296 THE NEW WORLD OF SCIENCE 



so that the circulation is ultimately shut off from the distal part 

 of the extremity. With the failure of circulation and the possi- 

 bility of infection through the damaged skin, a condition of dry 

 or moist gangrene develops which leads to serious infection or 

 to spontaneous amputation of the affected part. Operative 

 procedures were always necessary to secure a clean stump and 

 to prevent the spread of infection up the limb. The largest 

 number of cases in the American Army occurred during the 

 Argonne-Meuse offensive of October and November, 1918, 

 when the troops were fighting continuously day after day and 

 week after week in the rain and mud and in temporary trenches, 

 and in situations where it was impossible to provide them with 

 dry foot wear or to relieve them long enough for them to dry 

 out their own. In 1918 we had 1715 cases reported, giving 

 a rate per 1000 of 0.68. The total deaths from this disease, 

 however, were only five. Trench mouth is another new term 

 which sprang into use because the facilities for careful and 

 scientific examination of new cases were not available. The 

 symptoms were those of sore mouth, shown principally by red, 

 tender and bleeding gums, with more or less involvement of 

 the tonsils and the mucous membrane of the cheeks. The 

 lesion was, therefore, an ulcerative and sometimes pseudo- 

 membranous inflammation of the mucous membrane of the 

 mouth and gums. The corresponding lesion of the tonsil had 

 long been known as Vincent's angina, and that condition is 

 always associated with the presence of the spirillum and fusi- 

 form bacillus of Vincent. In these cases of sore mouth the same 

 microorganisms were found to be regularly present. Whether 

 they are the primary cause or merely secondary invaders is not 

 well established, nor is the manner of the spread of the disease 

 well known. It apparently spreads by contact from soldier to 

 soldier from common eating utensils, and possibly from pipes 

 or contaminated articles of food. The position of the troops 

 in the front areas, particularly in the trenches themselves, made 

 the ordinary principles of mouth hygiene impossible of execu- 



