Report of Three Cases of 
Xerostomia, or Dry Mouth. 
BY 
WALTER F. CHAPPELL, 
M.D., M.R.C.S."Eng; 
REPRINTED FROM THE 
Neta York fBelucal 
for February 89,1896. Reprinted from the New York Medical Journal 
for February 29, 1896. 
REPORT OF THREE CASES OF 
XEROSTOMIA, OR DRY MOUTH. 
By WALTER F. CHAPPELL, M. D., M. R. C. S. Eng. 
The writer's case of xerostomia was shown before the 
Laryngological Section of the Academy of Medicine in 
May, 1895; for the histories of the other cases he is in- 
debted to Dr. Beverley Robinson and Dr. Charles II. Rich- 
ardson of this city. An anonymous communication in the 
Medical Tinies and Gazette of November 21, 1868, gave the 
first history and symptoms of an affection which was sub- 
sequently called xerostomia by Hutchinson and Hadden, 
mouth dryness being about the only symptom in the first 
cases which came under their observation. Since then 
some twenty-three cases have been reported. Many of 
these have exhibited symptoms and trophic changes point- 
ing to the central origin of the disease. Dr. Frazer, in the 
Edinburgh Hospital Reports, volume i, collected nineteen 
cases; thirteen of the patients had dryness of the mouth, 
three had dryness of the mouth and nose, one had dryness 
of the mouth and eyes, and two had dryness of the mouth, 
nose, and eyes. The teeth were absent in five of these 
cases, and their disappearance dated from about the time 
of the first symptoms of mouth dryness. In one case the 
Copyright, 1896, by D. Appleton and Company. 2 
XEROSTOMIA, OR DRY MOUTH. 
teeth were well preserved. No note was made concerning 
the teeth in the remaining cases. 
The history of the writer's case is of special interest, 
inasmuch as the different symptoms and changes reported 
in the various cases were all exhibited in one patient. Fur- 
hermore, the nature of the death is an added proof of the 
central origin of the affection. 
Mary K., aged forty-six, native of Denmark, came to the 
throat department of the Manhattan Eye, Ear, and Throat 
Hospital on the 14th of May, 1894, complaining of dryness of 
the eyes, nasal fossae, mouth, larynx, and trachea. Her family 
history was clear with the exception of that of her mother, 
who had suffered all her life with epileptic attacks, which 
occurred three or four times a year. Personal history was 
free from any known rheumatic or specific affection. She 
married at twenty-two, but had no children, and enjoyed per- 
fect health until five years ago, when she began to have dry 
sensations in the eyes and nose which obliged her to rub the 
parts considerably at times. The attacks were much intensi- 
fied during the menstrual period, and markedly lessened be- 
tween the periods ; so much was this apparent that about the 
middle of the month the dryness lessened to such a degree 
that it caused little discomfort. As time progressed the dry- 
ness increased and extended to the mouth, tongue, pharynx, 
and larynx, and about the same time she noticed she had to 
urinate more frequently than usual. About four years after 
the onset of the mouth dryness the parotid glands began to 
swell; at first they were not tender, but a little later they 
would suddenly enlarge at times and become tender, and after 
two or three days gradually subside. 
Condition on Visiting the Hospital. - General condition 
good, but she seemed nervous, talking fast and expressing 
herself in exaggerated terms, crying very readily, and alto- 
gether seemed in a condition bordering on hysteria. The 
dryness of the eyes, nasal fossae, tongue, mouth, larynx, and 
trachea was complete and continuous, although the menstrual XEROSTOMIA, OR DRY MOUTH. 
3 
period had ceased for two years. The dryness of the eyes 
was so intense that the rubbing necessary to produce relief 
caused the conjunctivas to become very red. The nasal fossae 
were clear. Mucous membrane of the saeptum and turbinals 
was pale, atrophied, and dry. The tongue was very red, and 
the buccal mucous membrane somewhat pale and dry and 
sprinkled with small portions of food which adhered to the 
surface and caused constant desire to drink and clean the 
mouth. All her teeth decayed and crumbled so much that 
they had to be removed about a year after the first symptoms 
of mouth dryness. She also complained of a troublesome dry 
cough which nothing but oily sprays could relieve. The epi- 
glottis looked pale and anaemic, and the arytaanoids very red 
and somewhat swollen. 
A small white patch at the lower part of the interarytae- 
noid space was thought to be adherent mucus, but proved to 
be a small superficial ulcer, which was accompanied by an- 
other, a short distance below, on the posterior wall of the 
trachea. The walls of the trachea were red and dry in 
appearance. 
Both parotids were much enlarged, especially the right, 
and seemingly consisted of three or four nodular masses, 
which were hard and non-sensitive and resembled those of a 
patient with severe mumps. Submaxillary glands were also 
enlarged, and the lowest of the posterior chain of cervical 
glands. Stenson's duct was patent. 
The bladder symptoms had gradually increased, and when 
she visited the hospital she had a constant desire to urinate. 
Constipation was extreme. The temperature was taken at 
her first visit and registered 100° F., and at frequent subse- 
quent intervals it was never found to be less than 99° F. in 
the mouth. Mastication or the application or administration 
of different medicines never started any appreciable secretion 
in the mouth. Taste was considerably impaired, and only 
some of the most pungent solutions were immediately de- 
tected. The nasal mucous membrane and the conjunctivae 
were also particularly non-sensitive, as ammonia, oil of mus- 
tard, and such remedies produced little reaction. 4 
XEROSTOMIA, OR DRY MOUTH. 
The treatment of the case during the three months she 
visited the hospital consisted in the use of general nerve 
tonics, iodide of potassium, pilocarpine-in fact, everything 
was done that it was thought might relieve the extreme dry- 
ness. The laryngeal and tracheal ulcers healed under appli- 
cations of nitrate of silver. She ceased visiting the hospital 
early in August, 1894. 
Her next visit was on February 4, 1895, and was the re- 
sult of a communication I had sent her. She gave the follow- 
ing history: A few days after her last visit to the hospital 
she called at the house of a friend who had just died, and 
while there she became quite excited and suddenly lost the 
use of the left arm and leg. She did not completely lose con- 
sciousness, but for a few moments was unable to speak. For 
a time she was confined to her bed, but improvement gradu- 
ally set in and she now has some power in her hand and arm, 
and also became able to walk with assistance. Iler body was 
well nourished, but her will power was evidently much weak- 
ened and she wept constantly. The parotid glands had in- 
creased considerably in size, but the dryness of the upper 
respiratory tract was not so great. Two weeks after her 
appearance at the Academy of Medicine she became very 
drowsy, and could only be aroused sufficiently to take nour- 
ishment. Eventually she became completely paralyzed on 
both sides, and died four weeks after I had shown her before 
the section of the academy. I regret to say a post-mortem 
was not allowed. 
Case II (reported by Dr. Beverley Robinson).-On Novem- 
ber 20, 1894, Mrs. X. called upon me professionally, sent by 
Dr. Demorest, of Passaic, N. J. She complains of an almost 
constant pain in the roof of her mouth. This pain has lasted 
several years and came on soon after a severe attack of 
grippe. Many medicines and washes have been tried with- 
out notable good effect. It has been considered to be a 
local manifestation of gout. This opinion was regarded as 
doubtful by other competent clinicians. Unquestionably she 
has other manifestations of gout-i. e., enlarged and painful 
joints, particularly those of her fingers, and these joints have XEROSTOMIA, OR DRY MOUTH. 
5 
been made less painful by reason of antarthritic remedies. 
Patient has always been of spare habit, but remarkably active. 
She suffers from occasional pain in her temples and eyes. No 
organic disease has ever been discovered. 
Repeated examinations of the urine have shown it to be 
normal. She raises occasionally a little thick phlegm which 
looks like boiled starch. The principal pain at the roof of 
the mouth is to one side of the median line. The gums are 
swollen. Patient is obliged to put a piece of brown paper 
against the painful region at bedtime to prevent contact 
with the tongue. She takes water frequently at night to re- 
lieve the buccal dryness. Formerly she was relieved a short 
while by mastication of food. Now, as soon as she stops eat- 
ing, pain returns. Anything held in the mouth that excites 
salivation relieves her. She chews gum mainly because it is 
softer than most other useful substances. Patient has a float- 
ing kidney on the right side. 
I gave the patient a solution of chlorate of potassium in- 
ternally, hoping in this way to awaken the secretion of the 
salivary glands, and also prescribed tablets of tincture of 
strophanthus with the idea of strengthening her heart action. 
She returned in four days and told me that the potassium 
apparently increased the buccal pain. I repeated the chlo- 
rate-of-potassium solution, however, but advised her to take 
it in very small doses, well diluted. The strophanthus tablets 
were also continued. Patient was advised to hold wine of 
coca in the mouth to see if any lessening of the pain could be 
obtained. It remained without effect. 
November 28th.-Urine again examined. No sugar; no al- 
bumin. Passes rather more than a quart in twenty-four 
hours; quantity variable, especially when feeling badly. Has 
headaches every three days. Patient believes them to be of 
rheumatic origin. Suffers at night from distention of stom- 
ach and bowels with gas. This distention is relieved with 
camphor internally. 
December 5th.-Mouth dryness almost intolerable at times ; 
has been worse since she took chlorate of potassium and 
strophanthus. Has taken cod-livei* oil lately after meals, 6 
XEROSTOMIA, OR DRY MOUTH. 
which improved her general condition and relieved her head- 
aches. Mouth dryness and pain, however, are as had as ever. 
Patient took colchicine and salicylate of sodium during three 
months without doing her mouth any good; was of evident 
service so far as joints were concerned. The use of olive oil, 
three parts, and oil of Wintergreen, one part, locally applied 
to the mouth gives slight temporary relief. Has had stomach 
lavage. This appeared to relieve her headaches, but did not 
affect the pain in the mouth, jaw, or tongue, where it now is. 
20th.-Patient took a little brandy and water the other 
day and her mouth has been more painful ever since. Thinks 
the bad condition of her stomach caused it. I tried her with 
frequent doses of calomel, soda, ipecac, and bismuth, but with 
no result. 
In reply to a note from me the patient writes from Mor- 
ristown, N. J., that she has been under Dr. Barker's care 
since she last saw me, but there has been no improvement; in 
fact, she says, "I fear it grows slowly worse." 
Case III (reported by Dr. Richardson).-Miss X., aged 
sixty, applied to me for treatment of her condition in January, 
1893. 
The following history was given : Several years previously 
the patient had sustained a severe nervous shock. A sister 
had been stricken with a fatal apoplexy in her presence. 
For the four succeeding years Miss X. was an invalid and 
under medical care for nervous prostration. She suffered 
much from headache and insomnia and had attacks of inter- 
mittent deafness. She acquired the habit of taking camphor, 
eight to ten drops of the tincture several times daily. About 
the fall of 1890 the teeth began to crumble and decay, neces- 
sitating tie extraction of n jarly all. At this time also was 
the dryness of the mouth first noticed. She could no longer 
moisten a postage stamp sufficiently to make it stick. 
When she came under my observation she was markedly 
neurasthenic. The mouth was dry. The mucous membrane 
was rather pale. She swallowed dry food with extreme diffi- 
culty and used frequent draughts of water to facilitate deglu- 
tition. There was no change apparent, either to sight or XEROSTOMIA, OR DRY MOUTH. 
7 
feeling, in the salivary glands. She passed a large amount of 
pale urine of low specific gravity, 1'004 to 1'006, without casts. 
Neither galvanism nor faradaism of the glands produced any 
appreciable result. 
Pilocarpine in small, repeated doses, a fifteenth to a tenth 
of a grain every two to three hours, produced a fair amount 
of moisture in the mouth. 
She has been kept on general tonic treatment for the past 
theee years, and while her general health has improved the 
dryness of the mouth remains the same. 
In order to have some standard by which I might roughly 
determine the amount of moisture present in the mouth, I 
devised a test paper as follows: Some ordinary blue litmus 
paper was rubbed over with finely powdered and absolutely 
dry tartaric acid. This produced no change in the color of 
the paper, but when applied to the moist normal tongue it 
instantly became of the characteristic red. In the case which 
forms the basis of this report this test paper applied to the 
dorsum of the tongue required forty seconds' application be- 
fore the characteristic change was developed. On the floor 
of the mouth, by the orifice of Wharton's duct, where in the 
normal mouth there is usually a little lake of saliva, thirty 
seconds were required to change the color. The New York Medical Journal. 
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