438 DISEASES OF THE MOUTH. 



thrush. From numerous careful observations, JSohn has shown that, 

 when these white spots are punctured even in their earliest stage, no 

 fluid can be evacuated from them, and hence that they are not vesicles, 

 but solid thickenings, consisting of exudation on the free surface of 

 the mucous membrane under the epithelium.* I consider this view, 

 which in the main corresponds with that of Rokitamky and Foerst&r, 

 as correct ; but I think that, to be consistent, the affection, which on 

 other mucous membranes we call croupous inflammation, should have 

 the same name when it attacks the oral mucous membrane ; hence, 1 

 do not hesitate to define aphthae as a croupous stomatitis limited to a 

 circumscribed portion of the oral mucous membrane. 



Aphthae are chiefly observed in children. During the first few 

 months, however, they are rarer than during dentition. Weakly, 

 badly-nourished children are more disposed to them than strong and 

 well-nourished ones. Among the exciting causes, cutting the teeth is 

 the chief. Aphthae often accompany the affection of the skin in the 

 acute exanthemata, especially measles. Occasionally also they occur 

 as small epidemics, without any perceptible cause, and it then appears 

 as if they spread by contagion. Lastly, aphthae accompany other 

 severe affections of the mouth, particularly cancrum oris. 



ANATOMICAL APPEARANCES. Aphthae chiefly occur on the anterior 

 half of the tongue, and the inner surface of the lips, cheeks, and hard 

 palate. They are about the size of a lentil, round, often quite numer- 

 ous, and are either disseminated or run together into irregular figures. 

 The grayish or yellowish-white deposits separate gradually from the 

 periphery toward the centre, making the red border broader. When 

 the exudation has entirely separated, there is no ulceration, only an 

 excoriation ; this is characteristic of a croupous affection, and distin- 

 guishes it from a diphtheritic. The excoriated place is soon covered 

 with epithelium again ; aphthae leave no cicatrix. Catarrh, with copi- 

 ous production of mucus and cells, affects the rest of the mouth. 



SYMPTOMS AND COURSE. The eruption of aphthae is often pre- 

 ceded for several days by fever, restlessness, loss of appetite, and the 

 symptoms of oral catarrh. The disease itself is accompanied by pain, 

 which is increased by nursing, and in older children by speaking and 

 chewing. At the same time the secretion of saliva is so much in- 

 creased, that a clear fluid almost constantly runs from the half-open 

 mouth. From the decomposition of the accumulated epithelium and 

 the exudation thrown off, there is a disagreeable, penetrating fetoi 

 from the mouth, especially in the not unfrequent complication of the 

 croupous with diphtheritic stomatitis (see Chapter in.). By repeated 

 relapses the affection may last several weeks. Of itself it is scarcel} 

 ever dangerous. 



