442 DISEASES OF THE MOUTH. 



patients suffering from them always say they must have burnt them- 

 selves, smoked too much, etc. 



Diffuse catarrhal ulcers rarely occur in the oral mucous membrane ; 

 still I have observed them in some cases. In one instance the greater 

 part of the surface of the tongue was the seat of an obstinate catarrhal 

 ulceration. 



Follicular ulcers not unfrequently occur from stoppage, swelling, 

 and ulceration of the large mucous glands, which are particularly plen- 

 tiful on the inner surface of the lips. In some females these almost 

 always occur at the menstrual periods ; in others, during pregnancy or 

 lactation (stomatitis vesicularis materna). They are also seen in men 

 without any apparent cause. 



Irregular ulcers at the angles of the upper or lower jaw occur quite 

 often. According to Bednar and Bamberger, they result from the 

 destruction of a fibrinous exudation, infiltrating the mucous membrane, 

 but by their limitation to the above-named locality are distinguished 

 from the ulcers left by cancrum oris. 



Variolous ulcers result from the eruption in variola passing from 

 the skin to the mucous membrane of the mouth. Herpetic vesicles 

 may attack the mouth and cause small herpetic ulcers. The callous 

 ulcers on the tongue caused by sharp edges of teeth, and those of the 

 gums resulting from the formation of tartar, belong to surgery. Syph- 

 ilitic and scorbutic ulcers will be treated of in separate chapters. 



ANATOMICAL APPEARANCES. The small vesicles and excoriations 

 at the end of the tongue are only discovered on careful examination. 

 If the vesicle has ruptured, it looks as if the epithelial processes of 

 one or more filiform papillse were broken off; we see only a small, 

 slightly-excavated red spot. In diffuse catarrhal ulcers, there is a loss, 

 not only of the epithelial covering of the mucous membrane, but also 

 a superficial loss of substance of the mucous membrane itself, of varia- 

 ble extent, and usually of irregular shape. The rest of the mucous 

 membrane of the mouth shows the above-described changes of catarrhal 

 inflammation with extensive production of cells. 



Follicular ulcers are rarely numerous ; frequently there is only one. 

 This usually starts as a bright, pearly vesicle, which subsequently 

 breaks, and becomes an oval ulcer, several lines long. The base ol 

 this ulcer is quite yellow, or lardaceous, and covered with a thin secre- 

 tion ; the edges are somewhat elevated, hard, and red. 



The irregular ulcers at the angle of the jaw are occasionally sym- 

 metrical on both sides ; they may be several lines long, are irregularly 

 shaped, and present a loss of substance of the mucous membrane, 

 which even extends into the submucous tissue. They often cause ob- 

 stinate swellings of the cervical glands. 



