446 DISEASES OP THE MOUTH. 



They compel us to suppose an abnormal condition of the capillary 

 walls, which explains the various exudations and inclination to haemor- 

 rhage, seen in scorbutis, better than would be done by an abnormal 

 condition of the blood, the nature of which is entirely unknown, and 

 whose presence even has not been proved. 



For the causes of scorbutis, and hence almost always of this affec- 

 tion of the gums, see chapter on scorbutis. 



ANATOMICAL APPEARANCES. The seat of the scorbutic affection 

 of the mouth is exclusively in the gums, but, where any of the teeth 

 have been lost, the gums are just as free from the affection as other 

 parts of the mouth, and, where all the teeth are gone, the patients do 

 not have any scorbutic affection of the mouth. Occasionally the affec- 

 tion is limited to one side, and in some cases to the parts around a 

 few teeth. At the commencement there is a red border to the upper 

 margin of the gums ; these soon begin to swell, and to become dark 

 blue. The pointed processes between the teeth especially swell out, 

 and their attachment to the teeth is loosened. The swelling, which 

 depends on cedema and the escape of blood into the parenchyma of 

 the gums, may become so great that the gums press over the teeth 

 and hide them, or that spongy swellings, half an inch or more thick, 

 form on the gums. About the teeth, and at the top of the swelling, 

 the surface subsequently disintegrates to a soft, discolored mass, after 

 the separation of which there is left a loss of substance. This sloughing 

 appears to be caused partly by the excessive tension of the infiltrated 

 portion, partly by the pressure it is subjected to by the teeth. When 

 improvement begins, the swelling of the gums subsides ; they again 

 become attached to the teeth, and finally attain their normal color. In 

 a few cases, a new formation of connective tissue seems to occur during 

 the affection ; after the swelling has subsided, the gums retain a cica- 

 tricial solidity, are uneven and nodular. 



SYMPTOMS AND COURSE. Chewing is very painful, and often im- 

 possible, on account of the swelling of the gums. The secretion of 

 mucus and saliva in the mouth is greatly increased. Haemorrhages 

 occur on attempting to chew, as well as from slight pressure on the 

 gums. The decomposition of the contents of the mouth, which are 

 mingled with blood, and subsequently with dead tissue, causes a very 

 penetrating and disagreeable odor. These symptoms, and the exami- 

 nation of the mouth, in which we find the above-described changes, 

 together with the observance of the other symptoms of scorbutis, con- 

 firm the diagnosis of a scorbutic affection of the mouth. 



TREATMENT. With proper treatment of the original affection, the 

 affected gums often return to a normal state in a surprisingly short 

 time. Along with the dietetic and therapeutic remedies for the original 



