Aphthous Stomatitis.

Synonyms.—Follicular Stomatitis; Disseminated Vesicular Stomatitis; Fibrinous Stomatitis.

Definition.—A variety of stomatitis, characterized by small, round, white patches upon the mucous membrane of the tongue, gums, and cheeks. Small vesicles appear upon an inflamed base, and later form small ulcers.

Etiology.—This variety usually occurs in children under three years of age, though it may occur at any period of life. It may accompany the acute infectious diseases, and occasionally occurs as an epidemic. An impoverished condition of the blood favors the disease, as well as poor hygienic surroundings; gastro-intestinal disorders also predispose to this lesion, while Strumpell believes the milk from cows suffering from the hoof and mouth disease, is an exciting cause.

The time of the year may also be considered a factor in this disease, spring and fall being the seasons when colds prevail and intestinal disturbances are common.

Symptoms.—The mouth is exquisitely tender, and, when nursing or attempting to eat, a burning sensation follows. As a result, the child is peevish and fretful. The tongue is furred, the breath is fetid, and a slight fever is occasionally noted; there may be some gastric or intestinal disturbance.

On inspecting the mouth, small vesicles are seen on the inner surface of the lips, and along the sides of the tongue, and near the frenum; they may also be found on the cheeks; these rupturing, small, white patches, surrounded by a red base are observed, which may later ulcerate. There is a free secretion of saliva and mucus, which, in the infant, dribbles from the mouth, and in older patients necessitates frequent spitting. There may be enlargement of the submaxillary glands.

Diagnosis.—The small vesicles upon the sides of the tongue and mouth, followed by white or yellowish patches, make the diagnosis plain.

Prognosis.—The disease usually yields to treatment in a week or ten days, though some cases prove very intractable, with a tendency to recur at intervals.

Treatment.—Cleanliness is of the greatest importance, and the mouth should be rinsed with lukewarm water after each feeding. In bottle-fed babies, great care must be taken that the bottle and nipple are kept sweet and clean, the nurse being instructed to scald out the bottle after each nursing, and lay in plain cold water, or in soda or lime water.

For a mouth wash, potassium chlorate and hydrastis, or boracic acid, will prove among the best. Painting the patches with equal parts of thuja and water is also frequently beneficial. Internally, specific phytolacca is the remedy par excellence. If there is fever, add aconite to the above. Where the tissues are bluish and the breath bad, echinacea will prove more effective. Where the tongue is coated with a moist, yellow, pasty coating, potassium chlorate and hydrastis one dram, to water four ounces, a teaspoonful every hour, will give relief and the best results. Where there is hypersecretion of saliva, specific belladonna ten drops, to water four ounces, will be indicated. Dr. Webster likes the action of jaborandi for this same condition. In the adult, where the ulcers persist, apply bluestone direct to the ulcers.

The Eclectic Practice of Medicine, 1907, was written by Rolla L. Thomas, M. S., M. D.