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The New Zealand Dental Services

Ulcero-membranous Stomatitis

Ulcero-membranous Stomatitis

This disease is also known as Vincent's Stomatitis or trench mouth, and, when it attacks the fauces, tonsils and pharynx, as Vincent's Angina. It is contagious and community life provides ideal conditions for it to become epidemic. A state of lowered vitality such as that following influenza, overwork, severe cold or lack of essential page 111 vitamins in the diet is a general predisposing cause, while a septic mouth, calculus, overhanging fillings, food traps or impacted teeth provide ideal local conditions.

The etiology being both general and local, combined with its epidemic possibilities, put the disease in the no-man's-land between medicine and dentistry. Its importance as a potential incapacitator of large bodies of troops demanded a clear decision as to whose responsibility it was to treat it and prevent it spreading. As the general health of the troops was the responsibility of the Medical Corps, some medical officers considered it was in their department. As the disease was an oral one, usually diagnosed by the dental officer, and as treatment was mostly local, the dental officers considered it was in theirs.

The instructions from the DDS to his officers were quite clear. They were to treat all cases and were given implicit instructions how to do it. They were warned to be continually on their guard to prevent the spread of the disease. They had to notify the DDS by telegram of every case diagnosed, in addition to notifying the medical officer and unit commander. Apparently the instructions from the Director-General of Medical Services to his officers were not so specific and the medical officers were left to form their own opinions as to who should treat the disease. There was justification for both views but no justification for the lack of co-operation between the two Corps when it came to treatment.

Matters came to a head in 1941 when the Senior Medical Officer at Papakura Mobilisation Camp refused to admit cases sent to his camp hospital for isolation and evacuated them to the Auckland Public Hospital for treatment, thus taking them out of the control of the Principal Dental Officer of the camp. Under these circumstances the Principal Dental Officer had no option but to inform the DDS that he was unable to accept responsibility unless allowed to carry out the implicit instructions given to him on his appointment. He asked that a ruling be given to settle once and for all where the responsibility for treatment of the disease laid. As a result the Director-General of Medical Services gave the following instructions to the Assistant Director of Medical Services at Auckland:

During normal periods, namely when there is no epidemic or other unusual sickness rate in the mobilization camp, the Senior Medical Officer should retain all mild cases of disease whether contagious or otherwise, or accidents which can be effectively treated, in the camp hospital. This includes measles, mumps etc. As regards Trench Mouth in particular, there is no reason why this disability should not be retained in the camp hospital under the treatment of the Senior Dental Officer. The patient will of course be under the general control of the Senior Medical Officer for discipline etc. and the nursing personnel, but will carry out the treatment ordered by the page 112 Dental Officer. I may say in passing that the camp hospital at Papakura has a staff of three trained NZANS personnel with NZMC personnel, and the equipment, sterilisation etc., [which] is quite sufficient for dealing with all classes of minor disabilities including contagious diseases.

As you are aware the one great principle in the Army Medical Service is conservation of manpower and it should be the aim of the medical staff not to evacuate patients who can be equally well treated within the camp area. I do not in any way minimise the importance of Trench Mouth as a highly contagious disease, but at the same time I do feel that the camp hospital should be prepared to take cases of this nature under normal conditions. Will you please instruct the Senior Medical Officer accordingly.

Apart from treatment which was on standard lines, the most important consideration was to prevent the spread of the disease throughout the camp. The patient's eating and drinking utensils were kept away from the others and each patient received a printed card of instructions.

Most of the cases in New Zealand were of the mild sporadic type and nothing in the form of a serious epidemic occurred. In March 1944 there was a scare when an unusually large number of men, newly arrived from Middle East service, reported at Trentham Camp with the disease. Again in February 1945 there was a slight outbreak at Waiouru Camp. Neither of these was a serious epidemic, although without thorough precautions they might have become so. No case was considered cured until three negative bacteriological tests at weekly intervals had been obtained.