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48 VII. Diagram of the circulation of the blood 86 VIII. Position of the lung
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and irritation of the digestive tract. The rusts, such as _Puccinia graminis_, _P. straminis_, _P. Coronata_, and _P. arudinacea_, cause colic and diarrhea, and in some cases partial
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ean and the cavity injected once or twice daily with a solution of 1 dram of carbolic acid in 8 ounces of water. Under this treatment the pus may cease and the wound heal without comp
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n to be used in such case is made up as follows: Sulphate of zinc, 1 dram; carbolic acid, 2 drams; glycerin, 2 ounces; water, 14 ounces; mix. It is clear that this operation requires
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of 30 to 60 grains is good. Subnitrate of bismuth in doses of 1 to 2 drams may be given. Pulverized opium may be used, if the diarrhea is severe, in 1 to 2 dram doses. If the bowel mo
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first 24 hours, divided into three doses, and afterwards he gives 6 drams three times daily. Opium in doses of 2 to 3 drams may be given. To bring on evacuations of the bowels it is
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chronic poisoning may result. The poisonous dose for an ox is from 3 drams to 1 ounce. _Symptoms._--The symptoms of acute poisoning first appear as those of colic; the animal is rest
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symptoms have abated, iodid of potassium may be given, in doses of 2 drams each, three times a day for a week. No treatment is likely to be of avail until the cause is removed. COP
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y to be tedious. Tannin may be given internally in doses of one-half dram twice daily for a few days to neutralize the unabsorbed alkaloids of the ergot. At the same time give
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e the branches of a tree), become smaller and smaller, and ultimately ramify into every part of the body. Between the ultimate ramifications of the arteries and the beginning of the v
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y, and rapid, labored breathing. It is caused by non-closure of the foramen ovale, connecting the right with the left side of the heart, and the consequent mixing of the venous with t
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LOOD VESSELS, AND LYMPHATICS. DESCRIPTION OF PLATE. PLATE VII: Diagram illustrating the circulation of the blood. The arrows indicate the direction in which the blood flows. The va
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orrhage is profuse and persistent, either a drench composed of 1-1/2 drams of acetate of lead dissolved in a pint of water or 1-1/2 drams of gallic acid dissolved in a pint of water s
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tive tissue. Nerves divide and subdivide, sending off branches, which ramify in all parts of the body, and, as they near their terminations, they contain but one or two fibers. The b
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e ascertained by pouring a little cold water into the mouth), give 3 drams of stronger liquor ammonia, diluted with a quart of cold water. Be very careful in drenching the animal when
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ition to the wholesome dry food, and, by way of medicine, doses of 2 drams each of sulphate of iron and iodid of potassium may be given twice daily. In obstinate cases 2 drams ergot o
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tincture of chlorid of iron, 2 drams, may be given in a pint of water thrice a day. In some cases 1 or 2 teaspoonfuls of oil of turpentine twice
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After relief has been obtained the administration of belladonna in 2-dram doses daily for several days will tend to prevent a recurrence of the retention. When the body of the bladde
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ge doses of laudanum (2 ounces) or of solid extract of belladonna (2 drams) will not only soothe the pain but relax the spasm and favor the onward passage of the calculus. The animal
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Castile soap, or with a weak solution of sulphate of zinc (one-half dram to a quart of water). If these attentions are impossible, most cases, after cleansing, will do well if merely
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after this the sore may be treated by a daily injection of one-half dram sulphate of zinc, 1 dram carbolic acid, and 1 quart milk-warm water. SIGNS OF PREGNANCY. If a cow remains
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is avoids danger of exposure and yet leaves the whole arm free and untrammeled. Before inserting the hand it and the arm should be smeared with oil, lard, or vaseline, care being take
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ould be washed frequently with an antiseptic lotion (carbolic acid 1 dram in 1 quart of water). CONSTRICTION OF A MEMBER BY THE NAVEL STRING. In early fetal life the winding of the
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the pelvis or in the openings in the bones of its floor (obturator foramina) will give sufficient purchase for extraction. Another method is to insert a knife between the bone of the
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acid, or acetate of lead) may be thrown into the womb, and one-half-dram doses of acetate of lead may be given by the mouth, or 1 ounce powdered ergot of rye may be given in gruel. W
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ree are not without danger. Ergot of rye, 1 ounce, or its extract, 1 dram, may be resorted to to induce contraction of the womb. The mechanical extraction of the membranes is, however
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he teats and milk ducts with a solution of iodid of potassium (1-1/2 drams to 1 quart of water). This reduced the mortality to 17 per cent. Others followed this lead by the injection
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cted part is often fatal. It demands antiseptics (chlorid of zinc, 1 dram to 1 quart water) applied frequently to the part, or, if the case can not be attended, smear the affected qua
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acters. By fencing the spring in and giving the affected cows each 2 drams bisulphite of soda daily, the trouble was arrested promptly and permanently. CHAPPED TEATS. These may be
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ily with tincture of iodin, or an ointment of biniodid of mercury (1 dram) and lard (2 ounces) may be rubbed on the affected joints daily until they are blistered. In case of swelling
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elled in this way, carminatives and demulcent agents may be given--1 dram of anise water, 1 dram nitrate of bismuth, and 1 dram of gum arabic, three times a day. Under such course the
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branches of blood vessels which pass into the bones through holes (foramina) on their surface and are distributed in the soft structure (medulla) of the inside. The structure of the
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mined. If the animal is young, valuable, and of reasonably quiet temperament, and the fracture is not too great in extent, the chances of recovery are fair. On the other hand, if the
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l soon be noticeable. FRACTURES OF THE PELVIS.--The pelvis, or bony framework which gives shape to the posterior part of the body, is liable to fracture in many ways. A common one is
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e operation will better fit him for his work by so modifying his temperament and physical condition that he may easily be controlled by his master. Again, if he is merely to be used f
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of the organism together; bony tumors add nothing to the supporting framework of the body; the tissue of fatty tumors never serves as a storehouse of feed and energy; the cells of an
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o the swelling. Injections of iodin solution, 5 grains of iodin in 1 dram of 25 per cent alcohol, may also be made into the substance of the gland. When the swelling which follows thi
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xposing the exuding dermis, an application of boric-acid solution, 2 drams of the acid to 8 ounces of water, often relieves the smarting or itching, and also serves to check the exuda
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ed much shock, the animal may require internal stimulants, such as 2 drams of carbonate of ammonia every hour until it rallies. When the pain is very great, hypodermic injections of 6
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elieve it from foreign bodies which may fall upon it. It has for its framework a fibro-cartilage, irregular in shape, thick, nearly prismatic at its base, and thin anteriorly where it
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onics may be given in the feed, namely, powdered sulphate of iron, 1 dram; gentian, 2 drams; nux vomica, one-half dram; to be given twice a day. In cases of rheumatism, one-half ounce
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s._--Owing to the complexity of the structure of the lung tissue, its ramifications of bronchial tubes and blood vessels, and its abundant supply of lymphatics, the pathological chang
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ourse of the disease headache, pain in the limbs, vertigo, abdominal cramps, vomiting, diarrhea, and weakness are occasionally observed. The disease is seldom fatal, usually appearing
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readily be differentiated from rabies by the persistence of muscular cramps, especially of the face and abdomen, which cause these muscles to become set and as hard as wood. In tetanu
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_a_) is ulcerated and covered with yellowish cheesy particles. The supramammary lymphatic gland (_b_) is greatly enlarged and contains many miliary tubercular foci. * *
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e cure. The iodid of potassium is given in doses of 1-1/2 and 2-1/2 drams once a day, dissolved in water, and administered as a drench. The dose should vary somewhat with the size of
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5µ to 1µ. Hence it is described as polymorphic. It does not stain by Gram, but takes the ordinary anilin dyes, often presenting, especially the longer forms, a beaded appearance. A ch
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mouth make an excellent treatment. The internal administration of 2 grams of salicylic acid and 3 grams of chlorate of potassium three times a day has also proved to be very benefici
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ng the intestines with intestinal antiseptics, such as tannopin in 1 dram doses twice daily, and strengthening the animal by the use of stimulants such as strychnin in half-grain dose
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organisms apparently are in no way injurious. A species of fluke (_Paramphistomum cervi_ or a closely related species) is occasionally found in North American cattle, especially gras
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f fluke disease. Moussu states that the average dose for cattle is 1 gram of the extract for each 10 kilograms of live weight; that is, 10 grams for a young animal weighing 100 kilogr
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milk, protection from flies, 503 Cramps of hind limbs during pregnancy, cause, 162 Cranium, fracture, description and trea
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arts of body, cause, 109 _Paramphistonum cervi_, parasite affecting cattle, 519 Paraplegia, symptoms and treatment,
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, caused by twisted wireworm, treatment, 527 Pregnancy-- cramps of hind limbs during, cause, 162 duration,
scientists in recent times have definitely proved the entire dissimilarity
of the two affections, both from a clinical and a causal standpoint. The
disease is produced by a specific bacillus, readily distinguishable from
that causing anthrax. (Pl. XXVIII, fig. 4.) Cattle between 6 months and 2
years of age are the most susceptible. Sucking calves under 6 months are
rarely attacked, nor are they so susceptible to inoculation as older
animals. Cattle more than 2 years of age may become affected, but such
cases are infrequent. Sheep and goats may also contract the disease, but
man, horses, hogs, dogs, cats, and fowls appear to be immune.
Like anthrax, blackleg is more or less restricted to definite localities.
There are certain pastures upon which the disease regularly appears in the
summer and fall of the year. As to any peculiarities of the soil nothing is
definitely known. Some authors are inclined to regard moist, undrained, and
swampy pastures favorable to this disease, but these theories will hardly
hold, as it is found in all kinds of soil, in all altitudes, at all seasons
of the year, and under various climatic conditions. It occurs in this
country from the Atlantic to the Pacific and from Mexico to Canada, but it
is more prevalent in the Western and Southwestern States. In Europe it
exists in France, various parts of Germany, in Belgium, Norway, Denmark,
Italy, and in the Alps of Switzerland. In Africa it occurs in Algeria and
to some extent in Natal and bordering countries. In South America it
prevails quite extensively throughout Argentina. Cattle in Cuba and
Australia also suffer.
_Cause._--The cause of the disease is a bacillus resembling in some minor
respects the anthrax bacillus and differing but little from it in size. It
also possesses the power of forming within itself a spore. In Plate XXVIII,
figure 4, this is represented as an uncolored spot located in one end of
the rod, which is enlarged so that the rod itself appears more or less
club-shaped. What has already been stated concerning the significance of
the spore of the anthrax bacillus applies equally well to these bodies.
They resist destructive agents for a considerable time, and may still
produce disease when inoculated after several years of drying. This fact
may account for the occasional appearance of blackleg in stables. In order
to meet the requirements for the development of the spores, which takes
place only in the absence of the atmosphere, it is necessary that the wound
be very small and deep enough to penetrate the subcutaneous tissue.
Several observers have found this organism in the mud of swamps. By placing
a little of the mud under the skin, the disease has been produced.
Since the disease may be produced by placing under the skin material
containing the specific bacilli and spores, it has been assumed that cattle
contract the disease through wounds, principally of the skin, or very
rarely of the mouth, tongue, and throat. Slight wounds into which the virus
may find access may be caused by barbed wire, stubbles, thorns, briers,
grass burs, and sharp or pointed parts of feed. Infection by way of
digestive tract is also probable.
_Symptoms and lesions._--The symptoms of blackleg may be either of a
general or of a local nature, though more frequently of the latter. The
general symptoms are very much like those belonging to other acute
infectious or bacterial diseases. They begin, from one to three days after
the infection has taken place, with loss of appetite and of rumination,
with dullness and debility, and a high fever. The temperature may rise to
107∞ F. To these may be added lameness or stiffness of one or more limbs,
due to the tumor or swelling quite invariably accompanying the disease.
After a period of disease lasting from one to three days the affected
animal almost always succumbs. Death is preceded by increasing weakness,
difficult breathing, and occasional attacks of violent convulsions.
The most important characteristic of this disease is the appearance of a
tumor or swelling under the skin a few hours after the setting in of the
constitutional symptoms described above. In some cases it may appear first.
This tumor may be on the thighs (hence "blackleg," "black quarter"), the
neck, the shoulder, the breast, the flanks, or the rump; never below the
carpal (or knee) and the hock joint. It more rarely appears in the throat
and at the base of the tongue. The tumor, at first small and painful,
spreads very rapidly both in depth and extent. When it is stroked or
handled a peculiar crackling sound is heard under the skin; this is due to
a collection of gas formed by the bacilli as they multiply. At this stage
the skin becomes dry, parchment-like, and cool to the touch in the center
of the tumor. If the swelling is cut into, a frothy, dark-red, rather
disagreeable-smelling fluid is discharged. The animal manifests little or
no pain during the operation.
As it is frequently desirable to know whether the disease is anthrax or
blackleg, a few of the most obvious post-mortem changes may here be cited.
The characteristic tumor with its crackling sound when stroked has already
been described. If after the death of the animal it is more thoroughly
examined, it will be noted that the tissues under the skin are infiltrated
with blood and yellowish, jellylike material and gas bubbles. The
muscular tissue beneath the swelling may be brownish or black, shading into
dark red. (Pl. XLII.) It is soft, easily torn and broken up. The muscle
tissue is distended with numerous smaller or larger gas-filled cavities,
often to such extent as to produce a resemblance to lung tissue. Upon
incision it does not collapse perceptibly, as the gas cavities are not
connected with one another.
In the abdomen and the thorax bloodstained fluid is not infrequently found,
together with bloodstaining of the lining membrane of these cavities. Blood
spots (or ecchymoses) are also found on the heart and lungs. The liver is
congested, but the spleen is always normal in appearance.
_Differential diagnosis._--Among the features of this disease which
distinguish it from anthrax may be mentioned the unchanged spleen and the
ready clotting of the blood. It will be remembered that in anthrax the
spleen (milt) is very much enlarged, the blood tarry, coagulating feebly.
The anthrax carbuncles and swellings differ from the blackleg swellings in
not containing gas, in being hard and solid, and in causing death less
rapidly.
It is difficult to distinguish between the swellings of blackleg and
malignant edema, as they resemble each other very closely and both are
distended with gas. Malignant edema, however, generally starts from a wound
of considerable size; it usually follows surgical operations, and seldom
results from the small abrasions and pricks to which animals are subjected
in pastures. Inoculation experiments on guinea pigs, rabbits, and chickens
will generally disclose the differences between the three diseases above,
as all these species are killed by the germ of malignant edema, only the
first two species by the anthrax bacillus, while the guinea pigs alone will
succumb to the blackleg infection. Hemorrhagic septicemia may be
differentiated from blackleg by its affecting cattle of all ages, by the
location of the swelling usually about the region of the throat, neck, and
dewlap, by the soft, doughy character of the swellings without the presence
of gas bubbles, and finally by the characteristic hemorrhages widely
distributed throughout the body. Other means of diagnosis, which have
reference to the specific bacilli, to the inoculable character of the virus
upon small animals, and which are of decisive and final importance, can be
utilized only by the trained bacteriologist and veterinarian.
_Treatment._--In this disease remedies have thus far proved unavailing.
Some writers recommend the use of certain drugs, which seem to have been
beneficial in a few cases, but a thorough trial has shown them to be
valueless. Others advise that the swelling be opened by deep and long
incisions and a strong disinfectant, such as a 5 per cent solution of
carbolic acid, applied to the exposed parts; but this procedure can not be
too strongly condemned. As nearly all those attacked die, in spite of every
kind of treatment, and in view of the fact that when these tumors are
opened the germs of the disease are scattered over the stables or pastures,
thus becoming a source of danger to other cattle, it is obvious that such
measures do more harm than good and should be put aside as dangerous.
Bleeding, nerving, roweling, or setoning have likewise some adherents, but
the evidence indicates that they have neither curative nor preventive value
and therefore should be discarded for the method of vaccination which has
been thoroughly tried and proved to be efficacious.
_Prevention._--The various means suggested under "Anthrax" to prevent the
spread or recurrence of this disease are equally applicable to blackleg,
and hence do not need to be repeated here in full. They consist in the
removal of well animals from the infected pasture to a noninfected field,
the draining of the swampy ground, the burial or burning of the carcasses
to prevent the dissemination of the germs over vast areas through the
agency of dogs, wolves, buzzards, or crows, the disinfection of the stables
and the ground where the animals lay at the time of death, and, if
possible, the destruction of the germs on the infected pastures. One of the
most effective methods for freeing an infected pasture from blackleg is to
allow the grass to grow high, and when sufficiently dry to burn it off. One
burning off is not sufficient to redeem an infected pasture, but the
process should be repeated several years in succession. This method,
however, is in many instances impracticable, as few cattle owners can
afford to do it, and the only means left for the protection of the animals
is vaccination.
_Immunization by vaccination._--Three French veterinarians, Arloing,
Cornevin, and Thomas, were the first to discover that cattle may be
protected against blackleg by inoculation with virulent material obtained
from animals which have died of this disease. Later they devised a method
of inoculation with the attenuated or weakened blackleg spores which
produced immunity from natural or artificial inoculation of virulent
blackleg germs. Their method has undergone various modifications both in
regard to the manufacture of the vaccine and in the mode of its
application. Kitt, a German scientist, modified the method so that but one
inoculation of the vaccine was required instead of two, as was the case
with that made by the French investigators. The vaccine formerly prepared
and distributed by the Bureau of Animal Industry combined the principle of
Arloing, Cornevin, and Thomas, and the modification of Kitt.
By vaccination we understand the injection of a minute amount of
attenuated--that is, artificially weakened--blackleg virus into the system.
This virus is obtained from animals which have died from blackleg, by
securing the affected muscles, cutting them into strips, and drying them in
the air. When they are perfectly dry they are pulverized and mixed with
water to form a paste, smeared in a thin layer on flat dishes, placed in an
oven, and heated for six hours at a temperature close to that of boiling
water. The paste is then transformed into a hard crust, which is pulverized
and sifted and distributed in packages containing either 10 or 25 doses.
This constitutes the vaccine, the strength of which is thoroughly tested on
experiment animals before it is distributed among the cattle owners. This
vaccine, which is in the form of a brownish, dry powder, is mixed with
definite quantities of sterile water, filtered, and by means of a
hypodermic syringe the filtrate injected under the skin in front of the
shoulder of the animal. The inoculation is usually followed by
insignificant symptoms. In a few cases there is a slight rise of
temperature, and by close observation a minute swelling may be noted at the
point of inoculation. The immunity conferred in this way may last for 18
months, but animals vaccinated before they are 6 months old and those in
badly infected districts should be revaccinated before the following
blackleg season.
The effect of the vaccine prepared by this bureau in preventing outbreaks
of the disease and in immediately abating outbreaks already in progress was
highly satisfactory, and it is not to be doubted that thousands of young
cattle were saved to the stock owners during the 25 years in which the
vaccine was distributed.[6] More than 47,000,000 doses were sent out during
this period, and from reports received it is safe to conclude that more
than 40,000,000 were actually injected, whereby the percentage of loss from
blackleg has been reduced from 10 per cent, which annually occurred before
using, to less than one-half of 1 per cent per annum. With these figures
before us it is plain that the general introduction of preventive
vaccination must be of material benefit to the cattle raisers in the
infected districts. Moreover, there is every reason to believe that with
the continued use of blackleg vaccine in all districts where the disease is
known to occur, and an earnest effort on the part of the stock owners to
prevent the reinfection of their pastures by following the directions
given, blackleg may be kept in check and gradually eradicated.
Immunization against blackleg is now frequently accomplished by the use of
the so-called blackleg aggressin and blackleg filtrates.
NECROTIC STOMATITIS (CALF DIPHTHERIA).
[Pl. XLIII.]
Necrotic stomatitis is an acute, specific, highly contagious inflammation
of the mouth occurring in young cattle, and characterized locally by the
formation of ulcers and caseo-necrotic patches and by constitutional
symptoms, chiefly toxic.
This disease has also been termed calf diphtheria, gangrenous stomatitis,
ulcerative stomatitis, malignant stomatitis, tubercular stomatitis, and
diphtheritic patches of the oral mucous membrane.
_History._--During the last few years farmers and cattlemen in this
country, especially in Colorado, Texas, and South Dakota, have increasingly
noted the occurrence of enzootics of "sore mouth" among the young animals
of their herds. Instead of healing, like the usual forms, of themselves,
these cases, if untreated, die. Careful study of some of them has resulted
in their identification with cases reported in 1877 by Dammann, from the
shore of the Baltic; in 1878 by Blazekowic, in Slavonia; in 1879 by
Vollers, in Holstein; in 1880 by Lenglen, in France; in 1881 by
Macgillivray, in England; and in 1884 by Lˆffler, who isolated and
described the microorganism which produces the disease. Bang obtained this
organism from the diphtheritic lesions of calves in 1890, and Kitt likewise
recovered the bacillus from similar lesions of the larynx and pharynx of
calves and pigs in 1893.
[Illustration: PLATE XLII. SECTION OF MUSCLE FROM A BLACKLEG SWELLING.
a. GAS BUBBLES.
b. CAVITIES DUE TO GAS FORMATION.]
[Illustration: PLATE XLIII. NECROTIC STOMATITIS (CALF DIPTHERIA).]
_Etiology._--The cause of necrotic stomatitis, as demonstrated by Lˆffler
and since confirmed by other investigators, is _Bacillus necrophorus_,
often spoken of as the bacillus of necrosis. This organism varies in form
from a coccoid rod to long, wavy filaments, which may reach a length of
100µ; the width varies from 0.75µ to 1µ. Hence it is described as
polymorphic. It does not stain by Gram, but takes the ordinary anilin dyes,
often presenting, especially the longer forms, a beaded appearance. A
characteristic of the organism, of great moment when we come to treatment,
is that it grows only in the absence of oxygen, from which fact it is
described as an obligate anÊrobe.
Very few organisms exhibit a wider range of pathogenesis. According to
clinical observation to the present time, _Bacillus necrophorus_ is
pathogenic for cattle, horses, hogs, sheep, reindeer, kangaroos, antelope,
and rabbits. Experimentally it has been proved pathogenic for rabbits and
white mice. The dog, cat, guinea pig, pigeon, and chicken appear to be
absolutely immune. It is not pathogenic for man.
The importance of this bacillus is far beyond even its relation to necrotic
stomatitis. Besides this disease it has been demonstrated as the causative
factor in foot rot, multiple liver abscesses, disseminated liver necrosis,
embolic necrosis of the lungs, necrosis of the heart, in cattle; gangrenous
pox of the teats, diphtheria of the uterus and vagina, in cows;
diphtheritic inflammation of the small intestine of calves. Among horses it
is the agent in the production of necrotic malanders, quittor, and
diphtheritic inflammation of the large intestine. In hogs it has caused
necrotic or diphtheritic processes in the mucous membrane of the mouth,
necrosis of the anterior wall of the nasal septum, and pulmonary and
intestinal necrosis, accompanying hog cholera. Abscesses of the liver,
gangrenous processes of the lips and nose, and gangrenous affections of the
hoof have all been caused in sheep by this organism.
_Pathology._--The principal lesions in necrotic stomatitis occur in the
mucous membrane of the mouth and pharynx. The alterations may extend to the
nasal cavities, the larynx, the trachea, the lung, the esophagus, the
intestines, and to the hoof. The oral surfaces affected are, in the order
of frequency, tongue, cheeks, hard palate, gums, lips, and pharynx. In the
majority of cases the primary infection seems to occur in the tongue. (Pl.
XLIII.)
Infection takes place by inoculation. Some abrasion or break in the
continuity of the mucous membrane of the mouth occurs. Very likely the
origin may be connected with the eruption of the first teeth after birth,
or, in animals somewhat older, the entrance of a sharp-pointed particle of
feed. Gaining an entrance at this point, the bacilli begin to multiply.
During their development they elaborate a toxin, or poisonous substance,
which causes the death, or necrosis, of the epithelial, or superficial,
layer of the mucous membrane and also of the white blood cells which have
sallied forth through the vessel walls to the defense of the tissues
against the bacillary attack. This destruction of the surface epithelium
seems to be the essential factor in the production of the caseous patch,
often called the false membrane. From the connective-tissue framework below
is poured forth an inflammatory exudate highly albuminous or rich in
fibrin-forming elements. When this exudate and the necrosed cellular
elements come in contact, the latter furnish a fibrin ferment which
transforms the exduate into a fibrinous mass. This process is known as
coagulation necrosis, and the resulting fibroid mass, containing in its
meshes the necrosed and degenerated epithelium and leucocytes, constitutes
the diphtheritic or false membrane. Did the process cease at this point it
would be properly called a diphtheritic inflammation, but it does not. A
caseating ferment is supplied by the bacilli, and this, acting upon the
fibroid patch, transforms it into a dry, finely granular, yellowish mass of
tissue detritus resembling cheese.
Frequently this caseous inflammation results in the formation of one or
more ulcers with thickened, slightly reddened borders, surmounted by
several layers of this necrosed tissue. The floor of the ulcer is formed by
a grayish-yellow, corroded surface, under which the tissue is transformed
into a dry, friable, or firm cheesy mass. In the tongue this may progress
to two fingers' thickness into the muscular portion; in the cheek it may
form an external opening, permitting fluids to escape from the mouth; upon
the palate it frequently reaches and includes the bone in its destructive
course; upon the gums it has produced necrosis of the tooth sockets,
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