The local treatment consists in the destruction of the sphacelous areas by caustics after thorough cleansing. For the latter purpose a 1-grain solution of permanganate of potassium is very use ful, but peroxide-of-hydrogen, bichlo ride-of-mercury, or carbolic-acid solu tions arc preferred by some. These may be applie.d with an atomizer giving a coarse spray. The sloughs must be thoroughly removed and the bottom of the -ulcer fully expoF,ed. This being ac complished, a 10-per-cent. solution of cocaine is applied to the wound, and after four or five minutes the latter is touched with pure lactic acid by means of a small cotton pledget Fa pped around the end of a thin probe (Sajous). Every- part of the cavity must be cauter ized. This is to be. repeated daily until signs of resolution appear. Nitric acid, galvanocautery, and the Paquelin cau tery have als',o been recommended, but : . • ,lor, WI; el.-- .0 • .1 a f• and us• - . r i-intith sr. , (illion,e tinkitt-ted 1,11 the r- t.ltauliner,s of• • - „nit m :,rom tS(e ' Utile ir.) Anomalous Forms of Stomatitis. Membranous, or Croupous, Stotnatitis.
,tomatitis is always a • • ii (f eri..upons angina, the 10-eloping simultaneously - • ; f the tonsils. Diphtheritic -• rardy primary. but a corn • • f liphtheria of the fauees ? II ' i n dra \Nu to import:141,e of di . 111.111:l early. -with v '' it- trcati»ent by antidiplithe - r . Th. ugh the casual relation • I to the di-case i- not nett" • r. it is believed to he a not n oecurrene.. Fre-yin-nth and I - 4.y . Dent. med. lVoch.. 22, , I -e- of primary diphtheritic - in a man aged 35 years.
in I _fir, ;oz.. t 15. (-)f 400 eases examined. in (Illy 2 -was the to, -1..ted to he ill the mouth. A, -i et, r.; rot.c, arc present. it is int -1' le 0 litierentinte .4ot-eat itis (hie to - bacilln. by mere inspee . teriological examination ..( re imperative. E. T. Trovelyan Nle I —Tour.. Apr. 14. 19001.
/ ria found in all of eight - T.0111:1 examined 'bacteriologic•0 firl. one ( f the-e ca-cs gave a .1 t fire of the diphtheria haeillus, r. h.-curved in ft 111-P With n--0 ..rpigeal diphtheria. the child -f ioly recovering. Another de r TI• Tfil during mr.a-los, having r fr, eria four months i • -I.. and at the Tina, of develop , f being i-olat(q1 -with I who prt.-cnted elinical- ../ ( f diphtheria. hitt with nega i‘e cultures as regards this organism. hree of he other cases began just atter inca-les. Four of the eight eases 1,42an IN it I. an ulcerative stomatitis. Fifteen other cases of ulcerative stoma titis were examined in bope of finding diphilwria bacilli, but with negative re -. :since imitta is a species of moist gam2rene, requiring probably. from
analog.y. t‘vo dillerent organisms,—one a saprophyte. to produee the putrefac tion another a parasite, to in•oduce the printaQ- neerosis..---it is possible that in the ca,-.es in whielt diphtheria. bacilli are found they may be the primary causa tive agent ; and, secondly, that when other pathogenic micro-organisms capa lde of producing neerosis are found it pos-ihle that they may be the primary excitants. Joseph Walsh (Proceedings Poila. Path. Soe...fune, 1901).
What is often called "membranous stomatitis," however, is but an aggra vated form of aphthous stomatitis. The local inflammation is more intense, the aphthai assume a development 'suggest ing the presence of a diphtheritic pseudomembrane, while the ulcer, when the latter is removed. is deeper and larger. It is mainly observed in infants suffering from inherited syphilis or cronorrhceal infection. In the adult it is occasionally caused by- the local use of strong- caustics. The treatment does not differ from that of aphthous stomatitis, care being taken, however, to remove as far as possible the causative dis order.
Foot-and-mouth disease, or aphthous fever, an affection observed in cattle, is occasionally witnessed in the human being, particularly in children, the toxic element being transmitted through contaminated milk-, cheese, or butter. There is marked fever and gastro intestinal and bronchial irritation; a vesicular eruption appears upon the lips, mouth, and pharynx early in the history of the disease. The tendency to hmmor rhage is greater than in ulcerative phar yngitis. The mortality in a recent epi demic studied by Siegel was 8 per cent. The treatment indicated is that recom mended in the ulcerative form.
Foot-and-mouth disease as found in Spain is a highly contagious malady, and may affect not only the foot and mouth, but also the raucous membrane of the bronchi, stomach, and intestines, giving rise to symptoms resembling ty phoid fever. Infection is transmissible front animals to man, hut it is purely local, and does not reside in the flesh of the affected animals. Grinan y R. Turro (Gaz. saint. de I3arcelona, Mar., '93).
Bednar's Aphthm.—This is character ized by the presence, over the hard palate near the gums of infants, of white patches, or aphthm, which sometimes overlie deep ulcers. It is usually as cribed to the use of artificial nipples or to traumatism, such as that produced when the mouth is roughly cleansed by the nurse. This form of stomatitis is over come with difficulty. A shorter and softer nipple should be ordered when this cause is apparent and the measures indicated in ulcerative stomatitis re sorted to.