t o e s f o r 3 d a y s ow ing t o
R ice
more s h r u n k e n .
S o u t h bound Convov (6 d a y s ) .
B reakfast
first
in te rd e n ta l p ap illae
now.
Day 1 0 .
e.g .
and
2 days
roast
and t i n n e d
and r i c e
P o tato es,
can be o b ta in e d
steak
or liv er.
from a t r a w l e r .
steam ed
carro ts,
pudding once
jam and s y r u p o c c a s i o n a l l y .
or
peas
p e r week.
Supper - Eggs,
C ornbeef p ie ,
ham o r
145.
Case 3 2 .
B .W .
T raw ler
On a d m i s s i o n .
n eg ativ e.
album en.
No b i l e ,
n eg ativ e
f o r K .L .B .
B lood
count.
W .B .C .
blood
U rin e.
Trace
of
s w a b ,Tp o s i t i v e " .
f o r haem o ly tic
4 ,3 0 0 ,0 0 0 /c .m m . Hb. 9 5 $ .
C u ltu re
strep to co ccu s.
C .I.
1 .1 .
66 $ . L y m p h o c y t e s 3 2 $ . M o n o c y t e s 2 $ .
0$ . B a s o p h i l s 0 $ ,
C.
estim atio n .
6 hrs.
m g.$.
No n i c o t i n i c
acid
spec.
and h i s t o r y . -
Also
cough.
No p a i n s
F irst
3.5 8
estim atio n
C om plaint
n ig h t.
1 030.A c id .
T hroat
but p o sitiv e
R .B .C .
U rinary v i t .
some
S .G .
or sugar.
9 , 6 0 0 / c.mm. P o l y m o r p h s .
E osin o p h ils
3.07
1 0 2 . 8° . P u l s e 9 8 / m i n . B o w e ls not. o p e n .
Temp.
T ourniquet t e s t
8 m onths.
(B) f o r
spec.
m g.$.
(Y it.C .
No h e a d a c h e
spec.
d eficien cy ).
th ro at
and v o m i tin g .
He h a s f e l t
" ru n down" b u t h a s h a d
no d i a r r h o e a ,
and p a i n s .
w ith h is
No t r o u b l e
3 hrs.
done.
Has h ad a s o r e
elsew here.
2 .9 5 m g.$.
for
th e
He s l e p t
easily
la st
24 h r s .
badly l a s t
tifed
la te ly
and
stom ach t r o u b l e , n o r a c h e s
eyes.
He s m o k e s
a pipe
and
is a
n o n -d rin k er.
O.E.
Lungs -
C .N .S,
and
w hite
eyes
exudate
fauces
are
A.
M.
R,
D ay 1 .
adm ission
and B.
6 9 3 , fit
A.
1.
Bay 3 .
Fauces
2.
are
b o th
H eart,
strep to co ccal
and B.
and
sp o ts
of
inflam m ation of
in fec tio n ).
Gums a r e f r e e
cerv ical
abdom en,
enlarged
V ery m arked
b u t no t a r t a r .
of
in fec tio n .
ad en itis.
693 on t h e
day b e fo re
stated ).
fo u r h o u rly
(1)
G argle p o t.
ch lo r.
t.d .s.
a n d a s p i r i n o *1
and B.
im p ro v in g .
co n tin u ed .
S lep t b adly.
A.
- M .andB .
2,
4 h o u rly .
and B . .
Bay 4 .
$
Bay 5 .
F e e l i n g much b e t t e r .
present
in
^
ft*
same a m o u n t.
T hroat le s s
S to p M .andB .
N.A .B. g i v e n i n t r a v e n o u s l y .
!
! D&y 6 . No p a i n . C h e s t c l e a r .
%
areas.
neck.
D o v e r's p u ly .
Bay 2 .
1 .2
co in cid en t
and L. t e n d e r
(am ount n o t
all
on ea c h .
- He h a s h a d M.
(2 ) T h e r m o g e n e t o
B.
from
in
T o n sils
present
some c a r i e s
No g l o s s i t i s .
rales
- N .A .D .
(pro b ab ly
T eeth h a v e
C ourse.
scattered
D efin ite
red but th e
C ontinue
1 and 2 .
im provem ent
8 . F ilm y e x u d a te re m a in s on L. t o n s i l .
Rest
exudate
, 4 5 gm.
in g e n e ra l
of th ro at
s till
co n d iti
clear.
146.
Day 1 0 .
L.
Dp 2 h r s .
Day 1 3 .
sick
to n sil
alm ost
clear.
One m i n u t e
T hroat
clear.
rem ain s.
No c o m p l a i n t s .
D isch arg ed to
7 days’
le av e.
Temp.
Same a s
C hart.
M.
D ay 1 .
1 0 2 .8
Day 2 .
99 .4
Day 3 .
97 .4
Day 4 and o n .
case
22.
E.
P u lse.
M.
100
90
9 9 .6
85
80
9 8 .2
70
76
N orm al
Rem ained
f o r 10 m o n t h s .
On a d m i s s i o n .
P u lse
76/m in.
U rin e.
C lear.
Temp.
T ourniquet t e s t
reactio n .
B lood
co unt.
W .B .C .
4-^$.
9 8 .4 °.
n eg ativ e.
No b i l e ,
R .B .C .
b lo o d ,
1 1 ,4 0 0 /c .m m . P olym orphs
U rin ary v i t .
56.0 m g .$ .
C.
C om plaint
(B lood
acid
spec.
acid
8 3 . 0 m g.$
ep istax is.
asco rb ic
tro u b le
acid
th e
and no d i a r r h o e a .
o ccasio n ally .
C .I.
1 .0 2 .
spec.
2 0 .0 m g.$.
(No d e f i c i e n c y
3 hrs.
spec.
on a d m i s s i o n ) .
sc u rv y 2 \ m onths ag o .
th en
and u r i n a r y
H i s g u m s s h o w e d V i n c e n t Ts d i s e a s e
p ro fu sely
till
acid
L ym phocytes 2 0 $ . M o n o cy tes
.26 m g ,$ .
C a rio u s t e e t h w ere
d aily
1015. V ery
done.
equal to
He h a d n y c t a l o p i a ,
S.G .
a day.
album en.
D eveloped tim e
a c i d w as low t o o ) .
B ow els open o n ce
0$.
F irst
estim atio n
and h i s t o r y .
asco rb ic
asco rb ic
estim atio n .
stead y th e r e a f te r .
Hb. 98$.
75$.
B aso p h ils
6 hrs.
No n i c o t i n i c
th en .
sugar or
4,8 6 0 ,0 0 0 /c.m m .
E o sin o p h ils
E.
98
C ase 3 3 . M .C. M o to r d r i f t e r
A lso
alone
No a d e n i t i s .
D iet h i s t o r y .
in
spot
b l e e d i n g gums and some a n a e m i a .
sto p p ed th e n
present
S lig h t
tim e.
and he w as p u t
No c h e s t
rheum atism
He s m o k e s a n d d r i n k s b e e r
in
and
th e
or
on
stom ach
sh o u ld ers
sp irits
in
m o d eratio n .
O.E.
T eeth
S hotty,
show s l i g h t
ta rta r
n o n -te n d e r glands
b le ed in g . W h itish film
clear.
H eart,
Course.
Day 1 .
lu n g s,
all
i n n eck R.
caries
and L.
is
"sto p p ed ".
Gums s w o l l e n
o v e r b u t no f r a n k u l c e r a t i o n .
abdomen,
R o u tin e
and a l l
C .N .S .
scalin g ,
and
b ru sh in g
eyes
and
T o n sils
- N .A .D .
and E u s o l
sp ray in g
and
147.
d aily
p a in ts w ith
. 4 5 gm . N . A . B ,
D ay 4 .
(l
in
4) m.w.
4 i.d .
in trav en o u sly .
Gums l e s s
red
th e m ornings.
Day 8 .
and
m ore
shrunken.
B reath
less
o ffen siv e.
Gums a l m o s t f r e e
b leed in g
Day 1 0 .
D iet.
D ischarged
Same a s
o f membrane and
d iarrh o ea.
case
norm al in
s i z e . No
du ty .
23.
Temp. 1 0 1 ° .
T ourniquet t e s t
b lo o d ,
No K . L . B .
to
W . S . 20 y e a r s .
On a d m i s s i o n .
No b i l e ,
S l i g h t membrane p e r s i s t s
and p a i n .
Case 3 4 .
B lood
Eusol
Gums I . S . Q,.
D ay 6 .
in
10$ ch ro m ic a c i d .
sugar or
Shore
e s ta b lis h m e n t f o r 5 m onths.
P u lse
8 0 / m i n . B o w e l s o p e n b u t no
n eg ativ e.
album en.
U rin e S .G .
T hroat
1028.
A cid.
swab " p o s i t i v e " .
on sm ear o r c u l t u r e .
count.
R .B .C .
4 ,7 0 0 ,0 0 0 .
5 , 0 0 0 / c.mm. P o l y m o r p h s
E o sin o p h ils
1$.
U rin ary v i t .
8 .9 2 m g.$.
B aso p h ils
C.
acid
spec.
C .I.
. 9 8 . W .B .C .
L ym phocytes 5 3 $ . M o n o cy tes 6$.
0$.
estim atio n .
6 hrs.
No n i c o t i n i c
40$.
Hb. 92$.
F irst
spec.
1 0 .4 6 m g.$.
estim atio n
5 ,3 1 m g.$.
(No v i t .
C.
3.
hrs.
spec.
d efic ien cy ).
done.
C o m p lain t and h i s t o r y . S ic k f o r 7 d a y s w i t h s o r e t h r o a t and s e n t
•a
in w ith t o n s i l l i t i s " .
H ad b e e n o n M. a n d B . 6 9 3 b e f o r e a d m i s s i o n .
(27 h a l f
gram .
nausea. P ain
d iarrh o ea,
ta b s.).
in
th ro at
vague
week h e h a s h ad
im p roving.
aches
chest
G reat
day b e f o r e
Illn ess
started
no b e t t e r .
and p a i n s
sym ptom s -
ep ig astric
A p p etite
poor la te ly ,
o r eye t r o u b l e .
Cough,
dysp h ag ia p e r s i s t s .
sp it
He d e v e l o p e d
rash,
articarial,
on b o t h f o r e a r m s
L u n g s - No d u l l n e s s t o
p ercu ssio n .
Some s c a t t e r e d
all
and B.
areas.
free
of
H eart,
in fec tio n .
and u l c e r a t i o n
upper p o le .
R.
sid e.
abdomen,
eyes
Some c a r i e s
o f R. t o n s i l .
A d e n i t i s R.
and C .N .S ,
of te eth .
W h ite,
and L.
b u t no
la st
a n d w h e e z e . Now
smoke b u t
M.
p a in s and
D u rin g th e
He d o e s n o t
O .E .
ad m issio n .
w ith
a rash
d rin k s f a i r l y
th e
h eav ily .
and l e g s .
rale s
- N .A .D .
in
. Gums
C o n g estio n o f fa u c e s
a d h e r e n t membrane on i t s
sid es
of neck.
V ery p a i n f u l
on
148.
C ourse.
l.
D ay
Therm ogene t o
Day 2 .
F eels
Bed.
chest
Low,
flu id
and t h r o a t .
b etter
but
01.
Rash l e s s
D ay 4 .
Chest
Day 5 .
V ery l i t t l e
T o n sils
D ay 8 .
T hroat
and on t r u n k .
in trav en o u sly .
im pro v in g .
cough.
b o th have film y
swab
Day 1 1 .
b u tter,
B reakfast.
tea
b ean s, m utto n ,
R ice,
sago
or bread
B read,
Bacon,
D inner -
No
c o n s t i t u t i o n a l sym ptom s
k id n ey ,
p o ta to es,
A pple
p o ta to es,
or
about 3 b a rs p er day,
Thi s d i e t
is
th an
in
th e
sausages,
cabbage,
T urnip,
jam t a r t s
meat p ie s ,
n u t,
fru it
ones th e
bread,
beef
(stew ).
carro ts.
w ith
S u p p er - Egg and
b eetro o t
O ranges 2 p e r w eek.
C hocolate
refle cted
L iv er,
jam , m a rm a la d e .
A pples 3 o r 4 p e r w e e k .
is
to n sil.
eggs,
pu d d in g s.
bacon,
fu ller
p o sitiv e.
lam b o r c o r n e d b e e f .
b u tter,
ro lls,
t h e m . No s o r e t h r o a t .
d u ty .
and m a rm ala d e.
Peas,
sausage
s p o t on R.
D isch arg ed to
D ie t.-
on
g iv en .
O nly a s m a l l
Day 1 3 .
exudate
s t i l l stro n g ly
Day 9 . . 4 5 g m . N . A . B .
|and i t
4 i.d .
Rash g o n e.
D ay 6 .
ilea -
T hroat
ch lo r.
R ie .3 4 .
. 3 gm. N .A .B .
pronounced.
clear.
G argle p o t.
r a s h more e x t e n s i v e
(No v o m i t i n g n o r « ^ ^ t » - 0
Day 3 .
d ie t.
cu stard ,
ch ip s,
and c h e e s e .
Bananas 2 p e r w eek.
and n u t ,
sailo rs
on th e
and m i l k .
sh ip s
get
h is u rin a ry v itam in C t e s t .
i
Case 3 5 .
J.W .
23 y e a r s .
On a d m i s s i o n .
Temp.
co n stip atio n .
S,G. 1 0 2 6 .
S loop f o r 4 m onths.
9 8 .4 °.
P u lse
T ourniquet t e s t
A cid.
No b i l e ,
78/m in.
n eg ativ e.
blo o d ,
B ow els - t e n d e n c y t o
U rin e.
D ark s tr a w
s u g a r o r album en.
T hroat
co lo u r.
a n d gu m
swabs " p o s i t i v e ” .
Blood c o u n t .
J .B . C .
R .B .C .
4 ,9 3 0 ,0 0 0 /c .m m . Hb.
6 ,800/c.m m . P olym orphs 71$.
E osinophils 0 $ .
Urinary v i t .
U 3 m g .$ .
to n i c o t i n i c
C.
B aso p h ils
acid
spec.
1.
L ym phocytes 2 5 $ . M o n o cy tes 4 $ .
F irst
4 .0 m g.$.
estim atio n
spec.
3 .0 1 m g.$.
( Y i t a m i n C.
3 hrs.
spec.
d efic ien cy ),
done.
fompiaint and h i s t o r y .
-
Uth V i n c e n t ’ s d i s e a s e
o f gums and l e f t ,
1
C .I.
0$.
estim atio n .
6 hrs.
98$.
Was 7 w e e k s
in
a sm all
em ergency h o s p i t a l
ap p aren tly
cured,
on 10
days
sick
Now b r e a k s
C o n su lted
pain.
leav e.
h is
He h a d l o c a l
leav e
d en tist
P rio r to
p erio d
c/o
ap p licatio n s
a relap se
2 days p r io r to
th is
ou tb reak o f w ar.
of h is
tro u b le.
A p p etite
fairly
B ad t a s t e
i n m outh
in m ornings.
sym ptom s.
sea serv ice
general p ain s,
good,
scalin g .
ad m issio n w ith b le e d in g
he h as had c o n tin u o u s
No d i a r r h o e a ,
o n l y and no
but
gums - no
sin ce
th e
c h e s t o r eye
some " i n d i g e s t i o n "
Smokes 15 c i g s . / d a y .
la te ly .
L ight-
d rin k er.
0 ,E .
Gums r e d ,
esp ecially .
B ilate ra l
bottom ,
sw ollen
B reath
ad en itis.
m olar w ith
and t h i c k ,
cru sted
by t h e
s w o l l e n g u m s . No s c a l i n g
C hest,
h eart,
abdomen,
clear
C ourse.
Day 1 .
of u lc eratio n
D aily p a i n t s w ith
Much b l e e d i n g
Day 6 .
Gums now p a l e r
some s w e l l i n g
d aily
before.
No g l o s s i t i s .
b rushing
acid.
and E u s o l
sp ray in g .
. 4 5 gm. N . A . B .
in trav en o u sly .
o f gu ms a n d w h i t e m e m b r a n e p e r s i s t s .
C ario u s L. low er m o lar
A lv eo lar
abscess h ealin g
i n now.
treatm en t.
Day 1 1 .
D isch arg ed .
No p a i n
or b leed in g .
A d en itis has
subsided.
Sam e a s C a s e 3 1 ,
Case 3 6 .
G .D .
M inesw eeper (S)
for
On a d m i s s i o n . T e m p . 9 8 . 0 ° . P u l s e
d iarrh o ea.
album en,
W .B.C.
- N .A .D .
overlap p ed
a n d s o c k e t w a s h e d w i t h HgOg.
A lm ost n o r m a l .
Blood
bases,
and m em brane.
and s h r i n k i n g .
Day 1 0 .
D iet,
second,
H a s s om e c a r i o u s
done when t r e a t e d
scalin g ,
Gums a b o u t n o r m a l .
C ontinue
on lo w e r
caused.
S till
Day 8 .
w h ite f ilm
abscess b esid e
round t e e t h
and C .N .S .
10$ chrom ic
Day 4 .
ex tracted
ta rtar
eyes
R outine
A lv eo lar
cream y pus e x u d in g .
m olars
T onsils
d elicate
heavy.
subm ax illary
le ft
and b l e e d i n g ;
T ourniquet t e s t
sugar,
count.
R .B .C .
7 ,1 0 0 .
C.
8 0 / m i n . B o w e ls o p e n , b u t no
n eg ativ e.
o r blo o d .
T o n sil
U rin e.
S .G .
1020.
A cid.
No
a n d gum s w a b s " p o s i t i v e " .
4 , 3 7 0 ,0 0 0 /c.m m . Hb.
P olym orphs 80$.
E osinophils 1$.
U rinary v i t ,
b ile
7 m onths.
92$.
C .I.
L ym phocytes 1 5 $ .
1 .0 6 .
M onocytes 3 $ .
B aso p h ils 1$.
estim atio n .
F irst
spec.
2 .0 4 m g.$.
3 hrs.
spec.
150.
2 .9 8 m g.$.
6 hrs.
No n i c o t i n i c
C om plaint
acid
trea ted .
vague
aches
d ifficu lty
seein g
smoke
b ru sh in g th e
H eart,
te eth
lu n g s,
T o n s illa r g lan d s
w ith
d irty
grey
to n sillecto m y
and had w h i t e ,
w ith yello w
p ractically
t.t.
w h ich he d o es n o t
abdomen,
enlarged
D ay 1 .
C .N .S .
L.
++.
No d i a r r h o e a ,
teeth
R outine
acid.
Says he has
Gums b l e e d
and e y e s
on
- N .A .D .
Deep r a g g e d u l c e r o f L .
B .N .T .
sp ecia list
and
scalin g ,
aspects.
sw o llen
Some u l c e r s
In te r-d e n ta l p ap illae
caries
e tc .,
H^Og m . w .
to n sil
rep o rted th a t
Gums b l e e d i n g ,
bases.
B oth t a r t a r
10$ ch ro m ic
g u m s . He h a s n o t
do r e g u l a r l y .
ad v isab le.
sloughs a t
C ourse.
sore
th ro at
n i g h t w a tc h now.
f i l m y membrane on o u t e r
and r e d .
Has had s o r e
rem oval o f t o n s i l s .
s lo u g h on i t .
sw ollen
w ith
th ro at.
stom ach o r lu n g t r o u b l e .
is
was n o t
d efic ien cy ).
done.
sore
on t h e
and
(V it.C .
L a te ly h as had
in f o r
and p a i n s ,
He d o e s n o t
O .E .
c/o
7 m onths.
Sent
in
3 .2 5 m g.$
estim atio n
and h i s t o r y ,
on and o f f f o r
been
spec.
of te eth .
of te e th .
4 i.d .
No g l o s s i t i s .
D aily p a in ts
* 3 gm . N . A . B .
in trav en o u sly .
Day 5 .
T hroat
clearin g .
No p a i n .
A llow ed u p .
S t o p HgOg a n d b e g i n
E u s o l m.w.
Day 7 .
T hroat
d estro y ed .
clear.
D epression l e f t
Gums h a v e l o s t
D ay 8 . Two s m a l l p a t c h e s
r e m a i n o n R.
sid e
but
t h e i r film y
th ey
Day 1 1 .
D ischarged to
D ie t.-
B reakfast
b u tter
and
jam .
lo o k and a r e f i r m e r .
anyw here.
d u ty .
- K ip p er,
D in n er.
p u d d in g .
bread,
b u tter
R oast m utton,
Roafet b e e f .
Supper -
and t e a .
roast
No s w e e t .
Sausages,
2 apples
p o tato es,
Tea - T ea,
tu rn ip ,
bread,
B acon and m ashed p o t a t o e s .
Tea.
T his
is
a m onotonous d i e t .
com plained
of th e
food o r f r u i t .
has
are h e a lin g .
No m e m b r a n e o r u l c e r a t i o n
Y orkshire
tissu e
a t b a c k o f l o w e r w isdom t o o t h
Day 1 0 .
p e r week e a t e n .
w here t o n s i l l a r
A ll th e
m onotony o f i t .
cases
There
from th e
is
not
sh ip
enough g re e n
been
151.
C a s e 3 7 . W.W. 2 7 y e a r s .
On A d m i s s i o n .
reg u larly .
T raw ler f o r
Tem p 9 8 . 4 ° .
P u lse
T ourniquet t e s t
1017. F a in tly
acid .
18 m o n t h s .
7 0 /m in.
n eg ativ e.
No b i l e ,
b lo o d ,
B ow els n o t open
U rin e
- C lear.
sugar or
S .G .
album en.
Gum s w a b " p o s i t i v e ” .
B lood
count.
W .B .C .
R .B .C .
1 1 , 8 0 0 / c .mm. P o l y m o r p h s 7 7 $ .
M onocytes 3 $ .
U rin ary v i t .
spec.
4 ,7 5 0 ,0 0 0 /c .m m .' Hb. 95 $ .
E o sin o p h ils
C.
estim atio n .
1 .5 3 m g.$.
No n i c o t i n i c
0$.
6 hrs.
acid
spec.
0$.
spec.
1.6 1
m g.$.
1 .4 m g.$. 3 h r s .
(V itam in C d e f . )
e s tim a tio n done.
C o m p la in t and h i s t o r y . t
Gums b l e e d
B reath
not
is very
1 .0 1 .
L ym phocytes 20 $ .
B aso p h ils
F irst
C .I.
bad.
He i s
easily
com plaining
on r u b b i n g .
and w as p i c k e d
/
up a t
a ro u tin e
no lu n g o r
den tal
stom ach t r o u b l e
He s m o k e s 2 0 c i g s / d a y
O .E .
H ealthy
ta rta r
at bases
S h o tty
clear.
No p a i n s
in th e
lim b s,
a n d no d i a r r h o e a .
No e y e
tro u b le.
and d r i n k s b e e r
lo o k in g ,
ta n n e d man.
at
teeth
.
sp irits.
-
some c a r i e s ,
Gums r e d ,
te n d er
and
b a s e s o v e r la p p e d by s w o lle n ro u n d e d
su b m ax illary
No g l o s s i t i s .
and
T eeth
and brow n s t a i n i n g .
sw o llen . 'T a rta r
gum s.
ex am in atio n .
and c e r y i c a l g l a n d s .
H eart,
lu n g s,
abdomen,
T o n sils
C .N .S .
and e y es
-
N .A .D .
C ourse.
- Eusol
D ay 1 . -
sp ray in g .
E u s o l m .w .
R outine
D aily
scalin g ,
ro ta ry b ru sh in g ,
p a i n t s w ith 10$ chrom ic
Gums I . S . Q ,
C ontinue
Day 7 .
Gums l e s s r e d
and b r e a t h l e s s
Day 9 .
F u ll
d ie t.
4 i.d .
Day 4 .
in terd en ta l
acid .
and
d aily
treatm en t.
o ffe n s iv e .' S h rin k in g
of
p ap illae .
P ractically
no m em brane i n
th e m orning.
Gums n o t
b l e e d i n g when r u b b e d .
Day 1 2 .
D iet.
D isch arg ed .
B reakfast
B read,
b u tter
- Egg o r k i p p e r s .
++ a n d t e a .
C abbages tw ice
a week.
a week.
Tea -
is
a poor,
or
sausage
Bacon on Sundays o n ly .
D in n er — Soup,
T inned f r u i t
Tea, b re a d ,
Cheese o r b e e t r o o t,
T h is
t
b u tter
m eat,
and c u s ta r d
and
jam .
p o tato es.
about tw ic e
Supper -
and m a sh . T e a and b r e a d .
m onotonous d i e t .
152.
Case 38.
E .E .
56 y e a r s .
On a d m i s s i o n .
T em p.98
test
( o v e r 100
p o sitiv e,
1026.
F ain tly
acid .
2nd Hand on a t r a w l e r f o r 1 y e a r .
• P u lse
92/m in .
sp o ts).
No " b i l e ,
B ow els o p en .
U rin e.-
b lo o d ,
straw
sugar or
T ourniquet
coloured.
album en.
S .G .
Gum
swab p o s i t i v e .
B lood
count.
W .B .C .
3-j$.
R .B .C ,
9 , 4 0 0 / c.mm. P o ly m o r p h s
E o s i n o p h i l s -£$.
U rin ary v i t .
spec.
C.
asco rb ic
C om plaint
6 hrs.
acid
traw lers
in a b ility
w ere
all
0 .0 4 mg.$ .
to
see
life
at n ig h t
th e
bases.
but th e
th ro ats,
No c h e s t t r o u b l e .
O .E .
He s t i l l
ep istax is
He d r i n k s
e asily .
has
g lo ssitis.
abdomen,
sp irits
su b ject.
C ourse.
c it.
1 oz.
E u s o l m.w,
and a r e
R +
in
and
th e
tim e h i s
gums
does n o t
.25
red
no a d e n i t i s .
T his
is
a case
No s o r e
6.
R
U’O
.3
36
L
and b l e e d
en cru sted
at
clear.
H eart,
of
2 m onths
sm oke.
sph. m F
6
s p h . as ?>
B reath very heavy. T o n s ils
- N .A .D .
and
o r lim b s.
6
.25
T artar
for
ten d er.
th e back
spongy,
R outine
A sco rb ic
t.d .s.
scalin g ,
b ru sh in g
bases
No
lu n g s,
scurvy.
and E u s o l
a c i d 1 , 4 0 0 mg, t . d . s . . M i s t , f e r r i
D aily p a in ts
o f gums w i t h 1 0 $
T hin,
(1
in
et
4)
am mon.
chrom ic
acid .
4 i.d .
Day 3 .
Gums I . S . Q , .
Sam ple o f u r i n e
Day 5 .
Less
hx s w e llin g
frictio n .
at n ig h t.
*
Day 1 .
sp ray in g .
see
n o ticed
At t h i s
but
are v ery
No k a r a t o m a l a c i a ,
C .N .S .
to
a few t e e t h w i t h t a r t a r
o r p ain s
rep o rt.
low er,
te eth .
e s tim a tio n done.
and th y m o l m.w.
V i n c e n t ’ s membrane p r e s e n t .
o f rem ain in g
pale
th e
He f i r s t
ago.
L +
sp ecia lly
acid
d efic ien cy ).
V i n c e n t ’ s i n f e c t i o n was p r e s e n t
O p h th alm o lo g ist’ s
Gums,
C.
in a b ility
th a t.
b l e e d on p r e s s u r e
d iarrh o ea,
3 hrs.
a y e a r w i t h no c h a n g e o f d i e t ,
He h a s u s e d g l y c e r i n e
gums s t i l l
(V it.
No n i c o t i n i c
2 m onths
spongy and b l e e d i n g .
1 .3 8 m g.$.
2 .2 7 m g.$.
before
7 bad t e e t h w ere p u lle d .
at
spec.
C om plains o f
sh ip fo r
h is
0 .7 8 .
Lym phocytes 27 $ . M onocytes
F irst
spec.
and h i s t o r y . -
He h a d b e e n o n t h e
69$.
C .I.
B asophils 0$.
estim atio n .
1 . 4 3 mg.$*
B lood
in
4 , 5 0 0 , 0 0 0 / c.mm. H b . 7 0 $ .
redness
S kin c o n d itio n
on l e g s
shows 4 .3 m g.$ a s c o r b i c
of th e
gum s.
su g g estiv e
S till
b leed
on
of p so riasis-L o tio
acid .
calam in.
co.
Day 8, Membrane not so copious. Interdental papillae shrinking.
Day 1 0 .
Gums p r a c t i c a l l y
p ractically
Day 1 2 .
D iet.
B reakfast
P o tato es,
- B acon and eggs
jam .
and
jam .
32 y e a r s .
Temp, 9 8 ° .
n eg ativ e.
No b i l e ,
sugar or
b lo o d ,
R .B .C .
T raw ler
. 2.86 m g .$ .
C.
6 hrs.
i No n i c o t i n i c
C om plaint
acid
P o rk on S u n d ay s.
Tea - T ea, b re a d ,
bread,
b u tter,
B ow els n o t
p a l e . S .G .
a l b u m e n . Gum s w a b
spec.
80$.
1010.
A cid
and h i s t o r y .
F irst
(fain t).
p o sitiv e.
87$.
C .I.
1 .0 6 .
Lym phocytes 1 5$. M onocytes
'
spec.
2 ,9 4 m g.$.
estim atio n
jam .
open.
B aso p h ils ^$.
estim atio n .
bread,
f o r 7 m onths.
78/m in.
U rine
7 ,2 0 0 /c.m m . P olym orphs
j U rinary v i t .
(A)
4 , 1 5 0 , 0 0 0 . /c .m m . Hb.
4 $ . E o s i n o p h i l s -J$.
i
peas.
Tea,
a p p j.e s o r o r a n g e s f o r many y e a r s now .
P u lse
T ourniquet t e s t
count.
or tinn ed
He h a s h a d n o
D .A .G .
On a d m i s s i o n .
carro ts
Supper - Tea o r c o ffe e ,
any f r u i t .
W .B.C.
on l e g s
ev ery m orning.
D in n e r - M utton o r b e e f .
cabbages,
Case 3 9 .
B lood
co n d itio n
clear.
b u t t e r ++ a n d
Never
S kin
D isch arg ed .
-
b u tter
norm al.
3 .1 7 m g.$. 3 h r s .
( V i O C.
spec.
d eficien cy ),
done.
Gums b e g i n n i n g
to
sw ell
and b l e e d i n g
on
p r e s s u r e . A c h in g o f l o w e r ja w o f tw o d a y s d u r a t i o n . Bad t a s t e i n
I
j m o u t h . No g e n e r a l a c h e s a n d p a i n s . S l i g h t s o r e t h r o a t 7 d a y s b e f o r e
j
| adm ission b u t t h a t
nor n y c t a l o p i a .
is
b e t t e r now.
He d r i n k s h e a v i l y b u t i s
he h a s b e e n v e r y
co n stip ated
O.E. F r o n t
below
thick,
stain in g .
j furrow s.
clear,
te e th
hard
ta rtar
Boggy,
eroded
but larg e
Course.
abdom en,
Day 1 .
with E u s o l .
p er m a n g , m . w .
non-sm oker.
bases.
B reath o ffe n siv e .
C aries
of m olars
at
any tim e .
T eeth have
and d e e p b ro w n
F ilm y e x u d a te
in la b io -g in g iv a l
a re a s behind
upper c e n tra l
in c iso rs.
C ervical
ad en itis
R.
front
o f R.
a n d L . No g l o s s i t i s .
T o n sils
an terio r
H eart,
and e y e s - N .A .D .
R o u tin e s c a li n g ,
D aily p a in ts
4 i.d .
L ately
and t e n d e r .
u l c e r w i t h w h i t e membrane i n
C .N .S .
-
a
stom ach t r o u b l e
and h a s h a d no d i a r r h o e a
are lo o s e .
at th e
Gums s w o l l e n
faucial p i l l a r s .
lungs,
No b r o n c h i t i s ,
ro ta ry b ru sh in g
o f gums w i t h
3 v eg etab le
10$ chrom ic
la x a tiv e s.
and
sp ray in g
acid
and p o t .
Day 2 .
D a i l y t r e a t m e n t + 0 . 4 5 gm. N . A . B .
Day 4 .
Gums I . S . Q , .
Day 6 .
U l c e r on a n t e r i o r
S m aller
in
D ay 8 .
size.
D ay 9 .
D iet.
M or e f i r m .
red
of fauces
c le a rin g up.
and f i e r y .
i n g u m s. N o t b l e e d i n g on
F aucial u lc e r h ealed .
no v i s i b l e
m em brane.
Neck n o t t e n d e r .
D isch arg ed .
S am e a s
Case 4 0 .
case
18.
F .S .
1 8 y e a r s . B a t t l e s h i p 2 w e e k s , a n d cam p f o r
10 w eek s p r e v i o u s l y . S t e e l w o r k e r i n c i v i l l i f e .
On a d m i s s i o n .
Temp. 1 0 2 . 6 ° .
T ourniquet t e s t
A c i d . No b i l e ,
p o sitiv e.
n eg ativ e.
b lo o d ,
P u lse
U rine
B .B .C .
8 ,4 0 0 p e r
8 4 / m in.
deep
straw
su g a r o r album en.
(H undreds o f f u s if o r m
B lood c o u n t .
W .B .C .
p illa r
im provem ent
P ractically
Day 1 0 .
aching.
Gums l e s s
N o ticeab le
pressure.
Less
in trav en o u sly .
co lo u r.
T hroat
c.mm. P o l y m o r p h s .
M onocytes 5 $ .
E o sin o p h ils
2$.
U rin ary v i t .
C.
estim atio n .
F irst
E.65 mg. $ .
6 hrs.
96$.
61$.
Sudden o n s e t w ith
slig h t
spec.
headache
ill
per day and
alco h o l.
ldng t r o u b l e
O.E.
Ill
breath,
j Signs
or
A T ttrks c e l l w as
2 .7 m g.$.
lik e
p atien t.
n eg ativ e
in the
covered w ith
f o r K .L .B .
was s u s p e c t e d .
oaries.
H eart,
ad en itis
R.
spec.
L ips
ca m e o n 2 4 h r s .
d ry and s o r e .
He s m o k e s 1 0 c i g s .
No p r e v i o u s
” rheum atism ” ,
ashy g rey ,
sm ell.
ch est.
a w h ite,
d r y and s o r e .
B le p h aritis
T hroat
film y ,
-
in b o th
in jecte d .
exudate..
count tu le d t h i s
C .N .S .
in
P .M .
and
o u t.
abdomen - N .A .D .
so
eyes,
not
cu ltu re
-
ag ran u lo cy to sis
T eeth u n clean
T ender,
O ffensive
T o n sils
Swab a n d
H as b e e n on M an d B 693 o u t s i d e
B lood
and L.
!Course. -Day 1 .
to o .
in th e n ig h t.
L ips
a d ip h th eria
of b ro n ch itis
large b u t
3 hrs.
seen.
d iarrh o ea.
and t o x i c
not
d rin k
1 .1 .
(V itam in C d e f ic ie n c y ) .
Cough d e v e l o p e d . He b e c a m e
does n o t
1025.
Lym phocytes 3 1 $ .
Nicotinic acid excreted per d a y equal to 5 . 1 4 mg.
|
I C o m plaint and h i s t o r y .
Sore t h r o a t and so re ey es
| ago.
S .G .
seen).
C .I.
B aso p h ils 1$.
2 . 8 m g.$
open.
swab s t r o n g l y
organism s o n ly ,
4 ,3 6 0 ,0 0 0 /c .m m . Hb.
spec.
B ow els n o t
and
some
sw o llen
neck,
of day of admission. Extension of white film
155.
on i n s i d e
o f m outh
m ucosa. V ery i l l .
and c h e s t .
ox.
flav .
M and B 693
G arg.
to
and t h r o a t .
p o t.
eyes.
chlor.
F eels
a little
m outh.
S till
ill.
N .A .B .
- 2 t.d .s .
2 h o u rly .
appeared
on b u c c a l
Therm ogene to
L otio
A .B .
neck
+ u n g t. hydrarg.
F lu id s.
Day 2 .
ad d itio n .
Sm all u l c e r s
b etter.
E x ten sio n of w h ite
M andl’ s p a i n t
0 . 4 5 gm.
Day 3 .
F eels b e tte r ,
V om ited
d u rin g
D ay 4 .
M outh no w o r s e .
and b ra n d y ^
oz.
film
in
th e
4 h o u rly
in
in trav en o u sly .
a p p e a r a n c e s o f momth s l i g h t l y
im proved.
th e n ig h t.
and B eaum nnt’ s a r s e n i c
Enema g i v e n .
paint
D ay 5 .
Membrane l e s s
in
D ay 7 .
Membrane v a n i s h i n g .
M.
and B.
693 - 1 t . d . s .
g iv en .
am ount. E yes b e t t e r .
M any s m a l l u l c e r s
p ersist
in
b u c c a l m ucosa.
D a y 8 . M o u t h i m p r o v i n g . No g e n e r a l i s e d
D ay 1 0 . M uc h i m p r o v e d
in sid e
of cheeks.
S h o tty g la n d s
R.
s till
present
Gums f i l m y l o o k i n g b u t t o n s i l s
b etter.
and L.
D ay 1 1 .
Up o n e h o u r ,
D ay 1 7 .
S tead y
fo r th e
la st
Day 1 8 .
D iet.
In the
cabbage
the one
fu ll
d iet.
U lc e rs have
cleared
on
up.
im p ro v em e n t. Has b e e n on B eau m o n t’ s p a i n t
o n ly
days.
Camp.
sick le a v e .
B reakfast
-
One a p p l e p e r w e e k w a s t h e
and p o ta to e s
- Jam , b r e a d ,
or l i v e r
Few u l c e r s
i n n e c k now. W a n ts u p .
D i s c h a r g e d .to 14 d a y s
and t e a .
Tea.
six
g en era lly .
m em brane.
and g r a v y ,
Sausage,
only f r u i t .
e v e ry d a y . M ilk p u d d in g
te a
o r cake.
Supper
o r m eat and p o t a t o .
a p p le p e r week.
egg,
Cabbage was t h e
-
bread,
butter
D in n e r - M eat,
or b o iled
apples.
Corned b e e f + b e e t r o o t ,
The o n ly f r e s h
o n ly v e g e ta b le .
f r u i t was
CASE 4
CLINICAL CHART
UNI T OR SHIP.
....................
NO
............
DIAGNOSIS
-
ARM Y F O R M .
NAVAL F O R M .
R.A.F. F O R M .
(TO BE ATTACHEO TO CASE SH EET)
.. RANK AND N A M E _____
A G E
■'*'
f
^
*
DATE OF ADMISSION.: J j A j . 1 9 ! ^ .- DATE OF DI SCHARGE
B. 1 8 1
M. 4 1
549
HOSPITAL
. / ...J'
STATION
MONTH
/r
DATE
DAY O F D I S E A S E
106
M .E . M . E . M.E.
10 I
M.E . M.E. M .E . M .E . M .E . M .E . M.E. M .E . M .E .
I#
IX
M . E . M .E . M .E . M .E . M.E. M.E. M .E.
If
M . E . M.E . M.E. M .E . M . E . M .E . M .E . M .E . M . E .
6 10
10 2
6 10
J9X
105
104
103
102
101
100
99
98
97
96
95
150
140
130
120
100
90
80
70
60
50
40
30
20
B .O .
F O R M S /l8 l / l 7 .
S IGNATURE OF M.O.'/c
157
Case 4 1 .
S .E .
On a d m i s s i o n .
26 y e a r s .
Temp, 9 8 . 6
a day. T ourniquet
F ain tly
Has l i v e d
acid.
te st
.
P u lse
n eg ativ e.
Ho b i l e ,
b lo o d ,
in m otor b o a ts
for
1 yr.
78/m in.
B ow els r e g u l a r once
U rin e
clear,
sugar or
-
S .G .
album en.
1020.
Gum s w a b
p o sitiv e.
B lood c o u n t . H .B .C . 4 ,8 5 0 ,0 0 0 /c .m m .
I
| W .B .C . 1 0 , 8 0 0 / c.mm. P o l y m o r p h s 6 6 $ .
5$.
E o sin o p h ils
U rin ary v ita m in
spec.
0$.
j C om plaint
i
6 hrs.
acid
and h i s t o r y . -
of vitam in
i The o n l y t r e a t m e n t
1
| a c i d + 3 0 0 mg. v i t .
| gums w h i c h
u p sets,
; smokes and
O .E.
T ypical
P rom inent
no t a r t a r
C d aily .
; s w o l l e n gum.
4 w eeks,
th e n
showed
v a l u e w as 0 .2 1 m g.$.
p ain ts
w i t h 10$ ch ro m ic
T h e r e h a s b e e n no
im provem ent
r a w . He h a s h a d n o d i a r r h o e a ,
a n d no v a g u e
p ap illae .
furrow s. P ain
but
S lig h t
n o n -ten d er a d e n itis
j eyes
of v it.C ).
aches
in h is
stom ach
and p a i n s .
He
in m oderation.
in terd en ta l
v isib le
for
U rine t e s t s
b lood
" T re n c h M outh". B r i g h t
g in g iv o -lab ial
i
ago.
C and t h e
eye tr o u b le
d rin k s
(Ho d e f i c i e n c y
done,
16 d ay s
and
1 .0 2 .
2 0 .0 m g.$. 3 h r s .
3 6 .3 6 m g.$.
g iv e n was d a i l y
are te n d e r
lu n g o r
spec.
H as h a d " T r e n c h M outh"
He w a s s e e n b y a d e n t i s t
a d eficien cy
C .I.
L ym phocytes 29$. M onocytes
F irst
spec.
estim atio n
98$.
0$.
C estim atio n .
2 9 .5 m g.$.
Ho n i c o t i n i c
B aso p h ils
Hb.
s om e i s
caries.
R.
red,
ten d er,
sw ollen
W h ite membrane p r e s e n t
on e v e r t i n g
embedded
th e
cheeks.
gums.
in
T e e th have
and o v e r la p p e d b y t h e
T o n sils
clear.
Ho g l o s s i t i s .
S h o tty
and L. H e a r t ,
lu n g s,
abdomen, C .H .S .
and
- H .A .D .
i
j C o u r s e . - Day 1 .
Embedded t a r t a r
scaled .
R o tary b ru sh in g
and
; Eusol s p r a y in g o f t e e t h .
M.W. p o t . p e r m a n g . 4 i . d . D a i l y gu m
I
| p a i n t s w i t h 1 0 $ c h r o m i c a c i d . 0 . 4 5 gm. H . A . B . g i v e n i n t r a v e n o u s l y ,
i Day 4 .
I Day 6 .
Less p ain
S till
! p ap illae
some
le ss
in
gums. R e d n e ss
su b sid in g .
membrane i n g i n g i v o - l a b i a l
p rom inent.
C ontinue d a i l y
su lcu s.
In terd e n tal
treatm en t.
]
Day 8 . Gums v e r y m u c h b e t t e r . Ho r e d ,
is
a u n ifo rm h e a lth y
Day 9 .
D ie t.
F it
for
p in k .
P ractically
a n g r y c o l o u r now.
no m e m b ran e.
d isch arg e.
Same as c a s e 2 but no e g g s f o r t e a .
C olo u r
158.
Case
42.
C.H,
On A d m i s s i o n .
te st
40 y e a r s .
Temp.
n eg ativ e.
T hroat
B lood
99 .0
U rine
.
P u lse
- N .A .D .
9 7 /m in.
S .G .
B ow els o p e n .
1018.
T ourniquet
Gum s w a b n e g a t i v e .
swab p o s i t i v e .
count.
R .B .C .
W .B .C . 9 . 6 0 0 /
5$.
P a d d l e m i n e s w e e p e r f o r 12 m o n t h s .
c.mm. P o l y m o r p h s .
E o sin o p h ils
U rin ary v i t .
4 .0 2 m g.$.
1$.
6 hrs.
acid
spec.
and h i s t o r y .
y esterd ay .
Sore t h r o a t
stag e
sid e
He w a s t h o u g h t t o
spec.
0 .9 5 .
th en
alco h o l.
O .E .
V in cen t’ s in fe c tio n
Chest
- N .A .D .
H eart,
attack s
severe
of
cough,
before
general p ain s,
No p a i n
o f R.
C .N .S .
sh iv erin g
attack s y esterd ay .
in neck.
in
to n sil.
and e y e s
No h e a d a c h e
nor n y ctalo p ia .
No d i a r r h o e a .
1934 b u t
He s m o k e s 1 0 c i g s .
d rin k
spec.
(V itam in C d e fic ie n c y )
s w e a t i n g . No i l l n e s s
o n ly .
film .
3 hrs.
done.
have had m a la r ia
confirm ed by b lo o d
3 .9 5 m g.$.
Has had s e v e r a l
He h a s h a d n o
- R.
C .I.
Lym phocytes 20$, M onocytes
4 .6 1 m g.$.
Had s e v e r a l
no r v o m itin g .
74$.
F irst
estim atio n
fo llo w e d by a h o t
Hb. 95$.
B aso p h ils 0$.
C estim atio n .
No n i c o t i n i c
C om plaint
5 ,0 0 0 ,0 0 0 /c.m m .
t h i s was n e v e r
per
day and d o es n o t
P o st-n asal
- N .A .D .
d isch arg e.
A b d o m e n - No
| sp le n ic enlarg em en t.
B l o o d f i l m - n o e v i d e n c e o f m a l a r i a . Gums
!
I sw ollen b u t n o t in f e c te d .
Some t a r t a r b u t n o c a r i e s o f t e e t h .
No g l o s s i t i s . S l i g h t R . c e r v i c a l , n o n - t e n d e r a d e n i t i s .
]i
1
j C o u r s e . Day 1 . . T e e t h b r u s h e d an d s p r a y e d a t o u t s e t . 0 . 4 5 gm . N .A .B .
] in trav en o u sly .
Day 2 .
Not
G argle
No p a i n
in
p o t.
th ro a t.
chlor,
S till
4 i.d .
and E u s o l m.w.
a w h ite
p atch
on R, t o n s i l .
co lo u r.
A ppears to
sp read in g .
Day 4 .
S lough i s
d i r t y y ello w
Day 5 .
U l c e r on t o n s i l
in
ra p id ly h ealin g
aw ay ” e n m o r c e a u x " . C o n t i n u e m . w .
Day 6 .
O nly a v e r y
sm all w h ite
at
edges.
be
sh rin k in g .
S lo u g h com ing
and g a r g l e s .
spot
on u p p e r p o l e
of to n sil.
!
P atien t
h a s no p a i n
and f e e l s
Day 7 .
Ready f o r
d isch arg e.
D iet.
B reakfast
-
D inner -
Roast b e e f
only v e g e t a b l e s .
Sausages,
fit.
eggs o r b aco n .
and p o t a t o e s .
R ice
puddings
D ried
about
peas
once
Tea,
and
a week.
bread
and b u t t e r
cabbage
are
th e
They h a v e no
++.
fru it
in
th e
Tea - b re a d ,
d ie t.
te a ,
or sausages.
The l a s t
b u tter
On a d m i s s i o n .
count.
spec.
No n i c o t i n i c
C om plaint
the
R.
P u lse
U rine
b lo o d ,
for
-
dark
C estim atio n .
2 , 0 3 mg. $ ,
acid
colour.
and h i s t o r y . -
spec,
spec.
week h a s had a "b ad
C om plains o f
stom ach"
and f l a t u l e n c e .
u rin e
Then t o o t h a c h e
i.e .
He h a s n o t b e e n
He i s
in
bases
I m argins.
T o n sils
- N .A .D ,
ep ig astriu m .
C ourse.
D ay 1 .
B reath heavy.
caries
clear.
is
food
d rin k s
evidence
a
beer.
o f anaem ia.
rece n tly
evidence
H eart,
ow ing
Gums s p o n g y
stopped
Abdomen - N o n - t e n d e r b u t v e r y
of
do w n a t
stain in g
th e
gum
C .N .S .
and
g u ard in g
in
lu n g s,
slig h t
been
No g l o s s i t i s .
R o u tin e
scalin g ,
10$ c h ro m ic
j M.W.
4 i.d .
(l
low er
and f o r
T eeth have
rece n tly
No a d e n i t i s .
| D aily p a in t i n g w ith
Eusol
ago on
R.
chew ing h i s
en terin g h o s p ita l but th e re
and s l i g h t
v it.C ).
i n m outh i n m o r n in g s .
membrane o n c h e e k b e h i n d l o w e r R . m o l a r .
brushed b e fo re
th e
a non-sm oker b u t
p a t i e n t w i t h no c l i n i c a l
read ily .
(d e f.o f
p a in s b e f o r e m eals r e l i e v e d
O .E . W e ll b u i l t
b leed in g
2 .0 6 m g.$.
co n stip atio n
o r eye t r o u b l e .
1
| at th e
1026.
a gum boil 7 days
No " r h e u m a t i s m "
eyes
S .G .
2 .2 7 m g.$.
o f g u m s. Bad t a s t e
t e n d e r gums r e c e n t l y .
but not
co n stip ated .
done.
B r e a t h h e a v y . No c o u g h . T r o u b l e d w i t h
: F alse
B ow els
a l b u m e n . Gum s w a b p o s i t i v e .
F irst
6 hrs.
estim atio n
p r e - m o l a r . No b l e e d i n g
to
d ie t.
15 m o n th s.
6 4 /m in.
sugar or
lo w e r jaw p o s t e r i o r l y .
by fo o d ,
and b aco n
- Not done.
U rin ary v itam in
3 hrs.
Supper - Eggs
T r a w l e r (A)
n eg ativ e.
A l k a l i n e . No b i l e ,
jam .
ago.
o f t h e m onotony o f t h e
Temp. 9 8 . 2 ° .
T ourniquet t e s t
B lood
and
He c o m p l a i n s
C ase 4 3 . H .A . 33 y e a r s .
o ra n g e was 6 m onths
in
4)
ro tary
acid.
b ru sh in g
0 .4 5
and E u s o l
gm. N . A . B .
sp ray in g .
in trav en o u sly .
1 No. 9 p i l l .
]
I Day 4 .
Less te n d e rn e ss
in
g u m s . Raw,
red
a r e a u n c o v e r e d b y m em brane
!
i b e h i n d l o w e r R . m o l a r . Some f i l m y m e m b r a n e o n o u t e r a s p e c t s o f
! upper gums.
Day 6 .
Im provem ent
on g u m s f i r s t
th in g
in
R.
retro -m o lar u lc e r.
in th e m orning.
B reath
V ery l i t t l e
le ss
membrane
o ffen siv e.
C ontinue
d aily
treatm en t.
D ay 7 .
Gums o f n o r m a l c o l o u r a n d s i z e .
Day 8 .
F it
D iet
for
d isch arg e.
h isto ry .-
Case 44,
S am e a s
G .B .
On A d m i s s i o n .
b lo o d ,
case
23 y e a r s .
Temp.
T ourniquet t e s t
b ile ,
S p o nginess gone.
D estroyer fo r
100°.
n eg ativ e.
sugar or
18.
P u lse
U rine
84/m in.
-
album en.
8 m onths.
S .G .
B ow els n o t o p en .
1017.
F ain tly
Gum a n d t h r o a t
acid .
No
swabs b o th
p o sitiv e.
B lood
count.
W .B .C .
R .B .C .
3 ,7 4 0 ,0 0 0 /c .m m . H b. 98$.
3,2 0 0 /c.m m . P olym orphs 86$.
E o sin o p h ils 0$.
B aso p h ils
U rin ary v i t .
estim atio n .
3 . 2 7 mg. $
C.
.
6 hrs.
No n i c o t i n i c
C om plaint
acid
F irst
startin g
ex tractio n
to o th th e
sim ilar
p o sitio n
fe lt
off
w ith
general
aches
in je c te d
glands
in
th a n
larg e
sm ear.
eyes
-
D ay 1 .
p o t.
and
gums.
lu n g
ch lo r,
a fte r
th e m outh t o
a
o f gum s. Has
or
Not t r o u b l e d
eye t r o u b l e .
in m o d eratio n .
R.
to n sil
film y
en larg ed
and w h i t e .
and s u b s e q u e n t
strep to co cci.
in
L.
and
to n sil
B oth t o n s i l l a r
resu lt
Gums s w o l l e n
D ip h th eriae
- N eg ativ e
and r e d d e r
e x u d a t e . No u l c e r a t i o n .
of m olars.
H eart,
for
lu n g s,
T eeth
abdomen,
- N .A .D .
R o u tin e
d ressin g
0 .3
and
T o n s i l l a r - s m e a r - no B.
and c a r i e s
spec.
3 days. P ain
co n stip ated .
alcohol
Covered w ith f ilm y
and
C arb o lised
th e
round
stom ach,
exudate,
C u ltu re
and h a e m o ly ti c
show much t a r t a r
C ourse.
2 to
No b l e e d i n g
sym ptom s.
and t e n d e r .
norm al.
C .N .S .
for
and r e d b u t h a s no m em b ran e on i t .
d irec t
K .L .B ,
sid e.
and p a i n s ,
a copious
3 hrs.
(V itam in C d e f ic ie n c y )
pain went
smoke b u t d r i n k s
covered w ith
th ro at
B ow els a r e
No c o n s t i t u t i o n a l
2 .9 3 m g.$.
i n R. w isdom t o o t h
L.
colour la te ly .
He d o e s n o t
O .E .
on t h e
spec.
done.
Sore
gums 2 w e e k s a g o ,
o f th e
L ym phocytes 1 1 $ . M o n o cy tes 3 $ .
3 .8 5 m g.$.
estim atio n
-
1 .3 2 .
0$.
spec.
and h i s t o r y .
C .I.
to
th e
and E u s o l
10$ chrom ic
in trav en o u sly .
Therm ogene t o
c a s c a r a 2 drachm s.
b rushing
cario u s m olars.
gm. N . A . B .
t.d .s .
scalin g ,
sp ray in g .
acid
d aily
Bed and low d i e t .
th ro at.
L iq u id
to
G arg.
p araffin
161.
D ay 2 .
Throat f e e l s
g arg les
and t h e r m o g e n e .
Day 6 .
s till
T hroat
appears
in fe c te d .
tender
easier.
c lear of in fec tio n .
D ay 8 .
4 i.d .
Less
th ere.
the
m em brane and v i s i b l e
Gums
D ay 1 2 . No c o m p l a i n t s
B reakfast
3 tim es
a week.
or
"mash"
M eat
jam ,
and r e d
d aily ,
also
i m p r o v e m e n t o f g u m s , b u t H2 0 2
tw ice
b u t he
a day.
s till
com plainso fp a in
and
m outh a p p e a r s h e a l t h y .
- Ham,
B read,
te a,
sausage,
roast
-
steak
Plum d u f f
and b e a n s .
in
b u tter
P o rrid g e
D in n er -
m ashed p o t a t o e s
tin n ed
carro ts
on S undays.
ex tra.
L iver
and e g g s .
and t e a .
or b o iled ,
cabbage,
and b i s c u i t s
B read,
or
b u t t e r or m argarine
in w ater).
w ith pork
p ies.
Case
Gums
sulcuc
acid
HgOg c o n t i n u e d .
One v e g e t a b l e
(soaked
b u tter,
chrom ic
M.W.
stew ed m eat w ith
and g r a v y .
peas,
1 hour.
D ischarged.
D iet.
Roast
la tte r
appear healed
L m olar r e g io n .
Day 1 3 .
C ontinue
C ontinue
.
m akes th em raw - u s e t h e
D ay 1 0 .
Dp f o r
Membrane i n u p p e r l a b i o - g i n g i v a l
a r e a on R s i d e
HgOg m . w .
Some s l o u g h s e p a r a t i n g .
Supper -
and b a c o n .
or
d ried
Tea - B read ,
Sausage
F ish
and
and
ch ip s.
and t e a .
4 5 . W .H. 27 y e a r s . S h o r e e s t a b l i s h m e n t f o r m e a l s , b u t
w orking in m otor b o a ts by day f o r I y e a r .
On a d m i s s i o n .
d iarrh o ea.
S tro n g ly
Temp. 9 7 ° . P u l s e
T ourniquet t e s t
acid.
No b i l e ,
6 4 / m i n . B o w els o p en b u t no
n eg ativ e.
blood,
U rine
clear.
album en o r s u g a r .
S .G .
1015.
Gum s w a b
p o sitiv e.
B lood
W .B .C .
count,
R .B .C .
15,3 0 0
/ c.mm.
4 ,3 9 0 ,0 0 0 /c .m m . Hb.
P olym orphs
72$.
88$,
GJ.
1 .0 2 .
Lym phocytes 2 4 $ .
M onocytes 4$. E o s in o p h i ls 0$. B a s o p h ils 0 $ .
U rin ary v i t .
2 .0 4 m g.$.
C estim atio n .
6 hrs.
No n i c o t i n i c
acid
spec.
Gums b l e e d
m ornings.
spec.
1 2 .5 m g.$.
C om plains o f
a w eek ago f o r 4 d a y s .
easily .
He h a d
1 .2 m g.$. 3 h r s .
(No v i t a m i n
spec.
C d efic ien cy ).
e stim a tio n done.
C o m p la in t and h i s t o r y . "to n sillitis"
F irst
sore
A lso h ad
A lw ays h a s b a d t a s t e
a bad a t t a c k
gums f o r o n e w e e k . H ad
in
h is
of "in d ig estio n "
it
a year
m outh i n
a week
ago.
th e
ago,
but th is
m eals.
has cleared
B ow els
tro u b les.
O .E .
at th e
No c a r i e s .
larg e
aches
clear of
M ucosae/pink
and u n c l e a n
in fectio n .
lim b s.
A m ild
case
Thorough
scalin g ,
an d
boggy and e r o d e d .
n o n -ten d er a d e n itis
anaem ic. H e a r t,
- N .A .D .
in m o d eratio n .
on a d m is s io n .
in c iso rs
S h o tty ,
after
No e y e
betw een th e t e e t h
cen tral
and n o t
in h is
and d r i n k s
W hite f i l m
T eeth d ir ty
eru ctatio n s
lu n g s,
abdomen,
of V in cen t’ s in fe c tio n
gums.
C ourse.
sto n e
but
and a c i d
20 c i g s / d a y ,
and r e d .
ro o ts.
and C .N .S .
of th e
No p a i n s o r
R oof o f m outh b e h in d
an d L .
eyes
D iscom fort
He s m o k e s 1 5 t o
embedded
R.
reg u lar.
Gums s w o l l e n
T o n sils
u p .-
D ay
1.
pow der and
th en
ro tary
sp ray in g w ith E usol
p ain ts
w ith 10$ chrom ic
Day 4 .
Membrane l e s s
sw o llen
and h e a l t h i e r .
acid
and m .w s.
copious
b r u s h in g w i t h pum ice
so lu tio n .
of Eusol
D aily
(1 in
4)
and i n t e r d e n t a l p a p i l l a e
S till
gum
4 i.d .
le ss
membrane b e h i n d u p p e r c e n t r a l
in ciso rs.
Day 6 .
G reat
im provem ent. P r a c t i c a l l y
u n less
on m a n i p u l a t i o n .
D ay 7 .
A lm ost f i t
norm al.
Have l o s t
Day 8 .
D isch arg ed
D iet,
B reakfast
one d a y
in
orange
for
d isch arg e.
th e ir
to
-
g lazed
e tc .,
te a,
b u tter,
+ te a ,
bread
T h i s man g e t s
th e
gums
and a p p e a r
appearance.
b u tter,
f o u r w hen he g e t s
fish
b reak fast.
cooked f r e s h v e g e t a b le s .
B read,
Gums s h r u n k e n
in
d u ty .
B read,
ev ery day f o r
no p a i n
m arm alade and t e a ,
o r bacon
and
D in n er - M eat,
e g g s . He h a s
p o tato es
S p ro u ts ++, M ilk p u d d in g .
jam and s c o n e .
Supper -
except
an~
and
Tea -
Cooked s u p p e r ,
fish
and b u t t e r .
apples
and o t h e r f r u i t
reg u larly
from th e
shore
canteen.
Case 4 6 .
M.G. 19 y e a r s .
On a d m i s s i o n .
Temp.
T raw ler f o r
9 8 .8 °.
P u lse
T ourniquet t e s t
n eg ativ e.
No b i l e ,
s u g a r o r album en.
Blood
W .B.C.
b lo o d ,
count.
R .B .C ,
10,2 0 0 /c.m m ,
U rin e.
m onths.
82 /m in .
D ark s tr a w
colour.
Gum a n d t h r o a t
4 ,9 6 0 ,0 0 0 /c,m m .
P olym orphs.
B ow els n o t
71$.
Hb. 1 0 0 $ .
open.
S .G ,
1025.
swabs " p o s i t i v e "
C .I.
L ym phocytes 22$.
1 .0 2 .
M onocytes
163.
5$.
E o sin o p h ils
U rin ary v itam in
5 .8 2 m g.$
1 -J $ .
C estim atio n .
6 hrs.
N ico tin ic
acid
^ C o m p lain t
B aso p h ils
spec.
ex creted
and h i s t o r y .
P ain
chew in g ,h ard
food
th e m ornings
and p o o r a p p e t i t e
cig arettes
O .E .
a p ip e
T eeth fo u l
round t e e t h
in
and
bases.
h is
Gums s w o l l e n ,
u lc erated
and h a s w h i t e
H eart,
D ay 1 ,
sp ray in g .
acid
D ay 3 .
acid
Throat
s till
P ain
in
Day 6 .
Gums
le ss
much m em brane
! co n tractin g
n ig h t.
Has n e v e r had
and d o e s n o t
He s m o k e s
d rin k
and t e n d e r .
p ain fu l.
on them .
on i t .
eyes
alco h o l.
Gum m a r g i n s
L eft to n s il
Tender l e f t
and C .N .S ,
scalin g ,
cerv ical
-
bru sh in g
10$ c h ro m ic
a day g iv e n .
th ro a t gone.
in
i n m outh i n
and no d i a r r h o e a .
red
abdomen,
acid .
N .A .D .
and E u s o l
N ico tin ic
(250 g r . / d a y ) .
D aily n i c o t i n i c
. 3 gm. N . A . B .
Day 4 .
acid
and chrom ic
in trav en o u sly .
Gums I . S . Q , .
r e d and b e g i n n i n g
lab io -g in g iv al
to a lte r
su lcu s.
in
appearance.
U lcers
at teeth
S till
bases
and l o o k i n g m ore h e a l t h y .
A ll th e
no m e m b r a n e .
Day 1 0 .
lu n g s,
tim es
co n tin u ed .
Da y 8 .
patches
Thorough r o u ti n e
fiv e
and t e n d e r on
No s t o m a c h o r l u n g
at
sloughs
D a i l y gum p a i n t s w i t h
50 g r .
3 days.
co v ered w ith t a r t a r w hich was e n c r u s te d
and h a v e y e l l o w i s h
C ourse.
lim bs
in m oderation
u lc erated
ad en itis.
eyes
C. d e f i c i e n c y ) .
on s w a llo w in g f o r
la tely .
spec.
4 ,3 5 mgs.
f o r a b o u t two w e e k s . Bad t a s t e
and p a i n s
and
v it.
Gums b l e e d i n g
and no t r o u b l e w i t h h i s
aches
to
in th r o a t
a week.
4 .6 5 m g.$. 3 h r s .
(S lig h t
p e r day e q u a l
co lo u r fo r
vague
spec.
6.17 m g.$.
Has b e e n o f f
tro u b le
1 st.
fiery
appearance has
Throat
gone fro m gums. P r a c t i c a l l y
healed .
Gums s h r u n k e n a n d n o m e m b r a n e s e e n .
P atien t
ready fo r
d isch arg e.
I D iet h i s t o r y . B reakfast
!
'
eggs. B read, b u t t e r , te a .
or stew ed m eat^ Y o rk s h ire
- F i s h o r b a c o n o r t i n n e d s a u s a g e s and
i
P o rrid g e o c c a sio n a lly .
D inner - R oast
p u dding,
pork.
C abbie,
peas,
carro ts
or
i
I sp ro u ts,
"bubble
and
squeak"*
du ff o r m ilk p u dding.
Sweet on Sundays and T h u rsd ay s
Tea - B read,
b u tter,
jam and t e a .
- plum
Supper -
j B e a n s , l i v e r and b a c o n , f i s h and c h i p s , o r s a u s a g e p i e . B r e a d ,
1i
b u tter
and c h e e s e .
much s e a t i m e
th e y
No f r u i t
g e t no
at
all
in th e
d ie t
and as th e y
chance to
buy i t
ashore.
do
164.
Case
47.
J.M .
On a d m i s s i o n .
a day.
blood
29 y e a r s .
Tamp. 9 8 . 2 ° .
T o u rniquet t e s t
sugar or
R .B .C .
P addle
s w e e p e r (Z)
P u lse
n eg ativ e.
album en.
B aso p h ils
U rinary
66$.
S.G .
C .I.
1 .0 9 .
Lym phocytes 29$. M onocytes
once
1022. A cid.
No b i l e ,
B lood C ount W .B .C . 8 ,4 0 0 /e .m m .
4$.
E o sin o p h ils 1$.
0$.
v it.
C.
estim atio n .
3 1 ,4 5 m g.$.
6 hrs.
No n i c o t i n i c
acid
C om plaint
spec.
tiled
1st
spec.
42 .3 6 m g.$.
1 5 .6 m g .$ .
3 hrs.
(No d e f i c i e n c y
spec.
of v it.C .)
e stim a tio n done.
and h i s t r o y .
6 w e e k s . No s o r e
easily
U rin e.
6 m onths.
Bow els r e g u l a r
Gum s w a b p o s i t i v e .
4 , 4 5 0 , 0 0 0 / c . mm. Hb . 9 6 $ .
P olym orphs
65/m in.
for
Has h ad
th ro ats.
and o f f
sore
and b l e e d i n g gums f o r
A p p etite
colour.
poor la te ly
Bad t a s t e
and h a s f e l t
i n m outh i n
th e
m ornings.
No " R h e u m a s t i s m " , d i a r r h o e a o r a b d o m i n a l o r l u n g u p s e t s .
no d i f f i c u l t y
m o d eratio n .
( 3 0 0 mg.
in
seein g
He h a s b e e n t r e a t e d
d aily )
and g l y c e r i n e
He h a d n o s c a l i n g ,
O .E .
th e
red
in
R.
eyes
of m olars.
T o n sils
and s w o l l e n .
retro -m o lar
- N .A .D .
f o r 14 days w ith
S cales
S h o tty ,
spray.
D a il y 10$
250 mg,
d aily ,
Day 4 ,
Gums I . S . Q ,
H eart,
n o n -ten d er
R outine
scalin g ,
chrom ic
acid to
a n d Hg Og m . w .
ten d er
and l e s s
c l e a n w i t h HgOg m . w .
Day 8 .
su b stitu ed
Gums t e n d e r ,
b ru sh in g
and E u s o l
gums. F u l l
U lceratio n
C .N .S .
sid e
d ie t.
and
o n ly .
(1
in
4)
N ico tin ic
acid,
red.
under lin g u a l nerve
f o r HgOg a s g u m s a r e
o f l o w e r gum. U l c e r
ten d er.
i n R.
G reat
im provem ent.
T eeth
so ck ets h e a lth y
and
gums a l m o s t
and h e a l i n g .
some
retro -m o lar
and g l a s s y membrane m ark t h e
clean
b lo ck .
S till
Some r e d n e s s
T eeth
of
room
healed.
in fec tio n .
acid
reg u larly .
S ockets kept
of
abdom en,
on R.
C a r i o u s m o l a r s no w e x t r a c t e d
Day 1 0 .
in
im provem ent.
bases
ad en itis
Da y 7 .
aspect
at
No g l o s s i t i s .
lu ngs,
Gums l e s s
su lcu s
no
on i n s t r u m e n t a t i o n .
Day 6 .
mem brane on o u t e r
asco rb ic
and v e r y l i t t l e
c lear but la rg e .
su lcu s.
Day 1 .
and t a r t a r
te eth
L ow er gums b l e e d
C ourse.
Eusol
smokes and d r i n k s
and th y m o l m .w . w i t h
O vercrow ding o f th e
b e tw e e n them .
He b o t h
He h a s
etc.
Some c a r i e s
te eth .
at n ig h t.
5 to
site .
clear
D ay 1 2 .
Ready f o r
D iet.
Case
Same
48.
as Case24.
J.E ,
18 y e a r s .
On a d m i s s i o n .
Temp.
T ourniquet t e s t
1022.
disch arg e.
P ad d le
9 8 .6
,
n eg ativ e.
A c i d . No b i l e ,
sw e ep e r (Z)
P u lse
U rine
b lo o d ,
for
76/m in.
- pale
sugar or
4 m onths.
B ow els c o n s t i p a t e d .
straw
colour.
S .G .
a l b u m e n . Gum s w a b
p o sitiv e.
B lood
count.
- Not done.
U rin ary v ita m in
spec.
C.
2 .6 2 mg.$ .
No n i c o t i n i c
C om plaint
in h is
6 hrs.
acid
spec.
estim atio n
and h i s t o r y .
1st
a slig h t
"rh eu m atic
to n g u e.
O .E .
Gums s o f t ,
Bad t a s t e
sw o llen
free
No g l o s s i t i s .
ta rta r
S cattered
rales
C ourse.
of
S lig h t
en cru sted
in
th ro at
in fec tio n .
caries
chest
8 days b e fo re
T h e r e w as no l o c a l
C.
3 hrs.
d efic ien cy ).
beer o ccasio n ally .
in
bases.
ad en itis
R.
C .N .S .
( g r.5 0
B reath
and L,
(som e f i l l i n g s )
on d eep b r e a t h i n g ,
ad m issio n ,
a w e e k . No
No d i a r r h o e a o r
abdomen,
acid
for
te eth
S h o tty
of te e th
H eart,
at
aching p a in s
and no d y s p h a g i a .
n ig h ts
d rin k s
and u l c e r a t e d
He w a s g i v e n n i c o t i n i c
day f o r
i n m o u th and
smoke b u t
on t e e t h .
in
(V it.
stom ach o r eye t r o u b l e .
He d o e s n o t
T o n sils
2 .4 5 m g.$.
done.
cough and "w h eeze” a t
p ain s",
sore
spec.
2 . 5 3 mg. $ .
gums f o r 3 w e e k s . No p a i n
Has h ad
heavy.
estim atio n .
and
and ey e s
-N .A .D .
(m ild b r o n c h i t i s ) .
t.d .s.
a n eig h b o u rin g
) every
sick
t r e a t m e n t . No i m p r o v e m e n t r e s u l t e d .
q u arte rs.
H is p a in
has got w orse.
Day 1 .
In h o s p ita l.
sp ray in g .
R outine
0 . 4 5 gm . N . A . B .
10$ chrom ic a c i d .
scalin g ,
b ru sh in g
in trav en o u sly .
2 veg etab le
lax ativ e
and E u s o l
D a i l y gu m p a i n t s . w i t h
p ills.
Bed and
a fu ll
d ie t.
Day 3 .
Gums I . S . Q .
D ay 5 .
P ain
in
gums i s e a s i e r .
are beg in n in g to
co n tract
upper la b io -g in g iv a l
C o ntinue
Day 8 .
and
is
d aily
No p a i n
in
and h e a l .
su lcu s
chrom ic
Less red ness e v id en t.
much m em brane i n
and o n o u t e r a s p e c t s
acid p a in ts
g u m s now b u t
covered w ith w h ite
S till
and E u s o l
o f u p p e r gums.
(1 i n
u p p e r gum i s s t i l l
membrane*
U lcers
S u b stitu te
p o t.
4)
m w .s.
u lcerated
perm ang.
for
Eusol
as
D ay 1 1 .
a m.w.
Membrane
and m ore n o rm a l
is
in
Gums a p p e a r
m orning
is
Day 1 5 .
D isch arg ed .
P .L .
On a d m i s s i o n .
day.
B lood
case
Temp.
in fectio n .
T ra w le r hand
9 8 .6 °. P u lse
m g.$.
R .B .C .
n eg ativ e.
3 w eeks.
p illo w
C.
estim atio n .
spec.
acid
Now h e
eat
about
acid.
Gum s w a b p o s i t i v e .
Hb.
70$.
C .I.
0 .9 2 .
L ym phocytes 3 2 $ .
spec.
M onocytes
3 .7 2 m g.$.
3 hrs.
spec.
d eficien cy ).
done.
so lid
chest
per
in
gums f o r
p ain .
awakes and b ad t a s t e
d ifficu lty
20 c i g a r e t t e s
and t e n d e r
food w ith o u t
"rheum atism ",
in creased
a
1028. F a in tly
4 , 1 6 m g.$ ( V i t a m i n C.
t h e m o r n in g when h e
He s m o k e s
S .G .
Has had b l e e d i n g
cannot
n o ticed
-
B ow els open on ce
1$.
1st
estim atio n
No d i a r r h o e a ,
has not
B aso p h ils
and h i s t o r y .
in
in th e
f o r 18 m o n t h s .
U rin e
3 ,8 7 0 ,0 0 0 /c .m m .
1$,
6 hrs.
No n i c o t i n i c
C om plaint
Gums s h r u n k e n
Swab t a k e n
6 8 /m in.
1 1 ,8 0 0 /c.m m . P olym orphs 60$.
U rin ary v i t .
th en .
of
s u g a r o r album en.
E o sin o p h ils
3 .8 4
am ount.
24.
21 y e a r s .
b lood,
count.
W .B .C .
6$.
clear
T ourniquet t e s t
No b i l e ,
in
"n eg ativ e".
Sa me a s
Case 49.
le ss
colour.
D ay 1 4 .
D iet.
g ettin g
B lo o d on h i s
in h is
m outh
o r stom ach t r o u b l e .
seein g
day and o n l y
at n ig h t
d rin k s
He
la tely .
sp irits
in
m o d eratio n .
O .E . E y e s ,
free
from
y ello w
h eart,
lu n g s,
in fec tio n
foul b reath
g in g iv al
su lcu s.
gum s w o l l e n
and h a v e t h i c k ,
in terd en ta l
and f i l m
D ay 1 .
but has
R outine
N ico tin ic
p ap illae .
acid
sh o tty
ta rtar
at
-
acid .
50mg.
b ru sh in g ,
M ist,
5 tim es
T o n sils
T eeth
are
th e ir bases,
L o w e r gu m s w o l l e n ,
No f r a n k
ad en itis
no m e m b r a n e .
scalin g ,
p a i n t i n g w ith 10$ chrom ic
t.d .s.
hard
u lc eratio n
o f w h i t e m em brane o v e r gum a n d
Non*- t e n d e r
and r e d
- N .A .D .
and u n h e a l t h y l o o k i n g .
s w o l l e n g u m s . No c a r i e s .
and w i t h p r o m i n e n t
C ourse.
but larg e
and u n b ru s h e d
o v erlap p ed by th e
abdomen and C .N .S .
R.
sp ray in g
ferri
a day.
et
U pper
case.
and d a i l y
am mo n.
0 .4 5
but
in la b io -
and L.
A m oderate
red
cit.
1 oz.
gm. N . A . B .
in trav en o u sly ,
j
D ay 3 .
Gums I . S . Q , .
Day 5.
Gums l e s s
th e
S till
ten d er
and p a i n i n g .
ten d er
and h a v e l o s t
gums.
In terd e n tal
th e ir
b rig h t
red
co lour at
m argins.
Day 7 .
No p a i n
Membrane n o t
Day 8 .
so
G reat
Day 1 0 .
in
copious f i r s t
im provem ent.
D ie t.-
- S teeped
and t i n n e d
m ilk .
N early
alw ays " b u l l y
tin n ed
v eg etab les
duff tw ice
p ro m in en t.
a m orning.
sw ollen
No b l e e d i n g
and n o rm al i n
co lour.
on r u b b in g gums.
ham and p r e s e r v e d
bread
in v ario u s
up.
T inned
and
egg.
and b r e a d .
eggs.
and b u t t e r ++.
g u ises.
pears
Tea - B re ad, b u t t e r ,
and b e a n s
and b u t t e r
salted
Tea,
beef"
heated
a week.
- Pork
cheese,
le ss
d uty.
B reakfast
P o rrid g e
in
Gums l e s s
No m e m b r a n e v i s i b l e .
D ischarged to
j Supper
th in g
p ap illae
P o tato es
and
on S u n d a y s . P lum
jam ,
Sausage
D in n er -
b iscu its
and t e a .
and m ash . B u l l y b e e f ,
Cocoa,
‘
| Case 5 0 .
A .H .
On a d m i s s i o n .
26 y e a r s .
Temp 9 8 . 0 ° .
T ourniquet t e s t
A cid.
No b i l e ,
stro n g ly
n eg ativ e.
b lo o d ,
p o sitiv e.
D rifter
"P u lse
U rine
sugar or
M any B .
for
5-J- m o n t h s .
72 p e r m i n .
- pale
straw
album en.
fu sifo rm es
B ow els n o t
colour.
open.
S .G .
Gum a n d t h r o a t
1018.
swabs
ev id en t,
jB lo o d C o u n t, R .B .C . 4 6 8 0 ,5 0 0 /c .m m . Hb. 9 8 $ , C . I . 1 . 0 6 , W .B .C .
i
1 0 , 0 0 0 / c.mm. P o l y m o r p h s 7 2 $ . L y m p h o c y te s 2 5 $ . M o n o c y te s 3 $ .
E o sin o p h ils 0$. B aso p h ils
U rinary v i t .
2.85
mg,$
C.
0$.
estim atio n .
6 hrs.
spec.
1st
spec.
3 , 1 6 mg*$ ( V i t .
2 .3 1 m g.$.
C.
3 hrs,
spec.
d efic ien cy ).
i No n i c o t i n i c a c i d e s t i m a t i o n d o n e .
W .R .+
|
I C o m p la in t and h i s t o r y .
H ad t h r e e i n j e c t i o n s o f N . A . B . f o r
I
ip rim a ry s y p h i l i s , t h e l a s t one m onth a g o . T r e a tm e n t l a p s e d
! he c h a n g e d h i s b a s e . Gums w e r e s o r e a t t h a t t i m e
|
p a i n h a s l e f t t h e m . Now c o m p l a i n s o f p a i n i n t h e
d u ratio n .
for t h e
(lim bs.
Gums b l e e d
p a s t week.
No r e c e n t
but la te ly
th ro at
o n b r u s h i n g t h e m . No d i a r r h o e a ,
He h a s n e v e r h a d v a g u e
lu n g ,
eye o r
aches
as
o f 3 days
but
and p a in s
stom ach a i l m e n t s .
the
He b o t h
co n stip ated
in h is
sm okes
and
168.
d rin k s h e a v ily .
O .E .
scar
H eart,
lum gs,
a t fraenum
u lc erated
abdomen,
of penis
and
and s h o t t y
and w h i t e m em brane
c e rv ic a l te n d er
C .N .S .
ad en itis.
L.
eyes
- N .A .D .
S lig h t
glan d s b o th g ro in s .
adherent to
to n sil
its
in jecte d
R.
upper p o le.
to n sil
R.
b u t no u l c e r a t i o n .
Gums r e d
and s w o l l e n
and c o v e r e d
w i t h w h i t e membrane o n o u t e r
aspects.
B reath v ery
o ffen siv e.
C a r i o u s m o l a r a n d no
ta rtar.
T his
C ourse.
Day 1 .
D aily
is
gross
a v e r y m i l d gum i n f e c t i o n .
T eeth
10$ chro m ic
cleaned w ith
acid
ap p licatio n s
in trav en o u sly .
G arg.
p o t.
N ico tin ic
-
50mg.
acid
one
ro tary
ch lo r.
to
th e
4 i.d .
ta b let
brush
and E u s o l
gums.
0 .4 5
2 v eg etab le
5 i.d .
spray.
gm. N . A . B .
la x a tiv e p il ls .
C arb o lised
d r e s s i n g to
m olar.
Day 2 .
P ain
D ay 3 .
Membrane
No p a i n ,
D ay 5 .
in th ro a t
is
much e a s i e r .
not
sp read in g
and i s
yello w ish
in
colour.
gums I .S . Q , .
M embrane r a p i d l y v a n i s h i n g f r o m R.
to n sil.
T e n d e rn e ss g oing
from n e c k g la n d s .
Day 7 .
T o n s i l now c l e a r
g in g iv a l furrow s
o u ter
sid e
Day 9 .
have
o f m e m b r a n e . No p a i n
shrunk
o f u p p e r gum a t
R em aining
and v e r y
l e v e l o f R.
Neck g l a n d s
Day 1 1 .
D ischarged to
du ty .
D ie t.-
S am e a s C a s e 3 0 .
5 1 . W.O. 26 y e a r s .
p rev io u sly .
On a d m i s s i o n .
test
sugar or
B lood
album en.
count.
9 ,6 00/c.m m .
to o th .
of
in fectio n .
sh o tty but n o n -ten d er.
No i n f l a m m a t i o n o r m e m b r a n e i n
P u lse
clear,
8 0 /m in.
S .G .
any a r e a .
and t r a w l e r
B ow els o p e n . T o u r n i q u e t
1 0 1 2 , A c i d . No b i l e ,
4 ,9 2 0 ,0 0 0 /c .m m .
P o l y m o r p h s 78j , .
U rin ary v i t .
b ic u sp id
b lo o d
Hb.
99$.
Lym phocytes 1 9 $ .
C .I.
1 ,0 4 .
W .B .C ,
M o n o c y t e s 3f
B a s o p h i l s O f.
C estim atio n .
6 hrs.
on
Gum s w a b p o s i t i v e .
R .B .C .
E o sin o p h ils 0$.
2 . 2 3 mg*$
U rine
L abio-
membrane r e m a in s
D e s t r o y e r f o r 3-J- m o n t h s
Tem p 9 9 . 4 ° .
n eg ativ e.
th ro at.
r a w a r e a o n u p p e r gu m a l m o s t f r e e
No m e m b r a n e v i s i b l e .
Case
little
in
spec.
1st
spec.
2 .1 6 m g.^.
2 . 8 4 m g.$ ( v i t .
3 hrs.
C. d e f i c i e n c y ) .
spec.
j
N ico tin ic
acid
j
C om plaint
and h i s t o r y .
of le ft
'
b itin g
in
sid e
ex creted
of neck.
cru sts
O .E .
th e
aches
w h ite
at
rales
te eth
C ourse.
Day 1 .
N ico tin ic
S till
N ico tin ic
in ste ad
Day 5 .
acid
R outine
10^ chrom ic
50 mg.
root
f r e e and no
p resen t.
and e y e s - N .A .D .
scattered
p o st-tu ssiv e
b ru sh in g
acid
and E u s o l
and m .w . E u s o l
sp ray in g .
(l
in
4)
4 i.d .
5 i.d .
in gums.
and ch ro m ic
Gums f i r m e r
acid
Socket
and l e s s
0 .3
gm. N . A . B .
co n tin u ed
ten d er.
g iv en in tra v e n o u s ly .
and p o t .
ch lo r,
S e p t i c w isdom t o o t h
s p r a y e d w i t h HgOg.
Socket h e a lin g .
aspects
Chest
L e s s membrane i n
o f gums.
No t e n d e r n e s s
b e h in d L.
m.w.
No p a i n
or b leed in g .
lo w er m o la rs .
T ooth
socket
retro -m o lar
in
S till
appears
p u lled
clear.
su lcu s
neck g lan d s,
HgOg m . w . s
a sm all h e a lin g
clean
u lcer
and r a p i d l y g r a n u l a t i n g
in .
Day 1 2 .
A ll
D £ et.-
B reakfast
fish
I
at
ad en itis
C .N .S .
area s w ith
up b e h in d
o f E usol.
and on o u t e r
D ay 1 0 .
all
cerv ical
abdomen,
and much
sep tic
o f gum. T o n s i l s
scalin g ,
ten d ern ess
acid
under gas.
D ay 8 ,
in
E a s ily b leed
M ild b r o n c h i t i s .
D aily p a in ts w ith
Day 2 .
H eart,
and no
in m o d eratio n .
and s w o l le n .
L.
on
sp it fo r ten
no n y c t a l o p i a
and b o g g in e s s
n o n -su p u ratin g ,
R.M. v e s i c u l a r
au d ib le.
aspect
u rin e,
and b ad t a s t e
a cough and
l o w e r w isdom t o o t h
bases.
and b le e d
behind lo w er L. m o la rs ,
Some e r o s i o n
e x u d in g on o u t e r
T ender,
Has h ad
i n 46 o z s .
2 w e e k s and t e n d e r n e s s
Bad b r e a t h
Gums f i l m y
eroded
and p u s
mg.
He s m o k e s a n d d r i n k s
ev id en t.
Red and
3.4 2
on ch e w in g f o o d
stom ach t r o u b l e ,
i n c i s o r t e e t h . L.
Lungs -
I
no
cen tral
T artar
in
Gums s o r e
m embrane t h e r e .
g lo ssitis.
t h e gums f o r
and p a i n s .
Bad b r e a t h
on r u b b in g .
P ain
m ornings.
No d i a r r h o e a ,
general
equal to
and o t h e r h a r d f o o d .
t h e m outh i n
days.
p er day
about
areas fre e
tw iece
f r o m membrane and u l c e r s
- L iver or
a week.
3 tim es
a week. D in n er -
ro asted
or b o iled
pudding
and
Supper - B read
and
Tea,
bread,
or bacon w ith
Cabbages,
a week.
cheese,
Fresh
b u t t e r ++. P o r r i d g e
about
m eat,
tu rn ip s
Tea - T ea,
b u tter
D isch arg ed .
eggs.
S tew ed o r r o a s t
p o tato es.
jam t w i c e
sausages
h ealed .
pork
or
bread,
and c o c o a .
once
a week,
carro ts.
b u tter
R ice
and
jam .
C old m eat o r s a u s a g e s
w ith tin n ed beans.
A ll v e g e ta b le s
Case 52.
-
every
day.
21 y e a r s .
Temp 9 8 , 6 ° .
p a la ta l u lc ers
P u lse
R .B .C .
0$.
U rin ary v i t .
C.
4 . 2 1 mg. $ .
6 hrs.
No n i c o t i n i c
acid
estim atio n .
spec.
4.87
estim atio n
h u r t him t o
on b ru s h in g h is
on n i c o t i n i c
b etter.
acid
ta b lets
He n e i t h e r
smokes n o r d r i n k s
behind th e
p alate
red.
are
abdomen,
present
and o v e r u l c e r s .
T o n sils
clear
on p r e s s u r e ,
th em .
C aries
No a d e n i t i s
fe lt
(V it.
te eth .
Tem porary
la st
sym ptom s
C.
3 hrs.
spec.
d efic ien cy ).
ton g u e
and
fiv e
but th e
days he h a s been
pain
is
- no d i a r r h o e a ,
h is
eyes
no
lu n g
or ey esig h t.
alco h o l.
eyes
and C .N .S ,
th e back
of th e
Edges of u lc e r s
evidence
- N .A .D .
hard
F ilm y w h ite
a n d no g l o s s i t i s .
F u ll
d ie t
sh arp ly
S everal
p alate
and
membrane on
d efin ed
and b r i g h t
Gums s w o l l e n a n d r e d
of u lc eratio n
and t a r t a r
and b e d .
carb o lised
in trav en o u sly .
acid
Day 3 .
Less pain
th e
Day 5 .
U lcers v is ib l y
in
-
h ealin g .
to
and
o r membrane on
betw een t e e t h
bases.
scalin g ,
of
etc.
c a rio u s m olar.
and a r s e n i c
5 0 mg .
p alate.
ra th p r red.
R o u tin e
d ressin g
G ly cerin e
and gum s. N i c o t i n i c
s till
M o n o c y t e s 4 -J$ .
p alp ab le.
Day 1 .
are
1 . 0 7 . W .B .C .
A rea became t e n d e r
i.d .),
in c iso rs.
b u t no
C .I.
a rough a re a w ith h is
For th e
o f R. u p p e r m o la r s
C ourse.
N .A .B .
at
upper c e n tra l
88$.
3 . 5 6 mg. $ .
and no t r o u b l e w i t h
lu n g s,
b leed
but
spec.
m g.$.
( 1 ,4
tro u b le
sm all u lc e r s
Swab f r o m
done.
te eth .
He h a s h a d n o o t h e r
H eart,
- N .A .D .
c h e w . H i s gums h a v e b e e n b l e e d i n g
or g astric
O .E .
U rine
r o o f os h i s m outh a week ag o .
la te ly
d ie t.
5 m onths.
Lym phocytes 15 $ .
1st
and h i s t o r y . - F i r s t
and i t
the
B ow els open r e g u l a r l y
4 , 1 0 0 , 0 0 0 / c.mm. H b .
E o s i n o p h i l s ■£$. B a s o p h i l s
p ain fu l
in
"p o sitiv e” .
80$.
on th e
80/m in.
n eg ativ e.
1 3 , 6 0 0 , / c .mm. P o l y m o r p h s .
C om plaint
p ro v id ed
On a d e s t r o y e r f o r
T ourniquet t e s t
B lood C o u n t.
fru it
are w ell h eated .
J.R .
On a d m i s s i o n .
No f r e s h
p ain t
to
0 .3
gm.
u lcers
4 i.d .
S till
some m e m b ra n e o n t h e
Gums s h o w n o
sig n
of
u lcers.
in fectio n
D ay 7 .
U lcers
swabs
h ealed
in th e m orning
Day 8 .
D isch arg ed
D iet.
Same a s
s e v e r a l m onths
before
to
treatm en t.
"N egative"
Gums f i r m e r .
d u ty .
case
and
and m embrane g o n e f r o m p a l a t e .
27.
all
No f r e s h
v eg etab les
fru it
about
av ailab le
for
a week o ld
and w e l l
cooked.
Case 53.
R .J,
On a d m i s s i o n .
27 y e a r s .
Temp.
T o urniquet t e s t
A cid.
No b i l e ,
B lood
count.
1 2 ,5 0 0 .
98 .2
3 .9 6 m g.$.
blo o d ,
0$,
C om plaint
sugar
acid
spec.
in
seein g
in
th e
!
food
at n ig h t
T hin,
and p a i n
lu n g s,
I
m argins
|
C ourse.
B leed
C .I.
0 .9 5 .
W .B .C .
M onocytes 4$.
R.
and t h i c k
3 .8 1 m g.$.
c.
3 hrs.
spec.
d eficien cy ).
acid
is
3 w eeks.
( 5 0 mg.
no b e t t e r .
a bad b r e a t h
4 i . d . ) ;b leed in g
He i s
now a f r a i d
and f o u l t a s t e
lu n g o r
in h is
stom ach t r o u b l e .
n o tic e d undue
No h i s t o r y
and
of vague
d ifficu lty
aches
and p a i n s
smokes and d r i n k s h e a v i l y .
easily
B reath o ffe n s iv e .
on r u b b in g .
su lcu s.
retro -m u lar
cerv ical
abdomen and C .N .S .
w ith E u so l.
1026.
and was g i v e n g l y c e r i n e
and h a s n o t
la te ly .
T e n d e r R.
D ay 1 .
72$.
and t e n d e r gums f o r
No d i a r r h o e a ,
p atien t.
and i n
g lo ssitis.
Hb.
2 w eek s ago
upper g in g iv o -la b ia l
in c ise rs
S .G .
Gum s w a b p o s i t i v e .
(V it.
B leed ing
eyes
He b o t h
pale
colour.
a day.
done.
and he h a s
w ith h is
and t e n d e r .
i
co n tin u ed
lim b s.
straw
spec,
and n i c o t i n i c
th e m orning.
No t r o u b l e
B ow els o p en once
L ym phocytes 2 0 $ .
1st
estim atio n
th y m o l m .w .s 3 i . d .
m outh i n
76$.
4 .7 5 m g.$.
and h i s t o r y .
so lid
dark
o r album en.
estim atio n .
6 hrs.
i n gums h a s
-
3 , 8 6 0 ,000/c.m m .
C onsulted Naval D e n tis t
in E.
70/m in.
U rine
8-J- m o n t h s .
B asophild 0$.
C.
No n i c o t i n i c
O .E .
• P u lse
p o sitiv e.
R .B .C .
U rin ary v i t .
eat
for
/ c.m m . P o l y m o r p h s .
E o sin o p h ils
to
D rifter
en cru sted
Bed,
ten d er,
U lceratio n
su lcu s.
T o n sils
ad en itis.
- N .A .D .
ta rtar,
Thorough s c a l i n g ,
Gums r e d ,
up b e h in d
free
by
b ru sh in g
chrom ic
a n d no
sw o llen
and
acid.
area
cen tral
- Some c a r i e s
o v erlapped
D a i l y gum p a i n t s w i t h 1 0 $
sp read in g
No x e r o p h t h a l m i a .
T eeth
ro tary
sw ollen
H eart,
at
gum
gums.
sp ray in g
0 .4 5
gm. N . A . B .
172.
in trav en o u sly .
D ay 4 .
gums,
M ist,
Less p a in
in
th e
et.
ammon.
gums.
S till
cit.
1 oz.
sw ellin g
t.d .s .
and r e d n e s s
of
how ever.
D ay 6 .
Gums l e s s
su lcu s
and i n
chrom ic
acid
R.
S till
fiery .
p ain ts
some m e m b ra n e i n R. r e t r o - m o l a r
furrow .
C ontinue
d aily
and m.w. B u s o l 4 i . d .
shrunk m arkedly.
an a r e a w ith
upper cen tral
S till
upper la b io -g in g iv al
D ay 8 . Gums h a v e
in
ferri
No p a i n
m em brane oh R.
in ciso rs
is
clear.
on ru b b in g
u p p e r jaw .
In terd e n tal
now.
A rea behind
p ap illae
norm al
size.
D ay 1 0 .
Gums n o r m a l ,
apart
from
mem brane on u p p e r jaw on R.
a sm all
sid e.
area
C ontinue
covered w ith
chrom ic
acid
and
E u so l.
Day 1 2 .
D isch arg ed w ith
gums f i r m
D ie t.and
b u tter,
m eat,
every
tea,
- fresh
o th er
p ie
and
peas.
eggs,
Case
R ice
b u tter,
54,
B lood
W .B .C .
5$.
b iscu its
and
A lk alin e.
R .B .C .
1$.
U rin ary v i t .
C.
2.07
6 hrs.
No n i c o t i n i c
a week. B read,
carro ts
U rine
No b i l e ,
stew ed
p o ta to es,
or d ried ,
o ccasio n ally .
or
Tea -
Cheese
sa u s a g e and m ash.
4 m onths.
86 /m in .
-
or
Supper -
beans,
P u lse
dark
in
b lo o d ,
B ow els c o n s t i p a t e d .
co lo u r.
S p ecific
s u g a r o r album en.
Gum s w a b p o s i t i v e .
4 ,9 8 0 ,0 0 0 /c.m m .
59$.
Hb. 98$.
C .I.
1 .0 .
L ym phocytes 34$. M onocytes
B aso p h ils 1$.
estim atio n .
acid
L iv er o r bacon
or b o iled
and t e a .
9 , 8 0 0 / c.mm. P o l y m o r p h s .
mg. $ .
roast
Tanker f o r
n eg ativ e.
E o sin o p h ils
tw ice
tin n ed
and t i n n e d
swab p o s i t i v e .
count.
a week.
D inner - R oast
cabbage,
Temp. 9 9 . 2 ° .
G ra v ity 1020.
tw ice
P orrid g e
m ilk .
33 y e a r s .
T o u rn iq u et’t e s t
Throat
c l e a r o f membrane
p u d d in g o r plum d u f f
beef
S.W .
On a d m i s s i o n .
-
jam ,
b u lly
fish
or b u lly b eef,
one o t h e r v e g e t a b le
B read,
day.
and t i n n e d
co ttag e
steep ed
areas
and h e a l t h y .
B reakfast
eggs
all
spec.
spec.
2 .3 6 m g.$.
estim atio n
C o m p la in t and h i s t o r y .
1st
1 . 8 5 mg. $ .
(V it.
C.
3 hrs.
spec.
d eficien cy ).
done.
He d e v e l o p e d
a c h i n g gums and b l e e d i n g
173.
gums 10 d a y s
ago
and c o n s u l t e d
8 days
ago a s
an o u t p a t i e n t .
He w a s g i v e n n o l o c a l t r e a t m e n t b u t E u s o l m . w . s 3 i . d .
n ic o tin ic
Two d a y s
acid
-
5 0 mg .
4 i.d .
ago h i s
th ro at
became s o r e
d ifficu lty
in
sw allo w in g .
no d i a r r h o e a .
No i m p r o v e m e n t
He i s
No " r h e u m a t i s m " ,
stom ach t r o u b l e s .
and he
and
resu lted .
experienced
co n stip ated
and h a s had
n y c ta lo p ia o r lung or
He s m o k e s 2 0 c i g s .
p e r day
and d r i n k s
in m oderation.
O .E .
L.
to n sil
sw o llen
W h i te membrane w i t h
sh o tty ,
te n d er,
an terio r
te n d e r.
They b le e d
ta rta r
but
ho llo w ,
C ourse.
pum ice
acid.
4 h o u rly .
Day 2 ,
Temp,
bases
0.4 5
P ain
in
Gums s w o l l e n a n d
on i n s t r u m e n t a t i o n .
at
teeth
U lcerated
bases
spray.
and a l a r g e
H eart,
ro tary
in trav en o u sly .
to
lu n g s,
b ru sh in g w ith
D a i l y gum p a i n t s
d ressin g
No
- N .A .D .
scalin g ,
gm. N . A . B .
th ro at
and L .
of th e lo w er p re -m o la r t e e t h .
Thorough
C arb o lised
R.
U l c e r w i t h w h i t e membrane
lo w er m olar e x i s t s .
and E u s o l
upper p o le.
th ere.
fauces.
and c o n j u n c t i v a s
D ay 1 .
sto n e
chrom ic
of the
deep brow n s t a i n i n g
C .N .S .
-
ad en itis.
copiously
L .,
on i t s
areo la present
p illa r
at th e
cario u s,
abdomen,
red
cerv ical
on l e f t ,
gum m a r g i n s
and u l c e r a t e d
w ith 10$
G arg.
p o t.
ch lo r.
ca rio u s m olar.
gone. T enderness
in
gums p e r s i s t s .
norm al.
D ay 4 .
U lcer g e ttin g
s m a l l e r on L.
to n sil.
Da y 6 .
P ractically
firm er.
M embrane on l e f t , a n t e r i o r , f a u c i a l
p illa r
Day 7 .
T o n sils
in
Day 9 .
V ery l i t t l e
no m e m b ra n e o n t o n s i l .
Gums I . S . Q .
Gums l e s s
c l e a r o f m e m b r a n e . No p a i n
red
p ersists.
th ro at
o r gum s.
m em brane r e m a i n s o n gums an d u l c e r s
of te e th
have h e a le d .
D ay 1 1 .
Gums a p p e a r h e a l t h y .
and
a t base
B reath fre s h .
G lassy
appearance
on o u t e r
m argins has gone.
Day 1 2 .
D isch arg ed .
D ie t.-
H is d i e t w as m onotonous and he
of greens
eggs.
and
absence of f r u i t .
T inned h e r r i n g
once
D in n er - Soup e v e r y d ay .
B reakfast
a week.
M eat,
com plained o f t h e
B read,
p o tato es
-
S teak
b u tter,
lack
o r ham and
jam and t e a .
and t i n n e d v e g e t a b l e s
174
(peas,
carro ts
or p arsn ip s).
Tea -
Cake,
Soup,
meat o r f i s h
Case 55.
b iscu it,
L .S ,
On a d m i s s i o n .
a day.
B lood
R .B .C .
8,000/c.m m .
U rin ary v itam in
No n i c o t i n i c
P olym orphs 66$.
6 hrs.
acid
w ith to o th -ach e
acid
th y m o l m .w .s.
ru b b in g
O .E .
b reath
is
o ffen siv e.
cerv ical
ad en itis
en cru sted
ta rtar
caries
present
present
C .I.
0 .9 4 .
3 hrs.
as an o u t - p a t i e n t
on n i c o t i n i c
degree
acid
of V in cen t’ s in fe c tio n .
and g l y c e r i n e
im p ro v ed
and s t i l l
and
b leed
on
G e n e r a l gu m a c h i n g p e r s i s t s .
d iarrh o ea,
had b r o n c h i t i s .
"rheum atism ” o r
stom ach
He s m o k e s 1 5 c i g s .
all
R.
p resen t.
p ap illae
retro -m o lar
to o .
H eart,
C ourse.
Day 1 . -
b ru sh in g ,
and E u s o l
are
prom inent
su lcu s.
No g l o s s i t i s .
o v erlap p ed by th e
in
acid .
a f i l m y w h i t e m embrane and t h e
In terd en tal
in th e
is
breath in g
1 oz. t.d .s .
b a c illi).
(V itam in C d e f ic ie n c y ) .
d en tist
was g iv e n
food.
R .M . v e s i c u l a r b u t
10$ chrom ic
of
done.
t* i.d .)
covered w ith
is
is
tra c e
specim en 2 .7 4 m g.$.
a m oderate
ep istax is,
1010.
t.t.
an u l c e r
Lungs -
have
He h a s l a t e l y
Gums a r e
Hb. 9 8 $ .
4 .6 1 m g.$.
H i s gums h a v e n o t
is
V ery f a i n t
S .G .
B a s o p h i l s -§■$.
C o n su lted
(m g.50,
He h a s n e v e r h a d
p e r d ay and
clear.
L ym phocytes 2 6 $ .
1st
spec.
o r on c h e w in g h a r d
tro u b le .
-
t w o w e e k s a g o . Was t r i e d
as he was s e e n t o
N ico tin ic
1 -§ $ .
estim atio n
C o m p la in t and h i s t o r y .
B ow els open once
(M ostly f u s if o r m
C estim atio n :
3 .8 5 m g.$.
B rin e
5 ,2 5 0 ,000/c.m m .
E o sin o p h ils
7 m onths.
66/m in.
or sugar.
Gum s w a b p o s i t i v e .
M onocytes 6$.
spec.
P u lse
blood
Supper -
S a v o u ry and c o f f e e .
n eg ativ e.
No b i l e ,
count.
W .B .C .
te st
a week.
jam and t e a .
D estro y er A f o r
T em p 9 8 . 4 ° .
acid .
album en.
b u tter,
and p o t a t o e s .
23 y e a r s .
T ourniquet
F ain tly
bread,
P udding tw ice
scattered
C .N .S .
rales
R. t e n d e r
T e e th have h a r d ,
s w o lle n gum s.
abdomen,
and
are
and
Some
slig h t
eyes
- N .A .D .
heard
on deep
areas.
Thorough
(1 i n
4)
M.W. p o t .
scalin g
of
sp ray in g .
perm ang.
en cru sted
ta rta r,
ro tary
D a i l y gum p a i n t s w i t h
4 i.d .
Bed. M ist,
p ecto ralis
Day 3 .
Gums s t i l l
Day 5 .
Less p ain
su lcu s
is
s w o l l e n and t e n d e r .
in
sh rin k in g
th e gum s. U lc e r
and h e a l i n g .
in la b io -g in g iv a l
su lci
Day 8 .
U lcer
R.
healed.
D isease
o u ter
sid e
d aily
p ain ts
(1
4)
in
in
of th e
w ith
Chest
from
areas
and have l o s t
u p p e r gum o n t h e
c l e a r . Memrbane
of
gums.
th e ir
to
L.
alm ost e n t i r e l y
a strip
sid e.
along th e
Thorough
acid .
S t a r t m.w.
and
rednessd isap p earin g
Day 1 3 .
D isch arg ed .
See
Gums o f
fiery ,
M outh a p p e a r s
-
su lcu s
co n fin ed m o stly
Day 1 2 .
Diet.
W h ite membrane p e r s i s t s
and b e lo w .
retro -m o lar
10$ c h ro m ic
retro -m o lar
Eusol
4 i.d.
Day 1 0 .
all
is
above
in
FIN IS
colour,
red lo o k .
h ealth y .
case 17.
a norm al pink
No m e m b r a n e
in
th e m orning.
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