1156 



TONGUE. 



coriated, chapped, and in parts superficially 

 ulcerated. He told me that at one time the 

 left side had been diseased in a similar way. 

 The lymphatic glands behind and beneath the 

 jaw and down the neck were enlarged and 

 indurated, and had been so from the first. The 

 free application of lunar caustic to the tongue 

 lessened the affection, and the lymphatic 

 glands became smaller and softer ; but the 

 other side became afterwards diseased, and 

 was relieved by the same treatment ; the 

 tongue was, however, never restored to a 

 healthy state, though, when I last saw him, 

 there was no ulceration. There was profuse 

 secretion of saliva ; but, with this exception, 

 the man was remarkably healthy. 



Mr. Lawrence, in his Clinical Lecture, al- 

 ready referred to, describes this condition of 

 tongue. (Loc. cit. y p. 799, case ii.) 



Gangrenous ulceration, The tongue is liable 

 to a peculiar gangrenous ulceration, called 

 " Glossanthrax " or " Malignant pustule." 

 It commences as a vesicle containing bloody 

 serum ; it gradually becomes black and bursts, 

 and the lingual tissues beneath and around it 

 are seen to be gangrenous ; this may proceed 

 till the whole tongue is in a state of mortifi- 

 cation : when it exists to this degree, there is 

 fever of a profound typhoid character, with 

 delirium, and the patient soon dies. Audral 

 has given an account of this disease in his 

 Pathological Anatomy. Heyfelder narrates 

 the case of a Prussian butcher, who, when 

 slaughtering a diseased sheep, put the knife 

 and held it for some time between his teeth. 

 In two or three days the margin of his tongue 

 was covered with black pustules. The part 

 swelled alarmingly, and most painfully ; vio- 

 lent fever set in, and the patient was carried 

 off in the course of sixty hours. 



I once saw a patient in low fever, who had 

 enormous sloughing of the dorsum of the 

 tongue, which proceeded in successive por- 

 tions till a large deep excavation, that would 

 have received half a walnut, was produced. 



Syphilitic ulceration. Hunter* strangely fell 

 into the error of thinking that venereal ulcer- 

 ations of the tongue are uncommon, whereas 

 they are the most common to which the organ 

 is liable ; and the tongue, next to the tonsils, 

 is more frequently attacked, in the constitu- 

 tional forms of this disease, than any other 

 portion of the mucous surface. 



A small, circular, superficial ulcer is the most 

 common syphilitic affection of the tongue ; it 

 begins exactly like the little ulcers of dyspep- 

 tics, from which it cannot be distinguished. 

 These ulcers are situated principally at the 

 tip and along the edges of the tongue. As 

 in almost all instances of ulceration of the 

 tongue, the ulcer is the second part of the 

 process, and follows the deposition of fibrinous 

 matter under the basement membrane ; in this 

 case in a single papilla, or a few contiguous 

 ones, as I have already described. These ul- 



* Speaking of ulceration of the tongue, Hunter 

 observes, " these are commonly supposed to be vene- 

 real ; but I believe they seldom are." (Hunter's Trea- 

 tise on the Venereal Disease. Page 337. 2nd Ed. 4to.) 



cers generally do not extend, but yield to the 

 most simple treatment ; sometimes, however, 

 they do extend, and form various sized un- 

 healthy ulcers, deep in proportion to their 

 extent, cupped and indurated at the base. At 

 other times they show a tendency to run in 

 one direction, and remain superficial : I saw 

 an example of this in a patient who had a 

 very narrow superficial ulcer an inch in length, 

 originating in a small circular ulcer, and ex- 

 tending along the under surface of the tongue, 

 on the left side, just at the point where the 

 mucous membrane is reflected from that organ 

 to the jaw : it was very superficial, and, as it 

 progressed, it attacked the healthy membrane 

 in its course. 



Rhagades or fissures in the tongue are not 

 uncommon : they are ulcerated clefts, which 

 extend down, often to a considerable depth, 

 into the substance of the tongue. Mr. Lawrence 

 describes one three quarters of an inch deep ; 

 though sometimes they only form a chap in 

 the mucous membrane : he also describes one 

 extending the whole length of the tongue, just 

 in its centre, in the long axis ; this was deep, 

 and with irregular ulcerated edges. When 

 seen in the fore part of the organ, they are 

 generally in the middle line, or nearly so ; but 

 those further back are scattered about, and 

 just in front of the circumvallate papilla?, 

 which is their most usual situation. They 

 are commonly associated with an indurated 

 and irregularly tuberculated surface of tongue 

 these tubercular lumps being sometimes 

 like large fissured warts, at others glossy and 

 smooth. The rhagades are generally red, 

 while the surrounding tubercles are grey, or 

 whitish, or, at other times, red and excoriated. 



The glossy tubercle, to which I have re- 

 ferred, is a remarkable disease : it often forms 

 with great rapidity, and as quickly disappears. 

 It seems to consist in an effusion of lymph 

 into the cellular tissue underlying the mucous 

 membrane ; this effusion is very dense, and 

 raises and distends the surface of the tongue 

 at the affected part above the surrounding por- 

 tions ; the effect is, that the complications of 

 the membrane, which constitute the papillae, 

 become unfolded, and the papillas are, as it 

 were, opened out, they form now one smooth 

 extent, and stretch over a large surface, the 

 faintest indications only of the papillae being 

 apparent, and sometimes they are totally ob- 

 literated. That this is the true explanation 

 of these smooth tubercles is evident from the 

 fact, that as they form, and in proportion to 

 the distension of the membrane, the papillae 

 diminish and shorten ; and as, under the influ- 

 ence of medicines, the swelling decreases, they 

 reappear exactly in the same ratio. These 

 tubercles have little sensation or pain, unless 

 the surface be excoriated ; they are dense, 

 almost as hard as schirrus ; their base is felt 

 pretty deep in the substance of the tongue ; 

 their surface is polished, glossy, and whitish 

 they remind me of the tongue of a fish ; they 

 are generally oval or round, when smallish and 

 single, and they are most frequently situated 

 on "the dorsum of the tongue, about half an 



