[Reprinted from THE MEDICAL News, July 21, 1894.] 
4 CASE OF ANGINA LUDOVICI. 
By G. H. STOVER, M.D , 
OF EATON, COL.; 
LATE RESIDENT PHYSICIAN IN THE ARAPAHOE COUNTY 
' HOSPITAL, DENVER, COL. 
The following case occurred during the visiting ser- 
vice of Dr. J. W. Exline, of the medical staff of the 
Arapahoe County Hospital, during my residence there: 
Peter F., sixty-six years old, was admitted August 
io, 1893, with the symptoms of an incipient submaxillary 
abscess of the left side. In the afternoon of the nth he 
complained of sore-throat during my absence and was 
given tr. guaiac, ammon. by another resident. The 
soreness increased, and by evening there was slight dys- 
phagia. Examination showed a little swelling of the 
left anterior pillar of the fauces ; considerable saliva was 
being secreted. The man had not received any calomel. 
The conditions continued about the same until the 
evening of the 12th, when, on my evening round, I 
found him suffering from dyspnea, not very marked. 
Examination showed that the swelling on the left side of 
the throat had extended and presented more of an ede- 
matous than an inflammatory appearance. 
Upon the advice of Dr. Exline, he was given ice to 
hold in his mouth, and ice was applied to the side of the 
neck. A little later I saw him again and the dyspnea 
was alarming. He could not lie down, but was sitting 
up gasping for air ; his lips were dark and his face ex- 
pressive of the greatest anxiety and agony. Another 
examination was made, showing the left tonsil, soft 
palate, and walls of the pharynx to be greatly swollen ; 
and there was dangerous edema of the glottis, from 
which he was in imminent danger of suffocation. The 
mucous membrane of and about the pharynx and the 2 
tonsil was not hyperemic or injected, and there were no 
signs of exudate or false membrane upon it; neither 
were there any ulcers upon the tonsils. 
I ordered ten grains of calomel at once, and instructed 
the nurse to spray the throat every fifteen minutes with 
a solution of tr. ferri chloridi, ntxxx to the ounce of 
water ; meanwhile, as I was unable to reach the laryn- 
gologist by telephone, I prepared to perform tracheotomy 
should the embarrassment of respiration continue. The 
spray was thus used some five or six times, with remark- 
able effect, as the breathing soon became much easier 
and the edema less. The spray was then used every 
half-hour for a few hours, and the remainder of the 
night every hour. At frequent intervals the man was 
given whiskey and milk (the naso-esophageal tube to be 
used if necessary), and this, alternated with eggnog, was 
continued throughout the next day. On the morning of 
the 13th there was only slight dyspnea and the calomel 
had acted thoroughly. The spray was then used every 
two hours, later every three, and finally omitted. 
By evening there was noticed on the floor of the 
mouth (not in the cheek, as in noma) a good-sized 
necrotic patch, having a slight odor. 
Hydrogen dioxid was frequently applied to this, with 
the result of limiting the spread of necrosis and almost 
destroying the odor. This necrotic tissue detached 
itself, and was expectorated at times during the next 
few days. The submaxillary inflammation did not go 
on to abscess-formation. The man was gradually put 
upon regular diet, was given iron and quinin in tonic 
doses, and rapidly recovered from his prostration. He 
was discharged September 2, 1893. 
While the case here reported differs somewhat from the 
rather vague accounts of some authors, I believe that the 
diagnosis, which was based mainly upon Striimpell's 1 
description, is correct. 
The prompt action of the rather strong solution ot 
iron certainly obviated tracheotomy. 
1 Text-book of Medicine, Am. ed., 1892, p 326.