Noma : gangrenous stomatitis, water cancer, scorbutic cancer, gangrena oris, gangrene of the mouth / George H. Weaver and Ruth Tunnicliff.

  • Weaver, George H. (George Howitt), 1866-1947.
Date:
[1907]
Catalogue details

Licence: In copyright

Credit: Noma : gangrenous stomatitis, water cancer, scorbutic cancer, gangrena oris, gangrene of the mouth / George H. Weaver and Ruth Tunnicliff. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    15 Krahn, in 1900, described in the tissues of a case of noma threads corresponding to those observed by Perthes. He was unable to observe branching, and because of this, and because of the fact that threads were sometimes made up of distinct links, he concluded that the organism was not a streptothrix. The threadlike organisms were not cultivated. His idea is that noma is due to a mixed infection by various mouth bacteria, especially with the “Spirillum sputigenum and “Spirochaetae dentium.” Blumer and MacFarlane in 1901 reported a most interesting epidemic of noma, in which 16 cases of noma occurred among 173 cases of measles. In all cases a thread- like organism was present in cover-slip preparations. It stained best with carbol- fuchsin, and stained faintly by Gram’s method. In sections it was best seen after staining with carbol-fuchsin and decolorizing in oil of cloves according to Flexner’s method. In such sections in the deeper part of the necrotic zone the organism was present in enormous numbers. The individual bacteria were nearly always seen as long threads, which for the most part lay parallel and between the connective tissue fibrillae. The organisms were fewer in the zone of reaction, and a small number were found in apparently unaltered tissue. Efforts to cultivate the organism failed. Seiffert in 1901 reported the study of four additional cases, in all of which he was able by anaerobic methods to cultivate the same threads, “spirilla,” and branching forms of cladothrix as in the earlier cases. By animal experiments he showed his cultures to be pathogenic for guinea-pigs and rabbits, and he observed a spontaneous contact-infection of the lip of a rabbit. Braun, in 1901, in discussing Seiffert’s presentation, referred to a case of noma in which he had found the thread organism described by Seiffert, but efforts to cul- tivate it anaerobically or transfer it to animals were futile. In 1902 Matzenauer published a paper upon noma and hospital gangrene in which he attempted to show that the two diseases are identical clinically and bac- teriologically. In the nomatous tissues he described, in the border zone, a great number of bacilli of uniform shape, in entangled heaps, staining intensely and uni- formly by Weigert’s stain. The bacilli were slender, straight, or slightly curved, usually single, often in pairs end to end. The ends were usually not angular but slightly rounded. If the process was progressive the bacilli were deep in the tissues where there was no necrosis or even marked inflammatory reaction, and only fibrin network was present about the vessels. The bacillus is said to be anaerobic, but no details are given as to the cultures. He believes these bacilli are the same as observed by most former authors in cases of noma, and apparently identical with the bacilli observed by Vincent and himself in hospital gangrene. In 1903 Ranke was ready to declare his conviction that noma was caused by a fungus, closely related to actinomyces. The threads did not stain by Gram s method. Rosenberger in 1904 reported some observations in a child with noma of the cheek. In smears from the margin nearest the mouth there were various b,acteria. Most abundant were “spirilla” and bacilli arranged in pairs, the distal ends being pointed. Cultivation of these bacteria was not accomplished. Briining in 1904 described in sections of nomatous tissue, thick tangles of fila- ments, but in his illustrations he figures only individual bacilli. He was able to grow the same organism as described by Seiffert in anaerobic cultures in bouillon and agar. Hofmann in 1904 found, in a case of noma, bacilli in the freshly infiltrated part