Membranous Stomatitis.
Synonyms:—Croupous stomatitis; stomatitis crouposa.
Definition:—An inflammation of the mucous membranes of the mouth, more extensive in its involvement than the aphthous variety, and in which a false membrane is formed.
Etiology:—This disease is supposed to sustain an immediate relationship to diphtheria, developing either directly from the Klebs-Loeffler bacillus, or from streptococci or staphylococci. It also follows gonorrheal and syphilitic infection in new-born babes. True diphtheria of the mucous membrances of the mouth presents many of the appearances of this disease.
Symptomatology:—The constitutional symptoms may be acute and violent, with general muscular aching, headache, chilliness, a rapidly rising temperature, quick pulse and perhaps a mild delirium. There is anorexia, nausea and progressive debility.
The exudate begins with the deposit of small grayish patches on a sunken base, which is red, hot, and exceedingly sensitive. These increase in size and become darker in color, of a dirty grayish appearance, and finally they coalesce, thus covering uniformly a considerable surface of the membrane. Patches of the exudate become detached as the disease progresses, and others replace them. The mouth is kept constantly open, the tongue is swollen, and there is constant dribbling. The breath soon becomes foul and exceedingly offensive, and both the salivary (especially the submaxillary) and the lymphatic glands become involved, the face and neck are swollen, the face sometimes presenting both a puffed or bloated and dusky appearance.
Diagnosis:—The diagnosis depends upon the exclusion of true diphtheria and upon the presence of characteristic membranous exudate.
Treatment:—The constitutional treatment for the acute symptoms should be similar to that of tonsillitis or of a mild form of diphtheria. Aconite and phytolacca are of first importance, with belladonna for the local congestion and to control the too free action of the salivary glands. Later echinacea and baptisia are indicated, and occasionally rhus.
I am impressed that the internal use of a mixture which contains six minims of dilute sulphurous acid and four grains of sulphur to each dram of syrup of acacia is of prime importance. A dram should be taken internally every two hours, and each alternate hour a dram should be held in the mouth for a minute or two, and then ejected. No water should be taken immediately after this remedy, as its local influence is important.
In some cases, especially in youth or in adults, the dosage may be doubled. It must be strong enough to destroy the bacilli. A mouth wash of hydrogen peroxid, in from twenty to fifty per cent solution in water, will at times be of much value. Both the internal use and the local application of the infusion of quercus alba, rumex crispus and alnus rubra, mentioned heretofore, is of great value. Tonics must be given as soon as febrile symptoms abate; and restoratives, as the hypophosphites or glycerophosphates with quinin and strychnin will be needed in most cases.
