WATER CANKER. 451 



stitutional disturbance ; subsequently the pulse becomes small, the 

 patient listless, and signs of asphyxia may arise. Left to itself the 

 disease may gradually subside; sound treatment often relieves it 

 promptly. When an abscess forms, all the symptoms increase ; but 

 subside almost instantly when it breaks. 



Chronic partial glossitis causes a circumscribed dull pain, which 

 becomes burning when the mucous membrane is ulcerated. The in- 

 duration impairs the movement of the tongue. The affection may last 

 for years, and is often mistaken for cancer. In glossitis dissecans 

 the ulcerated fissures are painful. When these have healed, the tongue 

 remains lobulated but free from pain. 



Psoriasis of the lingual mucous membrane is a very distressing and 

 obstinate affection, and lasts with varying intensity for years. The 

 patient is often quite incapable of chewing solid food and smoking 

 tobacco, for every motion of the tongue occasions acute pain. 



TREATMENT. Acute glossitis demands the promptest treatment. 

 Bleeding, blisters, and purging, are useless ; leeches to the tongue in- 

 crease the evil. We should rather scarify it deeply and boldly, for 

 the swelling will protect the ranine artery. We may also lay pieces 

 of ice in the mouth, and give soothing mouth-washes when the symp- 

 toms have moderated. If deep incisions fail, and suffocation threaten, 

 tracheotomy may be necessary. 



In chronic partial glossitis we must first of all remove the sharp 

 edges of teeth, etc. But frequently this fails, and operation is the 

 only resource. Iodine, water from mineral springs, and systematic 

 purgation, have been recommended on theoretical grounds; experi- 

 ence has not proved their advantage. 



In glossitis dissecans we may limit ourselves to the treatment of 

 the ulcers by nitrate of silver in substance or solution. 



Psoriasis of the lingual mucous membrane will be aggravated by 

 the use of mercury, given under the false impression that the affection 

 is syphilitic. In one of my three cases, after applying all manner of 

 treatment without advantage, a permanent and material improvement 

 was effected by persistently rinsing the mouth with a very dilute 

 solution of carbolic acid, and touching the fissures with the same acid 

 pure. 



CHAPTER IX. 



NOMA WATER CANKER GANGRENOUS SORE MOUTH. 



ETIOLOGY. Noma is that form of gangrene which results from an 

 asthenic inflammation, that is, from an inflammation occurring in a de- 

 bilitated person. " If a nutritive change of destructive character af- 



