Totals

5873 5022 340 217 557 2590 1292 1087 493

184 321 1005 963 740 589 475 358 192 44 5 10895

Percentages to totals 53.91 46.09 3.12 1.99 5.11 25.05 12.49 10.51 4.77 1.77 3.10 9.72 9.31 7.15 5.69 4.59 3.46 1.85 0.42.0004

SUMMARY OF THE TRANSACTIONS

OF THE

COLLEGE OF PHYSICIANS OF PHILADELPHIA.

FROM MARCH 3, TO MAY 5, 1858, INCLUSIVE.

1858, March 3d. Gangrena Oris.-Dr. CORSE read the following note of a case of gangrena oris, and exhibited the patient in a convalescent condition. A little mulatto girl, about 9 or 10 years of age, was, without any known exciting cause, taken with inflammation in the left cheek, which gave but little suffering to her, and no uneasiness to the parents. The inside of the cheek had at one point the appearance of what is usually termed, among the nonprofessional, a canker sore. It was permitted to run on for some days, perhaps as many as eight or ten (the precise time not being remembered), when the cheek began to swell, and presented a reddish appearance externally.

About this time, a small sore spot attracted her attention in the right cheek, very similar to the one which first appeared in the left, and near about the same point, opposite the first molar tooth. The parents now began to be uneasy, and sent for a homoeopathist. On examining the case, he ordered her the lowest diet, and placed her under a course of treatment internally, assuring them it was but a small matter, and easily cured. This treatment not having the promised effect, a poultice of some ordinary kind, probably flaxseed, or bread and milk, was locally applied. The child grew worse rapidly, and an irritative fever, which had set up early, became a prominent symptom; the patient got no rest, and delirium now began to manifest itself. These symptoms went on increasing, the family became dissatisfied, and a consultation was held with one of the same class of practitioners. No benefit having been obtained, a second consultation with two homoeopathists, and at last a third consultation with three, were attended with a like result. They continued the treatment of low diet, with granules, etc., and poultices to the cheeks. She grew constantly worse, and the parents determined to get a regular physician to see the child, and sent for me. I found the patient sitting up in bed, moaning, with a pulse of 140 to 160 per minute, a poultice to each cheek, and the room filled with a most intolerable fetor.

On removing the poultices, I found both cheeks in a gangrenous state; in some places there was the red line of demarcation drawn, at others the disease was still spreading.

On learning the previous diet, I immediately ordered a few stewed oysters

VOL. III.-NEW SERIES.

16

NO. V.

to be given, and a teaspoonful of brandy in a wineglass of milk, to be followed by beef tea. The bowels being costive, I ordered a gentle laxative.

In two hours I returned, and having found the pulse 135 to 145 and stronger, I began to remove the gangrenous portions by dissection. This proceeding was, of course, astonishing to the family, but having given up all hopes of saving the child, they were desirous to have anything done which would benefit. After removing the dead fragments, as far as prudence would permit, I applied solid argent. nitras. to the whole gangrenous surface, where the disease was extending.

The red surfaces, where the slough had separated, were then dressed with cerate, and a pledget of lint saturated with dilute chlorinated soda, was placed in each excavation.

Next morning I learned that the patient had had several tranquil naps, but the destruction was not yet done. The right cheek, which was last taken, was the worst; the inflammation had extended down below the lower jaw, and up to the right eyelid, and the right eye was nearly closed. I made another dissection of the dead tissues from each cheek; the whole rows of teeth above and below were exposed to view, and part of the right malar bone also; the parotid ducts were pouring out their contents externally on each side. By repeated dissections, and vigorous application of the argent. nit., the progress of the disease was at last stopped. My difficulties were somewhat increased by the springing of the facial arteries, which took place during a violent fit of crying, while I was applying the argent. nit.; the blood welled out strongly at first, but was stopped by pressure and styptics.

Having succeeded in changing the gangrenous inflammation into a healthy one, I had only a large sore, and a greatly debilitated condition to treat; these, after a prolonged treatment of tonics and good diet, terminated the case in recovery; with large cicatrices, and some deformity from loss of parts, but with perfect cheeks and a very good mouth.

Abscess contained in an Aneurismal Sac.-Dr. WOOD stated that, during the last winter, a case had occurred to him which he thought of sufficient interest to be communicated to the college. A middle aged man entered the Pennsylvania Hospital, with symptoms which indicated phthisis; namely, cough, purulent expectoration, progressive emaciation, frequent pulse, night sweats, &c. No decided evidences, however, of a cavity could be detected. There was slight dulness on percussion beneath the inner extremity of the left clavicle; and on both sides a strong bronchial sound could be heard in respiration. Dr. Wood was under the impression that subcrepitant rales were audible here and there over the chest; but, as he reported the case from memory, he could not be certain on that point. He had no doubt of the existence of tubercles; but there was one peculiarity about the case which distinguished it from others of this kind. The bronchial sound above referred to gave the idea that it came from a particular point of the trachea; being