ULCERATIVE STOMATITIS (sTomAcAcE) For a long time ulcerous stomatitis was regarded as a buccal mani festation of genuine diphtheria, as the classical writer on diphtheria, Bretonneau, himself proclaimed this erroneous conception. The views in regard to the nature of this disease went through numerous changes, but it was finally recognized as a distinct form of stomatitis (Bergeron, 1839), when the identity of an epidemic of stomatitis among the troops of Paris with the ulcerative disease of the mouth in children (which could frequently be observed in hospitals) was established.
Pathogenesis, Local Symptoms, stoma titis (Flate 40) depends on the presence of teeth and almost always arises on the gums. The gums swell cushion-like and assume an inflammatory redness. The redness soon yields to a more livid dis coloration of the affected part. The gum surrounding the tooth loosens its attachment and begins to separate its swollen border completely from the tooth. Following this, a yellowish discoloration appears on the edge of the gums, which is produced by a purulent exudate in the superficial layers of the mucous membrane. Beneath this exudate the tissues undergo a necrctic process and in a short time we find an ulcer in place of the infiltrated margin. The ulcer beg,ins to grow rapidly and may extend to the buccal portion of the gum. As a consequence the larger part of the root is denuded and the tooth itself rests loosely in the alveolar socket.
The exudate has a yellowish, brownish, or dirty color and adheres firmly to the floor of the ulcer. If it is detached the base bleeds. Espe cially characteristic is the fetid odor of these greasy masses, which is also conveyed to tbe breath and to the increased secretions of the mouth. This penetrating fetid odor,. occasionally perceptible at a distance, is very characteristic of the disease.
The morbid process only exceptionally remains limited to tbe gums; in most cases it attacks the regions of the mouth adjoining the primary- foci. Consequently, we observe the neighboring mucous mem brane of the lips or cheek, as well as the edge of the tongue undergoing similar alterations; and it is remarkable that the resulting sore, are a real counterpart in shape of the original ulcers on the gums. We find these secondary lesions occurring especially typical on the edges of the tongue, which consequently has a marked indented aspeet. In the:r
nature, the secondary ulcers are decubitus sores, but still their specific character allows furthermore a genuine contact infection. The tongue is covered with a thick, slimy coat. At the same time a swelling of lips and cheek supervenes which may often be perceptible from the outside. The neighboring lymphatic nodes undergo an obstinate enlargement.
The region of the lower jaw is oftener affected than that of the upper jaw. The palate is generally exempt, but in certain cases deposits are found on tbe soft palate, especially the tonsils, which in appearance are identical with the pultaceous exudate of ulcerative stomatitis and which lead to a destruction of the tonsillar tissue (angina uleerosa). If the mouth remains free from the disease, this form of angina may be mistaken for diphtheria (see chapter on angina).
Very interestirig in this connection is a singular case reported by Bernheim and Pospischill in which an ulcerative stornatitis, without infecting the tonsil, spread to the larynx and actually produced stenosis.
Microscopical scrapings from an ulcer are examined microscopically the exudate is seen to be composed of detritus, pus-cells, disintegrated blood corpuscles, and epithelium, as well as numerous microorganisms. A .stained preparation reveals in every case a typical bacteriological picture which will be described later.
General general condition of tbe child is severely affected by the clisease. As early as the first stage we observe that the children are noticeably depressed, irritable, and complain of severe pain in the mouth. These symptoms increase in severity when the first ulcers are formed. Febrile movement supervenes regularly with these symptoms. The children are entirely without appetite and the ingestion of food is almost impossible on account of the local pain. From this condition, also from the general influence of the disease, the patients become very pale in the course of the disease; in fact, they often give the impression that they are suffering from sotne serious malady. After recognition of these facts, the opinion that an autointoxication is pro duced from the ingestion and resorption of the foul disintegrated masses cannot be denied.