XII. Diseases of the Mouth and Tongue.
Synonyms:—Acute catarrhal stomatitis; stomatitis erythematosa.
Definition:—An acute inflammation of the mucous membranes of the mouth, simple in character, and of less frequent occurrence in adults than in children. It may occur as a primary affection, or secondary to some constitutional disease.
Etiology:—When it occurs primarily, it may result from neglect of the mouth, or from bad teeth or from the cutting of teeth, or from wounds caused by foreign bodies in the mouth, which may or may not become infected; or from corrosion by strong acids or alkalies, or from irritating condiments, or hot food or hot drinks; and from the use of tobacco.
Symptomatology:—The constitutional symptoms are not marked except when the condition is a severe complication of other disease. There is restlessness, slight fever, an accelerated pulse, and usually some nervous irritation. Locally the mouth is at first dry and hot, and the membranes are red and tumefied, and soon become exquisitely tender, with then a greatly increased salivary secretion. Within the mouth the disease may be local—confined to the gums, or to one or the other cheek, or to the lips—or it may at once involve all the structures of the mouth. The mucous follicles may be enlarged and reddened, and the tongue may be red and furred, with enlarged papillae. Small ulcers may form on the edges or under the tongue and on the enlarged mucous follicles.
The soreness of the mouth greatly interferes with the taking of food, and in infants suckling is sometimes well nigh impossible. There is loss of appetite and a craving for cold drinks.
The acute manifestations of the disease usually terminate within a week. It is not intractable, usually yielding readily to simple measures.
Treatment:—Aconite should be administered for the fever and local irritation. Ipecac, given in small doses, will materially assist this remedy in allaying the irritation of the mucous membranes. If the membranes are dark red, baptisia should be given; if deep red, and the tongue be red and pointed, with red, elongated papillae, rhus toxicodendron is the indicated remedy. It should be given in conjunction with aconite. For local measures I use an infusion of white oak bark, one ounce of the bark to the pint of infusion for adults, and of half that strength for infants. To this I add one dram of boric acid, or from two to four drams of the tincture of myrrh. This treatment is usually very prompt, and other local measures are not demanded. An infusion of pinus canadensis or geranium, are of service if other measures are sought for, but caustics and active local measures should be avoided.
In some cases the adddition of phytolacca to the internal treatment is of much service; or if the membranes are very red and the tongue narrow, red and pointed at the tip, with a brown coat, the use of a few drops of the tincture of iron, freely diluted, every two hours, will favorably impress the condition. The mildly acid reaction of this remedy is important, under the circumstances named.
Conditions of the stomach which seem to act as complications should receive attention. The food should be very simple, bland, non-irritating, and readily digestible. When the soreness of the mouth is extreme, liquid food only must be taken for a time.