REMARKS

ON

CANCRUM ORIS,

AND

THE GANGRENOUS EROSION OF THE CHEEK OF MR. DEASE AND DR. UNDERWOOD,

AND MORE PARTICULARLY ON

THE EFFICACY OF THE CHLORATE OF POTASH, IN THE TREATMENT OF THOSE DISEASES.

BY HENRY HUNT, M.D.

READ MARCH 28TH, 1843.

severe.

CANCRUM ORIS has been described as a disease, as mild in character as the phagedæna of the cheek is When, however, the former has been neglected, it frequently becomes so similar to the latter, both in appearance and in the extent of its ravages, that they have appeared to me to be one and the same disease, only differing in the degree of severity, but depending on the same morbid condition of the body. To prevent my being misunderstood as to the disease over which I have found this remedy to possess such power, I will briefly describe it.

It commences by small ulcers, either on the inside of the cheek, or at the point of junction of the mucous membrane of the cheek and gums, or in

the gums themselves, separating them from the teeth: they are very tender and painful, and attended with profuse salivation; the breath soon becomes tainted with an offensive smell, not unlike the mercurial fœtor: if the disease is neglected, the ulceration goes on to destroy the gums, the teeth loosen and fall out, the alveoli are laid bare; at the same time the brown ragged ulcer spreads rapidly on the inside of the cheek, the integuments over the spot corresponding to the ulcer become hard, swollen, at first white and afterwards of a dull red colour, and shortly a black spot appears in the centre, which quickly spreads and destroys more or less of the cheek; and if the child survive, it is sadly disfigured, and not unfrequently loses the power of opening its mouth, from the unyielding nature of the cicatrix; but more commonly, if the disease has extended its ravages to this extent, it sinks and dies.

In all cases that have fallen under my observation, it has been quite clear that the mortification of the integuments has succeeded to the ulceration of the internal parts; for when my attention has been called to the hard, swollen, and painful state of the cheek, as if that were the only disease, I have invariably found, on examination, the brown ragged ulcer on the inside ;-the contrary, however, appears to be the case in the account given of it by Mr. James, in his work on inflammation, for he writes, "that the ulceration of the gums succeeds the swelling and hardness of the cheek," and Dr. Mar

shall Hall's description, in the Edinburgh Medical and Surgical Journal, agrees with that of Mr. James; for he states, "that children are liable to a particular affection of the face, which begins with pain, hardness, swelling, and slight erythematous redness, and terminates in the formation of a spreading eschar and ulcer." Whatever difference there may be in the commencement of these diseases, in their advanced and aggravated state they become so similar that it would be difficult, if not impossible, to determine in which of the two ways each individual case had begun. It has been remarked, that these diseases most often occur in winter, and this coincides with what I have seen of them, but I have noticed that they are more frequent at the commencement of the cold weather, particularly when it is both wet and cold: although this may be the general rule, it is not uncommon to meet with cases at all seasons, and the fatal one which will be detailed, occurred in August, during very fine weather.

It has been remarked to me by an old and very experienced physician who first directed my attention particularly to Cancrum Oris, that he had known it occasionally attack several children in the same family almost simultaneously; and once or twice during a practice of forty years, cases of it were so prevalent in the town in which he practised, that it appeared something like an epidemic; this, however, never occurred during the sixteen years that I lived and practised there.

The general appearance of the children afflicted with these diseases was extremely unhealthy, they were pale and cold, their flesh flabby and soft, and the secretions very offensive and unnatural. Before giving the chlorate of potash, when it has been possible to induce the child to swallow an aperient, I have given in the first place a dose of rhubarb and sulphate of potash with a grain of calomel; but generally the pain and tenderness of the mouth has been so great that it has not been feasible. I have therefore given the chlorate at once, and have waited a day or two, until the mouth has become less tender, and then have ordered the aperient.

The quantity of the salt that I have been in the habit of prescribing varies from twenty to sixty grains, according to the age of the child, in divided doses in twenty-four hours, dissolved in water; the beneficial effect is often observed on the following day, almost always on the second; the disagreeable fœtor soon lessens, the sores put on a healthy reparative action, the dribbling of saliva diminishes, and if there is mere ulceration it very speedily heals, if there is an eschar, it soon separates, and the sore granulates kindly. In no other disease did I ever see the beneficial effects of any medicine so soon manifested, as that of the chlorate of potash in these diseases. It is sometimes advisable, indeed necessary, that the aperient should be occasionally repeated.

CASE I.

Hutchins, ætat. 3, was brought to me, having a sore mouth, he was pale and haggard, flesh soft and flabby, the surface of the body was cold, pulse quick and weak, and he appeared to suffer much in his mouth, the saliva continually dribbled away, and the breath very offensive, so like the mercurial odour that I attributed the state of his mouth to the effect of calomel. With some difficulty I was enabled to examine his mouth, the gums were in a state of ulceration, particularly on the right side, and there was a brown ragged ulcer in the inside of the cheek; on the outside, corresponding to it, there existed a hard painful swelling, with a slight blush of inflammation on it, the tongue as well as I could see it was sodden, and swelled, and indented at its edges by the teeth;-the belly was large, and the alvine evacuations very offensive, and the food passed but little digested; the child had been pale and ailing for some time, but the state of the mouth had only been observed three or four days, and was getting rapidly worse. I prescribed the following mixture: R. Potassæ chloratis 3fs syr. simplicis 3j aquæ 3xi misce. :-a tea spoonful to be taken every hour, or oftener if possible. On the following day the smell of the breath was much less disagreeable, the salivation considerably lessened. On the succeeding day the ulceration of the gums was evidently checked, and the tenderness had much diminished,