1154 



TONGUE. 



cavity of the mouth ; and I could with diffi- 

 culty introduce my little finger between it and 

 the upper jaw. It felt smooth and hard to 

 the touch, and had a thick coating of viscid 

 mucus : from the high degree of tension, 

 the point presented a glistening appearance." 

 (Edinburgh Med. and Surg. Journal, vol. xxviii. 

 p. 76.) As the case advances the tongue 

 increases still further in size, the patient can- 

 not perform the first part of the act of deglu- 

 tition, and the liquid food is obliged to be 

 conveyed by some mechanism into the pha- 

 rynx ; respiration through the mouth ceases, 

 and that through the nares is impeded : the 

 patient is now almost on the verge of suffoca- 

 tion, and his distress and anxiety become 

 extreme. Mr. Martin remarks: "At this 

 period respiration through the mouth was 

 totally suspended ; and he could not breathe, 

 even through the nostrils, but with difficulty. 

 His countenance was flushed and anxious, the 

 pulse was fluttering, his breathing offensive : 

 in short, he was threatened with immediate 

 suffocation." (Loc. cit., p. 77.) The condition 

 of the tongue sometimes approaches gangrene. 

 Mr. Hayes, in describing a similar case at an 

 advanced stage, observes : "It now began 

 to look of a dark black colour, or rather as if 

 it had been broiled over a smoky fire; indeed, 

 I expected it would mortify." (Memoirs of the 

 Medical Society of London, vol. ii. p. 193.) 



I am not aware that mortification has ever 

 resulted in these cases ; neither does abscess 

 appear to be thus produced,* which, however, 

 may be accounted for by the fact, that these 

 urgent cases almost always render it necessary 

 that the organ should be freely incised on the 

 dorsum to evacuate the distending blood, and 

 this would prevent the formation of abscess ; 

 though in some very severe instances, where 

 incision has not been practised, no abscess 

 has resulted. When the inflammatory action 

 ceases, which is immediate when the before- 

 mentioned operation is performed, the tongue 

 rapidly recovers, and the fever vanishes. 

 When the tongue is incised, the quantity of 

 blood discharged is very great. 



The morbid change in the tongue does not 

 always go to the extent above described, and 

 then milder symptoms are produced. Dr. 

 England mentions two mild cases, in both of 

 which the left half of the tongue alone was 

 affected. Dr. Graves relates a severe case, 

 also confined to the left side, in which he 

 says the part " appeared on the verge of gan- 

 grene." (Dublin Hospital Reports, vol. iv. 

 p. 43.) De Lamalle narrates an example, in 

 which the patient was almost suffocated in 

 five hours from the first appearance of the 

 malady. The tongue was more than three 

 times its natural size; it filled the whole 

 mouth, and protruded between the teeth. 

 Free incisions saved the organ and the patient. 

 Trincavellius mentions a case where it oc- 



* Since the above has been in type, a case occur- 

 ring to Dr. Schneider has been published, where 

 this form of inflammation terminated in abscess. 

 (Casper's Wochensclirift. No. 23.) 



curred in Variola ; Mr. Hayes an instance, 

 where an individual, licking an urticurious 

 eruption, had this effect produced to a slight 

 extent on her tongue ; and the same thing, to 

 a small degree, I have known occur from a 

 person eating mussels. 



Collier, Taynton, Job a Mekren, Paletta, 

 Elbuig, Frank, and Orgill, also enumerate ex- 

 amples of this condition. 



Dr. Craigie has described a peculiar form 

 of glossitis, under the name of Lingual 

 Quinsy, which is an extension of ordinary 

 quinsy, or tonsillitis. The portion of the 

 tongue involved is that bounded in front by 

 the circumvallate papilke, behind by the epi- 

 glottis, and at the sides by the mucous mem- 

 brane passing off upon the pharynx and rami 

 of the lower jaw. The inflammation extends 

 down the palato-glossus muscle from the ton- 

 sils to the base of the tongue, and seems to 

 involve the mucous, submucous, and muscular 

 tissues. The parts are swollen, infiltrated, 

 and stiff ; the lower jaw cannot be depressed, 

 and attempts at deglutition are not only diffi- 

 cult, but the completion of the act is impos- 

 sible. There is an abundant secretion of 

 ropy mucus. Dr. Craigie had one fatal case, 

 in which he found after death, that " the base 

 of the tongue was tumid, hard, and much 

 distended with blood and serum infiltrated 

 into its cellular tissue, and the parts between 

 that and the angle of the jaw were in like 

 manner infiltrated." (Edin. Med. and Surg. 

 Journal, vol. xlii. p. 26.) 



Mercurial glossitis. Inflammation of the 

 tongue, the result of the mercurial action, is 

 but one symptom of the constitutional influ- 

 ence of that drug. The tongue in this case 

 becomes large, soft, painful, white and furred, 

 and much indented by the teeth along its 

 edges : the epithelium is soft and readily re- 

 moved, and the surface is apt to ulcerate. 

 The swelling is sometimes very great and 

 rapid. Slegel and Trincavellius each mention 

 such a case. I believe it has never caused 

 suppuration of the organ ; but the discon- 

 tinuance of the mercury is followed by com- 

 plete resolution. 



Ulceration of the tongue. This is the most 

 frequent of the morbid changes occurring in 

 the tongue, and of it there are several species 

 and varieties. The different species may be 

 enumerated as, I. The Dyspeptic ulceration, 

 or that arising from disorder of the primas 

 viae ; II. Indurated non-malignant ulceration ; 

 III. Gangrenous ulceration ; and IV. Syphi- 

 litic ulceration. 



Dyspeptic ulceration is met with in three 

 principal forms. 1. Small circular ulcerations 

 at the tip and along the edge of the tongue ; 

 2. Severe and deeper ulcerations of the body 

 of the tongue ; and, 3. Aphthous ulceration. 



The small circular ulcers of the tongue are 

 extremely common, and have been personally 

 experienced by almost every individual. They 

 consist of small, circular, generally regular and 

 well defined ulcers, which are superficial and 

 look as if a piece of mucous membrane had 

 been punched out ; the edges are sharp and 



