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Remarks on an Operation for the Removal of Fungoid Tumour of the Lower JawAuthor(s): Henry CrawfordSource: Provincial Medical and Surgical Journal (1844-1852), Vol. 10, No. 3 (Jan. 21, 1846), p.31Published by: BMJStable URL: http://www.jstor.org/stable/25499038 .

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SOUTH EASTERN BRANCH OF THE ASSOCIATION. 31

Who would dream of allowing inflammation, or

other disorganizing process, to run its course un

checked, for the first few days or weeks of attack,

in any of the organs or tissues of the human frame;

and yet this, the most calamitous if not the most fatal

of the diseases to which suffering humanity is exposed,

is not to be interfered with in its early and curable

stage from the dread of infringement on personal

liberty. Sedulously would we guard this most inva

luable and important privilege by every means in the

power of legislation to devise; but when the precau

tions taken to protect the personal liberty of the doubt

fully insane have a direct tendency to subject a large

proportion of their number to hopeless confinement

for the remainder of their days, then we cannot but see

that legislation has failed in its object, and only

inflicted and perpetuated the very evil which it was

intended to prevent. Those who consult this little work will find many

valuable reflections interspersed throughout its pages in reference to the treatment and moral management:

of the insane. We are unable to follow the author

further, but we cannot conclude without expressing I

an entire approval of the spirit in which his remarks

are written, and recommending his book to the atten

tion of our readers.

COMMITTEE OF THE SOUTH-EASTERN BRANCH OF THE PROVINCIAL MEDICAL I

AND SURGICAL ASSOCIATION.

TO THE EDITOR OF THE PROVINCIAL MEDICAL AND

SURGICAL JOURNAL.

SIR.

Fearing to trespass on your well conducted Journnl, the insertion of a few remarks, having reference td

Mr. Kelson's letter of the 1th instant, if not con.

sidered obtrusive, will suffice.

If I mistake not, Mr. Kelson appears to consider

Medical Reform and the unjust conduct of the Council

of the College of Surgeons, (to which the report

mentioned, when noticing this subject, had almost exclusive reference,) as convertible terms. If so, then

I, as an humble member of the Committee, whose

conduct has been arraigned, willingly bear my part of the "onus" of its report-more willingly, as -I ca assert with truth, that a more judicious, concise, yet

forcible allusion to the unprFedented conduct of the Council of the College of Surgeons, than in ths

official declaration, I have not met with. If they are

not, (as I humbly opine,) then I beg to re-assert" "that

the subject was distinctly referred to the Members

generally of the Branch Association."

My remarks on Medical Reform had reference to

the specific resolutions subsequently proposed, and, as the Journal referred to by Mr. Kelson states, " not

unanimously agreed to."

If I mistake not much, the highly respected gentle man with whom the resolutions originated, merely

wished to submit them to the meeting in bis individual capacity alone.

How far this explanation.will exonerate me from

the charge of being absurdly inconsistent, I must leave

your readers and Mr. Kelson to decide. With respect to his subsequent notice of my remarks, Mr. Kelson's

all-but unique opinions on medical polity, will, I fears

prevent the existence between us of that happy una

nimity, so desirable in every voluntary association.

Wishing Mr. Kelson every possible alleviation in

his multifarious occupations, I am, Sir,

Obediently yours, ROBERT H. POWELL.

Tunbridge Wells, January 14, 1846.

REMARKS ON AN OPERATION FOR THE REMOVAL OF FUNGOID TUMOUR OF THE

LOWER JAW.

TO THE EDITOR OF TIIE PROVINCIAL MEDICAL AND

SURGICAL JOURNAL.

SIR, In the last number of your Journal, a case is reported

of removal of a fungoid tumour of the lower jaw at the

Newcastle Infirmary, and I cannot help dissenting from

the conclusion of the reporter, viz., " that the operation was perfectly justifiable."

Operations for the removal of malignant disease are

unsatisfactory enough, even when the affected parts can be distinctly and entirely removed, but when a

fungoid tumour is " adherent to the jaw," and "the structures below it," I believe there is no sufficient

probability of good result to warrant the undertaking of such a "fearful and hazardous operation' as was

performed in the instance before us, especially as there was "a languid debilitated look, and pale, sallow

complexion," indicating general contamination of the

system. Had the operator persevered in extirpating the whole of the diseased parts, the man would pro

bably have died upon the table; as it is, I should feel

surprised to hear of his being alive six months hence, for so far as my own observation extends, life is seldom

much prolonged by the removal of malignant, (espe

cially fungoid,) disease in its advauced stages. In

many instances a temporary check is given to the

morbid growth, (probably by the loss of blood from the

operation,) but the re-action which ensues, increases

the fatal rapidity with which.the disease passes through its latter stages. I make these observations, not in

the spirit of captious criticism, but with the view of

.sserting as a principle in the science of surgery,-that no operation attended with risk of life should be

attempted, unless there are reasonable grounds whereon

to found an expectation of great and decided benefit, and I am persuaded, that the opinion of our greatest

surgical authorities would have been strongly against an operation in the case reported by Mr. Gibb.

I remain, Sir,

Yours respectfully, HENRY CRAWFORD.

Canterbury, January 8, 1846.

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