outside with compresses, between it and the foot, to press it inward, and has not besides the bag of chaff on the inside.

He recommends the same treatment also in luxations of the foot inward with fracture. Vol. 4. p. 387.

Whoever may have the credit of first suggesting the plan, the experiments and inductions of Mons. Dupuytren, with but few exceptions, establish satisfactorily the principles on which these accidents may be accounted for, and clearly point out an improved method of treatment; founded on correct views, and deduced from just reasoning, which can alone establish a permanent practice either in Surgery or Medicine. All else will prove merely ephemeral.

EXPLANATION OF THE PLATE.

FIGURE I.

Represents he apparatus of Mons. Dupuytren for fracture of the fibula with luxation of the foot backwards.

FIGURE II.

Represents the appearance of fracture of the fibula with luxation of the foot inwards. The original of the engraving may be found in Pott's Surgical Works.

FIGURE III.

Represents the apparatus of Prof. Dupuytren for Figure II.

Remarks on an Ulceration of the Mouth of a peculiar character, as it occurs in the New-York Alms House: By Dr. J. J. Howe, late Resident Physician to that Establish

ment.

This disease, commonly called the sore mouth, or caries of the jaw, in the Alms House, has long been known in that institution; though I believe it is rarely met with in private practice. I have never heard of an instance of it out of the city of New-York. Many of those physicians who have had an opportunity of seeing it in the Alms House, consider it as a new disease, and so far as they are able to judge, heretofore unnoticed by any medical writer.

Some few years since, it was made the subject of an inaugural thesis, by one of the graduates of our university; but nothing concerning it, to my knowledge, has ever been laid before the public.

Having had the immediate charge of nearly all the children in the Alms House, for about three years and a half, as house physician to the Institution, I have had many opportunities to observe the disease, and to witness the efficacy of treatment, instituted for its cure: these circumstances, and the silence of others on the subject, I trust will be deemed a sufficient apology for the present paper.

The subjects of the complaint, according to my observation, are children from two to twelve years of age; I have never seen an instance of it in any person arrived at the age of puberty, or in a child previous to the appearance of the first set of teeth. When it has made its appearance in the Alms House, it is frequently observed to affect a number of children about the same time, and I have often seen in one room, where fifty or sixty children were lodged, from six to twelve, at once labouring under the same disease. The first intimation of its attack is usually a drivelling of their saliva: sometimes a swelling of the cheek, with a slight

1

excoriation or ulceration in the corner of the mouth, appear as early symptoms. On looking into the mouth at this time, an ulceration is observed along the edges of the gums, and frequently on the side of the tongue and inside of the cheek.

The ulcers on the gums are at first of a light ash colour, with sharp irregular and slightly elevated edges: as they extend, they soon assume a darker appearance, and bleed on the slightest touch. Those on the cheek and tongue, from being superficial and of a whitish appearance without hard, ness of the neighbouring parts, soon become excavated, of a brown colour, and surrounded by an extensive induration and swelling of the parts adjacent. The ulcers from the first are strongly foetid. The saliva is increased in quantity, and often acquires a brown or molasses colour, from the admixture of a bloody ichor discharged from the ulcers. As the ulceration extends,the teeth become loose, and drop out, or are easily picked out with the fingers. The alveoli are exposed, and become carious. The ulcer in the cheek advancing through its substance,perforates the integuments, and rapidly extends in all directions. It has been my good fortune never to have witnessed the disease in a more advanced state, than that above described; and in few instances when it has progressed so far. In one instance there was a perforation through the cheek, the size of half a dollar, and a considerable portion of the jaw bone exfoliated; but the disease was arrested, and the child recovered. In another, of a child brought into the house, labouring under the disease considerably advanced, small portions of the lower jaw came away, and the ulceration passed nearly through the cheek. I lost one child suffering under this disease, but it was much reduced by scrofula, when attacked, and its death might be said to have been hastened by, rather than attributed to it. The ulceration, at the death of the child, was less extensive than I have frequently seen it in other cases which terminated favourably.

In the commencement, the ulceration is of small extent, and there is commonly no sensible constitutional disorder. The child eats, exercises, and sleeps as usual, and seems to experience very little uneasiness. At this time, by a person not acquainted with its nature and tendency, it would be looked upon as a trifling complaint, requiring no particular attention. Such is the origin of a disease, which, if left to itself, soon becomes one of the most distressing and frightful of human maladies, and is sure to destroy the patient.

Those who have witnessed its progress to a fatal termination, describe its advanced stages as deplorable indeed. All the soft parts of the face are destroyed by the ulcerative process, leaving the cavity of the mouth exposed, and the bones naked and in a carious state. The foetor becomes intolerable. In the course of the disease, a symptomatic fever supervenes, which assumes the typhoid character, and the patient dies in the most wretched and loathsome condition.

In order to form an idea of the remote causes of this singular affection, as occurring among the children of the Alms House, it may be proper to look at some of the peculiarities of the circumstances under which they are placed. Their diet is sufficiently nutritious, but coarse, difficult of digestion, and seldom varied. It consists of fresh beef, of which soup is always made; the soup serving for dinner one day, and the beef from which it was boiled, the next; rye bread fresh every day; indian meal porridge, a small quantity of molasses, and milk for their tea, which is bohea. In addition to these articles, they often have potatoes, turnips, cabbage, and in their season, other vegetables. Their drink, except the tea, is cold water. A different diet is allowed for the sick and debilitated, at the discretion of the physician: and wheat bread, rice, arrowroot, milk, chocolate, and beef, to be cooked according to his directions, are at his command.

Being kept constantly at school, put to bed early, and re

quired to perform no labour, they have but little exercise. Their clothing is comfortable, and this, together with their persons, are kept as cleanly at least as is common among children of the poor. In the nurseries they are stripped and washed regularly once a week, and have their under clothing changed as often. One very striking circumstance attendant on the situation of the children, is, the very impure state of the air in which they constantly live. Confined in crowded school rooms during six hours of the day, and in their close and no less crowded lodging rooms through the night, prolonged by the practice of putting them to bed at the approach of the evening, there is but a little time that they have the opportunity of being in the open air, and even then, being restricted to the yard adjacent to the house, they breathe an atmosphere contaminated by the exhalation arising from the offals, excrements and filth of a thousand people of all ages, many of whom are utterly ignorant of, and will not be taught the comforts of cleanliness. No watchfulness on the part of the superintendant and officers of the place, can obviate the effects of passing filth on the air of the yard, and apartments; and notwithstanding continual scrubbing and washing, there is no time when it can be inhaled by one not much accustomed to it without disgust.

After stating the above facts, I shall hazard but little in ascribing the production of the disease, in the Alms House at least, in a great degree to the constant respiration of air contaminated in the manner above related; connected with habits of inactivity and slothfulness, necessarily arising from the want of inducements and opportunities to perform sufficient wholesome exercise.

From the manner in which the ulceration extends from the parts originally affected to those contiguous, as it commonly takes hold of the tongue and cheek where they lie in contact with the ulcers previously formed on the gums, there would seem to be some reason for considering it as