SCURVY 403 



grayish white color resembling those of diphtheria form, adhering closely 

 to the mucous membrane, and after their removal the mucous membrane suf- 

 fers a more or less decided loss in substance, and a bleeding, very painful sur- 

 face remains. Sometimes the mucous membrane even becomes gangrenous. 

 The surface is coated with a dirty, fetid deposit, the upper layers of which 

 slough off, and are expectorated with the saliva. If this state continue for 

 a long time the gums may become gangrenous and necrose, the alveoli may 

 be exposed to a great extent, and the teeth may become loose and fall out. 

 The unfortunate patient now sufEers tortures, for these symptoms increase 

 in severity and usually many others go hand in hand, and particularly the 

 extremely severe cachexia. The latter is probably not a consequence of the 

 various severe local symptoms. On the contrary, it ushers in the aflfection, 

 forms a principal factor in all the phases of the disease, and is the primal 

 cause of the intensity of the individual symptoms. 



In many patients, and according to the severity of the disease of the 

 gums, there is an increase in the secretion of saliva, probably due to reflex 

 causes, so that a hemorrhagic fetid fluid, in which infusoria and low fungi 

 may be recognized, streams almost continuously from the mouth. 



If the affection terminate in recovery, complete restitution may occur, 

 and the teeth which were previously loose may again become firmly rooted. 

 More frequently a tough tissue resembling cicatrix forms and remains for life. 



Mechanical effects produced by chewing and mechanical irritation have 

 been assumed to be the cause of the almost invariable inflammation of the gums 

 in scurvy; to these may be added the inherent tendency of the disease to 

 inflammation. 



In children, besides the usual form of simple stomatitis, another variety 

 designated as aphthous stomatitis, an inflammatory affection of the mucous 

 membrane of the mouth, sometimes occurs, particularly during the period of 

 dentition, i. e., between the ninth month and the middle of the third year. 

 Henoch says regarding this : In some of the cases a disagreeable odor from the 

 mouth is added to the symptoms described, and minute investigation always 

 reveals a hyperemic gum which bleeds readily, which may even show a grayish 

 yellow detritus of friable character that may be readily loosened with a spat- 

 ula. This form of stomatitis, which is of a decidedly contagious nature, 

 usually runs a favorable course; more rare is another which is designated by 

 the name of ulcerative stomatitis. While the fibrinous plaques which are 

 invariably present in the latter affection are absent in the former, the impli- 

 cation of the gums requires the careful attention of the physician. These are 

 dark red or bluish red and swollen, they bleed readily and decompose from the 

 edge surrounding the tooth, gradually forming a grayish yellow paste; the 

 crown of the tooth is exposed, and finally becomes loosened. Upon pressure a 

 purulent fluid exudes from the space between the loosened gums and the teeth, 

 a fetid odor comes from the mouth, and the surrounding soft parts. The 

 cheeks and the submaxillary connective tissue frequently show edematous 

 swelling. Occasionally the process attacks the periosteum of the jaw, extend- 

 ing down into the alveolar processes, causing the teeth to fall out, and finally 

 gives rise to partial necrosis of the jaw. 



