Nature. Regarding the essential nature of stomatitis, it would appear (according to the work carried out in 1890 by Gallipe on mercurial stomatitis in man), that we should regard it as a septic stomatitis, and not as a primary toxic stomatitis. The mercury absorbed by the body not only produces salivation, but a very important change in the chemical composition of the saliva. The vitality and toxicity of the saprophytic microbes normally present in the buccal cavity appear greatly to increase, and although only the most trifling erosions may exist in the mucous membrane, true intra-mucous inoculation takes place, and forms the point of origin for septic stomatitis.
It has been found that it is not even necessary to have lesions in the buccal mucous membrane; in fact, this is the weak point in the theory emitted. Nor is a modification in the chemical composition of the saliva sufficient; for when a mixture of iodine and the iodides, for example, is being given, the saliva is chemically modified, and yet stomatitis, properly so-called, does not occur.
What seems most probable is that mercurial stomatitis is a toxi-infectious stomatitis, in the development of which mercury acts primarily by its toxic effect on the salivary glands, whose secretion it modifies, and on the buccal epithelium, the renewal of which it checks. Infection of the mucous membrane is thereby favoured, even in the absence of any previous lesion, and stomatitis develops.
Symptoms. The symptoms consist in abundant salivation with discharge from the mouth, suggesting the existence of foot-and-mouth disease. In grave cases the saliva appears streaked with blood, even from the beginning. The buccal cavity exhales an intense fœtid odour which, during the following days, becomes more marked; the mucous membrane is pale in colour, and coated with a greyish exudate. The mouth is hot and sensitive, the gums are swollen, reddish-violet in colour, and painful. Alveolar periostitis soon sets in, the teeth become loose, and mastication is rendered impossible, especially as the inflammation causes the tongue to swell and lose its mobility. These symptoms are unaccompanied by fever.
In the last stage ulcerations and local necroses appear on the gums, on the inner surface of the lips and cheeks, and around the commissures of the lips. The patients are almost unable to feed, rapidly lose flesh, become anæmic, and die from septic infection. The temperature is often below normal.
A toxi-infectious gastro-enteritis, with fœtid, blood-stained diarrhœa, is grafted on the primary stomatitis. Complications in connection with the respiratory, circulatory, and urinary apparatus appear, and the patients die in a condition of absolute exhaustion.
Naturally this termination is not inevitable; trifling cases of poisoning, and even grave forms, when properly treated, may, and should, recover.
Diagnosis. The diagnosis is mainly based on the history, except in cases of accidental and unsuspected poisoning.
Prognosis. The prognosis is grave, for even when the disease does not prove fatal the animals remain anæmic and exhausted for long periods.
Treatment should principally be directed towards combatting the local complications. When poisoning is due to external applications of mercury or its salts the skin should be washed with soap and water, and afterwards dressed with a soluble sulphide, which renders the mercury insoluble. The mouth should frequently be rinsed with boiled water, with decoctions of barley or marsh-mallow, with a 30 per cent. solution of boric acid or alum, or with a 1 to 2 per cent. solution of salicylic acid.