450 DISEASES OF THE MOUTH. 



ANATOMICAL APPEARANCES. In acute glossitis the whole tongue 

 is usually affected ; very rarely one side alone. The tongue doubles 

 in size, its surface is dark red, and smooth or fissured, and covered with 

 tough, often bloody exudation. Its substance is infiltrated, soft, and 

 pale. Sometimes it returns rapidly to its normal size and structure ; 

 in other cases it remains for a long while, or permanently, indurated 

 and enlarged. In severe glossitis, small abscesses form ; these enlarge, 

 unite, and may burst through the mucous membrane and heal, leaving 

 a depressed scar. 



In chronic partial glossitis we find, particularly at the edge of the 

 tongue, circumscribed hard spots, which project slightly or not at all, 

 and which often retract the neighboring parts of the tongue just like 

 cicatrices. At these points the muscular substance has disappeared 

 and is replaced by connective tissue. 



In glossitis dissecans, the tongue's surface is divided into lobules 

 by deep furrows. Remains of food and epithelium collect in these 

 furrows and cause ulceration. Many apparent cracks in the tongue 

 are mere wrinkles like those on the faces of the old. In the superficial 

 glossitis described above as analogous to psoriasis of the skin, the lin- 

 gual mucous membrane is thickened, rigid, and extensively cracked. 

 In some spots there is a morbid luxuriance of the epithelial coating, 

 while in other parts of the surface it is entirely absent, and the whole 

 tongue looks smooth and shining, as though it were varnished. 



SYMPTOMS AND COTTESE. In acute glossitis there is not room 

 enough in the mouth for the enlarged tongue, which projects almost 

 an inch beyond the teeth, which are kept apart. The upper surface is 

 whitish, or, if the exudation covering it is mixed with blood, it is dirty 

 brown ; the under surface is dark red. The deep impressions made by 

 the teeth in the sides soon change to ulcers with fatty coatings. 

 The tension of the tongue caused by the great swelling excites severe 

 pain. The movements of the tongue are impaired by the pressure 

 caused by the exudation on the muscular fibres, speech becomes unin- 

 telligible and soon impossible, chewing and swallowing the same way. 

 The saliva constantly runs out of the mouth at both sides of the tongue, 

 while, the mouth being open, evaporation constantly goes on, and the 

 surface of the tongue, not being moistened, becomes dry and incrusted. 

 The submaxillary and the lymphatic glands of the neck enlarge, the 

 circulation in the jugular vein is obstructed; the face appears blue 

 and swollen. The entrance to the larynx may be contracted by the 

 swelling at the root of the tongue, and respiration be very much im- 

 paired ; hence attacks of suffocation often occur at the height of the 

 affection ; these may cause death. Acute glossitis is accompanied by 

 high fever, full pulse, great anxiety and restlessness, and severe con- 



