ULCEROIIENIBRANOUS ANGINA (Angina ulcerosa, Plaut's and Vincent's angina. Angina baeille fusiforme, diphtheroid angina) This disease Yvas first described clinically- by Russian,: (Szimano wsky and Filatow), and by French authors (Barthez and Sanne). The first disooveries of etiological importance were made by Plant in 1804, who first called attention to the fusiform bacillus found in such cases. Vincent published his observations in 189S.
disease has an acute onset, but unlike other forms of angina, the constitutional symptoms are slight. This slight general disturbance with severe local lesions is characteristic. The inflamed and swollen pharyngeal mucous membrane has a tendency to bleed. Sharply defined.ulcers, covered with a tenacious secretion, then develop, usually on one tonsil.
Two forms are described: a cliphtheroid, in which a pseudornem brane, covering a slightly eroded surface, develops, not resulting in much destruction of tissue; and an ulceromembranous form, in which deep ulcers appear on the tonsils.
first variety runs a mild and rapid course, healing like an ordinary angina. In the second variety, the uiceromembranous form, healing is much slower. The membranous coating is not thrown off before the end of the first week or even longer, and the ulcers heal slowly. The majority of the patients get well, but in exceptional cases extensive necroses with a fatal outcome have been observed (Bruce, Ellermann, Mayer and Schreyer).
infectious nature of the disease has been well established, as many house and family epidemics have been observed. Some authors (Bernheim and Pospischill), regard the disease as an atypical localization of an ulcerative stoniatitis. Inoculation experiments on healthy persons have not succeeded (Uffenheimer). Certain bacteria and spirochaite appear in great numbers sometimes in pure culture even on cover-slip preparations. The fusifonn bacillus, not at all, or slightly, movable, is colored with difficulty by Grain's method. Along,
thin, movable (negative to Gram) spirochmta occurs in conjunction with this. Ellermann, after a long trial, has succeeded in obtaining the fusi form bacillus in pure culture as a strict anaerobe. The etiologic role played by these symbiotic bacteria is shown by their constant presence, and by the fact that they have been obtained in pure culture from the deepest layers of the mucous membrane (Hess, Gross, Ellermann, Graupner, Beitzke).
The same, or at least similar, organisms have been found in other ulcerative processes, such as noina. They have also been found in healthy mouths, in carious teeth, gonorrhcrial stomatitis, and chancre of the tonsil (Jfirgens, Hahn). These findings however should not be considered as counting against the etiological importance, beeause in pathology a great many instances are found in which the same organisms, which as saprophytes exist harmlessly on body surfaces, under favorable con ditions may develop pathogenic properties. The spiroehtete appear to be important factors in the production of the bad odor from the mouth.
is made hy the appearance of the pharynx, the bad odor, and the bacteriological examination. It must be differentiated from diphtheria and syphilis. This is often difficult, because diphtheria bacilli and angina microbes frequently occur together. In the same way angina and syphilitic ulceration occur simultaneously. The diagnosis must be made by exclusion. An examination for diphtheitia bacilli should always be made.
is similar to that for angina. Potassium chlorate has been recommended. The removal of the tonsil to sh-orten the attack has been suggested, but it has not been determined what the result would be (Uffenheimer).