Alexandria gazette. [volume] (Alexandria, D.C.) 1834-1974, 1885-03-23
GENERAL GRANTS MALADY.

eecOnd-class matter.l
GENERAL GRANTS MALADY.
The following appeared in the Medical
Record Of Saturday:
During the past week the local disc ase
Of General Grant has shown no marked ten
ency toward progressive liberation At
the recent weekly cons ultation DR.. Fordyce
Barker was unavoidably absent. Drs. J. Fl.
Douglass, Henry B. Sands and George T.
Shrady, who were present, made thorough
examination of the Generals throat, with
view of discussing the expediency OF q radi-
cal surgical operation for the removal of the
growth Such measure would involve the
division of the lower jaw in the median line
the extirpation of the entire tongue and the
greater part of the soft palate, together with
the removal of the liberated and infiltrated
fauces and the indurated glandular struc-
lures under the right angle of the lower jaw.
This was considered mechanically possible,
despite the close proximity and probable in
volvement of the tissues adjoining the large
arteries and veins in the neighborhood of
the alterations; but in the best interests OF
the distinguished patient the surgeons did
not feel inclined to recommend the proceed
ure Even by such means there could be no
guarantee, in view of extensive surrounding
infiltration, that the limits of the disease
could be reached without immediate risk to
life by the severe shock to constitution
already much enfeebled. The low vital
power is such strong element ip the decl-
sion that, for the present at least, no kind
of operation will be undertaken. The ul-
ceration on the side of the tongue has not
progressed far enough to produce the usual
intolerable pain associated with that condi-
ton, but should the latter symptom appear
it may be deemed advisable to divide the
gustatory nerve"
The Philadelphia Medical Ne'cs of last
week had the following article on the di.
sease from which Gen. Grant is suffering:
Although scirrhous carcinoma of the
tongue is occasionally met with, the most
important of the neoplasms of that organ
is epitheloma, the natural history Of which
has o special interest at this time, in con-
nection with the case of q distinguished |
citizen, in which minute examination has
disclosed that the disease is a cancer Of that
type. -,
"Lingual epithelioma, as rule, rapidly
progresses toward fatal termination.
When left to itself the life of the patient
from the first appearance of the disease
varies, in accordance with the estimates
y
months, the average being III months.
Death ensues, first from the gereraliza-
ton of the disease secondly, from septic
Pneumonia, from the Inhalation Of the pu-
trid emanations which result from the de-
composition of the products of the liberated
surface; thirdly, from starvation, through
the pressure of the infected Emphatic glands
and surrounding parts upon the @sophagus
thereby interfering with degiutition and,
lastly, from hemorrhage proceeding from
the liberated lingual arteries or the vessels
| of the neck.
"The duration oflife Of those who survive
an operation averages nineteen months. Not
| only does operative interference prolong
| life and relieve suffering, but it effects q
| final cure in fourteen per cent. Of 81! cases.
| In attaining these results it must, however,
| be remem bered that excision of the tongue is
attended with q mortality of twenty-three
per cent. the principal dangers being shock,
hemorrhage, edema of the glottis, septic
lung affections, pnamia and erysipelas,
some Of which risks can bo avoided by talk
ing careful precautions during the operation
| and by the perfecting of antiseptc measures
during and after the procedure.
"When, in addition to disease of the
tongue itself, the palate and the tonsi are
| involved, the prognosis is far more grave,
| whether the disease be permitted to pursue
| an unaided course or whether it be subject
| ed to the knife In the latter event not
only will the tongue have to be extirpated,
but the disease Of the palate and tonsil will
have to be reached either by Langenbeck's
or Mikuiiczs method of operation. In the
former the jawbone is divided just in front
| of the masseter muscle, while in the latter
the ramus of the jaw is resected. For car
cinoma of the tonsil alone temporary section
of the inferior maxila has been practiced by
| Cheeyer, Gensmsr and Won Bergman. In
Cheever's case the disease continued to pro-
press; in Gensmer's there was freedom from
recurrence for thirty-three months, while
we are not aware OF the fate of Won Berg
manns patient In Mikulicz's case of re-
section of the ramus the patient was well at
the expiration of six months.
$50 far as we can learn there is no ex-
ample of the performance of the double
operation on record. and it is, in our opin
ion, not justifable. The only available
measures are those directed toward the re-
lief of suffering, the prevention of septic
complications and supporting the powers of
the system. Should deglutition be greatly
interferred with, gastrostomy might be re-
sorted to, but this procedure, under the
circumstances, is of such questionable
nature that the prudent surgeon would
doubtless not take it into consideration"
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