MACULOFIBRINOT:S STOMATITIS (APHTHOUS STOMATITIS) In the following description the old term aphthous stomatitis is avoided and a new name is introduced. This is done with the best intentions. Without considering the fact that the term aplithm has wrought irremediable confusion, it explains nothing; for the translation of stomatitis aphthosa is "inflammatory inflammation of the mouth," as ,Icto,a: is derived from trissn'.., that is, to inflame.
In this usage I follow the example of E. Frankel and Kraus, who proposed the term "stomatitis fibrinosa maculosa disseminata," and in order to shorten the term, I shall employ the name maculofibrinous stotuatitis, which has the same significance.
The old physicians applied the word aphthoe to all diseases which were characterized by the formation of a white deposit on the mucous membrane with or without loss of substance. It is obvious that this broad view embraced a large number of different diseases. So it hap pened that genuine diphtheria of the mouth or throat, as well as all necrotic and ulcerative processes of the mouth, even thrush, were designated aplithx. Only after recognition of the various causative factors, did the clinical conception of aphtha become limited to a le.sser field, and finally, without any special reason was reserved for a certain inflammation of the mouth characterized by the forniation of dissem inated yellowish white plaques in the superficial layers of the mucosa.
Nature, Path o genesis.--The appel lation maculofibrinous stomatitis clearly ex presses the nature of the disease. We have to deal with a deposi tion of a fibrinous exu date in the superficial layers of the mucous membrane, as Henoch has already t au gh t. The eruptive lesions, which appear as small round spots, are well defined and have a whitish color. Their periphery shows a reddish areola. The patches at first lie epithelially upon the inflamed layers of mucous membrane. Soon the epithelial cover bursts and the yellowish white, disintegrated mass lies free upon the mucous membrane, occasionally surrounded by loosened epithelial cells (Fig. 5).
The histological investigation of the lesions permits the conclusion that the morbid changes must be identified anatomically with the fibrinous pseudomembranes, as they occur typically in croup and diph theria. Degenerative processes in the sense of a necrosis are entirely
absent, for, without considering the fact that such tissue alterations are not observed, after the absorption of the exudate no ulceration remains, except a superficial erosion which heals without a scar.
The reparative process occurs in that the floor of the deposit cleans off, the disintegrated masses are absorbed, and at the same time new epithelium is formed at the periphery- for the purpose of covering the erosion. It must be emphasized that the described efflorescences of maculo fibrinous stomatitis arise directly and are never preceded by an eruption of vesicles. Herperic stomatopharyngitis, and foot-and-mouth disease must be carefully differentiated from maculofibrinousstornatitis, although the former diseases sometimes, when the vesicles rupture and the white base is exposed, may resemble the latter affection.
Symptoms, Localization. Maculofibrinous stomatitis is charac terized by the appearance of discrete, yellowish white spots on an inflamed mucous membrane. The spots vary in size, from a hemp-seed to a pea, and may occur on the lips, the cheeks, or the palate. Not in frequently two adjoining spots coalesce whereby longer and irregular patches are formed. The plaques, of course, adhere firmly to their base; if they are forcibly detached their bed bleeds very slightly.
The symptoms are those which we have already learned in discussing simple stomatitis, but in greater severity. Usually severe burning pains are felt in the mouth and the children take food with great dis comfort. There is an increased flow of saliva which does not possess a di.sagreeable odor. The general condition also suffers in a great degree. The children are weak, irritable and have no appetite. Their sleep is restless and disturbed. Occasionally- diarrhoea supervenes. 'Whether this is due to the ingestion of large quantities of saliva may be considered doubtful. Not infrequently the maxillary lymph-nodes are found enlarged and, at the, onset of the disease, a febrile movement may be discovered.