4:34: DISEASES OF THE MOUTH. 



In moderate cases of acute oral catarrh, characterized by increased 

 mucous secretion and excessive cellular formation, the patients com- 

 plain particularly of a " bad taste," which they generally describe as 

 slimy or clammy. Accurately speaking, this " slimy, clammy taste " 

 is a misnomer, as physiologists only recognize bitter, sour, sweet, and 

 salty tastes. The patients fed a slimy substance on the oral mucous 

 membrane, and attempt to remove it by hawking and spitting. But 

 the sense of taste itself is also influenced by oral catarrh. Usually the 

 disturbance only causes the taste to be less acute, and not so sensitive. 

 Since an insensitive layer lies between the substance to be tasted and 

 the peripheral ends of the nerves of taste, only very irritant substances 

 excite distinct sensations. In such cases, the patients usually say their 

 taste is bad or stale. When they chew hard substances, and thus re- 

 move the insensitive layer from the mucous membrane, the sense of 

 taste is for a time better. In some cases, patients suffering from oral 

 catarrh complain of a bitter taste. The laity consider this a sure 

 sign of "biliousness," and some physicians think there is a status 

 biliosus, and not a status pituitosus. In far the greater number of 

 cases the bitter taste is a subjective symptom ; it is not excited 

 by bitter substances, but must depend on a perversion of the nerves 

 of taste. 



Lastly, the patients not unfrequently complain of a " foul " taste ; 

 this term is also unphysiological and incomplete. This foul taste is 

 caused by excitement, not of the nerves of taste, but of the olfactory 

 nerves, with whose peripheral expansions in the Schneiderian mem- 

 brane the gaseous emanations from the coating of the tongue come 

 in contact through the posterior nares. The foul taste, or, more cor- 

 rectly, the foul smell, is not solely a subjective symptom ; generally, 

 other persons perceive a fetor from the mouth of the patient, especially 

 in the morning, before breakfast ; this disappears when eating has re- 

 moved the foul epithelial coating from the tongue. It is doubtful 

 whether pain in the forehead, so frequent a symptom in acute catarrh 

 of the stomach, occurs in simple oral catarrh. The above symptoms 

 are by no means always accompanied by disturbance of the stomach 

 digestion. The patients often have a normal feeling of hunger ; but, 

 It is true, they usually choose very sour and salty, or highly-flavored 

 articles of food, which can excite the nerves of taste even through the 

 3pithelial covering. Frequently there is no evidence that the stomach 

 has not properly digested the food taken into it. After meals, there 

 is no pressure in the epigastrium, no eructation, or other symptom of 

 disordered digestion. It is often difficult, indeed, to persuade the pa- 

 tient that his stomach is sound, and not filled with decomposing sub- 

 stances. The thickly-coated tongue, the slimy, bitter, or foul taste. 



