P. Hennis Green
1839 The Lancet  
507 to its consideration with caution and deli. beration. He states his cases while the disease is progressing, the powers as yet little impaired, and the condition unbroken ; and to him it does seem we are indebted, not only for what we know of real utility and benefit, as regards this particular operation, but also for opening to us a new era in the surgery of the abdomen. I am, Sir, your obedient servant, JOHN GORHAM. (Continued from page 409.) CASE IX.-Francis Louis Janiver, ten years of
more » ... er, ten years of age, was admitted into the chronic wards on the 10th of June, 1833, with lichen agrius. On the 29th of December he was brought down to the acute wards, labouring under gangrene of the mouth. The left check was swollen, hard, shining, and of a pale colour; a gangrenous spot occupied the tissue of the gums on this side, and a portion of the mucous membrane of the cheek. The pulse was small, but not very frequent ; the child was strong; no diarrhoea.; a quantity of bloody sputa flowed from the mouth. The gangrenous parts were touched with the acid nitrate of mercury, and then with a strong solution of chloride of lime. The mouth was frequently washed out with a mixture of bark and borax. Jan. 1. The tumefaction of the cheek has not made any progress; the child merely complains of a slight degree of uneasiness, but not of pain. The amygdala on the left side of the mouth is much swollen. The gangrenous spots are looking favourably. 2. Left cheek in the same state as yesterday, although he complains more of pain. There is now a superficial greyish eschar, extending along the inner side of the right cheek, on a level with the teeth, to nearly the angle of the month; no difficulty in swallowing; no diarrhoea, or vomiting, or nausea; skin cold ; pulse 96; respiration natural; no abnormal sound of the chest or rale; left tonsil is still swollen. Continue former remedies. Soup. 4. Left cheek more tumid than the right one ; but the colour of both is natural ; on examining the inside of the mouth there are found some greyish spots mixed with gangrenous detritus along the cheeks, and near the amygdalas ; in the intervals the mucous membrane is of a deep red colour. Three molar teeth on the left side are ready to fall out, and the gums here are converted into a gangrenous mass. The breath is extremely foetid. Nevertheless the general state of the patient is favourable ; he walks about in the wards ; skin cool; pulse natural ; no diarrhoea. or vomiting; abdomen free from pain. Milk and Soup for diet. Continue medicines. 5. An oval-shaped eschar, not very deep, runs along the right cheek, on a level with the upper alveoli; it is about three-quarters of an inch in length, and a quarter across. The other gangrenous points are separating. M. Baudelocque recommended the boy to take as much exercise as he could in the wards; and ordered that the eschar be touched frequently with the acid nitrate of mercury. 7. The oval gangrenous spot on the right side is now completely destroyed ; the mucous membrane, which it occupied, is very red and tumefied ; on the left side there is still a small superficial gangrenous spot near the angle of the mouth. The breath is now barely foetid. No heat of skin, or acceleration of pulse; appetite good ; no pain in the abdomen ; no diarrhoea. In a few days this spot also healed under the use of bark gargles, and the child perfectly recovered. SCARLATINA.-ANASARCA,-GANGRENE OF THE MOUTH. CASE. X.-Schiller -, 10 years of age, admitted on the 23rd of July, 1833. This child is thin, pale, and sickly-looking ; eyes and hair dark. He is addicted to the vice of onanism, and has had diarrhoea for the last two years. For the last few days he was lame, and complained of pain in the left hip; the left leg is evidently longer than the right one. Has had the scarlatina a month ago. The stools and urine are passed involuntarily-As the diarrhoea, for which he was admitted, continued, he was ordered subnitrate of bismuth 8 grains, gum-arabic 8 grains. On the 27th and the 28th the diarrhoea was unabated, and the stools were passed involuntarily. On the 30th the dose of bismuth was augmented to 12 grains. 31. Persistance of the diarrhoea, without any general symptoms; no fever or acceleration of the pulse; no pain in the abdomen ; no thirst, nausea, or vomiting. Bismuth 16 grains. On the 3rd of August the diarrhoea was much diminished, and the power of retaining the evacuations recovered. The dose of subnitrate of bismuth carried to one scruple, acd on the 5th to 30 grains in the day. The lameness and pain in the hip had now disappeared. 2L2
doi:10.1016/s0140-6736(02)99766-7 fatcat:uq2bib7lp5ajhg3vhhurtdon4u