Lectures on children's diseases : A handbook for practitioners and students.

  • Henoch, E. H. (Eduard Heinrich), 1820-1900.
Date:
1889
Catalogue details

Licence: Public Domain Mark

Credit: Lectures on children's diseases : A handbook for practitioners and students. Source: Wellcome Collection.

Provider: This material has been provided by the Harvey Cushing/John Hay Whitney Medical Library at Yale University, through the Medical Heritage Library. The original may be consulted at the Harvey Cushing/John Hay Whitney Medical Library at Yale University.

    22/472 (page 10)
    nearly always some fever ; the temperature in some of my cases varied between 102-9° and 104°F., the pulse and respirations being correspondingly rapid. Even at this stage fatal collapse may suddenly take place, before the destructive process has yet implicated the entire thickness of the soft parts. Oftener, however, life still lasts after not only the gum and periosteum of the jaw have become gangrenous and the bones bare and some of the teeth have fallen out of the necrosed alveolus, but even after the gangrene has affected the corresponding side of the tongue and palate, and the perforation of the cheek or lip is completed. The most pro- minent part of the swelling takes at first a rosy colour, it then becomes hard, and soon acquires a blackish tinge. The further development is generally rapid. In a child of 2 in whom noma came on three weeks after scarlet fever, there was no spot to be seen on admission at 6 p.m. At 9 o'clock there was a black spot of the size of a farthing at the left angle of the mouth, and next morning it had increased to the size of a florin. There soon appears a black, dry gangrenous patch, implicating the whole thickness of the soft parts, which spreads rapidly, and may finally extend rapidly upwards to the eye and downwards to the neck. A pale red flush surrounding this patch indicates the line of demarcation of the gangrene, at which a portion of the dead tissue either separates spontaneously, or may be de- tached by the physician. A correspondingly large aperture, with sharp borders is then left, which permits one to see freely into the mouth where the destructive process has taken place. From this opening we also often have liquids running out. Largo portions of the cheek, lip, and eyelid may be entirely lost in this way, and still the unfortunate child scarcely ever shows any signs of pain. Indeed, we sometimes see the patient sitting up and asking for food even at this stage. Increasing loss of strength, persistent diarrhoea, or extensive broncho-pneumonia (which is certainly due in part to the inspiration of gangrenous fluids into the air passages) finally bring the lamentable condition to an end, after it has lasted, perhaps, 2—3 weeks. Further, sudden death is also reported to have occurred owing to the entrance of air into the veins of the gangrenous tissue. I have usually found that consciousness lasts till death. Only a few cases take a favourable turn, and this may even