Page:A Handbook of the Theory and Practice of Medicine - Volume I - Frederick T. Roberts.djvu/324

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THEORY AND PRACTICE OF JIEDICIXE.

In reat g of locc2l diseases, the plan is adopted of giving- a sum- mary of the general clinical characters which belong to each organ or system, and of the methods to be employed in their clinical in- vestigation, before entering upon the consideration of the individual disorders to which they are liable. It may be stated once for all, however, that it is always of essential importance to study the con- stitntional condition of the patient, as this materially affects the dia- gnosis, prognosis, and treatment of local affections. Some of the more important symptoms will be discussed as fully as the limits of this work will permit.

Clinical Characters. — Important indications are often afforded by the mouth and tongue w^ith regard to the state of the system gene- rally, and of the alimentary canal, but these parts may also be the seat of local affections, to which attention will now be directed. Their presence may be revealed by the following symptoms and signs : —

I. Altered sensations, such as pain, soreness, or a feeling of heat or dryness ; as well as various derangements of the sense of taste. 2. More or less interference with the actions carried on in the mouth, viz., mastication, sucking, the first stage of deglutition, and articu- lation. These acts are also often attended with pain. 3. Changes in the quantity or quality of the saliva; or the escape of un- usual discharges, such as pus, blood, &c. 4. A disagreeable odour of the breath, which may amount to extreme foetor. 5. Interference with the act of breathing occasionally, owing to me- chanical obstruction to the passage of air. 6. A change in colour, or the existence of any swelling, deposit, ulceration, or other morbid condition, as disclosed on objective examination of the mouth, aided by a good light. At the same time the absorbent glands in the neighbourhood should be examined.

Stomatitis is a very common affection, and occurs under several forms. Its varieties are : — 1. Catarrhal. 2. Follicular. 3. Aph- thous. 4. Ulcerative. 5. Parasitic. 6. Gangrenous. 7. Mer- curial