Syrup, 20 parts.
M. To be applied five or six times a day.
Ulcerative Stomatitis (Fcetid Stoma titis; Putrid Sore Mouth).
Definition.—Inflammation of the mu cous membrane of the mouth and under lying structures attended by the forma tion of a deep ulcer which usually de velops in the gum about the lower in cisors. It only occurs when there are teeth (Forchheimer).
Symptoms.—Ulcerative stomatitis gen erally develops near the edge of the gum immediately above the lahio-gingival sulcus. The area affected is at first rod and tumefied and very sensitive. A deep, pus-secreting ulcer having a red arcola, surrounded, in turn, by a zone of wdema, is soon developed. In some cases this ulcer reaches down to the porios teum, and is followed by necrosis of the alveolar process. The gingival mucous membrane becomes softened and spongy and the teeth arc loosened. Although the inflammatory process may invade all :Ilk month, die ulceration • .1.14 11.14 bk:%, lid the anterior por of the guin4. Occasionally the k.f the ilieek opposite the Arca Os 1 ulcerates. The breath 1.-• s 11,tc tisk 11 foul, and slight gin 1,..tiii..rrhaa.:es cause the profuse sa ,,NA rk tkil o appear bloody. Severe expc ric nced during mastication.
rk ,kcklling and pitting of the zilarzc ment of the submaxil i.o-N and,. Vomiting, diarrliwa. and sr-a, ri ft kr arc, usually present, and an x.41,tt.autatotis eruption resembling that f u,c11,-Ics is occasionally observed. In the disease sometimes culmi i stk, fatally. especially when unhygienic t rdn nt and unwholesome food n..t le replaced by improved condi tt,-. tilt diseas.e being one denoting a thl.ravc,1 state of the general organism.
Etiology and Pathology.—That a spe ,..1.,• ni;cro-organism must exist is em the occasional prevalence of t."0-rathe stomatitis as an epidemic in in-titutions, barracks, camps, and e-pecially when the sanitary ,incliti ,ns are defective and where poor f-nd i; -upplied. Squalor in all its t,nds to promote its appearance, damp, and defective ventilation among the many predisposing t‘. Insufficient care of the • r‘pecially when tartar is allowed . • ni.ulate. around the teeth. carious rr decaying. roots, infectious dis t.- c ngenital In.art affections (Duck
s -,..11rVy, saturation of the system lcad or pho5phorus are among the • frequent etiological factors known.
In a of 30 eases recently ex 1,y Bernheim and Popischill ,W,:encr Woch.. „No. ?I% '97) two rr r'rr.-organisms were found in the ul cer; in all the cases, a bacillus and spiro cha.ze. F-th being mrbile. Attempts to cultivate them failed. Besides these or ganisms, which were always present, there were usually also streptococci and staphylococci in addition to the organ isms generally found in carious teeth: leptothrix buccalis. The specific organ ism of ulcerative stomatitis may still be considered as unknown, however.
Treatment.—In this affection chlorate of potassium may be given internally, 2 to 5 grains three times a day to a child, and also applied locally in the form of a mouth-wash, the saturated solution being employed. This constitutes a truly spe cific treatment, the disease being thus readily controlled.
[in stomatitis ulcerosa chlorate of potash is almost a specific. It is best administered in a 3-per-cent. solution with a little syrup, 'A to 1 teaspoonful being given every two hours. Its toxic effects, if used in too large quantities, should not be forgotten. It usually pro duces considerable pain, but this soon ceases, and is a positive index of the curative effect of the drug. In obsti nate cases the application of a solution of nitrate of silver may hasten recovery. I,. EMMETT HOLT, Assoc. Ed., Annual, '90.] A 1-grain-to-the-ounce solution of per manganate of potassium is sometimes re quired to counteract the foul breath, and the nitrate-of-silver stick applied to the edges of the ulcers hastens recovery. Peroxide of hydrogen, 1 drachm to the ounce, is preferred by some clinicians as a mouth-wash. Care should be taken to preserve teeth that are loosened by special attention to the surrounding gums; the latter should, besides being kept scrupulously clean, be occasionally painted with a 20-grain-to-the-ounce so lution of alum. Pieces of necrosed bone occasionally keep up the ulcerative proc ess. The cavity from which the pus oozes should be carefully probed and surgical removal resorted to if needed.