TONGUE. 



fide, may be hindered by applying a bandage to the jaw, 

 and making tlie patient refrain from talking and mafticntion. 

 The fame author affirms, that fuch treatment has anfwered 

 as well as could be defired, in numerous cafes, fome of 

 which were large tranfverle wounds in reftlefs and un- 

 manageable children. During the treatment, however, the 

 patient is to be allowed only liquid nourifhment, which mufl. 

 be imbibed through a tube. 



Perhaps, however, on the whole, the propriety of em- 

 ploying a future muft depend entirely on confiderations of 

 the following kind. When the tranfverfe wound is deep, 

 and extends quite acrofs the dorfum of the tongue ; when it 

 is fituated towards the apex, and is conveniently within 

 reach ; and when the patient is uncontrollable, ar.d cannot 

 be made to keep the tongue and lower jaw quiet ; a future 

 may be advantageous. On the other hand, when the vv'ound 

 is at the back part of the tongue, (a cafe by the bye that is 

 unfrequent,) and a future muft be difficult of application ; 

 when tiie wound is trivial, likely to heal of itfelf, and there 

 is no riftc of its oocafioning any material cleft in the part ; 

 and when the patient is docile, and attentive to tlie advice 

 given him ; the moil; judicious praftice is to apply fuch a 

 bandage as is recommended for the fraftnrcd jaw, and to 

 forbid all motion of the tongue and lower jaw, by fr- king, 

 mafticating, &c. nothing but liqnid food being alii d to 

 be drunk through a tube. 



If the wound fhould be fo deep, as almoft to feparate the 

 anterior part of the tongue from the reft of this organ, the 

 remaining conneftion is not to be divided ; but an endeavour 

 made to bring about an union. There are numerous cafes 

 on record, encouraging the praAitioner to expedl the beft 

 confequences from the attempt. Richter's Anfangfgr. der 

 Wundarzn. b. iv. p. 26. 



With regard to other circumftances, relating to wounds 

 of the tongue, the treatment of thefe cafes does not differ 

 from that of wounds in general. 



Bleeding from the Tongue An haemorrhage from the 



raninal veffels fometimes follows accidental wounds, and 

 furgical operations on the tongue. When it is an artery 

 that bleeds, the accident may prove dangerous, and even 

 fatal, efpecially in children, who by moving the tongue and 

 Jaw about, and continually fucking, promote the hcemor- 

 rhage, and render the adoption of the meafurcs neceffary 

 for its fuppreffion extremely difficult. As, in thefe cafes, 

 a ligature, compreffion, and ftyptics, hardly admit of being 

 applied, the bleeding cannot be ftopped, without much 

 trouble. Whether the raninal arteries can be tied in the 

 manner fuggeftcd below, remains to be proved ; but, cer- 

 tainly, they are rather too far out of reach to be tied in the 

 common way. Nor can comprclfion, as ordinarily per- 

 formed, be trufted, fince it operates againft foft yielding 

 parts, and not upon any fixed point. Strong ftyptics, even 

 were they deemed worthy of trial, could not well be em- 

 ployed, fince they would be apt to mix with the faliva, and 

 be fwallowed. Yet, there are fome means, by which the 

 moft perilous bleedings of this fort have been ftopped. 



Among the moft celebrated of thefe laft methods is the 

 aftual cautery, which is preferred by feveral of the con- 

 tinental furgeons, and may, perhaps, in this folitary inftance, 

 feem almoft juftifiable to Britifti furgeons, averfe as they 

 properly are to this barbarous practice. 



Another plan is that of directing an affiftant to keep a 

 comprefs on the bleeding veflels, as long as neceffary, with 

 his finger ; while, with his thumb, he takes care to make 

 counterpreffiirc under the jaw. M. Jourdain ftopped a con- 

 fiderable haemorrhage from the raninal veffels, by laying a 

 piece of iee under the tongue. M. Petit was the inventor 



of an apparatus for flopping fuch bleedings, which is at 

 once fimple, ingenious, and effeftual. The furgeon is to 

 get a piece of birch, and cut it through below the place 

 where two branches of equal fize unite. It is to be made 

 to refemble a fort of fork, the prongs of which are to be 

 about eight lines long, and the handle four. It is then to 

 be covered all over with linen, and p'lt under the ^ongue in 

 fuch a way, that the end of the handle is to reft aga.uft the 

 middle of the concavity of the arch of the jaw, while the 

 prongs embrace the fraenum, and comprefs the bleeding 

 veffels. The middle of a roller is next to be applied to the 

 dorfum of the tongue, as far back as poffible ; and the ends, 

 after cioffing each other under the chin, are to be pinned to 

 the child's night -cap. 



If a furgeon were to be averfe to thefe plans, or find 

 them unavai'.ng, there is yet one refource left, namely, that 

 of cutting down to, and tying the trunk of the lingual ar- 

 tery, juft where it paffes over the cornu of the os hyoides. 



Haemorrhage from the raninal veffels occafionally arifes 

 quite independently of a wound. In one fuch example, the 

 bleeding proceeded from a varicofe veffel under the tongue, 

 and was effeftually ftopped with the cautery. See Default's 

 Journ. de Chirurg. 



Dangerous Enlargement of the Tongue from Inflammation. — 

 Sometimes when this organ is inflamed, it fxvells fo pro- 

 digioudy, that it protrudes between the teeth, entirely fills 

 the cav'ty of the mouth, and obilruAs fpeech, deglutition, 

 and even refpiration. In fuch a cafe, the moft prompt 

 affiftance is demanded. Ordinary evacuations of blood, and 

 other antiphlogiftic meafures, here feldom bring relief with 

 fufficient celerity. According to furgical authors, the moft 

 certain plan confifts in making two longitudinal cuts along 

 the edges of the dorfum of the tongue, from one to two 

 inches in length. A copious bleeding generally follows, 

 which foon brings about a diminution of the fwelling. No 

 troublefome confequences are to be apprehended from fuch 

 incifions, which heal with eafe, aiid fcarcely leave any fear 

 behind. De la Malle, Mem. de I'Acad. de Chir. tom. v. 



Jourdain fucceeded in affording prompt relief, by taking 

 blood from one of the raninal veins. This method feems 

 liable to no objeftion, except perhaps that of being difficult, 

 when the tongue is enormoufly fwelled. Traite des Maladies 

 de la Bouche, &c. 



In one example, the difeafe refifted every. means until a 

 blifter was applied to the throat. Richter's Anfangfgr. 

 band. iv. p. 29. 



Some inflammations of the tongue have been obferved to 

 originate from the lodgement of foreign bodies in it, which 

 ouglit to be extratted ; as, for inftance, a fifh-bone, or a 

 needle. (Jourdain, Traite des Mai. de la Bouche, &c. ) 

 Other cafes have arifen from the injudicious employment of 

 mercury, and the excitement of a fudden and immoderate 

 fahvation. Many examples are connected with violent in- 

 flammation of the parts about the throat. 



Sometimes inflammations of the tongue terminate in fup- 

 puration. Such abfceffes rarely admit of being opened, 

 and hardly allow the ufe of any means, except emollient 

 gargles. 



Cafes have occurred, in which inflammation of the tongue 

 has induced mortification, and the lofs of the greater part 

 of this organ. The treatment of fuch inftances muft con- 

 form to the general rules delivered in the article Gan- 

 grene. 



When, in confequence of any enlargement of the tongue, 

 or other difeafe in the mouth, the neceffary food and medi- 

 cines are, for a confiderable time, prevented from being 

 taken, they may be injedied into the ttomach through an 



elailic 



