Chloroform  may  be  administered,  but  Moore's  opera-
tion really  does  not  necessitate  chloroform,  unless  the
patient  suffei's  so  much  from  the  disease  that  he
cannot  bear  the  slightest  touch  upon  the  tongue,  and
perhaps  cannot  bear  to  open  the  mouth  widely  enough
to  allow  the  division  to  be  made.  If  chloroform  is
necessary,  I  think  it  is  wiser  completely  to  expose  the
nerve  by  Hilton's  method,  and  so  make  quite  sure  of
dividing  it,  or  of  resecting  a  portion  of  it.
Lastly,  the  administration  of  opium  and  morphia
play  a  large  part  in  the  later  treatment  of  most  fatal
cases  of  carcinoma  of  the  tongue.  No  special
directions  are  needed  in  such  cases  other  than  those
which  should  be  observed  in  the  administration  of  the
same  drugs  in  other  painful  diseases.  As  a  rule,
it  will  be  found  easier  to  administer  the  medicine  as
an  injection  than  by  the  mouth,  but  preparations  of
opium  may  be  given  with  advantage  to  the  majority
of  patients  by  the  mouth.  Two  rules  may,  I  think,
be  observed  with  benefit  to  the  patient  in  most  cases
of  cancer  of  the  tongue  ;  first,  never  to  give  narcotics
until  they  are  absolutely  necessary ;  second,  when
narcotics  are  used,  to  use  them  freely  enough  to  keep
the  patient  relieved  by  them.  The  first  rule  is  of
importance,  for  the  distress  produced  by  the  disease  is
frequently  increased  by  the  depression  which  opium
and  morphia  produce.  The  second  rule  is  also  very
important,  for  it  is  not  unusual  for  practitioners  to
administer  narcotics  in  small  doses,  yet  to  refuse  to
increase  the  dose  as  the  symptoms  become  more  acute,
and  as  the  patient  becomes  habituated  to  the  drug.
