Page images

necessity of the removal of the limb; but the patient being at this time in the fourth month of pregnancy, I advised the postponement of the operation till after her confinement. This took place September 19, 1841.

During, and after her pregnancy, the tumour was occasionally painful for a week or a fortnight together, but the pain readily subsided under rest and the application of cold lotions. For six months previous to the performance of the operation, and particularly after weaning her child, the tumour grew more rapidly, and she suffered more pain and inconvenience from it than at any former period.

In April 1842, Dr. Chambers's opinion was taken as to the state of the patient's general health, when he informed her that no disease existed that ought to prevent the performance of the operation. Accordingly, having recruited her health by a residence in the country for a few weeks, and after some little further delay, the operation was performed August 10, 1842, in the presence of Mr. Lane, Mr. Patten, Mr. Ridout, and Mr. Sannemann, who kindly rendered me their assistance.

The circular operation was performed; the stump healed by the first intention; the ligatures came away in about three weeks, and in a month she was perfectly well, and has remained so to the present time.

The circumference of the tumour was found to measure 20^ inches, while that of the limb below does not exceed 12 inches A longitudinal section through the centre of the thigh bone and the tumour, showed a complete identity of structure in this and the tumour of the former case, as well as a remarkable similarity in their position and general outline. The same nodulated appearance on the surface—the same transparent and cartilage-like texture—a similar displacement of the popliteal vessels, are conspicuous in both.

In each, a central cavity existed, but of less relative capacity in the smaller tumour, and the fluid contained in this was not yellow, but colourless, and not more than an ounce or two in quantity. On comparing together casts taken from the two limbs, a great resemblance may be remarked in the form and general appearance of the tumours. In both, the advancement of the growth has been upwards on the thigh, being restrained towards the leg by the insertion of the ham-string muscles—in each the most prominent part of the tumour is inwards, where a longitudinal constriction may be noticed, formed by the sartorius muscle—each presents a remarkable flatness on the outside of the limb, in which situation the tumour has been evidently compressed by the tense and unyielding fascia lata of this part, while in the loose texture of the popliteal space a considerable projection appears. I am happy, in conclusion, to be able to mention the more fortunate coincidence of the recovery of both patients from the operation—their entire freedom from any return of the disease—and their enjoyment at the present moment of perfect health.







READ MARCH 28th, 1843.

Cancrum Oris has been described as a disease, as mild in character as the phagedena of the cheek is severe. 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 foe tor: 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. Marshall 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.

« PreviousContinue »