ection is limited are local measures
successful in arresting the spread; in more severe cases amputation is
the only means of saving life.

#Cancrum Oris# or #Noma#.--This disease is believed to be due to a
specific bacillus, which occurs in long delicate rods, and is chiefly
found at the margin of the gangrenous area. It is prone to attack
unhealthy children from two to five years of age, especially during
their convalescence from such diseases as measles, scarlet fever, or
typhoid, but may attack adults when they are debilitated. It is most
common in the mouth, but sometimes occurs on the vulva. In the mouth it
begins as an ulcerative stomatitis, more especially affecting the gums
or inner aspect of the cheek. The child lies prostrated, and from the
open mouth foul-smelling saliva, streaked with blood, escapes; the face
is of an ashy-grey colour, the lips dark and swollen. On the inner
aspect of the cheek is a deeply ulcerated surface, with sloughy shreds
of dark-brown or black tissue covering its base; the edges are
irregular, firm, and swollen, and the surrounding mucous membrane is
infiltrated and oedematous. In the course of a few hours a dark spot
appears on the outer aspect of the cheek, and rapidly increases in size;
towards the centre it is black, shading off through blue and grey into a
dark-red area which extends over the cheek (Fig. 23). The tissue
implicated is at first firm and indurated, but as it loses its vitality
it becomes doughy and sodden. Finally a slough forms, and, when it
separates, the cheek is perforated.

Meanwhile the process spreads inside the mouth, and the gums, the floor
of the mouth, or even the jaws, may become gangrenous and the teeth fall
out. The constitutional disturbance is severe, the temperature raised,
and the pulse feeble and rapid.

The extremely foetid odour which pervades the room or even the house the
patient occupies, is usually sufficient to suggest the diagnosis of
cancrum oris. The odour must not be mistaken for that due to
decomposition of sordes on the teeth and gums of a debilitated patient.

The _prognosis_ is always grave in the extreme, the main risks being
general toxaemia and septic pneumonia. When recovery takes place there is
serious deformity, and considerable portions of the jaws may be lost by
necrosis.

[Illustration: FIG. 23.--Cancrum oris.

(From a photograph lent by Sir George T. Beatson.)]

_Treatment._--The only satisfactory treatment is tho