Diagnosis.—The general redness of the mucous membrane ; the pulta ceous matter adherent to its surface ; the peculiar fcetor of the breath— these symptoms, together with the large size, the irregular shape, and the want of uniformity of the ulcers, will serve to distinguish this complaint from the preceding. From cancrum oris it is distinguished by its slower course, its want of induration, and the absence of black slough. The exu dation cannot be confounded with the leathery, false membrane peculiar to the diphtheritic inflammation ; moreover, the latter disease is not usually accompanied by ulceration of the mucous membrane.
Prognosis.—Ulcerative stomatitis is rather inconvenient than dangerous. However severe the affection may appear when first seen, it is tractable enough when judicious measures are adopted ; and the worst results that can follow are loss of teeth, with perhaps a superficial necrosis of an alveo lar process.
Treatment.—In every case of ulcerative stomatitis our first care should be to rectify any deficiencies, in the sanitary surroundings of the patient, or to remove him at once to a more healthy locality. Fresh air should be especially insisted upon, and the child should pass a large part of his time out of doors. His diet should be rearranged, giving meat, eggs, and milk in suitable quantities, especially avoiding sweets and an undesirable excess of farinaceous food. Alcohol is of great value. The child may take port wine, diluted with an equal quantity of water, with his dinner, or two or three teaspoonfuls of the brandy-and-egg mixture several times in the day.
In addition to the above measures, no time should be lost in prescribing chlorate of potash. This remedy has an almost specific action upon this form of ulceration. The solution, however, must not be too weak. Three
grains, dissolved in a teaspoonful of water, may be given every four hours to a child of two years old. For an older child, the dose may be increased to five or six grains. In some cases, larger quantities are found to be ne cessary, and may be given to quite young children without apprehension. A case which has resisted the remedy when given in five-grain doses, may yield to it promptly when the dose is raised to fifteen. Of local applica tions, the best is tepid water. Cleanliness is of great importance, and after each meal the child, if old enough, should be directed to wash his mouth with warm water, so as to prevent food from collecting about the inflamed surface. In the case of younger children, the mouth should be swabbed out with a piece of soft linen rag dipped in warm water, as directed for aphthm. Other applications which may be used are powdered alum, or a powder of chloride of lime. These should be applied dry to the ulcerated surface with the finger, and are especially useful when the ulcers are indolent and slow to heal. Underwood speaks highly of the decoction of cinchona, made sharp with dilute sulphuric acid, as an application to the sores. Local treatment, however, with the exception of careful cleansing of the mouth, is seldom required. Few cases will be found to resist the chlorate of potash treatment, especially if this be combined with plenty of fresh air, and the employment of an invigorating diet with a sufficient quantity of alcoholic stimulant. No local treatment can be expected to succeed if these measures are neglected.