side of the mouth." He seems distrustful of it however, when the bone is carious. I resolved, notwithstanding, to use the strongest muriatic acid; and shall proceed with Mr. Shaw's daily report, which continues thus:

"8th, four o'clock, P. M., applied undiluted muriatic acid; six o'clock same; seven o'clock same; and continued to apply it every hour till 3 o'clock A. M., next morning; mortification arrested, and reaction established; sensibility in the parts acute. 10th. Same application twice a day; the sensibility of the parts acute. 11th to 19th. Applied tinct. myrrh and alum, appearances very favorable."

Here then, we find undiluted muriatic acid, not only capa ble of arresting mortification of the soft parts within the mouth, but also, that it is equally adequate to the subdual of caries, since we find that on the 9th day, the sphacelation was arrested, both in the bone and soft parts.

A swab was made by rolling and securing with thread, a piece of rag on the end of a stick, which, when charged with the acid, was carried up repeatedly, and brought in contact with every point of the diseased surface. These repeated and fresh applications of acid, appeared to give no uneasiness at first, excepting paroxysms of cough from the passage of muriatic acid gas into the glottis, in inspiration. The acid was, as it were, kneaded into the parts. It presently dissolved or decomposed the sloughs, and came into contact with the living parts, which re-acted healthfully under its enlivening stimulation. It was at this crisis only that the patient began to experience pain, which continued to be more and more acute, under each successive application, until he could no longer bear it; which was the case on the eleventh day, when it was discontinued, and tinct. myrrh with solution of alum, substituted.

When the sphacelation ceased the wound soon put on a healthy appearance, granulated and sccreted healthy pus. The swelling receded from the cheek, and eyelids; and a proportionate amendment occurred in the system at large; the digestion and health improved, and in a short time the patient was able to sit up. The ulcer, however, did not heal until a portion of the dead bone was extracted from the jaw, about the nineteenth or twentieth day; it then soon filled up, and cicatrized. The deformity is but slight.

Case 5. James, son of Mr. C., aged 5 years, was seized with intermittent fever of a quotidian type, in September, 1836. There was nothing in the symptoms to distinguish it from an ordinary endemic intermittent, except that he suffered very much from severe headache, which postponed the time for giving tonics. The treatment consisted of blood letting, three doses of calomel, always speedily worked off by castor oil, and infusion of spigelia by which a few lumbricoides were discharged. A few days after having discontinued our visits, his mother brought him to us, believing he was salivated. Upon examining his mouth, I found the gums sound, with the exception of that around the second molar tooth of the right side of the superior maxillary bone, which was converted into a yellowish white slough, receding from the body and neck of the tooth. The cheek was also affected, lying swollen but not glossy. The mucous surface of the cheek being against the diseased tooth, was somewhat scooped out and sloughy, with elevated, red margins. The tooth was still firm, but caries had nearly destroyed its external lateral surface. It was believed to be a case of incipient canker, or gangrena oris.

The chill and fever still continuing though in a subdued degree, tonics were prescribed, which arrested the paroxysms.

A solution of sulphas cupri and pulv. cinchon., as recommended by Dr. Coates, was applied three times a day, till the sloughy appearance of the part was removed, and the caries of the tooth was arrested, when mild unirritating washes were used to complete the cure.

This case was taken in time. The disease had not extended to the periostium, and the tooth remained firm It differed however from other cases, in which the teeth were not affected, excepting in their invest membrane. They became loose, and were extracted or fell out.

As already intimated I have never seen a case of gangræna oris, in any form, without its having been preceded by some serious constitutional derangement. Thus, at one time we find it engrafted upon bilious remittent or intermittent fever; at another, on fever with visceral inflammation; at another on measles, or scarlatina. I lost two children of this disease in 1823. The local affection occurred in each, in the first week of the fever, which was a bilious remittent. It may, however, occur in the wane of the disease, or when the system is verging towards collapse, or as a sequela.

The treatment of these cases must have regard, first, to the pathological state of the system at large; and, secondly, to the local affection. The latter is the result of constitutional derangement of a febrile kind: it was especially so in the first reported case. The sloughing could not be arrested until the fever was conquered. Therefore, the removal of the fever, or correcting the general constitutional derangement, is of the first importance; and indeed, an essential preliminary step towards arresting the local disease, in its first stage. The local disease on its appearance cannot modify our prescriptions, or afford contra-indications in regard to the employment of general remedies. Besides the general means

instanced above, local measures are of equal, and in some cases of paramount importance. The best we have used to stop the sloughing in its incipient stage, is a saturated solution of sulphas cupri, with which the part is to be touched three or four times in the twenty-four hours, until the sloughing is arrested.

If these means do not effect that object, and especially if the mortification have made much progress, having extended to the cheek, which is occupied by a deep, dark slough; and to the bone, which becomes carious, no remedy has, I believe, stronger claims, to our confidende, than undiluted muriatic acid. It is vain to expect an arrestation of gangrene, by the employment of general remedies at such a crisis, however valuable they may be as adjuvants. Nothing short of the ap plication of a strong local stimulant, such as is capable of making a vigorous change in the organic actions of the part, producing a lively reaction, and at once elevating the parts to a grade of excitement incompatible with the sloughing process, can avail in such a case.

October, 1838.

ART. IV.-A Case resembling Fungus Hæmatodes successfully treated. Reported to the Medical Society of Tennessee. By SAMUEL HENDERSON, M. D.

THE following case of Fungus Hæmatodes occurred in the subject of a lady, Mrs. L., ninety-two or three years of age, of full habit, and tolerable health.

Oct. 14th, 1838. I was called to see the patient, who about one year previously discovered a projection from the centre

of the forehead, covered with a hard horny scab, which, when removed, left a small fleshy tumor, of a soft, spongy, elastic feel, moveable not discolored, and but slightly painful. Gradually enlarging in size, the old lady become very uneasy. At the time I saw her the tumor had grown to the size of a dollar in diameter, and projecting irregularly half an inch above the surrounding integuments with small openings or fissures over its exterior portion, having the appearance of rough contused, or lacerated edges, of a dark red color yielding to pressure, but soon resuming its former state, and discharging a thin, bloody or ichorous humor, extremely offensive. It had occasionally stinging or darting pains as she described them. Upon examination, we advised extirpation of the tumor, to which she strongly objected. We then applied mild dressings, and pressure by means of a bandage. Afterwards we used escharotics and caustics, which retarded its growth for a time; but when they were omitted, it spouted out like a mushroom. From the extreme uneasiness of the patient, and her great aversion to extirpation, I determined on trying to destroy the substance by some arsenical preparation, with which view its surface was slightly and frequently touched with Fowler's solution. In a few days, the part turned dark, became gangrenous, and sloughed down to the periostium; and by means of mild dressings, and adhesive plasters, the ulcer healed kindly, leaving no trace of disease, except a small ulcer on the nose of the same nature, and two or three small prominences on the face having the appearance of the former.

Will the writer favor the profession with the result of this case? Did the new tumors grow to any thing serious?-Eds.