L I F, 



tl\an the female fex. (Richerand, Nsfographle Cliirr.rgi- 

 cale, torn. iii. p. 255, edit. 2 ) One important fad, iu which 

 all the belt informed I'urgeons afrree, is, that cancers of the 

 lips and face in general are far lefs mahgnant than carcinoma 

 of the bread, or at leall, admit of being effeftLially extir- 

 pated with the knife or cauftic witli more exterilive fiiccels. 

 The prudent furgeon, before removing a cancerous breaft, 

 feels himfelf obliged to explain the poffibihty of a return of 

 the ditlemper ; but when the lip is the part affefted, and 

 care is taken to remove every particle of the difcafe, he may 

 be much bolder in his promifes. 



The medicines uiually tried in other cafes of carcinoma, 

 mav be exhibited in thofe of cancerous lips. (See Cancer.) 

 The internal employment of arfenic has in particular been 

 much praif^d. On the whole, however, we have httle con- 

 fidence in any thing but extirpation, and it is only in doubt- 

 ful cafes, that delaying the operation to try the effeft of 

 medicines or apphciitions can be very juftiiiable. Wafting 

 time till the difeafe affefts the lymphatic glands under the jaiv, 

 or fpreads fo extenfively, that the wound after the opera- 

 tion cannot be united, is ferious mifconduft in the furgeon, 

 for the ill conlequences to the patien'. are irremediable. In 

 the firll cafe, the diftemper under the jaw moflly cannot be 

 taken away ; in the fecond, if the lower lip be affefted, as 

 is commonly the cafe, great deiormity, imperfect fpeech, 

 and (what is more terrible) a contmual Havering mull for 

 ever remain ; or at moft, admit of only flight palliation by 

 artificial contrivances. 



There are now only two modes of extirpating cancers of 

 the lip ; one with caultic, the other with a knife. 



In thefe cafes, cauftic has been very extenfively employed, 

 and fuccefs may be expcfted from the method, when the 

 whole of the diieafe admits of being at once deftroyed by a 

 fiO'^le application. But when the cauftic mull be repeatedly 

 ufed, it not only proves in many inftances ineffeftual, but 

 often aggravates the difeafe. Nearly all the varieties of 

 cauftic have been employed by different practitioners. The 

 great thing is to have one that is exceedingly active, and the 

 kali puruin with quick-lime is as good as any. We have 

 read of a cafe vfhich was cured by means of a burning 

 glafs, though we do not perceive any advantage that this 

 plan can have over the employment of cauftic. Comte, 

 Hiltoire de I'Acad. Pvoyale de Mcdeeine, ann. 1776. 



Let it not be inferred from the foregoing oblervations, 

 that we are advocates for the ufe of cauftic, as we frankly 

 own, that although it was our duty to mention the practice, 

 we Ihould be alhamed of adopting it. In every cafe where 

 cauftic can be employed, the knife can always be ufed with 

 advantage. It does its office more quickly, and with lefs 

 pain, at the fame time that it accomplidies the removal of 

 the difeafe, and furrounding fubftance with greater certainty 

 and exactnefs. But the grand recommendation is, that the 

 wound made with a cutting inftrument is fuch as can be 

 evenly united by the hrft intention. 



Notwilhftanding tlie teftimony of the beft fiirgical writers, 

 in fupport of the very frequent fuccefs attending the extir- 

 pation of cancers of the hp, one modern autlior is advcrfe 

 to making fuch attempt at all, ei'her v.ith cauftic or uith 

 the knife. (Juurdain, Mai. de la Bouche.) This doftrine, 

 we confcfs, furprifes us a good deal, as being fo repugnant 

 to the fentiments which we have derived, not merely from 

 the moft accurate books, but from the ebfervaticn of nu- 

 merous cure?. If M. Jourdain has, in his own individual 

 praftice, met with many inftances of a return of the difeafe 

 after the operation, we cannot help fufpedling, that his mode 

 of extirpation muft. have been faulty and incomplete. 



Although it is an important maxim in the operation, to 



make tlie wound of fa:h a fhape as will admit c£ an even 

 union, it is a ftill more important point to remove every 

 particle of the difeafe. The majority of rclapfes are ur- 

 qucftionably imputable to the neglect of this material ob- 

 ject, and not t« the incurablenefs of the complaint. It is 

 always better to remove too much rather than too little, 

 for the lips are fo very yielding, that, in numerous cafes, 

 nearly the whole lip has been cut away, and yet the wound 

 has been united without deformity. At the tin.e that vvf 

 are writing this article (namely Auguft 181 1,) there is la 

 St. Bartholomew's Hofpital a cafe, where the greater part 

 of the lower lip was removed by Mr. Vincent on account of 

 a cancer ; but, notwithftanding this great lofs of fubftance, 

 the edges of the wound were eafily brought into contact. 



The operator ought not only to take away all that is 

 manifeftly fwollen, ulcerated, or indurated ; he fhould be 

 careful likewife not to leave any parts which are at all dif- 

 coloured. In ftiort, it is fnfeft to make the incifions at fome 

 little dillance from, the perceptible boundaries of the diftem- 

 per. The extent of tlie difeafe upon the infide of tjie iip 

 will always demand careful examination. 



When the whole lip is thorouglily cancerous, tlie prafti- 

 tioner is under the ncccftity of cutting every particle of it 

 away, in which circumftance the wound will not admit of 

 union, but muft heal by granulations. On the contrary, 

 when the extent of the difeafe is more moderate, the opera- 

 tor fliould always make the wound in the maoner of that 

 practifed for the cure of the hare -lip, fo that it n/.iy be 

 united by means of the twifted future. (See Hare-lip.) 

 As the lips are very tenfile, this method is generally practi- 

 cable ; and it is well known, that the twifted future may be 

 fuccefsfully employed, though two-thirds of tlie lip have 

 been cut away. 



The fooner the operation is undertaken, the greater is tlie 

 chance of fuccefs. Cafes only become irremediable through 

 delay, or an ineffectual ufe of cauftic or the knife. The 

 more extenlive the malady is, the more difficult it is to cure. 

 The cafe indeed is paft relief, when the diftemper has fpread 

 to the bones, the gums, the glands beneath tlie jaw, or anr 

 other parts which cannot be removed. The furgeon, how- 

 ever, muft relinquifh no cafe where there is a poilibility of 

 making an effectual removal of the morbid parts. 



The mere magnitude of a cancerous tumour is not pro- 

 hibitory of the operation. In one cafe, excifion was per- 

 formed moft fuccefsfully, notwithftanding the excrefcence 

 was fo large as to hang down on the breaft. (Le Drsn, 

 Obferv. torn. i. p. 78.) In another example, the operation 

 had the happiell confcqucnces, although the infide of the 

 lip and cheek felt as rough as if it had been fmeared all over 

 with faiid. (Richtcr's Anfangfgr. &c. Band 2, p. 356. 1 

 Richerand upbraids with timidity, furgeons who are ftopped 

 by the extent of the malady, and he contends, that extirpa- 

 tion ftiould be undertaken, even though it be rccelTary to 

 feparatc the fott parts from the lower jawbone, provided 

 the glands under the chin are free from diieafe. He intjrms 

 us, that Chopart, after removing in one cafe the whole ot 

 the lip, and a portion of the cheek, was obliged to cover 

 the denudtd jaw with the integument;, of the neck. Not- 

 withftanding fuch lofs of fubftance, the wound healed ; the 

 opening of the mouth remained for a time contracted ; bv.t 

 it fervcs (fays this author) for the admiflion of aliment, 

 and gradually becomes larger, the power of better pronu.n- 

 ciation alfo returning. Nofographie Chirurgicale, torn. iii. 

 p. 2C2, edit. 2. 



Whenever the cafe is fuch, that an attempt to unite the 

 wound can be praCtifed, the furgeon muft take away a tri- 

 angular portion of the dileafed lip, fo that the iaciConmay 



ff^rr.U!- 



