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but, more frequently, the great distension of the skin of the
cheek seems to empty the cutaneous vessels, giving to the
part a smooth, polished, dense white appearance, very much
resembling the effect of a violent salivation. I have no
doubt that this is the tumour described by Poupart, and al-
luded to in an earlier part of this paper. Great thickness
and hardness have always occurred in the other situations
where this gangrene has approached the external cellular
masses of the face ; in the lip, however, they are less re-
markable, perhaps, from the smaller amount of cellular tex-
ture. After reaching this stage, a black spot is frequently
seen on the outer surface of the swelling. This spreads rap-
idly, and has always been, in my own experience, the imme-
diate harbinger of death. It is proper to state, however,
that I have heard it said that cases had recovered in this city,
in which the gangrene had produced a hole through the
cheek. Under what physician's care this occurred, I have
never learned.
In two cases it commenced in the fauces, and was marked
by the same unsuspected progress. In one of these, the lit-
tle patient was remarked to be languid, but had no positive
external marks of disease. The mouth was examined, and
found healthy ; but no suspicion of the real situation of the
disease was entertained, till after three or four days more,
when he complained of a slight sore throat. A large gan-
grene of the tonsils, half arches, and pharynx, was now
found, and the event need hardly to be told.
The closing stage of this affection is marked by large gan-
grenous patches in the gums—deep fissures between these
and the teeth—the latter loose, or falling out—large pieces of
the alveolar processes, often containing the roots of several
teeth in a state of entire necrosis—the whole lining mem-
brane of the mouth suffering a violent excoriation—the whole