Excision of the tongue : the substance of a paper read before the Surgical Section of the International Medical Congress, held in London, 1881 / by Walter Whitehead.

  • Whitehead, Walter, 1840-1913.
Date:
1881
Catalogue details

Licence: Public Domain Mark

Credit: Excision of the tongue : the substance of a paper read before the Surgical Section of the International Medical Congress, held in London, 1881 / by Walter Whitehead. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    be established the advantage of the ecraseur over cutting. But it has yet to be proved that the ecraseur is even effectual in crushing the arteries, consequently it cannot be conceded that it closes the lymphatics, which are undoubtedly much smaller. The operation I have finally adopted is the one just described, and, as I have never found any difl&culty in boldly removing the whole of the tongue through the mouth, I see no object in dividing the jaw. If the floor of the mouth or the glands below the jaw are involved, I advocate the excision of the tongue through the mouth first, and afterwards the re- moval of the glands and other structure by an independent incision below the jaw. During the last four years Billroth, who appears to have had by far the largest experience of any surgeon in removal of the tongue, has entirely abandoned the use of the ecraseur on account of the enormous mortaUty, which he estimates at 61-5 per cent. He now commences his operation by tying one or both hngual arteries, and removes through the wound made for this purpose, enlarged if necessary, any glands that may be affected, and afterwards utilises the wound as a channel for the drainage of the subsequent secretions from the mouth after removing the tongue. After having filled the wound with antiseptic gauze, the mouth is opened to its full extent by means of Herster's gag, and the angles of the mouth and the lower hp are drawn apart by three double hooks. Where the floor of the mouth is extensively affected, the teeth of the corresponding side are extracted, and the gums detached from the inside of the lower jaw by means of a raspa- tory. He then excises the diseased structures by repeated short cuts with a pair of curved scissors. Any hismorrhage that may occur is immediately arrested by the ligature of any bleeding vessels. If both lingual arteries are previously tied htemorrhage is nearly absent, and the stump looks pale, like the muscles of a limb after Esmarch's bandage has been used. If only one lateral half of the tongue has to bo removed he first makes a median division, and afterwards a transverse section of the affected side.
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