Part 2

A careful examination of the mucosa will sometimes detect slight conical elevations with red areolæ, representing the tumefied orifices of the obstructed mucous follicles, and later these may show as minute erosions. Even vesicles have been noticed (Weber, Dieckerhoff, Kosters), but when these are present one should carefully exclude the specific stomatites such as horsepox, contagious pustular stomatitis, aphthous fever, etc.

Erosions of the mucosa and desquamation of the epithelium have been noticed in horses fed on purple (hybrid) clover, buckwheat or ergot, and in some of these cases the inflammation has extended (in white faces especially) to the skin of the face, the mucosa of the nose, and the adjacent glands, and as complications icterus, constipation, colics, polyuria, albuminuria and paresis of the hind limbs have been observed. These latter are common symptoms of cryptogamic poisoning.

_Prognosis._ In uncomplicated cases the disease is not a grave one, lasting only during the continued application of the local irritant, and recovering more or less speedily when that has been removed. Complications are dangerous only when due to some specific disease poison (glanders, actinomycosis, strangles, etc.), and even poisoning by the usual cryptogams of leafy or musty plants is rarely persistent in its effects.

_Treatment._ This resolves itself into the removal of the irritant cause and the soothing of the irritation. When the cause has been definitely ascertained the first step is easy.

In the direction of soothing treatment, a careful selection of diet stands first. Fibrous hay and even hard oats, barley or corn may have to be withheld, and green food, or better still, bran mashes, gruels, pulped roots or fruits allowed. Scalded hay or oats, ensilage, sliced roots, or ground feed may often be taken readily when the same aliments in their natural condition would be rejected or eaten sparingly.

Medicinal treatment may often be given in the drinking water which should always be allowed in abundance, pure and clean. In the way of medication chlorate of potash, not to exceed one-half to one ounce per day according to the size of the animal, may be added, together with an antiseptic (carbolic acid, borax, permanganate of potash, common salt, naphthol, creolin, hyposulphite of soda). In case of severe swelling, a cap made to fit the head with strips wet in alum and vinegar or other astringent solution maintained against the intermaxillary space may be desirable. Support for the tongue may be necessary as mentioned under glossitis.

In case of complications on the side of the bowels, liver or kidneys, laxatives, diuretics and antiseptic agents may be called for.

GENERAL CATARRHAL STOMATITIS IN CATTLE.

Dense resistant mucosa protective: Affection usually circumscribed. Action of violent irritants, and toxins of specific fevers. Mechanical irritants. Symptoms: Salivation; congestion; eruptions; erosions; ergot; acrid vegetables; caustics. Treatment: Astringents; antiseptics; refrigerants; derivatives; tonics. Removal of foreign bodies. Lesions and symptoms in sheep.

The mouth of the ox as Cadeae well says has a cuticular epithelium too thick and resistant to be easily attacked by microbes. It follows that infected inflammations are far more frequently circumscribed than in the thinner and softer buccal mucosa of the horse. The more general buccal inflammations come more particularly from the use of food that is too hot or that contains strongly irritant agents. The thickness of the buccal epithelium however, is no barrier to the local action of poisons operating from within as in rinderpest, or aphthous fever, or in malignant catarrh, nor is it an insuperable barrier to the local planting of the germs of cow pox, anthrax, actinomycosis, or cryptogamic aphtha (muguet). The wounds inflicted by fibrous food make infection atria for such germs, hence the great liability to such local inflammations, in winter when the animals are on dry feeding. For the same reason, perhaps, the prominent portions of the buccal mucosa,—the papillæ—are sometimes irritated themselves while serving as protectors for the general mucous surface, and hence they become specially involved in inflammation, which constituted the “_barbs_” of the old farriers. Utz records a buccal inflammation occurring in herds fed on green trefoil, first cutting, showing that even in cattle this agent may determine a general stomatitis.

_Symptoms._ These do not differ from those of the horse, and resemble, though often in a milder form, the buccal manifestations of aphthous fever. There is the difficulty of mastication and indisposition to take in fibrous aliment, the drivelling of saliva from the mouth, or its accumulation in froth around the lips, the frequent movement of the tongue and jaws, and the congestive redness, papular eruption, vesication, or even erosion of the affected mucous membrane. It is always necessary to guard against confounding the simple stomatitis, and the slighter infected inflammations, from the more violent infections above referred to. The special diagnostic symptoms must be found under the respective headings. The aphthous fever is not to be expected in American herds, but the stomatitis which is associated with ergot in the food is met more particularly in winter and spring, and must not be confounded with the specific disease, on the one hand nor with the simpler forms of buccal inflammation on the other. In the case of ergoted fodder the signs of ergotism in other situations will be found, in the affected animals, such for example as necrotic sloughs and sores around the top of the hoof, sloughing of the hoof or of one or more digits, or of the metatarsus, of the tip of the tail or ear; abortions, convulsions, delirium, lethargy or paralysis. If not seen in the same animals some of these forms may be observed in other members of the herd. Then the buccal lesions are in themselves characteristic: soft, whitish, raised patches of the epithelium (rarely blisters) are followed by desquamation and exposure of the red, vascular surface beneath, and this tends to persist if the ergoted fodder is persisted in.

_Treatment._ Simple stomatitis of the ox generally tends to spontaneous and early recovery. The simplest astringent and antiseptic treatment is usually sufficient to bring about a healthy action. Borax given in the drinking water, not to exceed four ounces per day, or the same amount mixed with syrup or honey and smeared occasionally on the tongue, or hyposulphite or sulphite of soda, or weak solutions of carbolic acid will usually suffice, after the irritant cause has been removed. Vinegar, or highly diluted mineral acids may be used but are somewhat hurtful to the teeth. Decoctions of blackberry bark or solutions of other vegetable astringents may be used as alternatives. When there is evidence of irritant matters in the stomach or bowels, a saline laxative will be advisable to be followed by vegetable bitters or other tonics. Thorns and other foreign bodies imbedded in the tongue or other part of the mouth must be discovered and removed.

CATARRHAL STOMATITIS IN SHEEP.

The more delicate buccal mucosa in these animals would render them more subject to inflammations, but this is more than counterbalanced by the mode of prehension of aliments, not by the tongue, but by the delicately sensitive lips, and further by the daintiness and care with which these animals select their food. The _treatment_ would not differ materially from that prescribed for the ox.

GENERAL CATARRHAL STOMATITIS IN DOGS.

Causes: burns; spiced food; bones; sepsis; ferments; pin caterpillar; dental and gastric troubles. Symptoms: careful prehension and mastication; congestion; swelling; eruption; erosion; furred tongue; stringy salivation; fœtor; swelling of lips, cheeks, intermaxillary space, and pharynx. Treatment: demulcent foods; antiseptics; derivatives; tonics; care of teeth and gums.

_Causes._ Hot food is a common cause in hungry dogs. Spiced food in house dogs fed scraps from the table tend to congestion of mouth and stomach alike. Irritation through wounds with bones, especially in old dogs with failing teeth, and in exceptional cases the impaction of a bone between the right and left upper molars are additional causes. Putrid meat must also be recognized as a factor, the septic microbes seizing upon the wounds and spreading from this as an infecting centre. Lactic acid and other irritant products developed through fermentation of particles of food retained about the gums and cheeks soften the epithelium and irritate the sub-epithelial tissue, causing congestion. Megnin draws attention to the fact that the pin caterpillar (bombyx pinivora) found on the stalks of couch grass (Triticum repeus) produces buccal irritation when chewed and swallowed to induce vomiting. As in other animals more or less buccal congestion attends on gastric congestion and inflammation. Dental troubles are often sufficient causes.

_Symptoms._ The animal becomes dainty with regard to his food, picking up the smaller or softer pieces and rejecting the larger or harder. Mastication is painful and selection is made of moist or soft articles which can be swallowed without chewing or insalivation. The mouth is red and hot, and at times the mucous membrane eroded, or blistered, the lesions concentrating especially on the gums and around the borders of the tongue. The dorsum of the tongue is furred, whitish, yellowish or brownish. Saliva collects in the mouth and escapes in filmy strings from its commissures, and the odor of the mouth becomes increasingly foul. Swelling of the lips, cheeks or intermaxillary space marks the worst cases.

_Treatment._ Withdraw all irritant and offensive aliments. Give soups, mushes, scraped or pounded lean meat in small quantities, washing out the mouth after each meal with a 20 per cent. solution of permanganate of potash or borax or a two per cent. solution of carbolic acid. Cadeac advises against chlorate of potash on account of its known tendency to bring about hæmoglobinæmia in dogs. A laxative and bitters may be called for in case of gastritis or indigestion, and any morbid condition of the teeth must be attended to. Decayed teeth may be removed. Tartar especially must be cleaned off by the aid of a small wooden or even a steel spud and a hard brush with chalk will be useful. A weak solution of hydrochloric acid is usually employed to loosen the tartar, but this is injurious to the structure of the teeth and had best be avoided if possible. Tincture of myrrh is especially valuable both as a gum-tonic and as a deodorant and antiseptic. This may be rubbed on the irritated gums as often as the mouth is washed.

GENERAL CATARRHAL STOMATITIS IN SWINE.

Causes: Irritants; ferments; noose on jaw; specific poisons. Symptoms: Careful feeding; thirst; frothy lips; champ jaws; redness; swelling; fœtor. Treatment: Cooling, astringent, antiseptic lotions; mushy food; derivative; tonics.

_Causes._ Swine suffer from simple stomatitis when exposed to thermal, mechanical or chemical irritants. Food that is too hot, or that which is hard and fibrous, or that which contains spikes and awns, capable of entering and irritating gland ducts or sores, or food which is fermented or putrid, food or medicine of an irritant character. The habit of catching and holding swine with a running noose over the upper jaw, and the forcing of the jaws apart with a piece of wood in search of the cysticercus cellulosa are further causes. In several specific infectious diseases inflammation of the mucous membrane with eruption or erosion is not uncommon. Thus aphthous fever is marked by vesicular eruption, muguet by epithelial proliferation and desquamation, hog cholera and swine plague by circumscribed spots of necrosis and erosion. Patches of false membrane are not unknown, and local anthrax, tubercle and actinomycosis are to be met with. Inflammation may start from decaying teeth.

_Symptoms_ are like as in other animals, refusal of food, or a disposition to eat sparingly, to select soft or liquid aliments, to swallow hard materials half chewed or to drop them, to champ the jaws, and to seek cold water. Accumulation of froth around the lips is often seen, and the mouth is red, angry, dry, and hot, and exhales a bad odor.

_Treatment_ does not differ materially from that adopted in other animals. Cooling, astringent, antiseptic lotions, honey and vinegar, and in case of spongy or eroded mucosa, tincture of myrrh daily or oftener. Soft feeding, gruels, pulped roots, or well kept ensilage may be used, and clean, cool water should be constantly within reach. In case of overloaded stomach or indigestion a laxative followed by bitter tonics will be in order.

CATARRHAL STOMATITIS OF BIRDS. PIP.

Causes: hurried breathing; local irritants; exposure; filthy roost. Symptoms: gaping; roupy cry; epithelial pellicle on tongue, larnyx. or angle of the bill. Treatment: pick off pellicle; smear it often with glycerized antiseptic. Remove accessory and exciting causes.

This form of inflammation of the tongue of birds is characterized by the increased production and desiccation of the epithelium so that it takes on a horny appearance. According to Cadeac it may accompany various inflammatory affections of the air passages, which cause hurried breathing with persistently open bill, and thus entail evaporation of the moisture. More commonly it has its primary cause in local inflammation of the surface in connection with damp, cold, draughty hen-roosts, and above all, the accumulation of decomposing manure and the exhalation of impure gas. Even in such cases the abnormal breathing with the bill open is an accessory cause of the affection.

_Symptoms._ The breathing with open bill should lead to examination of the tongue, but above all if at intervals the bird with a sudden jerk of the head emits a loud shrill, raucous sound, which reminds one of the cough of croup. The tip and sides of the tongue are found to be the seat of a hard, dry, and closely adherent epithelial pellicle, which suggests a false membrane.

_Treatment._ The common recourse is to pick or scrape off the indurated epithelial mass, leaving a raw, bleeding surface exposed. This is then treated with a solution of borax, or chlorate of potash. Cadeac deprecates this treatment as useless and dangerous, and advises the disintegration of the dry epithelial mass with a needle taking care not to prick nor scratch the subjacent sensitive tissue, and to wash with a 5 per cent. solution of chlorate of potash. A still more humane and effective method is to make a solution of hyposulphite of soda in glycerine and brush over the affected surface at frequent intervals. This may be conveniently applied through the drinking water.

In case of implication of the lower air passages or lungs, the treatment must be directed to them, and soft, warm, sloppy food and the inhalation of water vapor will prove of great advantage. Secure clean, sweet, dry pens, pure air, and sunshine. (See pseudo membranous enteritis.)

LOCAL STOMATITIS.

Division of circumscribed buccal inflammations: palatitis; gnathitis gingivitis; glossitis. Causes: injuries; acrid; venomous or caustic agents; diseased teeth; foreign bodies in gland ducts; malformed jaws; infections, etc. Symptoms: salivation; difficult prehension and mastication; dropping half masticated morsels; distinctive indications of different caustics; abrasion; abscess; slough; infective disease lesions. Treatment: for _palatitis_, massage by hard corn ears, scarification, laxatives; for _gnathitis_, care for teeth and ducts, astringent washes, eliminate mercury; for _glossitis_, remove cause, use antidote to venom, or to chemical irritant, astringent, antiseptic lotions or electuaries, evacuate abscess, soft, cool diet, elevate the head, suspend the tongue.

Localized inflammations in the buccal cavity are named according to the portion of the lining membrane attacked;—_palatitis_ if seated in the roof of the mouth; _gnathitis_ if restricted to the cheeks; _gingivitis_ if to the gums; and _glossitis_ if to the tongue.

=Palatitis. Lampas. Congestion of the hard palate behind the upper front teeth.= This is usually seen in young horses during the period of shedding the teeth and is caused by the irritation and vascularity consequent on teething. The red and tender membrane projects beyond the level of the wearing surfaces of the upper incisors, and may materially interfere with the taking in of food. A common practice in such cases is to feed unshelled Indian corn, the nibbling of which seems to improve the circulation in the periodontal membrane and by sympathy in the adjacent palate. Superficial incisions with the lancet or knife will usually relieve, and may be followed by mild astringent lotions if necessary. If apparently associated with costiveness or gastric or intestinal irritation a dose of physic will be demanded. Nothing can excuse the inhuman and useless practice of burning the parts with a hot iron.

=Gnathitis. Inflammation of the Cheeks.= Usually resulting as a distinct affection from irregular or overgrown teeth, or the entrance of vegetable spikes into the gland ducts, these cause local swelling and tenderness, slow imperfect mastication, dropping of food half chewed, accumulation of food between the cheeks and teeth, thickening, induration and sloughing of the mucous membrane with excessive fœtor.

_Treatment._ Consists in correcting the state of the teeth and ducts and using one of the washes recommended for glossitis.

=Gingivitis. Inflammation of the gums.= This is either connected with the eruption of the teeth in young animals and to be corrected by lancing the swollen gums and giving attention to the diet and bowels; or it is due to scissor-teeth or to the wear of the teeth down to the gums in old horses; or it is dependent on diseased teeth, or mercurial poisoning, under which subjects it will be more conveniently considered. Barley awns or other irritants must be extracted.

=Glossitis, Inflammation of the Tongue.= _Causes._ Mostly the result of violence with bits, ropes, etc., with the teeth, or with the hand in giving medicine; of scalding food, of acrid plants in the food: of irritant drugs (ammonia, turpentine, croton, lye, etc.), or of sharp, pointed bodies (needles, pins, thorns, barley and other barbs, etc.) which perforate the organ. In exceptional cases leech and snake bites are met with especially in cattle, owing to the tongue being exposed when taking in food. Local infections and those of the specific forms, determine and maintain glossitis.

_Symptoms_: Free flow of saliva, difficulty in taking in food or drinking, and red, swollen, tender state of the tongue, which in bad cases hangs from between the lips. The mucous membrane may be white, (from muriatic acid, alkalies, etc.), black, (from oil of vitriol, lunar caustic, etc.), yellow, (from nitric acid, etc.), or of other colors according to the nature of the irritant. It may be raised in blisters, may present red, angry sores where the epithelium has dropped off; may become firm and indurated from excessive exudation; may swell and fluctuate at a given point from the formation of an abscess; or may become gangrenous in part and drop off. Breathing is difficult and noisy from pressure on the soft palate. There is usually little fever and death is rare unless there is general septic infection.

_Treatment_ will depend on the cause of injury. In all cases seek for foreign bodies imbedded in the organ and remove them. If snake bites are observed use ammonia or potassium permanganate locally and generally, or cholesterin as a local application. If the irritation has resulted from mineral acids, wash out with calcined magnesia lime water, or bicarbonate of soda or potash. If from alkalies (lye) use weak vinegar. If from caustic salts employ white of egg, vegetable-gluten, boiled linseed, slippery elm, or other compound of albumen or sheathing agent. In ordinary cases use cold astringent lotions, such as vinegar and water; vinegar and honey; borax, boric or carbolic acid, chlorate of potash, alum or tannin and honey. Poultices applied around the throat and beneath the lower jaw are often of great value. The bowels may be relieved if necessary by injections, as it is usually difficult to give anything by the mouth. If ulcers form touch them daily with a stick of lunar caustic or with a fine brush dipped in a solution of ten grains of that agent in an ounce of distilled water. For sloughs use a lotion of permanganate of potash, one drachm to one pint of water, or one of carbolic acid, one part to fifty of water. If an abscess forms give a free exit to the pus with the lancet, and afterward support the system by soft nourishing diet, and use disinfectants locally. As in all cases of stomatitis, the food must be cold gruels or mashes, or finely sliced roots will often be relished.

The mechanical expedient of supporting the tongue in a bag is essential in all bad cases, as if allowed to hang pendulous from the mouth inflammation and swelling are dangerously aggravated.

APHTHOUS STOMATITIS. FOLLICULAR STOMATITIS.

Causes: in horse, ox, dog; rough, fibrous food, blistering ointments, bacteria. Symptoms: general stomatitis, and special; papules with grayish centres and red areolæ, vesiculation, ulceration. Treatment: Astringent, antiseptic, derivative, tonic, stimulant.

This is a rare affection in ruminants where the thickness of the epithelial covering appears to be a barrier to infection or injury, while it is common in the more delicate and sensitive buccal mucosa of the horse and dog. In the horse the ingestion of irritant plants with the food and the penetration of vegetable barbs into the mucous follicles may be charged with causing the disease, while in both horse and dog the licking of blistering ointments and the local action of fungi and bacteria are factors in different cases.

_Symptoms._ With the ordinary symptoms of stomatitis, there appear minute firm, whitish, circular elevations representing the openings of the inflamed mucous or salivary follicles, having a reddish areola, and grayish white vesicular centre. They may amount to a line or more in diameter, and on bursting leave red cores or ulcers. The whole mouth may be affected or the disease may be confined to the lips, gums or tongue.

_Treatment._ Beside the general astringent washes, this affection is greatly benefited by the local use of antiseptics, as sulphite or hyposulphite of soda, 2 drachms in a quart of water. Borax, permanganate of potash, carbolic acid or other antiseptic in suitable solution may be substituted. Saline laxatives are often useful to remove sources of irritation in stomach and intestines, and iron salts (chloride or nitrate) in full and frequently repeated doses may be given internally. Ulcers may be cauterized and soft food and pure water given from an elevated manger.

ULCERATIVE STOMATITIS. GANGRENOUS STOMATITIS.

Causes: specific disease poisons; debility; rachitis; cancer; chronic suppuration; irritation—mechanical, chemical, thermic, venomous, etc. Symptoms: difficult, imperfect prehension and mastication, salivation, bleeding, swollen, puffy epithelium, blisters, extending erosions, deep or spreading. Duration. Treatment: correct constitutional fault, tonics, soft, digestible food, antiseptics, mild caustics.