leaving a clean surface, which is much prone to hæmorrhage. The induration extends across the median line as well as posteriorly, and ultimately the whole organ is destroyed, as is shown in one of my drawings. Occasionally the tongue shrivels and wastes away without any ulceration. This has more nearly the aspect of epithelioma, but the effect is the same. Death ensues in a great measure from the inanition brought about by the inability to take that even extra nourishment which is necessary to combat the disease.

In all cases of cancer of the tongue that have proceeded to ulceration, infusoria,-vibriones, and sometimes members of the monad tribe,—will be found in the pus taken from the sore. This is not the case in cancerous ulcers of other parts of the body, and certainly they are not found in syphilitic ulcers of the tongue. This may afford a diagnostic clue in cases of doubt, and is altogether a curious phenomenon, which would be seized upon by the author of 'Vestiges of Creation' as a testimony in favour of that startling theory of spontaneous generation, the logical result of which, if established, would be to make Frankenstein' a possibly true story. It is now made out that intestinal worms, and even others that penetrate the muscles of the body, have their origin in the food we eat. It therefore needs no revolution of the laws of nature to account for the presence of these animalcules in a nidus which is peculiarly fitted for the reception and propagation of such universally distributed creatures.

Perhaps the worst form of cancer of the tongue is that which commences at the frænum. Its progress is

generally very quick. The ulceration extends through the muscles which connect the tongue with the hyoid and inferior maxillary bone, and these being largely supplied with arteries, much hæmorrhage ensues, and the system suffers from this serious waste. The submaxillary glands also become implicated in the disease, and these proceeding to suppuration reduce the powers of life, and greatly impede the ingestion of food.

Adhering to my text, that the restoration of diseased tissue to healthy structure is only to be brought about by nourishment, it will be readily understood that I look upon a diseased condition of the organ which stands at the portal of the digestive apparatus as one of the most serious misfortunes that can happen to man. There is no doubt that real cancer of the tongue is the most surely fatal of all diseases, simply because a patient so afflicted dreads the pain inflicted by taking the food which can alone sustain the powers of life. Applications and concentrated food and tonics may put off the evil day, but come it will in spite of all our efforts. The grand hope of the patient must be that it is not cancer he is suffering from; and I propose presently to give some few remarkable instances of cure of badly ulcerated tongues, which had from their long continuance caused the greatest despondency.

Before doing so, however, I will refer shortly to the question of operating upon the tongue in cancer. We have all heard of Mr. Syme's two cases of excision of the entire organ. It was a skilful and heroic proceeding, but the unfortunate patients died nevertheless. Mr. Nunneley of Leeds has since performed the same operation, and the patient lived, but in his case the

proof was by no means certain that the case was one of cancer at all. At any rate, he must have a strong love of life indeed who would submit to such an operation with so little prospect of a favourable result.* I have seen a recurrence of the disease so frequent and at so short an interval, after excision of even a portion of the tongue, that I think we are only justified in advising this proceeding when the isolation of the cancerous tumour is very complete, and situate in the free portion of the tongue. In that case we may hope that a delay may be obtained, and that such interval of repose may be utilised to nourish and invigorate the system by changes of climate, and by dietetic, therapeutic, and hygienic measures of such a nature as shall tend to restore the lost balance of supply and decay, and so possibly prevent the return of the disease. The method of performing this operation is of some importance. The ecraseur of Monsieur Chassignac was popular for a time, because it has the great merit of avoiding hæmorrhage, but from what I have seen of its effects in removing portions of the tongue, I am indisposed to its employment in this operation. The bruising of the adjacent parts is so great, that the whole organ not unfrequently sloughs, and the patient dies a miserable death, at a much earlier period than if he had been left alone. I have seen this result in cases operated on by surgeons of the very highest repute, and I find from Mr. Hutchinson's report in the Medical Times,' that

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* In the Lancet of February 4, 1865, there is a report from Mr. Syme of another excision of the tongue performed by him, but as the report appeared a month only after the operation, we are in the dark as to its ultimate advantage.

patients so operated on have died of pyæmia not many weeks after the operation.

Whenever it is decided that an operation is desirable, the plan adopted by Dr. Humphrey and Mr. Bryant of Guy's Hospital is unquestionably the best. A needle carrying a stout thread is passed through the healthy tissues of the tongue quite clear of the disease. By means of this stout thread the tongue may be drawn well out of the mouth. The surgeon has thus full control over the part he wishes to excise, and whether it be by a transverse or by a triangular section, he is enabled to effect his object thoroughly and easily. The hæmorrhage is very considerable, but the vessels may be readily seized, owing to their large size and free flow. When this is effected, the incised parts have of course to be brought together by means of sutures; and even here the metal sutures may be used in preference to the old irritating silk things, which encourage suppuration, and fail in their object entirely, when the powers of life are low, and the healing process is consequently protracted. Perhaps, even in this operation, by some clever mechanical twisting of the needle, Dr. Simpson's second splendid original contribution to surgical practice may be utilised for checking the hæmorrhage, without having recourse to the ligature, which does more mischief in the excitation of suppuration than tongue can tell.

Mr. Hilton, some years ago, with the object of cutting off the chief nervous supply to the tongue, and so rendering a cancerous ulcer painless, divided and snipped off a portion of the gustatory nerve, as it lies upon the inner side of the ramus of the jaw, and passes from the