The Preventive Treatment of Scarlet Fever
Authors: P. Hood
Journal: BMJ (1869)

S. W., aged 48, was admitted to the Royal Infirmary, on March 3rd I868, with a tumour of the upper jaw.She was in her usual health till about fifteen months previously, when she began to be troubled with a "stuffing" of the right nostril.Eight months before admission, she lost the sense of smell, and at the same time she became aware of a ful- ness of the right cheek.Previously to this, she was trbubled with swell- ing and pain of the gum near the right molar teeth, which was attributed to gum-boil, and for which she got some teeth extracted, without relief.On admission, there was observed a very marked protrusion of the right superior maxillary bone.The swelling was nodular, and hard to the touch.The growth extended into the right nostril and pressed up the nasal bone.It also protruded into the mouth.It did not seem to invade the orbit; but a semi-elastic tumour was felt in the right temple behind the malar bone.For a few weeks before admission, there had been a fcetid discharge from the right nostril.She was rather feeble, and had lost appetite lately.The nature of the operation having been explained to the patient, she eagerly accepted the chance of relief from the distress which she had latterly been suffering.On March 7th, the operation was performed, as follows.The patient was placed deeply under the influence of chloroform.The upper lip was slit up to the septum of the nose, and separated on the right side from the nasal orifice.A perpendicular incision was made from the ala of the nose up to the inner angle of the orbit.A transverse incision was extended from that along the infra-orbital ridge to the malar bone.The whole cheek was then dissected from the bone and tumour, and held back.Strong cutting pliers were used to divide the zygomatic process of the malar bone, the nasal process of the maxillary bone, and the palate in the mesial line.Little force was necessary to dislodge the su- perior maxillary bone and the contained tumour, but, owing to the softness of the latter, it broke off, and a part was left adhering to the bottom of the wound.That was removed with polypus-forceps; the gouge was used to scrape away any remaining portions; and a red-hot iron was freely applied to the bones against which the mass seemed to have been resting.The only vessels which required attention were the coronary, which were secured by torsion.A strong solution of chloride of zinc was applied to the whole wound; experience having shown that this substance has a remarkable efficacy in controlling the fcetor which wounds in the mouth produce.The edges of the incision were brought togetherwith silver sutures.-ioP.M. Shewas wonderfully well.Pulse i i8.She felt little pain.She had had some sleep, and had taken some milk and beef-tea.March 8th.-She had some sleep.Pulse Ioo; better than -before the operation.March ioth.-Shewas going on well.Pulse go.The wound in the face had healed by the first intention.She was ordered to wash out her mouth freely with solution of chlorate of potash.March i ith.-The lint which was introduced to support the cheek was removed to-day.There was not much discharge from the interior of the mouth.March 2oth.-All the stitches were removed to-day.The patient said that she had recovered the sense of smell, also partly that of taste, a pleasure which she had not enjoyed since eight months before the oper- ation.This morning she walked up to the theatre-two stairs-and was shown to the clinical class.