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be thrown for a moment ofl’ his guard, andaccidentaDy let out his real opinion of thecase, as when Mr. COCK termed the death inthe present case A WARNING which wouldprevent such a "mistake from again occur-ring in that hospital;" but such lapses of thetruth are not obtainable from more perfectlycunning and less candid witnesses, and in-quiries into matters of life and death shouldnot be perilIed on such uncertain confes-sions. As to the promise of Mr. Cock thatsuch deaths shall not again occur in Guy’sHospital, the public have not the slightestguarantee that what has been continuallyhappening in these hospitals, under the

existing system of management, shall notbe repeated there twenty times within thenext six months, especially while Mr. Paynedepends, in them, on such a constable asMr. BROWELL for his notices of deaths.

GANGRENE OF THE MOUTH

SUCCESSFULLY TREATED

BY THE ACTUAL CAUTERY.

By HENRY OBRE, Esq.,House Surgeon to the Marylebone Infirmary.

March 18.-Charles Harris, aged nine

years, living in a damp, unhealthy atmo-sphere, was attacked a few days since withfever, which quickly terminated in typhus.He was in a low insensible state fur twoor three days, requiring wine and stimu.lants to recover him. When sufficientlyrecovered to sit up in bed, on the 25th, anulceration was perceived on the externaland back part of the gum of the left uppermaxilla, having an ash colour. This hadincreased to such an extent, before beingdiscovered, that the two first molar teethwere loose, and soon fell out; the fauceswere covered with aptbae, the tongue andother parts of the mouth remaining per-fectly natural. The ulcerated surface wastouched with muriatic acid, mixed withhoney; and he continued the use of qui-nine and red wine, which he has beentaking since.

26. The ulceration has passed to the mu-cous membrane of the cheek, which ishard, swollen, and has a glazed appearanceexternally, except in one point in the

centre, which feels soft, as if the diseasehad nearly passed through ; pulse small ;no diarrhoea, perspiration, or any symptomof debility. Nitric acid was applied to theulcerated surface, the mouth cleansed witha gargle of bark and alum, and a blistetapplied to the back of the neck.

29. The gangrene has passed through the

cheek to. day; its size is about that of ahalf-crown ; it presents a dark colour, andgangrenous foetor ; the hands require to berestrained to prevent his disturbing a poul-tice of yeast which has been applied ; theulcer to be washed with a solution ofchloride of soda ; he sits up in bed, andeats mutton-chops, indeed any thing he canget, his appetite being seldom satisfied.

30. The disease has increased in extent,nearly joining the commisure of the mouthin front, and passing back to within aninch of the tragns. The parents havingconsented, the actual cautery was appliedto the diseased surface, on the externalparts, with little uneasiness to the child.From this time, until the 4th of April, thedisease was perfectly arrested, when it be-

gan to increase under the integument. Theedges of the sore were irregular and

everted, the internal parts of the mouthquite exposed from the wound, and alsothe superior maxilla as high as the zygoma.Being afraid that the lower eyelid wouldbe destroyed, as the disease was extendingin that direction, the cautery was repeatedwith the same success as previously. Char-coal was ordered to be sprinkled on thepoultice, the smell of the chlorine beingunpleasant.

8. The greater part of the slough pro-duced by the last application is comingaway ; granulations on many parts are

making their appearance ; perspirationshave come on this last day or two ; in otherrespects he is improving, eats, sleeps anddrinks well. Another of the double teethon the diseased side has fallen out.Those parts not showing a disposition to

heal, on the 10th were touched with nitro-muriatic acid. The perspirations have lefthim ; had an attack of diarrhoea this morn-ing, for which he was ordered aromaticconfection. The boy is up and walkingabout the room ; continues the use of wine,meat, &c. From this time the wound

gradually improved, and he attended at theinfirmary two or three times a-week ; theface being perfectly healed, excepting a

small part the size of a pea. He is unableto open the mouth to a greater extent thanhalf an inch, in consequence of an adhesionof the cheek near the mouth to the gumson the diseased side, which can easily beremoved by the division of the adhesion.The face is not disfigured to the extent thatwould have been supposed.On the 2nd of January, 1840, Margaret

Dagnell, aged three years, became my pa-tient, when the following history was elicitedfrom her parents, who are labouring people :- Previous to the present illness the childwas never seriously indisposed, alwaysresided in a confined neighbourhood, eitherin London or Manchester, her diet beingchiefly vegetable; she seldom took animal

’ food, in consequence of their poverty. About

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a month since, an epidemic of measles pre-vailing, she was attacked slightly, being illonly a few days. While convalescent, somesmall spots or ulcerations were observed onthe inner surface of the lower lip and gums,for which the child was taken to-a druggist,who ordered a bitter mixture; no other medi-cine being given. The ulceration now ra-

pidly increased, and destroyed part of the- lower lips and gum, loosening the lowerteeth, all of which fell out in a few days,except the first molar on each side.The child lays on the back, appearing to

suffer little or no pain ; the lower part ofthe face has a frightful aspect, the coveringof the lower jaw anterior to the insertion ofthe masseter is quite denuded, except anarrow communication joining the angles ofthe mouth; the exposed bone beginning todecay ; the integument surrounding the dis-ease is pale, tumid, and hardened; foetormost unpleasant; pulse, 108; tongue coveredwith a brown fur ; the hands are continuallythrown about, and attempts made to pickher face ; wine and quinine were given inter-nally ; warm applications to the face.

3. The gangrene much increased, has

destroyed the communication between the

angles of the mouth, and separated the baseof the tongue from the bone, passing downnearly to the os hyoides, exposing the sub-maxillary gland, which is but little affected.The actual cautery was applied all over thediseased surface on the external parts, whichseemed not to be perceived by the child ;chlorine cloths were applied, and the mouthwashed with a gargle of bark. A quantityof sanious fluid flowed through the wound.

4. The gangrene has not extended exter-

nally, where the cautery has been applied ;not so inside the mouth, which has beentouched with nitric acid to-day ; the child isfed with fluids, the head being held back toprevent their flowing out through the chasm.The child remained in this state until the 6th,when it died, exhausted by diarrhoea ; thetoes of the left foot, for a day or two beforedeath, were cold and blue ; flannel was keptapplied to them ; the teeth and gums of theupper jaw remain perfect.

Remarks.—The cases which I have re-

lated above, demonstrate the very great efti-cacy of the actual cautery in extensive de-struction of the face from gaingreda oris. Iwas induced to employ the actual cauteryon the recommendation of Dr. P. HennihGreen, who informed me that he consideredit to be the only remedy which afforded anychance of arresting the gangrenous destruction of the soft parts, after perforation of th{cheek. In the first case a complete cure wa!obtained ; in the second the child died, butthe cautery completely arrested mortificatiorat the parts to which it was applied, ancwould, probably, have been attended wit!the same success as in the first case, if it hacbeen employed under equally favourable

circumstances. I am not aware that theactual cautery has ever been used in thiscountry in the treatment of gangrena oris,although most of our writers recommend it,on the testimony of Baron, Isnard, andMarjolin. It is evidently a powerful agent,and is worthy of trial in that severe form ofa disease, which, according to Dr. Willis,destroys nineteen out of twenty of thoseattacked.

LUXATION OF THE ODONTOIDPROCESS;

PRESSURE ON THE SPINAL MARROW, WITHOUTSYMPTOMS.

THE political journals have alluded to avery remarkable case of luxation of theaxis, with considerable displacement of theodontoid process, which by its pressure had

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reduced the spinal marrow to nearly one-third of its bulk ; yet, although the accidentdated from several years, no symptoms ofparalysis had occurred during life. Thiscase has been the subject of medico-legalinvestigation before the medical coroner forMiddlesex. A very similar one is related inthe April number of the " Edinburgh Jour-nal." A young man, 22 years of age, wasconfined to bed for seven weeks by rheuma-tism. On becoming convalescent, it wasdiscovered that anchylosis of the superiorvertebrae had taken place, the head beingfixed and bent forwards. The man wasable, however, to return to his occupationof cutler; at the age of 28 he was seizedwith severe bronchitis, which recurred oc-casionally for four years, when he diedsuddenly in a fit of asphyxia. On examin-ing the body after death, besides extensiveanchylosis of the upper cervical vertebræ,there was luxation of the axis ; the odon-toid process was thrown backwards, so asto approach within three lines of the ante-

rior surface of the posterior segment of theatlas. Notwithstanding this remarkablediminution of diameter, the membranes and

substance of the spinal marrow, at thispoint, appeared to be perfectly healthy, andthe nerves arising from the cervical portionof the cord, presented their normal size,colour, and consistency.

PUNCTURE FOR CHRONIC HYDROCEPHALUS.

In the same number of the " Edinburgh- journal," are recorded the histories of twocases of chronic hydrocephalus, treated by; puncture. The subject of the first case wasl two months old ; the head measured 20I inches round, and 12 inches from ear toI ear. On the 10th of March, 1839, a punc.i ture was made, with a troehar, on the rightI side of the head, and 15 ounces of clear; Quid were drawn off; the child turned pale,