CROUPOUS STOMATITIS APHTHJE. 437 



or, still better, a long pipe should be used. Oral catarrh, caused by the 

 use of mercurials, requires their discontinuance, and in such cases all 

 traces of blue ointment are to be carefully removed from the skin. The 

 secondary oral catarrh usually disappears with the cure of the erysipe- 

 las, angina, gastritis, etc. We shall hereafter see that the latter does 

 not require emetics nearly so often as these are ordinarily used in 

 practice. The fact of the tongue being for a time cleaner after the 

 vomiting depends altogether on mechanical causes, and does not at all 

 prove that the oral and gastric catarrh are benefited. When caused 

 by some infectious disease, the indications are the same as those for 

 the treatment of the original affection. 



The treatment of the disease itself is essentially local, just as for 

 affections of other mucous membranes that are within easy reach. 

 This direct treatment is especially required in those cases of chronic 

 oral catarrh which prove very obstinate even after the exciting cause 

 nas disappeared. For this obstinate clamminess I can strongly recom- 

 mend a well-known domestic remedy ; namely, slowly chewing small 

 pieces of rhubarb before going to bed. I cannot ascribe the very gen- 

 eral improvement to the direct action of the rhubarb on the gastric 

 mucous membrane, since it does not produce the same effect when 

 given in very soluble pills. 



In chronic catarrh persisting without cause, rinsing the mouth 

 with solution of carbonate of soda, or slowly drinking a bottle of soda- 

 water, on an empty stomach, is very useful. This evidently depends 

 on the well-known power of the carbonates of the alkalies to diminish 

 the tenacity of the mucus and render it more fluid. If this treatment 

 is inefficacious, we may confidently order the mouth to be pencilled 

 with a solution of corrosive sublimate (gr. j ij to the pound of water), 

 as recommended by Pfeuffer^ or with a solution of nitrate of silver 

 (gr. j to 3 ss water), as advised by Henoch. The effect of these pre- 

 scriptions in oral catarrh is not inferior to that in other catarrhs from 

 the same remedies. 1 



CHAPTER II. 



CllOTJPOUS STOMATITIS APHTHAE. 



ETIOLOGY. On the mucous membrane of the mouth we often see 

 Email white spots, surrounded by a red border, which look like flat 

 vesicles ; after a short time these are thrown off, and an excoriation, 

 which heals readily, is left. This affection of the oral mucous mem- 

 brane is designated by most authors as " aphthae," a name which is 

 also used for other diseases of the mouth, especially cancrum oris and 



