TONGUE. 



elaftic catheter, which is to be pafled through one of the 

 noilrils into the oefophagus. It has besn recommended to 

 have the outer end of the inftrument to turn upward out of 

 the noftril, and (haped like a funnel, whereby it is fuppofed 

 fluids might be more conveniently introduced. (Libouton, 

 Journal de Medecine, torn, xxxiv. ) But we do not confider 

 this any material improvement, fince all liquids may be eafily 

 injeiEled with an elaftic gum fyringe, fuch as is ufed for in- 

 jecting hydroceles, without having the external end of the 

 catheter made in the manner above fuggeiled. 



Ulcers, Indurations, and Tumours of thi Tongui Ulcers 



on the tongue, of an exceedingly painful, obftinate, and 

 mahgnant looking nature, are fometimes produced by the 

 Iharp or rough edge of a tooth. This mechanical kind of 

 caufe is eafily detected on examination with the finger. If 

 the tooth be found, the projection or roughnefs mull be 

 filed off; if it be carious, the beft plan is to extract it. 

 When thefe objects are accomphfhed, the fore ulually heals 

 without further trouble. 



Some very obftinate ulcers, which originate on the tongue, 

 and are connected with dif order of the digeftive organs, may 

 be cured by a long perfeverance in the ufe of the antim. tart, 

 exhibited alternately in {mail dofes, and then in larger ones, 

 fo as to excite vomiting. 



Ulcers, deferving the epithets mahgnant and cancerous, 

 not unfrequently form on the tongue. Sometimes the ma- 

 lady, in its moft incipient ftate, appears as a fore. Some- 

 times a circumfcribed moveable, or immoveable, fcirrhous 

 fweUing is firft obfervable, which gradually becomes pain- 

 ful, and ulcerates. In other inftances, there is, in the be- 

 gmning, only an induration in the fubftance of the tongue, 

 without the fmalleft appearance of any fwelhng. The 

 ulcers, under confideration, are always furrounded by hard- 

 nefs. They may make their firft appearance either at the 

 edges or at the apex of the tongue. In certain cafes, the 

 whole, or a large portion, of this organ is covered with nu- 

 merous fmall fcirrhous tubercles, which gradually fall into 

 a ftate of ulceration. Thefe we have feen greatly dimi- 

 niftied by a gentle courfe of mercury. All tlie medicines, 

 tried in other cafes of cancer, may be exhibited in the pre- 

 fent ones ; but, on the whole, the timely employment of 

 the knife merits the moft confidence. 



However, the lollo\ving kinds of cafes have yielded to 

 particular remedies. 



A mahgnant exceedingly painful ulcer on the tongue, 

 furrounded with a good deal of inflammator)- hardnefs, has 

 been cured by the continued internal ufe of opium. The 

 dofe is to be gradually augmented ; patients are ftated to 

 have taken, at laft, eighteen grains in one dav. 



One fpecies of malignant ulcer yields to the long con- 

 tinued exhibition of tartar eraetic. The dofes muft be in- 

 creafed, in proportion to the time which elapfes from the 

 firft taking of the medicine. 



Very malignant and unyielding for-es on the tongue are 

 faid to have been cured by repeatedly apph-ing leeches to 

 the under furface of this organ. Med. Commei;. vol. ii. 



It would be inexcufable to pais over in filence fuch ill- 

 conditioned ulcers of the tongue, as originate during violent 

 falivations. Sometimes fimilar fores, produced fay the fame 

 caufe, take place, at the fame time, on the tonfils ; and, in 

 this citcumitince, inexperienced furgeons, or miftakeu prac- 

 titioners, who are blinded with the fear of fyphilis, are ver\- 

 apt to fuppcfe the fores to be venereal ones. This error 

 leads to the treer ufe of mercurv- : the fores frequently 

 flough ; and the patient's health becoming greatly deringed, 

 he is thrown intj a ftate of great peril. In this cafe, it is 

 hardly neceffary to obferve, that the ufe of merctny muft 



be immediately omitted, and the moath very frequently 

 wafhed with a folution of alum. 



Violent inflammations, followed by ulcerations of this 

 fort, are particularly apt to occur, when patients catch 

 cold, while they are under the influence of mercury. 



For the removal of a cancerous portion of the tongue, a 

 biftoury is the beft inftrument ; and the patient's mouth 

 fliould be kept open during the operation, by the interpofi- 

 tion of fomething between the teeth. The himorrhage is 

 generally what is moft apprehended ; but we have inilances 

 related of large portions, and even of the anterior half of 

 the tongue, being amputated, and of the bleeding being 

 eafily fupprefled, either bv the aftual cauten.-, or fome of 

 the ordinary means for the fuppreffion of haemorrhage. It 

 appears to us, that a tolerably dexterous man might tie the 

 mouth of an artery in this fituation, with the affiftance of 

 two pair of forceps to tighten the ligature, when the noofe 

 has been put over the tenaculum round the bleeding point. 

 Certainly, cancerous difeafes of the tongue may have ad- 

 vanced to fuch a degree, that an operation cannot be pru- 

 dently undertaken. The bleeding would be a ferious 

 objeftion ; the whole diilemper of the tongTie itlelf might 

 not be removeable ; and the contaminated ftate of the ad- 

 jacent lymphatic glands below the jaw, ufually exi&ing in 

 this advanced ftate of the maladv, would, according to re- 

 ceived opinions, render a radical cure quite impra&icable. 



WTien the difeafe is not in the vicinity of the apex o{ the 

 tongue, the operator may find it diflicult to draw the part 

 fufBciently forwards, and keep it in this pofition. In this 

 circumftar.ee, furgical authors recommend the employment 

 of a pair of forceps for the purpofe, the blades of which are 

 to be covered with rag. Should this inftrument he found 

 inetfeftual, they advife the furgeon to ufe a pair of forceps, 

 the blades of which terminate in two ihort double hooks. 

 As being painful, one fliould alwavs avoid, if pofEble, the 

 employment of fuch an inftrument. 



Here, as in all other cancerous cafes, it is the duty of the 

 furgeon to take care that no point, lufpected of partici- 

 pating in the difeafe, be left behind. Unlefs this maxim 

 be attended to, the operation will moflJy be followed by % 

 relapfe. 



Abroad, furgeoos have fometimes effected a cure by ap- 

 plpng the cauterv, notwithllaading the wound after the 

 operation had put on an unhealthy and fungous appearance. 

 (Journ. de Med. tom. xviii. ) In this countn , pradi- 

 tioners might hope for fimilar fuccefs from the cautious em- 

 ployment of caullic ; for the revival of tlie cautery, under 

 any circumftances, is an idea now almoft intolerable to every 

 Britiih practitioner. 



After the escifion of a difeafed portion of the tongue, 

 local applications cannot be very well ufed ; nor are they 

 in general neceifarj-, when the patient moves the part as 

 httle as poilible, and avoids putting ftimulating food and 

 liquids into his mouth. 



Cancerous portions of the tongue may alio V>e extirpated, 

 by pafliqg a double ligature through tliis organ, and firmly 

 tying one part of the hgature over each fide of it. 



This plan muft be infinitely more painful, than the re- 

 mo\-al of the difeafed part with a kaile. To the latter 

 method, the hemorrhage is the only objection ; and, not- 

 withftanding all that has been faid, we think no furgeon 

 ought to venture to cut away a dileafed tongue, without 

 havmg firft made up his mind refpecting what method fhould 

 be adopted for ftopping the bleeding. 



When much of the tongue has been loft, there certainly 

 is reafon to expeA, that its fundions will aftersvards be 

 performed in a very imperfed manner. However, there 



are 



