The patient should at first be fed by the rectum. After three or four days a catheter or soft tube may be introduced into the pyrifoim sinus on either side of the larynx, and the patient may be fed through it. As soon as the patient is able to sit up, the second or third day, he should, as much as possible, hold his head forward and downward so as to prevent gravitation of the discharges into the pharynx and oesophagus.
Sarcoma.—The number of recorded cases of sarcoma of the tongue, according to Georges Marion (Rev. de Chir., Aug., '97), is limited to 24; it may occur at any age, but in one-half of the cases it occurs before the thirtieth year. It is as common in the female as in the male. The tumor may be composed of round or spindle cells or of a mixture of these. It may be seated in the substance of the tongue or be pedunculated. The symp toms are chiefly the result of its situ ation or volume. They offer nothing characteristic of the neoplasm. The sec ondary swelling of the glands seems to occur very late. A positive diagnosis of lingual sarcoma can hardly be obtained except by "test-excision" and careful microscopical examination of the excised pieces. The differential diagnosis be tween sarcoma and gumma is frequently impossible, even by microscopical ex amination of excised fragments; in such cases an energetic syphilitic treatment is first indicated. Neither lunmorrhage nor pain are frequent. The enlargement of glands which may accompany the affec tion is either inflammatory or an evi dence of generalization. Although the progress of the disease is rapid, the prog nosis is relatively favorable, for recovery may be expected in one-half of the cases.
The operative treatment consists in the removal of the tumor, with a suffi cient margin of healthy tissue surround ing it.
Injuries of the Tongue.
Injuries of the tongue are seldom dangerous, though profuse bleeding sometimes ensues. The organ is fre quently bitten during falls, trismus, an epileptic attack, etc., and occasionally completely severed. Injuries of external source are infrequent, owing to the pro tected position the organ occupies. Foreign bodies are occasionally intro duced, and remain in the lingual tissues, giving rise subsequently to an enlarge ment suggesting a growth.
Case in which a tooth lodged in the base of the tongue for several years and simulated carcinoma. Sanford (Jour. of Laryn., July, '91).
Foreign bodies in the tongue may give rise to the appearance of serious troubles. In personal case, a man of 55 presented lesion of tongue. The lateral situation, size, and hardness of lesion; absence of functional phenomena; and suspicious antecedents, all pointed to syphilitic neoplasm. A piece of pipe, 2 centi metres long and 1 centimetre wide, was extracted. Denville (Jour. des Sci. Med. de Lille, June 29, '95).
—In slight or moderate traumatisms the use of ice, compression, etc., soon arrests the flow. If this does not succeed, the solution of perchloride of iron or the cautery may be tried. Profuse haemorrhage requires ligation of the cut artery — probably the ravine, easily found usually by raising the tongue. Approximation with sutures sometimes suffices even when the hemor rhage is quite severe, but it is usually easier to find and tie the main bleeding vessel. Sutures should be tied with un usual care, to avoid undoing the knots by the movements of the tongue. Loose pieces heal quickly when carefully ad justed. While the wound is healing, the mouth should be kept as nearly aseptic as possible, by means of a borate-of sodium wash (10 grains to the ounce of water) frequently employed.