CATARRH OF THE MOUTH. 435 



and the smell from the mouth, appear to him sc distinctly to indicate 

 an emetic, that he considers advice unnecessary. 



The milder grades of oral catarrh, such as occur in most smokers, 

 cause but slight subjective symptoms. In the morning the epithelium, 

 which has collected during the night, usually causes a slimy taste and 

 disagreeable odor from the mot th ; but these soon pass off, and, during 

 the day, the patients nave nothing to complain of ; nevertheless, they 

 usually prefer the most piquant, to the bland and unirritating kinds 

 of food. 



In severe cases, chronic oral catarrh is a most annoying affection. 

 The victims of it occupy a considerable time in the morning in hawk- 

 ing and spitting, in scraping the tongue and rubbing the teeth and 

 gums with a hard brush to clear off the adherent mucus. The sensa- 

 tion, taste, and smell of the mouth are perverted all day ; the odor from 

 the mouth does not pass away. The patients consult the physician on 

 account of the " slimy taste," for which they have in vain taken va- 

 rious kinds of spring water, StraTiFs and Morrison's pills, and which 

 occasionally gives them severe hypochondriasis. The healthy appear- 

 ance and well-nourished state of the patients usually contrast with 

 their complaints. On questioning them, we find that even articles of 

 difficult digestion are eaten with impunity. It is necessary to under- 

 stand these states, in order to recognize them in special cases and to 

 treat them successfully. 



DIAGNOSIS. The coating on the tongue, observed in oral catarrh, 

 must not be confounded with that which is found in healthy persons, 

 especially in the morning, on the back part of the tongue, and which is 

 called the normal coating. According to Miquel, this is caused by 

 the air passing through the nose and fauces during the night, inducing 

 evaporation from the neighboring parts of the mouth, so that the epi- 

 thelium, which, under normal circumstances, is thrown off, becomes dry 

 and forms an opaque coating. According to Neidhart, who, in a disser- 

 tation, written under Seitz^s supervision, makes serious objections to this 

 explanation of the coating of the tongue, other causes have much to do 

 with its production. The epithelium of the mouth and tongue under- 

 goes continuous desquamation, which is to be regarded as a result of 

 the mechanical action of speaking and chewing. It is evident that 

 where the movement of the tongue is greatest, and where it is most 

 brought in contact with other parts, the epithelium will be soonest and 

 most effectually cleaned off. Now, this occurs particularly in the an- 

 terior part of the tongue, which, with every movement, is brought in 

 contact with the roof of the mouth, and in the sides, which lie directly 

 against the teeth. The back part of the tongue, on the contrary, 

 where the normal coating mostly occurs, does not lie against the roof 



