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produced no wound of the pharynx； and was passed from the anus on the sixth day。 Stevenson mentions a case of an organist who fell forward when stooping with a pipe in his mouth； driving its stem into the roof of the pharynx。 He complained of a sore throat for several days； and； after explanation； Stevenson removed from the soft palate a piece of clay pipe nearly 1 1/4 inches long。 Herbert tells of a case resembling carcinoma of the tongue； which was really due to the lodgment of a piece of tooth in that organ。
Articulation Without the Tongue。Total or partial destruction of the tongue does not necessarily make articulation impossible。 Banon mentions a man who had nothing in his mouth representing a tongue。 When he was young； he was attacked by an ulceration destroying every vestige of this member。 The epiglottis； larynx； and pharynx； in fact the surrounding structures were normal； and articulation； which was at first lost； became fairly distinct； and deglutition was never interfered with。 Pare gives a description of a man whose tongue was completely severed； in consequence of which he lost speech for three years； but was afterward able to make himself understood by an ingenious bit of mechanism。 He inserted under the stump of the tongue a small piece of wood； in a most marvelous way replacing the missing member。 Articulation with the absence of some constituent of the vocal apparatus has been spoken of on page 254。
Hypertrophy of the Tongue。It sometimes happens that the tongue is so large that it is rendered not only useless but a decided hindrance to the performance of the ordinary functions into which it always enters。 Ehrlich； Ficker； Klein； Rodforffer； and the Ephemerides； all record instances in which a large tongue was removed either by ligation or amputation。 Von Siebold records an instance in which death was caused by the ligature of an abnormally sized tongue。 There is a modern record of three cases of enormous tongues； the result of simple hypertrophy。 In one case the tongue measured 6 1/4 inches from the angle of the mouth about the sides and tip to the opposite angle； necessitating amputation of the protruding portion。
Carnochan reports a case in which hypertrophy of the tongue was reduced to nearly the normal size by first tying the external carotid； and six weeks later the common carotid artery。 Chalk mentions partial dislocation of the lower jaw from an enlarged tongue。 Lyford speaks of enlargement of the tongue causing death。
The above conditions are known as macroglossia； which is a congenital hypertrophy of the tongue analogous to elephantiasis。 It is of slow growth； and as the organ enlarges it interferes with deglutition and speech。 It may protrude over the chin and reach even as far down as the sternum。
The great enlargement may cause deformities of the teeth and lower jaw； and even present itself as an enormous tumor in the neck。 The protruding tongue itself may ulcerate； possibly bleed； and there is constant dribbling of saliva。 The disease is probably due to congenital defect aggravated by frequent attacks of glossitis； and the treatment consists in the removal of the protruding portions by the knife； ligation； the cautery； or ecraseur。
Living Fish in the Pharynx。Probably the most interesting cases of foreign bodies are those in which living fish enter the pharynx and esophagus。 Chevers has collected five cases in which death was caused by living fish entering the mouth and occluding the air…passages。 He has mentioned a case in which a large catfish jumped into the mouth of a Madras bheestie。 An operation on the esophagus was immediately commenced； but abandoned； and an attempt made to push the fish down with a probang； which was； in a measure； successful。 However； the patient gave a convulsive struggle； and； to all appearances； died。 The trachea was immediately opened； and respiration was restored。 During the course of the night the man vomited up pieces of fish bone softened by decomposition。 In 1863 White mentions that the foregoing accident is not uncommon among the natives of India； who are in the habit of swimming with their mouths open in tanks abounding with fish。 There is a case in which a fisherman； having both hands engaged in drawing a net； and seeing a sole…fish about eight inches long trying to escape through the meshes of the net； seized it with his teeth。 A sudden convulsive effort of the fish enabled it to enter the fisherman's throat； and he was asphyxiated before his boat reached the shore。 After death the fish was found in the cardiac end of the stomach。 There is another case of a man named Durand； who held a mullet between his teeth while rebaiting his hook。 The fish； in the convulsive struggles of death； slipped down the throat； and because of the arrangement of its scales it could be pushed down but not up； asphyxiation； however； ensued。 Stewart has extensively described the case of a native 〃Puckally〃 of Ceylon who was the victim of the most distressing symptoms from the impaction of a living fish in his throat。 The native had caught the fish； and in order to extract it placed its head between his teeth； holding the body with the left hand and the hook with the right。 He had hardly extracted the hook； when the fish pricked his palm with his long and sharp dorsal fin； causing him suddenly to release his grasp on the fish and voluntarily open his mouth at the same time。 The fish quickly bolted into his mouth； and； although he grasped the tail with his right hand； and squeezed his pharynx with his left； besides coughing violently； the fish found its way into the esophagus。 Further attempts at extraction were dangerous and quite likely to fail； his symptoms were distressing； he could not hold his head erect without the most agonizing pain and he was almost prostrated from fright and asphyxia； it was thought advisable to push the fish into the stomach； and after an impaction of sixteen hours the symptoms were relieved。 The fish in this instance was the Anabas scandens or 〃walking perch〃 of Ceylon； which derives its name from its power of locomotion on land and its ability to live out of water for some time。 It is from four to five inches long and has a dorsal fin as sharp as a knife and directed toward the tail； and pectoral fins following the same direction； these would admit of entrance； but would interfere with extraction。 MacLauren reports the history of a young man who； after catching a fish； placed it between his teeth。 The fish； three inches long； by a sudden movement； entered the pharynx。 Immediately ensued suffocation； nausea； vomiting； together with the expectoration of blood and mucus。 There was emphysema of the face； neck； and chest。 The fish could be easily felt impacted in the tissues； but； after swallowing much water and vinegar； together with other efforts at extraction； the fins were loosenedabout twenty…four hours after the accident。 By this time the emphysema had extended to the scrotum。 There was much expectoration of muco…purulent fluid； and on the third day complete aphonia； but the symptoms gradually disappeared； and recovery was complete in eight days。 Dantra is accredited with describing asphyxiation； accompanied by great agony； in a man who； whi