SUCCESSFUL MANAGEMENT OF PROTRUSION OF THE TONGUE IN A FIVE-YEAR-OLD ENGLISH BOY (1805)

Abstract

The following case report published in 1805 describes the successful treatment of a markedly protruding tongue in a young boy. The method is so simple that one wonders whether the author has not omitted something in the history.

On Thursday, May 24, 1804, Ralph Heighington, five years old, was admitted into the Sunderland Dispensary. He had been much distressed with worms, and for this complaint he was put under my charge. He had every appearance of scrofula, such as ophthalmia tarsi, and marks under the chin from scrofulous sores, etc.; but what chiefly attracted my attention was his tongue, which was so much enlarged in length, breadth, and thickness, that it hung out of his mouth considerably below the chin. It had a very disgusting appearance. The upper part of it was rugose, and indented with a few longitudinal fissures. The dentes incisores were gone; and the few remaining molares were much diseased, and ready to drop out. He could not utter a single syllable, but appeared to understand everything I said to him. The tongue began to swell before he was a year old; and increased so rapidly, as to prevent him from learning to speak a word. By the use of a few vermifuge medicines, a large quantity of worms were expelled, and, with them, all the concomitant symptoms disappeared. The tongue remained still much the same, being protruded without the mouth about three inches. The more he endeavoured to pull it within his lips, the further it appeared to be protruded. I thought it expedient to ... push back the tongue, and shut the mouth; but the moment he withdrew his hand, it burst without the mouth, the same as before. I ordered the tongue to be returned into the mouth, and retained there by means of a silk handkerchief, which was passed below the chin, and the ends firmly fastened at the crown of the head. By this means the jaws were kept perfectly close together. At first he appeared very uneasy, but being relieved occasionally, by taking off the handkerchief for a few minutes, and replacing it again, he was enabled to bear it; and, in the course of five weeks, the tongue became of the natural size and appearance, and he could pronounce several short words very distinctly. By these means, a perfect cure was effected.