MEDICAL STUDENTS AT BELSEN

730 has not been generally accepted, and most recent workers have failed to grow T. vincenti at all. The experimental inoculation of spirochaetes and fusiform bacilli into animals has never produced the disease, though Smith2 has shown that inoculation of a mixture of spirochsetes, fusiform bacilli, streptococci, and vibrios produced abscesses in animals. It must be remembred, however, when assessing these results, that organisms pathogenic to man are not necessarily pathogenic to the experimental animal. General diseases of certain types, and vitamin deficiencies, appear to predispose to the condition. It has been known for some time that diseases characterised by leucopenia or alteration of the leucocytes-agranuloshow cytosis, leukaemia, glandular fever, &c.-often ulcerative gingivo-stomatitis as one of their most mistress= ing features. It is interesting in this connexion that recent work with ’Scillaren B,’ a glucoside mixture producing leucopenia, has shown that injections of the drug into an animal predispose it to-attack by spirochoetes and fusiform bacilli. The association of ulcerative stomatitis with local damage, or intoxication-e.g., bismuth and mercury stomatitis-is also a common observation. In recent years vitamin deficiencies have been cited as the main predisposing cause of the disease. Vitamins A, B, and C have all had their share of attention, and King 3 has reported that nicotinic acid combined with local measures seemed more beneficial than local measures alone ; in his experience vitamin-C supplements did not accelerate healing. The two main predisposing and precipitating factors in the causation of the disease seem to be : (a) lack of resistance in the gingival tissues, brought about by various local or general conditions ; and (b) invasion of the tissues either by some unidentified organism or virus which is causal and also provides a suitable environment for the excessive growth of spirochaetes and fusiform bacilli, or by the spirochsetes and fusiform bacilli themselves. Attempts to raise the resistance of the tissues by vitamin therapy have not proved particularly encouraging, except possibly as an adjunct to local treatment; and local treatment, both mechanical and chemical, still remains the accepted practice. This usually takes the form of syringing, packing, scaling, and application of oxidising agents and caustics, sometimes followed in severe cases by gingivectomy to eliminate the gum pockets and areas of stagnation. MacGregor and Long 4 have shown that the infection in its acute stages responds rapidly to penicillin in pastilles allowed to dissolve in the mouth. With pastilles containing 500 units of penicillin taken at regular intervals by 75 patients, clinical improvement was well marked after 24 hours and the spirochaetes disappeared in the same period ; the fusiform bacilli were absent or greatly diminished after 48 hours, and in 72 hours both organisms had disappeared from the films in all patients. After 5 days of this treatment, clinical and bacteriological improvement was such that the pastilles were stopped. The coincidence of clinical improvement with disappearance of the spirochsetes and fusiforms suggests that either these organisms themselves

other hitherto

unrecognised penicillin-sensitive responsible for the acute inflammation. The treatment devised by MacGregor and Long is a or some

organisms

are

distinct advance in the treatment of the acute form of the disease since it can be carried out easily and rapidly without frequent attention by the dental surgeon. They point out, however, that, even after scaling and general hygienic measures have been carried out, gingivectomy, extraction of wisdom teeth covered by a gum flap, and similar measures may later be needed, because while gum pockets remain recurrence is still possible. Further evi-

dence of the efficacy of penicillin has lately been published by Greey and Macdonald5 in Canada. They have shown that penicillin included in an agar base is effective, and its use in the mouth resulted in all instances in the rapid elimination of the infecting organisms together with prompt alleviation of clinical symptoms and signs. A different technique of application has been adopted by Thexton and Dick 6 in this country. They apply the penicillin to the gum tissues -by incorporating it in a pack, and their preliminary results have been excellent -in 15 cases symptoms vanished in 24 hours. They agree, however, that the pastille methods of application is preferable, where pastilles are available. The value of penicillin in the treatment of the condition now appears to be beyond doubt. MEDICAL

STUDENTS

AT

BELSEN

"

No other group of people could have done the job." Dr. A. P. Meiklejohn, adviser on nutrition to the Rockefeller Foundation and UNRRA, thus commends the work of the 96 medical students from the London teaching hospitals who volunteered to serve in Belsen camp. Dr. Janet Vaughan, at the Royal Society of Medicine on May 29 (see p. 723), described conditions in the camps while this welcome aid was lacking, and her picture gives a measure of the need. Some 29,000 released prisoners were transferred to the panzer training school alongside the camp, and here the medical students, working in pairs under the official relief teams, were made responsible for the huts, one pair to each hut of 150 people. They brought, as Dr. Meiklejohn said, initiative, energy, enthusiasm, team spirit, medical knowledge, and hope. No doubt they also brought an ability to make reassuring jokes. They scrubbed the filthy floors, they organised the fitter prisoners’ into hospital staff, they fed the starving who had been too weak to succeed in the scramble for food, and they attended to the needs of the worst cases. Patients with a chance of recovery and typhus cases were evacuated first, and as the daily drafts went off, and conditions became easier, the students were able to plan a hospital area within the camp itself. They share the credit for the fact that within ten days of their arrival the death-No doubt Dr. Meiklejohn rate had dropped by half. is right in thinking that an equal number of doctors could not have worked together in the same way. Students carry the sense of community gained in schooldays into the wards of their hospitals : they have not yet been chiselled by life into the rugged individualists who distinguish our profession. It was a fine stroke of imagination to send them where their team spirit was of such moment. Of the students who returned to England last week one (from King’s College Hospital) has developed typhus and three (from Bart’s, the London, and the Middlesex) are under observation. ’

A COLOUR film showing the movements of the brain during head injuries, as seen through a lucite calvarium, has been made by the Medical Corps of the United States Navy. This film will be shown by Lieut. Robert Pudenz at the house of the Royal Society of Medicine, 1, Wimpole Street, London, Wl, at 4.30 PM on Friday, June 15. Lieut.-General Sir Alexander Hood, director-general of

Army Medical Services, will preside. Greey, P., Macdonald, I. B. Canad. med. Ass. J. 1945, 52, 327. 6. Thexton, R., Dick, P. K. Brit. dent. J. 1945, 78, 292.

5.

.ROYAL COLLEGE OF. PHYSICIANS OF Macdonald Critchley will now deliver the Croonian lectures, which had to be postponed owing to VE-day, He on Tuesday and Thursday, July 10 and 12, at 4.30 PM. is to speak on problems of naval warfare under climatic

LONDON.——Surgeon

Captain

extremes. -

2. Smith, D. T. Ibid, 1930, 46, 303. 3. King, J. D. Brit. dent. J. 1943, 74, 174. 4. MacGregor, A. B., Long, D. A. Brit. med. J. dent. J. 1945, 78, 33.

1944, ii, 686; Brit.

LONDON AND COUNTIES MEDICAL PBOTECTION SOCIETY.The annual meeting will be held at Victory House, Leicester Square, London, WC2, on Wednesday, June 20, at 3.30 rnz.

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