436 DISEASES OF THE MOUTH. 



of the mouth, and only touches it in the act of swallowing. Hence it 

 follows, on the one hand, that the most superficial epithelial patches 

 on the anterior part are soonest and most completely loosened, and 

 also that they are soon removed ; but, on the other hand, that they 

 should remain attached longer at the base, and even when loosened 

 should remain longer in position, especially as the elongated processes 

 of the papillae afford them a great protection. 



In most feverish complaints the whole top of the tongue appears 

 whitish. This does not generally depend on an increased formation of 

 cells due to oral catarrh, but occurs because, while there is an increased 

 loss of fluid through the skin, the secretions of the mouth are dimin- 

 ished, so that the epithelium is less moist and transparent. Besides 

 this, patients with fever suffer from loss of appetite, and do not chew 

 hard substances, such as best remove the epithelium. Just as, in ma- 

 rasmic persons with dry skin, there is continued apparent desquama- 

 tion of the epidermis without its formation or removal being actually 

 increased, so in fever the horny processes of the papillae and the 

 epithelium of the mouth become more evident without their being 

 formed or removed in greater amounts. The presence of the swelling 

 and moisture of the mucous membrance, which exist in oral catarrh, 

 prevents our mistaking the coating of the tongue, that occurs in it, for 

 that which we find in fevers, where the tongue is flat, small, and some- 

 times even very pointed, the mouth dry, and consequently the patient 

 thirsty. If the tongue of a fever-patient is dry, without the epitheli- 

 um and processes of the filiform papillae being at least of normal 

 amount, of course the tongue does not appear coated. 



For the difference between simple oral catarrh and that accompany- 

 ing gastric catarrh, see Section III., Chapter I. 



PROGNOSIS. If we except the spasms during dentition, which are 

 sometimes dangerous to life, and whose dependence on oral catarrh is 

 still doubtful, the prognosis as regards life is favorable. The progno- 

 sis for a perfect cure, especially in chronic oral catarrh, is less favora- 

 ble, although even here a suitable, judicious treatment, if carefully fol- 

 lowed by the patient, which is rarely done, may give a favorable 

 result. 



TREATMENT. The causal indications cannot be fulfilled in all 

 cases. In difficult dentition, cutting the gums is of doubtful benefit ; 

 occasionally the incisions inflame and cause the catarrh to become 

 worse. Sharp edges of the teeth, which are easily overlooked, are to 

 be carefully removed, wounds of the mouth and ulcerated gums are to 

 be properly treated. Where smoking, especially the use of strong 

 cigars, causes troublesome oral catarrh, it must be totally forbidden, 

 or at least weak cigars only should be smoked through a cigar-holder, 



