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278 THE MICRO-ORGANISMS OF THE HUMAN MOUTH. ;

Wieclener Hospital. We found particularly the right half of the
face terrihly swollen, the skin reddened and tense, Loth eyelids
closed hj cedema ; the infiltration extended across the arch of the
jaw, occupied the entire floor of the oral cavity, and continued
upon the right side of the neck almost to the clavicle. The
whole part was tense and as hard as a board ; a disagreeable
stench was emitted from the moutli ; the jaws could hardly be
opened to the breadth of a finger. The cheeks, gums, and base
of the tongue were all intensely swollen, and the gums corre-
sponding to the extracted tooth covered with a diphtheritic exu-
dation. Swallowing impossible ; respiration somewhat ditficult
rattling on account of the inability to expectorate; evening tem-
perature 39.8°. The mouth is syringed with sublimate 1-1000;
externally ice-collars employed.
" On the morning of the fourth day we succeeded with com-
parative ease in removing the broken roots of the right inferior
second molar h\ means of the elevator. Iodoform gauze was
l>laced in the wound, permanganate of potassium used as a
mouth-wash and for syringing; evening temperature 40° C.
The respiration l)ecame more ditficult; the patient spent the
night in a sitting posture, and gasped for breath.
" On the morning of the fifth da}' the patient is, if possible, still
more swollen; from the nose downward to far l)elowthe larynx
all outlines are erased; nothing is visible but a hard, stiif, even
surface, covered with the dark red skin; no trace of fluctuation.
We have here, therefore, an angina Ludovigi septica in optima
forma. Breathing is extremely diflicult, the face somewhat
cyanotic. We bring her into the operating-room, and split the
soft tissues in the median line from the chin to below the hyoid
bone a distance of about 15 cm. The tissue is stiff from the
infiltration, bleeding very slight; a scanty, brown, thin ichor
flows from the incision. We make our way preparando to the
floor of the tongue, but discover no large center of infection, no
accumulation of fluid. Sublimate dressing 1-2000; improve-
ment 'in respiration; evening temperature 38.9°. On the 6th
of February we find fluctuation on the right side of the iifck.
Another deep, longitudinal incision from the angle of the jaw
downward obliquelj^ is Ibllowed by a discharge of ichor. The