Volume 3

A system of medicine / edited by J. Russell Reynolds.

Date:
1866-1879
Catalogue details

Licence: Public Domain Mark

Credit: A system of medicine / edited by J. Russell Reynolds. Source: Wellcome Collection.

    34/1032 (page 10)
    4, Ulcekative Stomatitis. In |_tlie two previous diseases of the mouth no ulceration or loss of substance occurs ; but the disease wo are now about to consider is characterised by the formation of thick, adherent, yellow patches of membrane, and by inflammation, erosion, and ulceration of the subjacent parts. Cancrum oris Iras by some authors been described under this liead, bat in this work it will be treated as a distinct disease, inasmuch as it differs entirely in the character of its ulcer. The membranous form of this disease is most probably the early stage of the ulcerative affection; it may not, however, proceed so far as ulceration, the thickened patch of membrane being either absorbed or thrown off without the formation of an ulcer. The patches of membrane are at first white ; they then become grey, and sometimes almost black; the mucous membrane around them is red, swollen, and inflamed; the false membrane looks as if im- bedded in it; it is firmly adherent at first, and, if raised at this time, is found to have covered a superficially eroded, bleeding surface. If it proceeds to ulceration, the membrane comes olf, and discloses an ulcer with irregular red or violet-coloured margins, and generally covered with more or less of a thick, yellowish, pultaceous exudation. The onset of the disease is not marked by any special symptoms, and it is rare for the child to be brought under notice till more or less ulceration exists. On opening the moutii, irregularly-shaped, isolated patches of ulcera- tion are to be seen on the inner sides of the cheeks opposite to tlie line of junction of the teeth, and extending down from this below the angle of the mouth to the gums of the incisor and canine teeth ; the gums are swollen and spongy, and bleed easily; later on they become retracted, the teeth are laid loare, and become loose. The ulcers, at first more or less isolated, soon run together, and form a line as above described, with irregular, greyish, and raised edges, the membrane around being SAvollen and infiamed, and of a bright I'ed colour. The inflammation may spread rapidly, and involve the whole mucous membrane of the mouth, and even of the palate; but such. severe cases as these are exceedingly rare. At first the ulcers are; quite superficial, but if left to themselves they become deeper, and I the disease gets into a chronic state which is sometimes very difficultt to cure. For some time after the ulcers have healed there is more or lesSJ redness of the new-formed membrane, and the subjacent tissuM remains hard and thickened. ■ Accompanying tlie idceration there is more or less swelling of'i the side of the face attacked ; and the neighbouring glands, siib-i lin<nial and submaxillary, become hard, painful, and very tender to f the'^touch. Tlie surrounding cellular tissue very rarely participates m | this iunnjnmatiou.