360 DISEASES OF THE GASTRO-INTESTINAL TRACT. 



Gangrenous stomatitis, noma, or canerum oris, is a rare affec- 

 tion, characterized by a spreading gangrene of the cheek, gen- 

 erally involving one side only ; it is nearly always fatal. It 

 occurs most frequently in weakly, ill-nourished children, 

 especially after some exhausting acute infectious disease. The 

 earliest lesion usually noted is a sloughing ulcer on the inside 

 of the cheek, near the corner of the mouth. The mucous 

 membrane becomes black and gangrenous, and soon the proc- 

 ess involves the entire thickness of the cheek and extends in 

 all directions. 



Thrush, or muguet, is a mycotic stomatitis, due to a fungus, 

 the oi'dium albicans, occurring especially in infants. It is 

 characterized by the presence of white patches, resembling 

 curdled milk, upon the mucous membrane. There is a ten- 

 dency for these patches to extend and involve the pharynx, 

 and even the gastro-intestinal tract. If a white patch is re- 

 moved, the underlying mucous membrane is red, eroded, and 

 may bleed. Microscopically the white deposit is found to be 

 composed of the delicate filaments of the parasite and degen- 

 erated epithelial cells. 



All the infectious granulomata may affect the mucous mem- 

 brane of the mouth. 



Tuberculosis is not often noted. It may be primary or sec- 

 ondary. The nodular masses undergo caseation, often result- 

 ing in the formation of ulcers closely resembling those of 

 tertiary syphilis. 



Syphilis affects the mouth either in the form of mucous 

 patches in the secondary stage ; or gummata varying in size 

 from that of a pea to that of a hazelnut, in the tertiary. The 

 gummata may break down and leave deep ragged ulcers in 

 their site. 



Tumors : Flat-celled carcinomata, epitheliomata, are of quite 

 frequent occurrence. They appear first as a small nodule, or 

 circumscribed infiltration, which soon tends to ulcerate and 

 spread rapidly. 



Sarcomata usually affect the gums, sarcomatous epulis. 



