42 THE TONER LECTURES. 



noma, or cancrnra oris. This is especially frequent in children 

 and in the arm}-. Murchison speaks of it in the Crimea, as 

 frequent and invariably fatal ; Ch^nu, however, in his report 

 does not name it. Its ravages are extremely extensive, often 

 involving even the bones. 



The ear, also, and the e3^elids are sometimes destroyed. 

 From each of these, singly or all together, the most frightful 

 deformities often follow, which require the utmost ingenuit}' in 

 the plastic operations necessary to remedy them. In many 

 cases the gangrene is local and subcutaneous, producing ne- 

 crobiotic masses of tissue, which are, I believe, often, if not 

 generally, the cause of the abscesses so commonly seen in all 

 parts of the bod}^ Sometimes even the mediastina are opened, 

 the anterior from the chest wall, the posterior from the deep 

 tissues of the neck ;' unless, by a timely surgical operation, the 

 danger be averted. 



The male genitals are occasionally destro3"ed to a greater or 

 less extent. Except the organic destruction, no special result 

 follows, except, possibly, hemorrhage, for one case is recorded 

 of death from a hemorrhage of fl^xxx from the scrotum.^ 



That the perineum and the female genitals are not more 

 frequently the seat of gangrene, is rather surprising, when we 

 consider the neglected condition of many of the patients and 

 the constant soiling of the parts, as a result of unconscious and 

 unavoidable discharges, especially in females. The troubles of 

 the female generative organs ai'e either distinct external gan- 

 grene, or gangrenous ulcers in the vagina. I have found 9 

 cases, 8 from typhoid and one from typhus ; all in j'oung per- 

 sons from IT to 2 Y years of age, except one of 34. In 6 of the 

 cases there was gangrene of the labia, extending sometimes to 

 the perineum and the thigh. At least one case was followed b}^ 



' See Bibliog'. Fraentzel, Werner, and Hoffman, p. 388. 

 2 Murohison. n. 194. 



^ — ^ Q. . 



2 Murchison, p. 194. 



