This disease, which is fortunately a rare one, occurs in badly nourished children, particularly when reduced by severe illness such as scarlet fever or measles. It presents itself first as a diffuse swelling of the cheek which is seen to be tense, red, and glistening, with one spot in the centre usually redder than the rest. On examining the inside of the mouth there is already an excavated ulcer opposite the red spot on the cheek, and the gums opposite may also be ulcerated. As the disease progresses more and more of the mucous membrane of the mouth is ulcerated away. At the same time the red spot on the cheek gets black in the centre, and afterwards extends in area. By and by a slough, which varies in size, separates and a communication forms through the cheek with the inside of the mouth. If the patient survive, still further destruction occurs, the necrosis passing on to the surrounding skin of the face, even to the ear and eyelids. There may be necrosis of the jaws. Not infrequently this disease is associated with a gangrenous pneumonia and there are general symptoms of septic poisoning.

The disease advances by a progressive necrosis, so that in a section through the advancing edge there is in the parts already necrosed an absence of nuclear differentiation. This is bounded by a highly cellular area evidently from inflammation. It is apparent that the morbific agent in its advance produces necrosis, almost directly, but leads also to inflammation, which is not very great, in front of its advance.

The author found, in addition to the usual microbes of decomposition at the sloughing surface, a very remarkable growth of a bacillus into the necrosed, but otherwise unaltered tissue. The microbe was in the form of long threads, occasionally with evident spores, and it extended in large numbers to the very edge of the necrosis, and to a very slight extent beyond it into the inflamed part. The bacillus was apparently anaerobic, growing into the tissue away from the surface. It was readily stained by Gram's method, but not by ordinary watery solutions.