The disease spread until the whole of his tongue became a mass of soft and black putrifying tissue, which no disinfectant would touch. As might be supposed, his difficulty of swallowing became much greater, and he could get down but a few drops at a time; but he did not seem to be particularly affected by the mixture of the teaspoonful of wine and water or beef-tea with the putrid liquid oozing from the mass of sphacelus which nearly filled his mouth. The poor fellow, throughout the progress of this horrible disease, always looked cheerful and hopeful and contented; and although his speech was at this period very muffled and indistinct, we could understand him to say that, if he could swallow, he would be better. The process of starvation was rapid. He became excessively thin and haggard, and cold in his extremities; and by the time the black slough began to separate at the apex of the tongue, he became pulseless. The case appeared quite hopeless. There was every prospect of his immediate death from starvation; and, besides, there was the risk of the extension of the disease to the pharynx and glottis. To relieve his sinking state, I ordered an injection of strong beef-tea and brandy twice daily, as he was quite unable to swallow; and after the third injection his pulse returned. The ragged and putrid black mass which represented his tongue was at this period coming away in shreds; and, after about three weeks from the beginning of the mortification, the last portion separated, leaving a tolerably clean surface covered with flabby granulations, bounded by an irregular edge posteriorly, just high enough to hide the epiglottis. He now regained the power of swallowing fluids, but in a peculiar way. He could drink; but the last portion of the fluid, which filled his mouth, was always rejected, as he had no power of bringing it back within the scope of the pharyngeal muscle. His speech, which had been unintelligible, now became of service to him; and at the present time (Sept. 25th) perhaps more than a fortnight after he passed through that terrible crisis, he can make himself easily understood. The emaciation was so complete that he was quite haggard, his eyes being sunk in the orbits; and when he could swallow, and the separation of the slough gave him the feeling of returning health, his craving for the fat of meat was most remarkable. Large pieces of the fat of pork and roast mutton were sent up to him at dinner-time; and he masticated and squeezed out the softer parts with his teeth, leaving but shreds of hard tissue behind. He could swallow no solid, and particularly disliked the lean part of the meat. At the present time the mouth is clean, and the floor is healing over. He can talk tolerably well, but can only swallow while he is lying down. He has regained his strength so far that he is able to walk about with ease. Since the date when this report was read, the patient has still further improved in strength, and has returned to his home. ART. 107.-On a Peculiar Form of Disease of the By Mr. FERGUSSON, Surgeon to King's College Hospital, &c. (Lancet, Sept. 6, 1862.) What Mr. Fergusson says upon this subject is reported as "clinical remarks" in the Mirror of the Practice of Medicine and Surgery in the Hospitals of London : 66 “It may be remaried, that the sense was afted to the sh side of the lower jaw, and Jocket lie ment that had been married for a long time, and had beecue biestbed of a pinaad ale alen "On the 19th of July a base DIPERLY 10 repesi Le ope tion; for although but three weeks had elapsed since the last avan gion of removal, the amour had grown very rap ly, and in general characters resembled as predecessor. It was cut away chiefly by means of tarved forceps, and portions of it were scraped from tão bone. With regard to the last, very little of it was left, and Mr. Fergusson mentioned that it was necessary to procved wità osunion in such an old patient. "After remaining about another fortnight in the hospital, the patient left for the country. Up to this time there had been no further recurrence. The cicatrix was, however, touched with the chloride of zinc." ART. 108.-Osteoplastic Resection of the Jaws, By Dr. BILLROTH, of Zurich. (Langenbeck's Archiv, vol. ii. p. 651; and Medico-Chir, Review, Jan. 1888.) Our readers are no doubt acquainted with the operation which Langenbeck has proposed and successfully carried out on the upper jaw, for the removal of tumours situated behind that bone. It cons sists in separating the superior maxilla from its connexions autli The disease spread until the whole of his tongue became a mass of soft and black putrifying tissue, which no disinfectant would touch. As might be supposed, his difficulty of swallowing became much greater, and he could get down but a few drops at a time; but he did not seem to be particularly affected by the mixture of the teaspoonful of wine and water or beef-tea with the putrid liquid oozing from the mass of sphacelus which nearly filled his mouth. The poor fellow, throughout the progress of this horrible disease, always looked cheerful and hopeful and contented; and although his speech was at this period very muffled and indistinct, we could understand him to say that, if he could swallow, he would be better. The process of starvation was rapid. He became excessively thin and haggard, and cold in his extremities; and by the time the black slough began to separate at the apex of the tongue, he became pulseless. The case appeared quite hopeless. There was every prospect of his immediate death from starvation; and, besides, there was the risk of the extension of the disease to the pharynx and glottis. To relieve his sinking state, I ordered an injection of strong beef-tea and brandy twice daily, as he was quite unable to swallow; and after the third injection his pulse returned. The ragged and putrid black mass which represented his tongue was at this period coming away in shreds; and, after about three weeks from the beginning of the mortification, the last portion separated, leaving a tolerably clean surface covered with flabby granulations, bounded by an irregular edge posteriorly, just high enough to hide the epiglottis. He now regained the power of swallowing fluids, but in a peculiar way. He could drink; but the last portion of the fluid, which filled his mouth, was always rejected, as he had no power of bringing it back within the scope of the pharyngeal muscle. His speech, which had been unintel ligible, now became of service to him; and at the present time (Sept. 25th) perhaps more than a fortnight after he passed through that terrible crisis, he can make himself easily understood. The emaciation was so complete that he was quite haggard, his eyes being sunk in the orbits; and when he could swallow, and the separation of the slough gave him the feeling of returning health, his craving for the fat of meat was most remarkable. Large pieces of the fat of pork and roast mutton were sent up to him at dinner-time; and he masticated and squeezed out the softer parts with his teeth, leaving but shreds of hard tissue behind. He could swallow no solid, and particularly disliked the lean part of the meat. At the present time the mouth is clean, and the floor is healing over. He can talk tolerably well, but can only swallow while he is lying down. He has regained his strength so far that he is able to walk about with ease. Since the date when this report was read, the patient has still further improved in strength, and has returned to his home. ART. 107.-On a Peculiar Form of Disease of the By Mr. FERGUSSON, Surgeon to King's College Hospital, &c. (Lancet, Sept. 6, 1862.) What Mr. Fergusson says upon this subject is reported as "clinical remarks in the Mirror of the Practice of Medicine and Surgery in the Hospitals of London : "Familiar as he was with diseases of the jaw, and he had seen as many examples as most surgeons, here was an instance, Mr. Fergusson remarked, of disease he had never seen before or read of. About the middle of June the patient had called upon him with a letter from a friend. He noticed something wrong with his jaw, and on looking into his mouth, he asked if he had a bit of potato in it. To his astonishment he found it was a growth upon the jaw. Some surgeons would call it fibrous; but it was a form of disease which he had never met with previously in this or any other part of the body. It looked like vegetable matter, or greatly elongated papillæ. He could not undertake to give it a name. It was something like malignant disease; and the question arose as to what ought to be done. "The friend who wrote to him (Mr. Fergusson) had operated several times. It would, perhaps, have been better to have removed the whole of the jaw; but he did not like to submit so old a patient to such an operation, for his age was eighty years. He selected a milder method, that of cutting the disease out instead of making a large wound in the cheek. He removed on this occasion (June 21st) probably the greater part of it, together with its base. It certainly was not unlike medullary disease. He thought he had succeeded in taking away the whole of it. If there should be any left, he expected to remove or destroy it by means of chloride of zinc. We shall see, Mr. Fergusson observed in conclusion, when the granulations spring up, the process the disease may take; and we must look upon the present case more as an instance of the curiosities of pathology than of surgery. "It may be remarked, that the disease was confined to the right side of the lower jaw, and looked like meat that had been macerated for a long time, and had become bleached of a pinkish white colour. "On the 12th of July it became necessary to repeat the operation; for although but three weeks had elapsed since the last occasion of removal, the tumour had grown very rapidly, and in general characters resembled its predecessor. It was cut away chiefly by means of curved forceps, and portions of it were scraped from the bone. With regard to the last, very little of it was left, and Mr. Fergusson mentioned that it was necessary to proceed with caution in such an old patient. "After remaining about another fortnight in the hospital, the patient left for the country. Up to this time there had been no further recurrence. The cicatrix was, however, touched with the chloride of zinc." ART. 108.-Osteoplastic Resection of the Jaws. By Dr. BILLROTH, of Zurich. (Langenbeck's Archiv, vol. ii. p. 651; and Medico-Chir. Review, Jan. 1863.) Our readers are no doubt acquainted with the operation which Langenbeck has proposed and successfully carried out on the upper jaw, for the removal of tumours situated behind that bone. It consists in separating the superior maxilla from its connexions suffi ciently to allow of its dislocation, so as to penetrate behind it and remove the tumour without so far separating the bone from the surrounding soft parts as to destroy its vitality. The tumour being removed, the dislocated bone is replaced, adheres like any other compound fracture, and the patient recovers without any loss of substance in the face. Dr. Billroth, of Zurich, has applied the same principle to the lower jaw in two cases of extensive tumours situated beneath it. He divides the lower lip, or cheek, down to the bone, in one or two places, as may be necessary, saws through the bone with a chain-saw at the same place, separates it from the soft parts on its inner surface, and displaces the portions of the jaw (still adhering to the external soft parts) sufficiently to obtain access to the interior of the mouth and side of the pharynx and larynx. The operation having been completed, he re-unites the separated portions of bone by metallic sutures introduced through holes bored in them. Of the two operations performed on this plan, which he describes in the present paper, one at any rate seems to have been (temporarily at least) successful, and the bone re-united without any deformity, except from the cicatrices. In the other case the patient died of the direct effects of the operation, the pneumogastric nerve having been divided. ART. 109.-Apparatus for the purpose of Remedying Defects in the Parts about the Mouth. By M. PRÉTERRE. (Jurors' Report of the International Exhibition for 1862.) M. Préterre exhibits, under the title "Prothesis," a numerous collection of apparatus for the purpose of remedying defects in the parts about the mouth-clefts in the hard and soft palate, both con. genital and accidental, and losses of portions of the maxillary bones from various causes. The different apparatus are susceptible of the following classification:-(a) Plain Obturators for Perforations of the Hard Palate. There is nothing new in these, but they are made on the best principle, simply spanning across the perforation and avoiding the injurious plug in the nasal cavity which is too often adopted. (b) Various Combinations of Obturator and Artificial Velum for cases of cleft both of hard and soft palate. These are very diverse, to meet the particular losses which have required restoration. M. Préterre has applied spiral springs to keep the artificial soft palate in proper apposition; and, though the method is not new, it has been ingeniously modified to suit individual cases. One plan of forming artificial hard and soft palate in a continuous structure appears to be quite original. This object has been accomplished by employing caoutchouc mixed with different proportions of sulphur, that forming the hard palate becoming indurated by heat, while that which replaces the wanting soft palate remains pliablə and elastic. (c) Masses of Vulcanite bearing Teeth to supply con |