The Head and Neck 75 



ing commonly designated "noma" or "canker." The gangrenous 

 form may lead to fatal termination by production of septicemia. 



The disease occurs as the result of local infection, probably 

 through invasion by ordinary pyogenic microorganisms which un- 

 der normal conditions inhabit the mouth in large numbers together 

 with other varieties which are entirely innocuous. But for these 

 microorganisms to produce pathologic lesions it is essential that 

 some favoring conditions should exist, and such conditions are 

 generally believed to be either a local or general reduction of vi- 

 tality and diminished resistance of the tissues of the organism, or 

 an increased virulence on the part of the microorganism. 



Amongst the local conditions are irritation produced by the 

 prehension or administration of hot or caustic liquids, by trauma- 

 tism, by penetration of foreign bodies such as needles, bones, etc., 

 by the constricting action of certain bodies such as threads, rub- 

 ber-bands, and annular objects mischievously placed on the tongue 

 or accidentally prehended, by the presense of calcic incrustations on 

 the teeth, by carious teeth, and by neoplasms. Amongst the general 

 conditions are certain states of infection of the entire alimentary 

 tract such as gastro-enteritis, and toxemias such as distemper. 



Symptoms and Diagnosis. Mandibular action is inhibited, the 

 mouth exhales an obnoxious odor, and saliva dribbles and hangs in 

 filaments. In the catarrhal form the mucosa exhibits all the char- 

 acteristic signs of inflammation and is often covered with greyish 

 sordes. In gingivitis the gums are dark red, swollen, bleeding and 

 separated from the teeth. 



In glossitis the organ is considerably swollen and in ad- 

 vanced stages of constriction cases may be many times larger than 

 normal so that it protrudes from the mouth and impedes respiration. 

 In the gangrenous form of stomatitis, the gums, internal face of 

 the lips and cheeks, and sometimes the entire buccal mucosa and 

 even the cuticular border of the lips are studded with fetid, grey- 

 ish necrotic patches, or round or oval ulcers. In gangrenous glos- 

 sitis the lesion is partial, being distinctly demarked and confined to 

 the tip and edges, the diseased portion being cold and of brown- 

 ish black color. 



Treatment. In inflammation due to local conditions the indi- 

 cations are to remove the provocative agent and disinfect the mouth, 

 preferably with permanganate of potash solution (2:100). Atten- 



