This is one of the most interesting, as well as vexatious, diseases with which we are acquainted. It is interesting because of its limited history and prevalence, its peculiar pathology, its mortality under the dominant practice, and the imperfect development of its homoeopathic therapeutics; vexatious, because of its multiplied forms and complications, and its intractable nature, if not modified and remedied by appropriate means.
Hence the desire, in the following Report, to add, if possible, something in the line of perfecting its pathological detail, and likewise of pointing out the precise indications for such particular remedies as may promise relief for the same.
I. Nature. — Regarding the essential nature of this malady, various opinions have been and are still entertained by the profession at large. The most plausible of these, we apprehend, is that which refers its phenomena to a scorbutic cachexia. It has been convenient for the majority of medical men to attribute its origin to miasmatic influences; to a diminution of the red corpuscles of the blood; to scrofula; to menstrual irregularities, antecedent to conception; to a depraved and insufficient nourishment, and the like; but the best writers incline to the opinion that this-catalogue embraces only the crude outline of its causes and its consequences, while it leaves the radical nature of the malady itself an open question.
e. — They are alike mortal under treatment by mercurials, etc., agreeably to the antiquated method of medical practice; and this fatality is induced by an identical process of disintegration of the tissues, in which their elements are forced to remain, without elimination, as abnormal constituents of the blood.
II. Peculiarities. — The Stomatitis Materna has the following characteristics: — It is peculiar to females, and of these to women during the term of utero-gestation, [or at some period of the maternal lactation. A few writers, indeed, claim to have witnessed examples of this disease in males, but such reports need confirmation, implying as they do some grievous error in diagnosis. As a rule, one would as readily anticipate attacks of “morning sickness” among the latter sex, as of this particular variety of stomatitis; and, in what follows, we are therefore to declare, and to keep in view the essential characteristics afore-named.
1. Of the Local symptoms. — These phenomena of the Stomatis Materna are not subject to a regular order of development, but vary with each particular example of the disease. Their more general approach, however, is as follows: The patient calls attention to a burning or scalding sensation in the mouth, which sensation is greatly aggravated by the taking of warm, or even by cold drinks, and by efforts to masticate her food. Upon inspection, the physician remarks a fiery, red look of the mouth, which redness is found to exist either in patches, or diffused more or less continuously over the whole buccal surface. Sometimes this eruption is isolated, presenting the appearance of ulcerated tuberculae of the size of a pea, less or more. Again the aforesaid patches attain the diameter of a quarter of a dollar, when they may degenerate into ragged and indolent ulcers, thus constituting the worst examples of the disease which are to be met with, and which frequently spring of a chronic neglect, or from that still more deplorable cause — a dyscrasia induced by drugs that have been ignorantly prescribed for their removal.
With this local inflammation, whether it be diffused or isolated, deep-seated or superficial, there are other symptoms which are equally characteristic. Among these there will be found a marked pallor of the surface, resembling chlorosis; a sad and dejected expression of countenance; soft, flabby muscles, while the rotundity of the form remains as in health; anorexia, pyrosis, and other disorders of digestion; a profuse flow of saliva; the tongue is red and smooth: cutting colicky pains from the simplest ingesta; alternations of constipation and diarrhea; strangury, with strong and scalding urine, which is acid to test-paper; palpitation, especially troublesome at night; the secretions are generally normal, the skin soft, but without any sensible perspiration; and, if during lactation, a decided sympathy between the child and its parent, whereby it is discovered to have inherited thus early, some of her more immediate and palpable frailties.
Chronic cases are likely to be accompanied by a diarrhea, which is chargeable to an extension of the specific inflammation to the middle and inferior portions of the alimentary mucous membrane. This symptom is frequently a very perplexing one, as well on account of the increased emaciation and debility which it occasions the general system, as because of its intractable nature, as shown in its alternating with the mouth symptoms, being better when they are worse, and vice versa.
In these examples it is not unusual to discover that all the mucous membranes lining the different interior surfaces of the body partake of this inflammation. Thus the inner coats of the larynx, the trachea, and of the lungs, of the pharynx, esophagus, and of the whole alimentary tract, as well as of the vagina, urethra, etc., etc., are sometimes found to be either separately, or universally involved. Hence there results great disturbances of function, nutrition, etc.; for the destruction of the epithelial scales which marks the invasion of this disease upon local surfaces, interferes very materially with the healthy condition and requirements of those organs which are indirectly but more seriously implicated.
The foregoing symptoms are liable to so frequent modification, both in the order of their succession and their severity, that authors have fancifully described some three to five distinct varieties of the nursing sore-mouth, for which classification, practically speaking, there would appear to be no real necessity. In order, however, the more fully to comprehend the significance and value of these symptoms as displaying the nature of this disease, and as indicating its proper therapeutics, we shall consider a few of them separately.
(a.) Of the buccal symptoms. — These, are the primary and more palpable symptoms of the Stomatitis Materna. There is very little question, however, but that these local phenomena are symptomatic of a more profound disturbance of the general organism; and that, properly speaking, we are to regard them as the certain evidence of some such original disorder. Examples are not wanting in which this disease is believed to have pursued a latent course in the system, during which interval, for a greater or less period of time prior to the development of these symptoms, it has sapped the strength and impaired the functional processes of the economy.
Indeed there is every reason to believe that those cases of digestive and assimilative disorder, incident to utero-gestation, which distress and harass the patient exceedingly while carrying the foetus, and which, subsequent to her confinement, will not unfrequently result in a manifestation of the above local symptoms, are to be referred solely to the existence of a latent stomatitis from the beginning. These examples are perhaps as infrequent as they are invincible, but in the practical experience of those physicians whose opinions are of value, the remark will hold good that it is only through a close and careful study that we may come to appreciate the worth of this class of symptoms, as affording us an index at once to their pathology and treatment.
The peculiar characters which such symptoms present are found to vary with the severity and duration of the complaint. In very mild cases the eruption assumes more of an erythematous appearance, being diffused in patches over the sides of the tongue, and of the cheeks. Or it may consist of small vesicles resembling the Aphthae Adultorum of some writers, which vesicles ultimately degenerate into more or less troublesome centres of infection, each showing at its base a hardened and whitish colored ring. These indurations terminate either by cicatrization or ulceration. To this form of the complaint the name of Follicular Stomatitis has been given, for the reason that the peculiar eruption finds its more frequent seat in the mucous follicles of the mouth.
In the more aggravated examples, these aphthae upon bursting are very prone to ulceration, especially if the system has been previously depraved in any very considerable degree. They may have located themselves on the sides or the upper surface of the tongue, upon its frenum, or upon the exterior and anterior surfaces of the gums, the cheeks, or elsewhere, and are painful in proportion to the rawness of the surface exposed, and to the depth of the ulceration itself. In a few very severe cases these ulcerations are reputed to have grown very deep, even to the hone, it is said.
Generally speaking, this crop of vesicles and ulcers has a duration of a week to ten days or longer, when they disappear, sometimes very suddenly, leaving the patient with the consoling reflection of restored health. Soon, however, they re-appear, and thus keep coming and going to the mutual annoyance of the physician and patient, or until the former has happily succeeded in ridding her entirely of this troublesome and intractable malady.
As a rule, the more sudden the cicatrization and disappearance of this variety of local symptoms, the greater the reason to suspect a more serious constitutional sympathy, and to anticipate such untoward results as might arise from their sudden metastasis to some neighbouring surface or surfaces. The worst cases are those which the professional tyro would be prone to declare the most readily healed by medical, and especially by local measures. Hence the significant inference that in our treatment, the most prudent course does not always lie in the direction of efforts made to resolve away the local disturbance and suffering, but in keeping an eye also to the liability of their translation, as well as to their safer and more more permanent relief through the employment of constitutional, and more strictly curative means.
(b.) Of the dyspeptic complications. — These symptoms almost invariably take the initiative among those which mark the existence of this variety of stomatitis. This is so literally true that they might with great propriety be styled the primary symptoms, while those which we have already enumerated should take rank as essentially secondary.
In the writer's experience, symptoms of a more or less troublesome indigestion have been among the earliest and most reliable tokens of an incipient sore-mouth. We have seldom witnessed an example of this disease, during maternal lactation, which had not been previously characterized by epigastric uneasiness, anorexia, pyrosis, etc., etc. There are exceptions to the above rule however, in which we shall. find these symptoms are developed, only when the existence of stomatitis is confirmed by the appearance of the peculiar eruption upon the buccal or lingual surfaces. Indeed, there may be such a thing as the sore-mouth running its course without any very decided sympathy of the stomach therewith, but such cases are believed to be rarely met with, as well as necessarily of a very mild nature.
Various reasons have been assigned in explanation of the occurrence of indigestion in this disorder, the more prominent of which consists in the interruption of mastication and deglutition, because of the mouth and throat being involved in the peculiar inflammation. Another has its origin in a transfer of this local disorder to the stomach itself; while a third depends upon the improper character of the food which is chosen. It will, of course, be of considerable importance therapeutically to determine in a given case, which of these or of other causes is the one in question, and how we shall set about forming a correct diagnosis of their more obvious morbid consequences.
(c.) Of the urinary symptoms. — After calling the attention of the physician to the local suffering in the mouth, it frequently happens the patient will voluntarily confess to a troublesome strangury, with considerable smarting and scalding of the urinary passages, either during, or immediately after micturition. These symptoms may have anticipated both the sore-mouth and the diarrhea. Where they are less promptly acknowledged, we shall find upon enquiry that they do really exist.
Testing this excretion will discover it to exhibit an acid reaction, a symptom reputed by some authorities as pathognomonic. Its specific gravity will, in most cases, vary from 1024 to 1030. The acid which is found in excess is the uric acid, or one or another of its salts — the urates of ammonia, soda, etc. Its presence is referred by physiologists to an absorption of certain protein bodies, furnished the system beyond its more immediate necessities.
(d.) Diarrhea. — It will be readily conceded that among the numerous morbid sequelae of pregnancy there are few more troublesome symptoms than an inveterate diarrhea. Especially is this true among patients of a scrofulous or consumptive diathesis. It is this latter class which is most liable to developments of this sort, during attacks of the nursing sore-mouth. Hence it is important to be on the alert for such a symptom, which, while it complicates the case, will almost certainly contribute to augment its danger. The diarrhea may either anticipate or succeed the mouth symptoms already enumerated. Most frequently, however, it will be found to alternate with them in severity, a fact which is significant of a metastasis of the peculiar irritation from the oral, to the intestinal mucous membrane.
Where disorders of digestion or assimilation have preceded the more obvious signs of this affection, we can readily conceive a fit condition of the bowels for the advent of an early and troublesome diarrhea. Sometimes the local inflammation which may have disturbed the stomach in the outset, will have been translated to the lower section of the intestinal tube, thus relieving the former, by so much as it increases the abnormality of function in the latter.
In the great majority of examples of the Stomatitis Materna, this symptom will be present. To the old school physician it constitutes the chief source of alarm, as indeed it is the principal cause for a noted mortality under his administration. It it be borne in mind, however, that the diarrhea which accompanies this variety of the stomatitis, constitutes but a symptom of that disorder; that its essential pathology is analogous to that of the buccal erythema or eruption; its capability of metastasis, or of dangerous modification by harsh measures, and of relief by mild and specific means; there is no real necessity that we conclude it an unfortunate complication, or elect it as a drain to the strength and support of the economy at large. One's increased security under the guidance of the homoeopathic law, as compared with the hap-hazard routine of the old school, is not more gratefully manifest in any other condition of any other disease, than in the one under present consideration. And, it is just here that some of our best cures are performed. We speak as an Allopath who has had occasion to remark, and to confirm the truth of the assertion made, that, for this single disorder, there is nothing in the Therapeutics of the opposite school which will compare, in point of efficiency, with the specific appliances of the homoeopathic method.
2. Of the General Symptoms. — These are for the most part such as imply a debility which is more or less extreme. The more prominent of this order of constitutional phenomena is the anemia. In well-marked examples this symptom is seldom wanting. The patient wears a hue of the complexion which is less waxy and clear than in chlorosis, and with more of the sallow and cadaverous shade in it, than is common to almost any other among ordinary diseases. To one familiar with this tint, there is something peculiar, and which he will recognize at first sight.
The causes of the depraved condition of the blood, which is responsible for this, as well as the remaining constitutional symptoms, have been already enumerated, and it is therefore unnecessary to repeat them in this connection. Excepting the anemia, it is sufficient to refer the general phenomena of, the nursing sore-mouth to the effect of local irritation and suffering, superadded to a cachexia which borders upon the scrofulous, and of which certain morbid symptoms are the most natural fruits. Such physiological perversions of function and of structure are found, however, to be more readily analyzed than ameliorated, and we accordingly pass to the more important divisions of our subject.
IV. Diagnosis — The peculiar circumstances in which the patient is found — enciente, or in one or another of the stages, of recovery from confinement; with the characteristic local symptoms afore-named, will leave but little room for doubt in the diagnosis of the malady.
V. Prognosis. — As the result of a somewhat extended experience in the practice of the Medical Profession, as well as of a wide correspondence with the Fraternity, your Committee cannot conclude this to be a fatal malady, under homoeopathic treatment. Not one of the brethren appealed to has reported a single death from this disease — always excepting, however, their previous experience as Old-School Physicians. Many of them, as is doubtless true of a majority of the members of the Institute, have succeeded in curing cases which have been abandoned by physicians of a different persuasion, and which if left to themselves or to the influence of mistaken advisers, would certainly have succumbed.
In brief, your Committee cannot agree with the sentiment of the following extract, from a report upon this disease, which was presented to the Illinois Medical Society (Allopathic) two years since. The writer, says, that “on the score of its fatality, this disease clearly has claims equal to any known to the profession in the Western part of the United States.”
In respect of its fatality, our experience may have been as peculiar, as it has been satisfactory in its results to the patient; but, omitting the details, it certainly establishes the fact of the curability of the Stomatitis Materna by homoeopathic measures. We can conceive of examples in which, by reason of their chronic and inveterate nature, or of a complication of its phenomena with the toxical effects of drugs upon a previously depraved condition of system, the prognosis might be unfavorable; but it is morally certain that, under this new and more successful method of treatment, such a decision is rarely called for in any other class of cases.
We apprehend, however, that in many examples of this disease where physicians have been led to pronounce a genyun avorable prognosis, it has happened that they have confounded the symptoms present with those which characterize the aphthae of advanced phthisis.
1. Of the Constitutional treatment. This division of the subject is based upon a proper selection of the true homoeopathic similar, which is appropriate to the relief of the more prominent and characteristic symptoms to be met with in each individual case. There are various remedies which have been recommended as entitled to the rank of specific, by those in whose hands they have been most successfully employed. We shall name these in the order of their importance, pausing only to specify a few of their peculiar pathogenetic features, and confirming their value as best we may by clinical evidences and indications of a practical nature. The first in order is the
Arsenicum album. — The Arsenicum appears in general to be best suited to those examples of the Stomatitis which are to be met with in malarious districts. A majority of these cases are supposed to result from the combined influence of the miasm and of Quinine or other drugs, which are calculated greatly to disorder the healthy nutritive processes of the economy.
Dr. Wm. B. Murch, of Macon City, Mo., after many years experience, considers it a leading indication for this remedy in the nursing of sore-mouth; when this disease occurs in families residing in a malarious district, where the water which is drunk is more or less stagnant, and impregnated with the epidemic causes which are common to such an atmosphere. These cases are marked by a depraved condition of system which is analogous to Typhus, and it is to their relief that Arsenicum appears peculiarly adapted.
Dr. M. views this agent as being still the more strongly indicated in case the local eruption is vesicular in character. in debility, with considerable digestive disorder, he alternates the Arsenicum with small doses of Belloc's charcoal, and has never lost a case. He employs the former in a low attenuation.
Dr. D. T. Brown, of Milwaukie, recommends the Ars. in cases marked by a very considerable dryness and inflammation of the buccal mucous surfaces. Occasionally, where the patient has been greatly exhausted and enfeebled, he has witnessed the best effects from preceding the employment of Ars. by a few doses of the Carbo-vegetabilis.
Dr. W. C. Barker, of Waukegan, III., extols the use of Ars.6, given in alternation with Sulphur6, once in four hours; in those examples of the nursing of sore-mouth, which are characterized by a very slight and almost imperceptible odor of the breath, along with considerable prostration of the general system.
These hints, subtracted from the correspondence of experienced physicians, would seem to indicate those general features of the S. Materna which demand the use of this agent. It were superfluous to detail the more intimate pathogenetic characteristics of the Arsenicum, since these are already the property of the profession, and in the treatment of particular cases, have necessarily become matters of the most familiar reference.
Belladonna. — Dr. R. B. Clark, of Racine, Wis., records the radical cure of an inveterate example of the nursing sore-mouth by the employment of this one remedy alone. The sixth attenuation was the one chosen. The case had been abandoned as hopeless by several allopathic physicians, and the cure is undoubtedly authentic.
Calcarea Carbonica. — Where we have reason to believe that disorders of digestion in pregnant, or lying-in, women are due to a Stomatitis which may be either latent, or perhaps have so already localized itself that we may remark its real nature; and these symptoms are present in a scrofulous or consumptive habit of body; accompanied by an inveterate diarrhea, which fails to respond to other remedies, we may sometimes prescribe the Calc. carb. with the most happy results. Indeed there are some cases which, in the experience of your Committee, it would seem almost impossible to cure without it.
These examples are marked by such symptoms as the following: — Great dryness of the mouth and tongue, with a sense of roughness and stinging; a dry, bitter, sour, or metallic taste of the month; great aversion to boiled food, and to meats in particular; inclination to salt diet, or to eat such forbidden articles as pickles, dirt, chalk, slate-pencils, &c.: strong and unconquerable desire to sleep after dinner or tea; nausea, with acid eructations; vomiting of ingesta; profuse, colliquative diarrhea, the stools being sometimes quite undigested; faintness, with swooning, after stool or exercise; a sudden metastasis of the eruption from the mouth to the alimentary mucous membranes; acidity of the urine, with burning in urethra during micturition, &c., &c.
In cases also where 'it appears desirable to impress the child's system through that of the parent — the mouth and the contiguous mucous surfaces being considerably involved in the diseased action, we may find the Calc. carb. of very great service. We employ it in the third decimal trituration repeated thrice daily.
Mercurius. — The Mercurius has proved very beneficial in certain varieties of this disease. The form to which it seems best adapted is that in which the eruption has assumed the character of ulcers, which, in their nature, are more or less corroding and destructive to the adjacent tissues, — the S. Ulcerosa of the older writers. In curing the most inveterate examples of this peculiar species of the nursing sore-mouth some of our brethren have been remarkably successful. With them, the Merc. vivus appears to have become the favorite preparation.
Dr. Barker recommends that the third attenuation of this latter be given in alternation with Sulphur6 once in four hours, where the corroding tendency of the ulcers is manifest, and the breath is characterized by a very offensive, putrefactive odor.
We have employed the Merc. iodatus3, in the S. Ulcerosa, where there was reason to suspect a syphilitic taint of system. For kindred complications, the Merc precip. rub3., might also be of essential service.
Nitric acid. — This has doubtless been the most popular remedy in use by Homoeopathists in this disease. It has been given in every conceivable manner, under almost every variety of indication, and with results surpassing those which have been recorded of any other constitutional remedy.
Dr. M. Troyer, of Peoria, III., has witnessed the best effects from the raw Nitric acid administered in water thrice daily. He has treated more cases of this disease during the last winter (1859 — '60) than for twelve years before.
Prof. N. F. Cooke, of Chicago, has the utmost confidence in this acid. He, however, considers some examples of the disease to be essentially parasitical; and, for these, regards this remedy as almost a specific.
Additional testimony might be adduced in favor of Nitric acid as among the most promising means of relief for this disease, and your Committee could enumerate examples and evidence in confirmation of its clinical and pathogenetic resources, but want of time and space forbid.
Nux vomica. — In its very incipiency, and especially in cases where this disease is first manifest through perverse disorders of the nutritive system, we have administered the Nux vomica with the best possible effect. After the appearance of the eruption in the mouth, but more particularly after the advent of the diarrheic symptoms, if they be at all serious, we recommend its discontinuance.
Rhus toxicodendron. — Dr. Davies has succeeded in some obstinate cases by the application of a trituration of the Rhus tox., and an internal use of the attenuations of the same remedy. He triturates the berries of this plant with Sacc. lactis, in the proportion of one berry to ten grains of the sugar, and applies the powder, moistened, through the medium of a thin linen cloth.
Sulphuric acid. — In the experience of your Committee, this is an invaluable remedy for the Stomatitis Materna. We have certainly witnessed the most satisfactory results from its employment. In one example, in which two of our most prominent Allopaths had treated a lady for two months, and told her that she must wean her child, and that it would take her at least a year to recover her health, three visits and a fortnight's use of the Sulph. acid2 in water, effected a radical cure, and that without weaning the infant, or the employment of any local application whatever.
Veronica baccaburga. — Dr. N. F. Prentice, of Freeport, III., has employed this remedy and with the most marked success during the last three or four years. In a letter to the writer, he says: — “Formerly I had a great deal of trouble in the treatment of this disease, and of sore-mouths in children, but during the above-named interval I have used the Veronica (empirically it is true, for I have but a very few provings of it,) almost exclusively, and with universal success. I have been in the habit of giving it internally in the first decimal attenuation, and of applying it locally to the mouth in the proportion of ten to thirty drops in two fluid-ounces of soft water. When they are indicated, I use other remedies in alternation with the Veronica.”
2. Of the local treatment. — As might be anticipated, “Doctors will differ” upon this point of practical enquiry. It must suffice to say, in this connection, that in their treatment of this disease, the majority of Physicians, with whom your Committee has corresponded, prefer constitutional to local measures. A few, however, present the claims of some particular topical application, in the strongest possible light. Of these we may mention the following: —
Dr. Murch employs the Golden Seal, (Frasera Caroliniensis). He recommends to gargle the mouth well with an infusion of this substance, thrice daily. In case of severe ulcers of the oral mucous membrane, he applies the powder directly to the diseased surface. The infusion forms an excellent application to the mother's nipple, when it is surrounded with little vesicles, and has become almost too tender for the child to nurse the breast at all.
The mischievous results of local treatment already hinted at, are best avoided either by neglecting ail such measures whatever, or by employing only those which we are positive can produce none but a specific effect upon the eruption, healing it without harm to other surfaces or to the system at large. With these latter qualifications, we opine that certain local appliances may sometimes be used with advantage.
(a.) Of the mother's diet — Without spending time upon the various speculations and theories which have been advanced and' supported by superior minds in the profession, your Committee would declare the conviction that the most important item in reference to this subject, and one which should constantly be born in mind, is that the diet of the patient must be as nutritious as possible. It should consist of an admixture of vegetable and animal food, taking especial pains to omit neither the one nor the other variety of aliment. We have witnessed the best of results from a rich diet of beef tea, or oyster soup, with good, dry, mealy potatoes, and some vegetable acid, — as afforded by baked apples, oranges or a weak lemonade. These latter we almost never deny the patient, and have invariably found them to be as really beneficial as they were grateful to her. The idea that, because she craves these acids, and would perhaps eat of them to excess if allowed, it is therefore best to deny their enjoyment at all, is a cruel relic of the ancient regime. The hint which Nature throws out m such a case, we may always find it safe to adopt; and we shall soon be led to remark that at least nine-tenths of the examples of nursing' sore-mouth which are to be met with, like the Scorbutus, demand an extra supply of vegetable acid, in one form or another.
(b.) Of the diet for the child. — It was at one time recommended indiscriminately, that the infant be taken from the breast immediately upon the advent of this disease. But the opinion of our best modern physicians is adverse to this proceeding, where it can possibly be avoided. As a rule, it is not necessary to wean the child. We have never ordered it; and, unless the mother Were weak and emaciated, with so great a lack of vitality, as at once to impair her power of reaction from the violence of the disease, and of furnishing her offspring a support at all commensurate with its necessities, we could not feel justified in making so unnatural a prescription.
|The American Homoeopathic Review Vol. 02 No. 05-06, 1860, pages 193-201, pages 252-260
|Stomatitis Materna - a report to be presented to the American Institute of Homoeopathy.
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