Part 6

ULCERATIVE STOMATITIS IN CARNIVORA.

Causes: dietary causes; constitutional debilitating diseases; dental disorders; microbian infection; microbes. Symptoms: difficult sucking or mastication; salivation; dullness; prostration; mucosa red with gray patches, erosions, and ulcers; fœtor; loose teeth; excess of tartar. Extensions to face, throat, lymphatics, nose, eyes, stomach, liver, bowels. Duration. Treatment: clean teeth; antiseptics; mild caustics; stimulants.

Causes. This affection is more common in this class of animals than in the herbivora, being apparently dependent in great part on their artificial habits of life, the sweet and stimulating diet and the derangement of the digestive organs. The lowering of the general health in connection with privation or disease and especially canine distemper, rachitism or indigestion must be recognized as predisposing causes, while the accumulation of tartar on the teeth, or the decay of the teeth themselves, constitutes a potent exciting local cause. In connection with such cretaceous deposits the decomposing elements of the food collect, and the irritant products of their fermentation lead to disease of the gums, congestion and ulceration. Superadded to this is the bacteridian infection of such diseased parts, through which the ulceration is started, maintained and extended. This infection is not that of a specific microbe, but usually of a multiplicity of germs, one or more of the bacteria that live habitually in the healthy mouth, taking the occasion of the existence of a wound, or of a reduction of vitality to colonize the mucosa which would otherwise have remained sound. The microbes actually found in the ulcers are very varied. Pasteur isolated a spirillum, Fiocca the bacillus salivarius septicus, others have found pus bacilli, and in sucking kittens the bacillus coli communis.

But the attempts made to convey the disease to healthy mouths by the transfer of the microbes have usually failed (Pasteur, Netter, Cadeac). To establish their pathogenic action therefore, it appears to be necessary to furnish a susceptible mucosa as well as an infecting microbe. This explains why the disease does not spread as an infection, the average mouth is immune and it is only when it becomes the seat of a wound, bruise or other injury, or when the general system has become so reduced that the resisting power is a minor quantity, that the hitherto harmless germ becomes actually pathogenic.

Symptoms. There is indisposition to suck or eat, the patient leaves the teat or the food, and looks dull, depressed and disposed to lie down apart. There is evident salivation and on opening the mouth we may find the offensive odor, the tartar covered teeth with red or ulcerated gums, and on the cheeks, lips and tongue dark red patches of congestion, or whitish or yellowish gray, soft, pulpy spots of disintegrating epithelium. This is followed by shedding of these epithelial patches, and the formation of rounded ulcers of a line in diameter or less. These are tender, and bleed readily. They may extend to the skin of the lips, or deeply into the mucosa, the muscles or bones, and the attendant morbid process may cause loosening and evulsion of the teeth. There may be implication of the pharynx, the lymph glands, the nose, the eyes, the stomach, the liver, or the intestines with corresponding symptoms. Death may supervene in from six to thirty days, or a more or less speedy recovery may take place.

Treatment. The first step as a rule is to remove the tartar from the teeth. This is often done with a wooden spud dipped in a weak solution of hydrochloric acid. A steel scraper will usually act well and without the solvent action of the acid.

Next will come the removal of all diseased teeth which are operating as local irritants and as centres for infectious microbes and their hurtful products.

Then antiseptics in the form of liquids applied as in the other animals with each meal, will be necessary to counteract infective action, and give the tissues an opportunity to re-establish their integrity. Cadeac recommends a 10 per cent. solution of oil of thyme, as a safe and efficient application. Boric acid, borax, salol, salicylic acid, tannic acid, sulphurous acid, or carbolic acid largely diluted may be substituted. Internally iron tonics and bitters are of great value in improving the tone of the system and securing antisepsis of the intestinal canal. The sulphites too may be given with advantage internally. In depressed conditions alcoholic stimulants may be used both as local antiseptics and general stimulants. As in other animals ulcers may be touched with a rod dipped in tincture of iodine, or a strong solution of chloride of zinc, or nitrate of silver.

MERCURIAL STOMATITIS.

Animals suffering. Causes: mercurial baths, ointments, blisters and surgical dressings; mercurial vapors; deposits on vegetation; rat poisons; malicious poisoning. Lethal dose in horse, ox, sheep and goat. Mature and old eliminate more slowly. Symptoms; Salivation; red, swollen buccal mucosa; gingivitis; loosening of teeth; fœtor; ulceration; anorexia; gastro-intestinal tympany; loose, fœtid stools; fever; weakness; dyspnœa; langor; blood extravasation in nose, mouth, throat, bowels, womb, skin; abortion; skin eruptions. Lesions in mouth, stomach, intestines, serosæ, kidneys, muscles, encephalon. Treatment; stop the introduction of mercury; as antidote potassium sulphide; emetic; cathartic; mucilaginous and albuminous antidotes; potassium iodide as an eliminating agent. Locally potassium sulphide or chlorate. Iron tonics.

This has been especially seen in the sheep, dog and ox, and less frequently in other domestic animals.

Causes. In sheep the use of baths containing corrosive sublimate, or of mercurial ointment for acariasis or other cutaneous parasitism. In other animals it comes mostly from licking mercurial dressings applied to the skin—calomel, red precipitate, mercurial ointment, protoiodide of mercury. The red iodide being more irritating is less frequently taken in. The modern extensive usage of mercuric chloride solutions as surgical antiseptics opens up a new channel of infection. In the injection of the uterus or of large abscesses, or in the daily irrigation of large wounds a dangerous amount may be absorbed. The application of this agent as a caustic in cases of tumors is correspondingly dangerous. Vapors from metallic mercury in confined spaces as in ships’ holds, or from fires on which the mercurial compounds have been thrown, are ready means of poisoning, acting primarily on the air passages and lungs and later on the mouth. The condensation of mercury on vegetation and other food products in the vicinity of factories where mercury is handled (Idria) affects domestic animals directly. Finally the small animals are poisoned by eating the mercurial rat poisons, and all animals are subject to malicious mercurial poisoning, with sublimate especially.

Stomatitis with fatal pharyngitis and enteritis will result in the horse from 2 drs. of corrosive sublimate. About one-half of this may poison the ox, and one-fourth the sheep or goat. Ruminants are more susceptible to the toxic action of mercury than monogastric animals, one evident reason being the long delay of the successive doses in the first three stomachs, so that finally a large quantity passes over at once into the fourth stomach and duodenum for absorption. The old too are more readily poisoned than the young, as the functions of the kidneys are more impaired in age and the poison is not eliminated with the same rapidity.

Symptoms. Mercurial stomatitis is a local manifestation of a general poisoning. Salivation is one of the most prominent phenomena, the watery saliva falling in streams from the angles of the mouth. The buccal mucosa generally becomes red and swollen and the tongue becomes indented at the edges by pressure against the molars. The gums especially suffer and the teeth raised in their sockets by the swelling of the periodontal membrane, become loose, and easily detached. The mucosa of the gums becomes soft and spongy, bleeds readily under pressure and soon shows erosions and ulcers. This condition extends to the lips, cheeks and lower surface of the tongue while the upper surface of the latter organ, the fauces and pharynx commonly escape. The breath and buccal exhalations are very offensive, and the animal loathes food, and has little power of mastication or deglutition. Sometimes the ulcers extend even to the bones.

Along with these local symptoms there are usually gastro-intestinal irritation, tympany, inappetence, continuous rumbling in the belly; badly digested fœtid stools, often diarrhœa, small weak pulse, hyperthermia, accelerated breathing, cough, and great langor and prostration. A tendency to blood extravasation is shown in sanguineous fæces, epistaxis, bleeding from the mouth, the throat or the womb and even into the skin. Pregnant females may abort. The eyes are dull and sunken, and the conjunctiva yellow. Eczematous or pustular eruptions may appear on the skin on the nose, lips, neck, back, loins, croup or perineum.

Lesions. In addition to the lesions described above, there are usually gastro-intestinal inflammation, œdema of the peritoneum and pleura, in the lung as well as in the serosæ, (pneumonia is not uncommon especially in sheep), intestines, kidneys and muscles, hæmorrhagic spots are not uncommon, the blood forms a loose black coagulum, and the encephalon is anæmic and softened.

Treatment. The first consideration is to cut off the supply of mercury. Mercurial applications on the skin should be washed off with tepid water and if necessary soap. An application of sulphide of potassium will precipitate the mercury in an insoluble form. For mercurial agents in the alimentary canal an emetic may be given (if the animal is one susceptible to emesis) followed by a saline laxative. This may be combined with or followed by raw eggs, mucilage, wheat gluten or other albuminoid, sulphide of potash or sulphur, to precipitate the mercury and prevent its absorption. Later, when the bowels have been cleared, iodide of potassium in small doses will serve to dissolve and remove what mercury may be lodged in the tissues.

Locally one of the best applications is chlorate of potash as a mouth wash, 2 drs. to the quart of water. To this may be added tannic acid or other vegetable astringent and even alcohol.

Finally a course of iron and bitter tonics will serve a good purpose in restoring the general tone.

STOMATITIS FROM CAUSTICS.

Caustic Alkalies; symptoms, lesions and antidotes. Caustic Acids; symptoms, lesions and antidotes. Caustic salts; symptoms, lesions and antidotes.

=Caustic Alkalies= (soda, potash, ammonia and their carbonates) often cause stomatitis. What is supposed to be weak lye, given to counteract indigestions, colics, and tympanies often proves dangerously irritating, and some of the worst forms of stomatitis we have ever seen in the horse originated in this way. As the animal refused to swallow, the caustic liquid lay in the mouth and virtually dissolved the epithelium and surface layers of the fibrous mucosa. The surface in such a case is usually of a deep red, and where the cuticular covering remains, it is white and corrugated. The antidote is a weak, non-irritant acid, such as vinegar, boric, citric, or salicylic acid. When the caustic alkali has been thoroughly neutralized in this way the ordinary treatment for catarrhal stomatitis may be followed. The attendant gastritis must receive its special treatment.

=Caustic Acids.= Sulphuric, nitric and hydrochloric acids act by abstracting liquids and charring the tissues. The lesions from strong sulphuric acid turn black, those due to nitric acid, yellow, (zanthoproteic acid,) and those due to muriatic acid are white, with the characteristic odor of chlorine. The antidote in such cases is a non-irritant basic agent, such as chalk, lime water, soapsuds, calcined magnesia, and mucilaginous liquids, albumen, gluten, flax seed, with opium. The same agents are applicable to the attendant gastritis and when the acids are thoroughly neutralized the treatment is as for simple inflammation.

=Caustic Salts.= Among caustic salts may be named mercuric chloride, sulphates of copper and iron, chlorides of iron and zinc, tartar emetic. These may be treated by albumen, blood, white of egg, milk, gluten, mucilage and other sheathing, protecting agents which will form with the salts insoluble and harmless coagula. The subsequent treatment will follow the lines marked out for simple stomatitis. To prevent infection of the raw surface Cadeac recommends: tannic acid 1 oz., benzo-naphthol 3 drachms, powdered gentian 6 drachms, honey, sufficient to make an electuary.

MYCOTIC STOMATITIS IN FOALS, CALVES AND BIRDS. THRUSH. MUGUET.

Oidium (saccharomyces) albicans; a parasite of the young; cultures. Symptoms in foals and calves; congested buccal mucosa; curd-like concretions; erosions. Diagnosis from rinderpest. Treatment; disinfection; sunshine; open air; exercise; locally antiseptics.

This is a form of stomatitis manifested by a raised white patch on the mucous membrane and determined by the presence of the =oidium albicans= (=saccharomyces albicans=), a cryptogam discovered by Berg in 1842 in thrush in children. It is closely allied to the mucor, and attacks only the young and feeble. The white crust consists of epithelial cells intermingled with an abundance of the white mycelium and oval spores of the fungus. Andry in his artificial cultures found that it was pearly white when grown on gelatine, dirty white on potato, and snow white on carrot.

=Foals and Calves.= Symptoms. The buccal mucosa red, congested and tender, shows here and there white curdy looking elevations, or red erosions caused by the detachment of such masses. These bear a strong resemblance to the concretions seen on this mucosa in rinderpest, but are easily recognized by the absence of the attendant fever, and by the discovery, under the microscope, of the specific microphyte. The eruption may extend to the pharynx and œsophagus and interfere fatally with deglutition, but usually it merely renders sucking painful and is not serious.