Trench Mouth

Trench mouth, a survey of the land last week revealed, is spreading. To what extent no one knows, for only twelve States require dentists (who commonly see the infection when it affects the gums) and doctors (who treat the infection of other parts of the mouth & throat) to report their cases. The U. S. Public Health Service makes no record, except to note that hospitals everywhere mention mounting numbers of trench mouth cases.

The East seems more affected than the West. San Francisco's Health Officer Jacob Casson Geiger knew of very few cases. At the University of Missouri there were none; students are being instructed in protecting themselves. Health Commissioner Herman Neils Bundesen of Chicago thought that his community had only the usual number of cases, not enough for alarm. New York City's worst centre seems to be the Greenwich Village neighborhood. Vacationists have imported many cases from Europe. Partially isolated communities, like colleges, have been able to eradicate the disease when it appeared. At Smith College, Dr. Anna Root Mann Richardson had all infected girls eat and sleep in the infirmary until cured. Vassar declared it had no trench mouth.

The Disease. Xenophon, ancient Greek general, noted that many of his men had sore mouths and foul breaths. World War troops had the same. Dr. H. Jean Vincent discovered the cause long before the War when he was a French army surgeon with Colonial troops in Africa. Although Dr. Hugo Karl Plaut of Hamburg two years earlier (in 1894) reported the same cause, credit for discovery goes to Dr. Vincent. The disease is called variously Vincent's angina, trench mouth, ulcerated stomatitis, necrotic gingivitis. Two germs, which may be variant forms of the same microorganism, are always associated with trench mouth. One is a wriggly spirillum, the other a cigar-shaped bacillus. They take hold anywhere in the throat. Commonest sites of infection are gums and tonsils. "Trench mouth" refers primarily to the gum condition. The ulcers of this disease and the membranes which cover them are deceptive. They may resemble diphtheria, septic sore throat, syphilis. Bacteriological examination quickly differentiates the four diseases.

Contagion. Vincent's angina is highly contagious. Kissing seems to be the commonest mode of spread. Restaurants where dishes are not thoroughly sterilized are probably the next most common distributing agents. School children are infected by public drinking fountains. Drs. C. Rex Fuller and John Charles Cottrell of Salida, Colo, were obliged to amputate an Italian miner's left index finger after another man with trench mouth had bitten the finger. More males are attacked by trench mouth than females. But females suffer more, are harder to cure. An attack does not give immunity, apparently makes one more susceptible.

Prophylaxis. Strict personal hygiene. Individual towels, linens. Thorough cleanliness of teeth, mouth, throat.

Treatment. Possible complications (chronic infection of gums, cancer, gangrene, lung abscess) make trench mouth more a medical than a dental disease. But dentists can cure most cases. Treatment requires one to several weeks. Neosalvarsan may be applied directly to the sore or by intramuscular injection. Stubborn sores may be cauterized by 10% chromic acid, 50% trichloracetic acid or strong silver nitrate solution. It is preferable that a doctor or dentist apply the foregoing treatments. Most cases, after they have been accurately diagnosed, may be treated with oxidizing agents. Both the fusiform bacillus and Vincent's spirillum (perhaps they are the same) are anaerobic (cannot live in oxygen). They die when exposed to oxygenizing chemicals. Hydrogen peroxide diluted with an equal amount of water often suffices. Diluted potassium permanganate is very useful. But it stains. Preferable is sodium perborate. Every druggist sells sodium perborate cheaply. But it has an unpleasant taste, hence every druggist also carries more expensive preparations of sodium 'perborate mixed with appetizing aromatics. Simple or savored, sodium perborate releases the oxygen which kills the germs. A 2% solution makes the proper mouth wash and gargle. The powder may be made into a thick paste with a little water and applied directly to the ulcer. The paste should be kept there about five minutes while the oxidizing froth develops. Then the mouth should be rinsed with warm water.

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