TONGUE. 



1155 



well defined : these ulcers vary in size from 

 that of a pin's head to that of a split-pea, or 

 larger ; they are almost constantly situated at 

 the tip, or edges of the tongue ; they are 

 sometimes grey, at others red ; when touched 

 against the teeth they are acutely painful, and 

 their presence causes an abundant and con- 

 stant secretion of saliva. In the commence- 

 ment, however, there is no ulceration, but 

 the malady begins by an affection of a papilla, 

 consisting in an effusion of lymph into a 

 fungiform papilla (hereafter to be described), 

 and this terminates in ulceration : the papilla 

 is at first large, yellow, and distended with 

 lymph ; in a few hours it has disappeared, and 

 its site is occupied by an ulcer, which after- 

 wards more or less spreads in a regular, cen- 

 trifugal manner. I believe this process has 

 never before been properly described, per- 

 sons not being aware that any thing has hap- 

 pened until the ulcer exists, and consequently 

 never seeing or exhibiting the malady in the 

 first stage; but any one, subject to these little 

 infirmities, may satisfy himself of the truth of 

 what I have said by carefully watching the 

 state of his tongue from day to day. 



The severe and deep-seated ulcerations of 

 the tongue, arising from mere disorder of the 

 alimentary canal, may consist of an extension 

 of the already-described variety, or it may 

 commence by a vesication, or an excoriation 

 of the surface ; it generally occurs in people 

 who are debilitated from some cause or 

 another. Mr. Lawrence relates the following 

 characteristic case : "A lady, between fifty 

 and sixty, of unhealthy appearance, with a red 

 pimply face, who had often suffered from dis- 

 order of the digestive organs, consulted me 

 for a disease of the tongue of formidable ap- 

 pearance. The middle and upper part of the 

 organ was swollen, and occupied by a deep 

 ulcer of irregular figure and foul aspect. It 

 was very painful, interfering with mastication 

 and articulation. The digestive organs were 

 much disturbed. The complaint yielded 

 speedily and effectually to simple measures 

 regulation of diet, and the digestive organs, 

 small doses of extract of henbane, and sooth- 

 ing local means." (Clinical Lecture, Medical 

 Gazette, vol. xxxvi. p. 800.) 



Mr. Lawrence mentions an instance in 

 which rawness and severe excoriation of the 

 tongue often repeated, the result of periodic 

 and long-continued dyspepsia, appear to have 

 induced true scirrhus of the organ. 



Aphthous iilccrat'um. The ulceration is 

 merely one stage of a peculiar morbid change, 

 to which the tongue, in common with some 

 other portions of the gastro-intestinal mucous 

 membrane, is liable. The tongue, however, 

 suffers more severely than most other parts. 

 It is eminently the result of disordered diges- 

 tion, and is accompanied with more or less 

 fever of an atonic character. An aphthous 

 tongue is rather swollen, tender, and furred, 

 and has a sensation of burning heat : on its 

 surface, scattered about irregularly, are small 

 white bodies, resembling little masses of curd, 

 varying in size from a split pea to a pin's- 



head, attached pretty firmly ; these bodies, as 

 well as the swollen state of the tongue, cause 

 the subject of them pain and inconvenience : 

 alter a variable time these little white masses 

 fall off, leaving the membrane on which they 

 rested in an altered condition, it is either raw 

 and excoriated at these spots, the epithelium 

 being peeled oft' and leaving the papilla? naked, 

 exposed, and red ; or else, the deeper ele- 

 ments of the membrane being affected, an 

 ulcer is formed. These ulcers are generally 

 more or less circular and superficial, and are in 

 no way to be distinguished, at this stage, from 

 the little circular ulcers already described, but 

 aphthae on the neighbouring portions of the 

 tongue disclose their true nature. The white 

 aphthous mass itself has been variously de- 

 scribed as a slough, concrete mucus, and albu- 

 mino-Jibrin, but it consists in reality of a mi- 

 nute parasitic fungus, which attaches itself to 

 the mucous membrane and burrows among its 

 epithelial cells. Seen under the microscope, 

 it is found to be composed of threads matted 

 together like felt, and intertwining among the 

 epithelium. Accompanying aphthas are gene- 

 rally to be seen on the surface of the tongue, 

 small vesicae, spots of epithelium raised with 

 a little serum underneath, and also some of 

 the papillae distended with fibrinous exuda- 

 tion conditions to be described presently. 



Indurated non-malignant ulceration. Indu- 

 rated ulcers, which are neither syphilitic nor 

 malignant, but closely resembling scirrhus, 

 are occasionally met with, and their doubtful 

 character gives the surgeon not a little trouble. 

 Mr. Lane narrates the following formidable 

 example : " Mr. G. B., aged 33, came to 

 me in the month of June, 1813, with a very 

 foul ulcer beneath the tongue, and said that 

 he some time before had had one on the upper 

 part of it, which he said was healed ; but on 

 examination there was a deep irregular fissure, 

 with raised, jagged, hardened edges, commu- 

 nicating with the ulcer under the tongue, 

 which, on examining with a probe, I found not 

 only communicated with the fissure on the 

 upper surface, but the instrument passed 

 through the substance of the tongue, into a 

 deep seated ulcer at the root of it, and thence 

 into the throat. The general appearance of 

 the disease was most alarming, bearing a very 

 strong character of carcinoma. He experienced 

 great pain and difficulty in deglutition, and 

 complained that the pain had of late extended 

 behind the ears, to the back of the head and 

 neck." (Medico-Chirur. Trans., vol.viii.p. 20:-?.) 

 The case, however, was not one of carcinoma, 

 for the patient completely recovered under 

 alterative treatment. About two years since 

 an instance came under my own notice. A 

 man of about 45, had been a sailor ; had never 

 had syphilis ; for about six years had been 

 labouring under a disease of the tongue, with 

 little improvement, or permanent change, in 

 its condition. When I saw him, the right half 

 of the tongue was enlarged and much indu- 

 rated ; the left was of natural size and soft, but 

 with few papilla? ; on the right side no pa- 

 pilla; were to be seen, and the surface was ex- 



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