398 The Philippine Journal of Science isu 



a high, irregular temperature and was steadily failing, until by 

 the latter half of September it was deemed necessary to submit 

 him to a second operation by enlarging the old drainage wound. 

 Condition of the patient remained but little changed. 



On October 1, 1912, the patient's upper lip was noticed to be 

 swollen and oedematous and further examination showed slight 

 necrosis of the mucosa opposite the insertion of the teeth. The 

 necrotic tissue was scraped, and the exposed surface cauterized 

 with pure phenol. By the next day the necrotic process had 

 extended to the inside mucosa of the lower lip and a small part 

 of the gums of both upper and lower jaws. Four front teeth 

 wer^ removed because they were found to be so loose that there 

 was danger of their being swallowed. The same treatment as on 

 the previous day was instituted, plus frequent swabbing of the 

 parts with hydrogen peroxide, and later with a potassium per- 

 manganate solution. 



On October 3, the skin over the upper lip became glossy, and by 

 the fifth day the gangrenous process had invaded new tissues 

 outward, so as to present a typical picture of cancrum oris — a 

 foul, ashy gray, pultaceous mass, involving the entire upper lip 

 (Plate I, fig. 1). 



It was impossible for the patient to take anything but liquids, 

 and his low state of health from the original trouble did not 

 warrant a more active surgical interference, which would have 

 necessitated general anaesthesia. The treatment outlined above 

 was continued except that iodine was substituted for phenol on 

 account of the exposed situation of the parts. The course of 

 the lesion was progressive, until by the tenth day the fioor of the 

 nose also was involved, and the patient presented a pitiful ap- 

 pearance. The odor from the sloughing necrotic tissue was most 

 offensive. 



There was no further extension of the process, a line of demar- 

 cation gradually formed, and by the twentieth day of the disease 

 the margins of the ulcer began to show a more healthy appear- 

 ance, and the general condition of the patient showed slight 

 improvement. The favorable local changes continued until 

 healing was complete, but the process had destroyed so much of 

 the upper lip that the middle of the upper jaw was left exposed. 

 The patient has not yet sufficiently recovered from his original 

 affection to justify a plastic operation (Plate I, fig. 2) . 



Examination of smears from the slough showed long spirilla 



