EXCORIATIONS AND ULCERS OF THE MOUTH. 44.3 



The variolous ulcers occur particularly on the roof of the mouth. 

 After the rupture of the flat pustules, with which the eruption begins, 

 superficial, round, easily-healing ulcers are left. Herpetic ulcers usually 

 occur on the insides of the cheeks, and on the roof of the mouth. The 

 vesicles, which form groups like the herpes vesicles on the lips, break 

 early, and leave flat ulcers, which soon heal. 



SYMPTOMS AND COURSE. The small vesicles and excoriations on 

 the point of the tongue are annoying, but perfectly free from danger. 

 They disappear without treatment in a few days. The inconvenience 

 they cause contrasts strongly with the very slight anatomical changes. 



The diffuse catarrhal ulcers render the motions of the mouth, es- 

 pecially of the tongue, very painful. After they have lasted some 

 time, this pain seems to diminish, even if the objective symptoms con- 

 tinue unchanged. 



Follicular ulcers also are accompanied by pain in speaking and 

 chewing, and by the symptoms of oral catarrh. The lardaceous base 

 and hard edges of these ulcers greatly frighten half-initiated non-pro- 

 fessionals, who have suffered from syphilis, because, from these appear- 

 ances, they make up then* minds that the ulcers are of specific nature. 



The ulcers at the angle of the jaw render chewing and swallowing 

 difficult, and, in some patients, cause severe pain, while in others they 

 are not discovered till the mouth is carefully examined. They are 

 rarely dangerous, although they sometimes last for weeks. 



Variolous and herpetic ulcers rarely cause much pain. 



TREATMENT. The small vesicles and excoriations at the point of 

 the tongue disappear if the mouth is kept free from injuries for a few 

 days, smoking and the use of hot food, etc., being avoided. 



Chlorate of potash is not so serviceable in diffuse catarrhal ulcera- 

 tion as in other affections of the mouth. Continued and energetic 

 local treatment with nitrate of silver, and particularly with a weak 

 solution of corrosive sublimate, is most serviceable. The beneficial 

 effects of the latter are analogous to those attained by the treatment 

 of some skin affections with mercurials. 



In treating follicular ulcerations, we must look out for any disturb- 

 ances of digestion. If these have been removed, or are not discover- 

 able, we confine ourselves to the use of chlorate of potash and energetic 

 local treatment. Touching the ulcer with solid nitrate of silver is very 

 painful, it is true, but it acts surely and quickly. 



The ulcers at the angle of the jaw require no internal treatment, 

 but chlorate of potash is recommended for them also. Locally, we 

 may use nitrate of silver or concentrated acetic acid, as recommended 

 by Rittiet and Barthez. 



Variolous and herpetic ulcers require no special treatment. 



