TONGUE. 



1159 



inches from the lips of a young man, nineteen 

 years of age, the disease having been con- 

 genital. It was of a brown and livid colour, 

 rough, granulated, and fissured, and beneath 

 the mucous membrane were abundant venous 

 plexuses. This tongue was liable to periodic 

 intumescence, when it became much larger, 

 was very painful, and bled profusely. Mr. 

 Liston has stated his belief, that, from the 

 periodical enlargement and diminution of the 

 tongue, and the erectile tissue being evident 

 in many parts of its surface, the mass was 

 partly composed of a structure resembling 

 aneurism by anastomosis. 



These hypertrophied tongues, when cur- 

 tailed by the knife or ligature sufficiently 

 to be taken within the teeth, generally soon 

 Accommodate themselves to the form and 

 dimensions of the oral cavity. 



Professor Lassus has given instances, where 

 this has been accomplished by means of ban- 

 daging and compressing the tongue. 



Atrophy of the tongue. I am not ac- 

 quainted with any instance of atrophy of the 

 entire organ, nor with any unassociated with 

 paralysis. It generally shows itself in cases 

 of hemiplegia, when the tongue does not im- 

 mediately recover, and results from diminished 

 nutrition, the consequence of want of ex- 

 ercise, being confined to the paralysed half, 

 just as the arm and leg of the affected side 

 become atrophied under the like circum- 

 stances. It is more obvious, however, when 

 the hypoglossal nerve alone is the seat of 

 injury or disease. Professor Budd mentions, 

 in his lectures, an instance which fell under 

 the care of his brother, Dr. William Budd, 

 of a man who sustained a stab in the neck, 

 dividing the external carotid artery and hypo- 

 glossal nerve on the left side. The artery 

 was secured, and the man recovered with 

 palsy of the left side of the tongue. At the 

 end of some weeks that half of the tongue 

 was much wasted, and all the movements of 

 the organ were perform' ' by the other half. 

 The atrophy was confi... :1 to he muscular 

 element of the organ : taste aud touch re- 

 mained uninjured. (M5. Notes of Lecture.') 



Dupuytren mentions an example of atrophy 

 and paralysis* of the left half of the tongue 

 caused by the pressure, upon the hypoglossal 

 nerve, of an hydatid cyst in the anterior con- 

 dyloid foramen. 



In this condition, as well as in hemiplegia, 

 the state of the tongue is remarkable from 

 one part of the organ being passive, while the 

 other is active. As long as it is at rest, the 

 diminished size of the affected si'.'e is all that 

 is observable. When the tongue is extruded, 

 it is thrust over towards the affected side, it 

 emerges from the mouth obliquely, because 

 the extruding muscles of the sound side have 

 no antagonists. The paralysis of the intrinsic 

 transverse muscular fibres gives rise to another 

 phenomenon, which I have never seen de- 



* In both these cases the muscular motion was the 

 only function implicated, which, as Dupuytren ob- 

 serves, is interesting physiologically; taste and or- 

 dinary sensation not being in the least affected. 



scribed, it is the curved form of the tongue 

 itself ; the raphe in the middle of the tongue 

 is not straight, but curved, and the concavity 

 looks towards the affected side. These fibres, 

 whose function it is to make narrow, and, by 

 that, to lengthen the tongue, only act on one 

 side, and only half the tongue is thus elon- 

 gated ; and this, being adherent to the other 

 half which sustains no elongation, is thrown 

 into an arch, on the same principle as the 

 curving of the compound wire in a Breguet's 

 thermometer. 



Diseases of the papilla;. In considering the 

 diseases of the surface of the tongue, authors 

 have not taken sufficient care to consider the 

 true anatomy of the papillary membrane, and 

 their descriptions are consequently loose and 

 ill-defined. It is of the utmost importance to 

 state where the morbid changes are situated ; 

 whether above or beneath the basement mem- 

 brane; whether it is the epithelium, or the 

 vessels and sub-basement areolar tissue that 

 have undergone the alteration. 



The papilla; are liable to hypertrophy, atro- 

 phy, effusion of blood or of fibrine into their 

 interior ; they may be denuded of their epi- 

 thelium, or that covering may be stained or 

 rendered opaque, producing what is called /r. 

 Hypertrophy of 'papilla; . The circumvallatc 

 papillae are liable to be enlarged, the central 

 portion forming a little tumour, rising above 

 the surrounding ring of membrane. Dr. An- 

 drew Ferguson has described them as increas- 

 ing to the size of peas. There are generally 

 several affected at once. I have seen them 

 increased to this size, as well as some of the 

 fungiform papillae at the back of the tongue, in 

 an individual suffering from scrofulous enlarge- 

 ment of the tonsils. The polypoid tumours 

 (retaining the same form and proportions as 

 these papillae, though greatly enlarged), I 

 believe to be nothing more than hypertrophied 

 fungiform, or circumvallate papillae. 



The conical or filiform papillae are liable 

 to a peculiar change, which has, to the best 

 of my knowledge, never been described. It 

 consists in an enormous increase in their 

 epithelial element, forming long cylindrical 

 rods; in fact, hairs: the only apparent change 

 in these organs being superficial to the base- 

 ment membrane. I am in possession of the 

 notes of two examples of this malady. For 

 the first I am indebted to my brother, Dr. 

 James Salter. He observes, " My patient 

 was an old gentleman, impoverished by in- 

 temperance ; his general health was good, and 

 he was now temperate : for some years he 

 had suffered from the peculiar affection of the 

 tongue under which he now laboured. This 

 affection was a great elongation of the conical 

 and filiform papilla3, in all parts of the tongue 

 where these abound : they were eight or ten 

 times their natural length, and over-lapped 

 each other, like the pile of plush, or long 

 velvet. The hypertrophy appeared to be en- 

 tirely in the long axis ; there was no increase 

 in circumference, and they were little larger 

 at their base than the apex. They were soft, 

 and lay over lapping each other on the sui - 



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