SECONDARY AFFECTIONS OF THE MOUTH As a complication of severe and protracted diseases, as well as a consequence of infectious diseases, secondary- diseases of the oral cality may arise. This observation suggests that the mucous membrane during the course of these diseases acquires a diminished power of resis tance. The following must be considered as predisposing causes; the lessened power of self-cleansing due to the relative dryness of the mouth, as in fevers; the insufficient care of the mouth during the disease; and the cachectic condition of the mucous membrane which forms a part of the general depression.
In considering the several forms of stomatitis, we have already noticed that ulcerative stomatitis (cachectic) and especially noma are frequent complications of the infectious diseases. Measles, especially, as experience has taught, seems to predispose to these and other diseases of the mouth. Frequently we observe in measles an inflammation of the mouth which shows a marked resemblance to maculofibrinous stomatitis. The white efflorescences arise in various parts of the mouth, more fre quently on the gums in front, on the inner side of the Eps, and on the MUCOUS membrane of the cheek. Yet its tendency to lead to a superficial necrosis and ulceration indicates that it must be separated from the maculofibrinous stomatitis and must be regarded as a distinct affection (necrotic stomatitis after measles).
Likewise during the course of scarlet fever, diphtheria and typhoid, secondary and generally' ulcerative processes may arise, which lengthen convalescence by their painfulness and by hindering the intake of food. (See the chapters describing these diseases, also the changes of the mucous membrane in scurvy and in syphilis.) The mouth of infants afflicted with sepsis is often the seat of sec ondary morbid changes. Besides the appearance of a septic enanthem and punctiform subepithelial hailiorrhages, which are identical in their nature with similar changes on the skin and appear most plainly on the palate or mucous membrane of the cheek, the oral cavity in septiemmia is occasionally the seat of an extensive secondary process, which was observed at first by Epstein, and described as pseudocliphtheria of septic origin. Further observations of this rare disease have been made in
Pfaundler's Clinic (Breceli).
The small ulcers of the oral mucous membrane at the onset rapidly enlarge and spread toward the organs of the throat. On account of this localization and on account of the grayish yellow discoloration of the exudate, the disease suggests diphtheria, especially since in certain cases a genuine fibrinous exudate, and tough elastic, and recurring membranes are formed in the mucous membranes of the throat, which show a tendency to invade the respiratory' tract. The local process as a rule does not arise until a few days before death, but it must be recognized so that the erroneous diagnosis of diphtheria be not made.
Recently, Swoboda described a fatal disease of the mouth under the name "gang,reuous inflammation of the dental germs in early infancy,"* which may occur during the course of some septic disease in the new born or very young infant, The characteristic symptom of this rather rare disease (six observed cases) is the gangrenous disintegration of the gums and the subsequent avulsion of the crowns of the teeth in infants who are still very far removed from the dentition period.
Finally, the secondary processes of the mucous membrane which occur in children ill with cardiac or bamorrhagic disease must be re membered. Here isolated grayish yellow plaques make their appearance and arise from minute embolic luemorrhages of the mucous membrane. The destruction of the epithelial cover leaves a minute loss of substance which becomes covered with a white deposit. These plaques have a certain resemblance with the eruptions of maculofibrinous stomatitis, but are distinguished from these particularly by the transition to super ficial necrosis and filially by the fact that only one is present.