SURGERY. 
738 
the seton was drawn, by means of the thread, from within 
the moutli outwards into the track of the wound; but 
care was taken not to draw it through the external opening, 
out of which the single thread alone passed, and was then 
fastened to the cheek with a bit of sticking plaster. The 
outer aperture was now dressed with lint, covered with 
compresses wet with the saturnine lotion. Thus the external 
opening had an opportunity of healing, with the exception 
of a mere point which soon closed; the seton, after being 
worn long enough, was taken out, and the little aperture 
touched with the argentum nitratum. 
Hare-lip.—This well known deformity is curable by a 
surgical operation which requires, however, a great deal of 
attention and address. In the operation, the object is to 
make the wound as smooth and even a cut as possible, in 
order that it may more certainly unite by adhesion, and of 
such a shape that the cicatrix may form one narrow line. 
The best plan is, either to place any flat instrument, like 
a spatula, the handle of a wooden spoon, or a bit of paste¬ 
board, underneath the lip, and then cut away the edge of 
the fissure with a sharp bistoury, or to hold the lip with a 
pair of forceps, in such a manner, that as much of the edge 
of the fissure as is to be removed is situated on one side of 
the blades of the instrument, so that it can be cut off with 
one sweep of the knife. This is to be done on each side of 
the cleft, and the two incisions are to meet at an angle 
above, thus A, in order that the whole track of the wound 
may be brought together, and united by the first in¬ 
tention. 
The lips being exceedingly moveable, and it being essen¬ 
tial in this case to heal the wound by adhesion, a particular 
process is always pursued to keep the lips of the wound in 
contact. Two silver pins, made with steel points, are in¬ 
troduced through the edges of the wound, and a piece of 
thread is then repeatedly twisted round the ends of the pins, 
from one side of the division to the other, first transversely, 
then obliquely, from the right or left end of one pin above, 
to the end of the lower on the opposite side, &c. Thus the 
thread being made to cross as many points of the wound as 
possible, greatly contributes to maintain its edges in even 
apposition. It is obvious, that a great deal of exactness is 
requisite in introducing the pins, in order that the edges of 
the incision may afterwards be precisely applied to each 
other in the proper manner. The pins ought never to ex¬ 
tend more deeply than about two-thirds through the sub¬ 
stance of the lip. It would be a great improvement always 
to have them constructed a little curved. This is what is 
named the twisted suture. The pins are usually removed 
in three or four days; the support of sticking plaster being 
afterwards quite sufficient. 
We come to speak of diseases about the mouth. The 
tongue is liable to ulcers of a painful, obstinate, and malig¬ 
nant-looking nature, sometimes produced by the sharp or 
rough edge of a tooth. Some very obstinate ulcers are con¬ 
nected with disorder of the digestive organs; but ulcers that 
are malignant and cancerous, not unfrequently form on 
the tongue. Sometimes the malady, in its most incipient 
state, appears as a sore. Sometimes a circumscribed move- 
able or immoveable scirrhous swelling is first observable, 
which gradually becomes painful, and ulcerates. In other 
instances, there is in the beginning only an induration in 
the substance of the tongue, without the smallest appearance 
of any swelling. The ulcers under consideration are always 
surrounded by hardness. They may make their first appear¬ 
ance either at the edges or at the apex of the tongue. In 
certain cases, the whole, or a large portion of this organ is 
covered with numerous small scirrhous tubercles, which gra¬ 
dually fall into a state of ulceration. All the medicines tried 
in other cases of cancer, especially arsenic, conium, &c., 
may here be tried, but on the whole, the timely employ¬ 
ment of the knife merits the most confidence. 
The tongue is in children occasionally too much confined 
by its framum: it may be divided to a very small extent 
with a pair of blunt-pointed scissars. 
The most frequent wounds of the tongue are those which 
are transverse. They are hardly ever produced by outward 
means; but usually by the teeth, when the lower jaw is 
forcibly and spasmodically brought against the upper one, 
while the tongue is out of the mouth, as sometimes happens 
in epilepsy, and falls upon the chin. In this way, trans¬ 
verse wounds of considerable extent frequently happen, 
almost separating, in some instances, the apex from the body 
of the tongue. In such cases, the injury may easily be con¬ 
verted into a sort of cleft, which may remain for ever after¬ 
wards, and more or less impede the functions of the organ. 
This disagreeable consequence is more likely to happen 
when no care is taken to keep the opposite sides of the wound 
in proper contact, and hinder them from becoming distant 
from each other. Hence, wounds of the tongue should be 
immediately closed with a suture. 
An haemorrhage from the raninal vessels sometimes follows 
accidental wounds, and surgical operations on the tongue. 
When it is an artery that bleeds, the accident may prove 
dangerous, and even fatal. Moving the tongue and jaw 
about, and continually sucking, promote the haemorrhage, 
and render the adoption of the measures necessary for its 
suppression extremely difficult. As in these cases a ligature, 
compression, and styptics, hardly admit of being applied, 
the bleeding cannot be stopped without much trouble. 
The plan is that of directing an assistant to keep a com¬ 
press on the bleeding vessels, as long as necessary, with his 
finger, while with his thumb he takes care to make counter¬ 
pressure under the jaw. 
If a surgeon were to find this unavailing, he must cut 
down to and tie the trunk of the lingual artery, just where it 
passes over the cornu of the os hyoides. 
Sometimes, when this organ is inflamed, it swells so pro¬ 
digiously, that it protrudes between the teeth, entirely fills 
up the cavity of the mouth, and obstructs speech, degluti¬ 
tion, and even respiration. In such a case, the most prompt 
assistance is demanded. Ordinary evacuations of blood, 
and other antiphlogistic measures, here seldom bring relief 
with sufficient celerity. According to surgical authors, the 
most certain plan consists in making two longitudinal cuts 
along the edges of the dorsum of the tongue, from one to 
two inches in length. A copious bleeding generally follows, 
which soon brings about a diminution of the swelling. No 
troublesome consequences are to be apprehended from such 
incisions, which heal with ease, and scarcely leave any scar 
behind. 
The ranula is a tumour arising from a distension of the 
salivary ducts underneath the tongue, and from an accumu¬ 
lation of the saliva in the dilated part. The cause of the dis¬ 
order is an obstruction of the excretory duct either of the 
sublingual, or of the inferior maxillary gland. 
The swelling is usually situated on one side of the fraenum 
linguae, and particularly when it is large, sometimes extends 
under the apex of the tongue. The tumour consists of a sac, 
which is composed of the dilated portion of the duct, and is 
either filled with clear fluid, a purulent matter, or an earthy 
substance. Unless the tumour has been of long standing, 
its contents bear a perfect resemblance, in colour and con¬ 
sistence, to the white of an egg. When the disease is less 
recent, the matter is thicker, and it may become like plaster, 
or even acquire a calcareous hardness. Its size varies consi¬ 
derably in different cases, from that of a pea to that of a 
hen’s egg. Iri some instances, it becomes exceedingly large, 
elevating the tongue so much, that deglutition and respira¬ 
tion are greatly obstructed. Some swellings of this kind 
have been known to contain a pint of matter. 
Ranulae are frequently quite free from pain; but, in some 
instances they are very painful, especially when the tongue 
is moved; and in others, they are more or less in an inflamed 
state. 
From what has been stated, it might be inferred, that the 
cysts of these swellings ought to be dissected out, in the same 
manner as those of ordinary encysted tumours. Owing to 
the particularity of the situation of ranulae, this is not exactly 
the 
