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Aphthous Stomatitis

derangement, mouth, ulcer, membrane, mucous, appear and cachectic

APHTHOUS STOMATITIS.

The derangement called aphthous stomatitis (follicular stomatitis or aphtbee) is a common source of inconvenience to young children. It is induced almost invariably by derangement of the stomach, and is often seen during the progress of the first dentition—a time at which so many forms of gastric and intestinal disorder are apt to arise. Actual irritation of the mucous membrane of the mouth may also give rise to aphthm ; for children who are over-indulged with sweets often suffer from this com plaint, even if the digestion is unimpaired.

Symptonis.—Aphthae consists of a vesicular eruption of the mucous membrane of the mouth. Pearly gray or yellowish vesicles appear, vary ing in size from a pin's head to a millet-seed. They are circular or oval in shape, and their base is surrounded by a red areola. After two or three clays the vesicle ruptures and a round ulcer remains. The base of the ulcer is grayish in colour, from the presence of a sebaceous secretion ; the edges are thickened, and there is redness of the mucous membrane surrounding the sore. Under appropriate treatment the ulcer soon heals, and the complaint is at an end. The number of the aphthm varies from two or three to fifteen or twenty, or even more. They may occupy any part of the mucous membrane, but usually appear first on the inner side of the lower lip and gums ; afterwards on the tip and edges of the tongue, the cheeks, and on the palate.

Aphthee are sometimes accompanied by a considerable rise of the tem perature, and the thermometer may mark 103° or 104° ; but fever is not an invariable rule. The tongue is very sore, and the child, if an infant, sucks with great difficulty, or may even altogether refuse the bottle or the breast. He is peevish and thirsty ; often vomits ; has a sour smell from the breath, and shows all the signs of disordered stomach. Often the bowels are relaxed.

If the sores are so numerous as to be almost confluent, the child's con dition may cause some anxiety. He refuses all nourishment on account of the smarting excited by the movements of the tongue in the act of swal lowing. His breath is offensive ; salivation is profuse ; the fontanelle be comes deeply depressed, and the sub-maxillary glands are sometimes en larged. This severe form is seldom seen except in weakly babies, and may come on at the end of an attack of diarrhoea. In these cases the unfavour

able termination of the illness may be hastened by the impediment thus created to the taking of nourishment. In weakly or cachectic children the complaint is sometimes obstinate ; for although the course of each indi vidual ulcer may not be unusually prolonged, fresh vesicles continually appear as long as the digestive derangement to which they owe their origin remains unrelieved. Again, in rare cases, the ulcers are slow to heal, and may give some trouble before they are cured.

Diagnosis.—Aphthm are not difficult to recognise. In the vesicular stage the nature of the derangement can scarcely be mistaken ; and when the ulcers have formed, their circular shape, uniform size, and the limita tion of the inflammation to the immediate neighbourhood of the sore, will prevent the disorder being mistaken for the more serious lesion—ulcera tive stomatitis.

Prognosis.—The derangement is of little consequence, as a rule. Even in the cachectic child, in whom the distribution of the sores is more extended, and their course more obstinate, than in the healthy subject, any danger which may be present is due more to the accompanying general condition than to the local complaint. In a healthy subject, the derangement, under judicious treatment, will readily subside.

ordinary cases of aphthee all that is required is a dose of rhubarb and soda, with a grain of gray powder to clear away unhealthy secretion from the bowels, and attention to the cleanliness of the mouth. After each meal the mouth should be washed out with a piece of linen rag, or a large soft brush, soaked in tepid water. Afterwards, glycerine mid borax (half a drachm to the ounce) may be applied with a soft camel's hair pencil. If an ulcer is slow to heal, it may be touched gently with a solu tion of nitrate of silver (ten grains to the ounce of water).

In the more obstinate cases, attention must be paid to the general con dition of the patient, and any chronic derangement of the alimentary canal must be remedied. In a cachectic child, the use of an alcoholic stimulant in sufficient closes will often cause a speedy improvement in the state of the mouth.