The course of the disease is always favorable. As soon as the local inflammatory' changes cease, the general condition improves. The febrile movement ceases, the appetite and proper sleep return, and after a week, if no complications arise, recovery supervenes to proper treatment.
Etiology.--The cause of maculofibrinous stomatitis is uncleanli ness of the oral cavity, inadequate care of the mouth, the use of filthy "soothers" and unclean utensils. The disease, therefore, occurs chiefly among the children of the proletariate and is rarely observed among the higher classes. The fact that most cases occur during the second year of life suggests some relationship to teething. Indeed, in some cases the disease is observed to arise at the time of the eruption of a tooth, as a complication of the catarrhal stomatitis. Fibrinous deposits appear and wreath-like encircle the crown of the 11 C W tooth. Otherwise, the fact that infants, when they commence to walk, crawl on all fours, must be. considered since the hands are soiled and may directly infect the mouth (lischerich's dirt infection).
These factors argue that maculofibrinous stomatitis has an infec tious origin, especially since the sudden appearance of the eruption is attended by fever and, moreover, many cases have been reported which establish the communicability of the disease.
Investigations concerning the nature of the exciting cause have, as yet, not yielded any definite results. Staphylococci have been found most frequently, but the etiological relation has not been established since they form a part of the normal fiora of the oral cavity. Stoos was able to demonstrate in a number of typical cases the piesence of a large diplostreptoeoceus, which very much resembled Tavel's cliplococew intestinalis major. Since this diplococcus is constantly present in the disease and constantly absent from the healthy mouth and, moreover, since the microorganisms have a crowded arrangement in the exudate, Stoos insists that the diplocoecus is the specific cause of maculo fibrinous stomatitis. Still, the fact that a long diplostreptococcus is often found in microscopical preparations of faucial exudates and in the stools of infants warns us to be cautious in accepting this finding as final, especially since positive inoculations have not been made.
The etiological relation of "foot-and-mouth" disease has often been discussed. It is more than probable, however, that this disease,
both etiologically and clinically, is quite distinct from rnaculofibrinous stomatitis and must be regarded as a distinct disease entity.
stomatitis is adequately character ized by its appearance and the seat of tbe lesions, so that the diag nosis as a rule offers no difficulties. In the differential diagnosis only herpetic stomatopharyngitis and small decubitus ulcers of genuine ulcerous stomatitis need be considered. The involvement of the throat (especially the pillars of the fauces) and the possible presence of recent vesicular lesions would point to the herpetie sore-mouth; while in the case of ulcerous stomatitis the localization of the deposits (around the teeth, gums, and edge of the tongue) and the fetor of the .secretions, are diagnostic, the foul breath usually being absent in maculofibrinous stoxnatitis.
Like herpetic stomatopharyngitis, the foot-and-mouth disease arises by the eruption of vesicles, which may attain the size of a pea. This vesicular eruption is not limited to the oral cavity, but appears also on the integument particularly in the neighborhood of the nose and mouth. Although the foot-and-mouth disease usually assumes a milder form in children than in the adult, still the local and general symptoms (espe cially in regard to thc alimentary canal) are much more severe than in inaculofibrinous stomatitis. A common peculiarity of the two diseases is that no destruction of the deeper tissues takes plaee. In doubtful cases the previous history (such as ingestion of raw milk from diseased cows) must decide the question.
The prognosis is invariably- good.
The prophylaxis consists in a rational care of the mouth, in the prevention of contact, and the avoidance of unclean "soothers" and filthy eating and drinking utensils.
local use in older children a solution of potassium chlorate (2 per cent.) or boric acid (2 per cent.) should be prescribed. In young children the potassium chlorate should be g,iven internally (1-2 per cent.) a teaspoonful every two hours. In obstinate cases the local application of a 2 per cent. solution of silver nitrate, carefully applied with a brush, is indicated and should be used once or twice daily.
In order to spare unnecessary pain, it is best to give cool liquids and to exclude solid and acid foods from the diet.