440 DISEASES OF THE MOUTH. 



In cancrum oris the infiltration and ulceration always begin on the 

 gums, usually at their upper border on the anterior surface. In severe 

 cases it advances to the posterior surface of the gums, and the adjacent 

 parts of the lips, cheeks, and tongue. The teeth become loosened, 

 and occasionally the periosteum of the jaw is exposed and destroyed. 

 In consequence of this, in some cases there are caries and necrosis of 

 the maxillary bones. 



SYMPTOMS AND COUBSE. The diphtheritic form of mercurial sto- 

 matitis is accompanied by severe pain, particularly when the sloughs 

 have separated and left ulcers. Chewing, or even speaking, will ren- 

 der this pain unbearable. The secretion from the salivary and mucous 

 glands is enormously increased, the patients cannot sleep, as the secre- 

 tion, if not ejected, runs into the larynx, and induces cough or suffoca- 

 tion ; if they lie on the side anc^ succeed in sleeping, they soon wake 

 to find the pillow cold, wet, and saturated with saliva. On the parts 

 of the tongue and gums, but especially along the edges of the teeth, 

 which are free from sloughs or ulcers, there is an unusually thick, yel- 

 low, soft coating. There is a very penetrating bad odor from the 

 mouth, caused by the decomposition of this coating, and of the slough 

 of the mucous membrane. It is not decided whether or not this 

 smell is caused by the formation of sulphuret of ammonium from the 

 disintegration of the sulpho-cyanide of potassium, which is a normal 

 constituent of the saliva, by the decomposition going on in the mouth. 

 Even when the mercurials have been stopped, the pain, flow of saliva, 

 and smell, pass off slowly, and even in mild cases it is usually from 

 eight to fourteen days before the patient feels well. In severe cases 

 the cure progresses even more slowly ; as was mentioned above, there 

 may even be permanent injury. 



At the commencement of cancrum oris, according to the excellent 

 description of JBohn, the gums are dark red and greatly swelled by 

 excessive hyperaemia. They appear loosened from the teeth, and bleed 

 on the slightest pressure. After this stage has lasted two to four 

 days, a gray membranous deposit almost always appears on the upper 

 border of the gums, particularly about the incisor teeth of one side of 

 the lower jaw. On careful examination, we find that this deposit, 

 which is a pulpy substance, does not He on the gums, but consists of the 

 gangrenous tissue of the gums. After the separation of the pulpy 

 mass which we, in opposition to Bohn, must consider a diphtheritic 

 slough, there is found a loss of substance of the gums, on the surface 

 and periphery of which the same process is repeated as long as the 

 affection lasts, until in severe cases the contours of the gums are lost, 

 the teeth loosened, and the other evils described above have resulted. 

 At the same time the neighboring lymphatic glands are swelled and 



