EXCORIATIONS AND ULCERS OF THE MOUTH. 441 



painful ; the parts of the lips and cheeks corresponding to the affected 

 part are cedematous ; the breath has a cadaverous odor ; the saliva, 

 which is often bloody and discolored, flows constantly from the mouth ; 

 and every attempt to swallow, or even to drink, causes severe pain. The 

 patients avoid closing the mouth and even keep the jaws apart, to 

 prevent rubbing. Strange to say, the general condition and even the 

 appetite are affected but little ; fever is slight or even absent ; when 

 properly treated, the disease almost always runs a favorable course, the 

 diphtheritic sloughs separate, and the ulcers under them heal in a 

 relatively short time. Neglected and improperly treated, the affection 

 may exist for months, but it rarely endangers life. Fatal results 

 probably always depend on complications. 3 



TREATMENT. In the diphtheritic form of mercurial stomatitis we 

 must not neglect to tell the patient how slow his cure will be. He 

 will bear his sufferings much better if he does not find his hopes dis- 

 appointed from day to day ; but if we promise him that, if not cured 

 sooner, he will, at least, be comfortable by the eighth or ninth day, he 

 will be patient and submit to what is unavoidable. Frequently wash- 

 ing the mouth with cold water, or with water and red wine, at the 

 commencement, subsequently painting the ulcers with dilute muriatic 

 acid, or, still better, with the solution of nitrate of silver, described in 

 Chapter L, but especially the use of solution of chlorate of potash, are 

 far preferable to the internal administration of iodide of potassium and 

 mercurial antidotes, or painting the mouth with spirits of camphor, 

 which is as painful as useless. Touching the ulcers occasionally with 

 solid nitrate of silver is very beneficial, but exceedingly painful. 



Chlorate of potash is just as certain a specific against cancrum oris 

 as against aphthae. To children under one year we may give one, scruple 

 daily, to older ones half a drachm, to adults one to two drachms, dis- 

 solved in six ounces of water. Under this treatment the bad odor very 

 quickly disappears ; the ulcers also commence to clean up in a few 

 days and heal rapidly. We are very rarely obliged to touch the ulcers 

 with nitrate of silver. 



CHAPTER IV. 



EXCORIATIONS AND ULCERS OF THE MOUTH. 



ETIOLOGY. The rapidly-healing excoriations which remain after 

 aphthae, and the ulcers caused by mercurial stomatitis and cancrum 

 oris, were discussed in the last chapter and the one before it. 



Small vesicles, followed by very painful excoriations about the 

 point of the tongue, appear to be caused by local injuries ; at least, the 



