DIPHTHERITIC STOMATITIS. 439 



TREATMENT. Chlorate of potash has very properly attained the 

 reputation of a specific for aphthae. In almost all cases, under the use 

 of a watery solution of this remedy (gr. jv vj. at a dose), improvement 

 and cure very soon occur. If, contrary to our expectation, the chlorate 

 of potash does not produce this result, we may paint the aphthae with 

 dilute muriatic acid, or with nitrate of silver. 



OHAPTEK III. 



DIPHTHERITIC STOMATITIS, STOMACACE, CANCRUM ORIS, MUNDFAULE. 



ETIOLOGY. As has been repeatedly said, in diphtheritic inflam- 

 mation a fibrinous exudation is deposited in the tissue of the mucous 

 membrane, and the part of the membrane affected sloughs from the 

 compression to which its vessels are subjected by exudation. After 

 the detachment of the diphtheritic slough thus formed, which is some- 

 tunes dry, sometimes moist, a loss of substance remains. 



Diphtheritic stomatitis results 1. From the too continued or too 

 excessive use of mercurials. 2. It not unfrequently occurs without 

 perceptible cause, especially among people living under unfavorable 

 circumstances (mal Iog6s, mal vetus, mal nourris, Taupin, JBohn). 

 The latter form is usually called stomacace or cancrum oris ; exten- 

 sive epidemics of it occur in foundling hospitals, orphan asylums, bar- 

 racks, and other institutions, and also in armies not in barracks, but in 

 the field, or otherwise living in the open air ; it is not improbably ex- 

 tended by contagion: 



ANATOMICAL APPEARANCES. In the milder grades of the diph- 

 theritic ijrm of mercurial stomatitis, at certain parts of the mouth, 

 along the lateral borders of the tongue, and on the parts of the cheeks 

 and lips v< 'lich lie against the teeth, we at first find a whitish or some- 

 what dirty discoloration of the mucous membrane. These white spots 

 cannot be wiped off, but after a few days the superficial layer of 

 mucous me nbrane, with the exudation infiltrating it, falls off, and in 

 its place iy left an unhealthy-looking ulcer, which cleans off slowly 

 and finally cicatrizes from the margins. In more severe cases, where 

 the exudation infiltrates and destroys the whole thickness of the 

 mucous membrane, a large portion of the inner surface of the mouth 

 is often converted into a soft, discolored slough. If this separates, a 

 deep ulcer with irregular borders and uneven base is left. The loss 

 of substance is but slowly filled with granulations, and as the lost 

 mucous membrane is not regenerated, but is replaced by cicatricial 

 tissue, contracted cicatrices, or even adhesions and false anchylosis, noi 

 unfrequently 1 3maln. 



