TONGUE. 



1157 



inch or an inch in front of the circunivallate 

 papilla;, and on one side of the mesial line. 

 Sometimes they form over the whole surface 

 of the tongue. lam acquainted with a gen- 

 tleman who, at the time he was suffering from 

 syphilitic psoriasis, got an attack of dyspepsia ; 

 in less than thirty-six hours the whole of his 

 tongue was one mass of these tubercles, and 

 not a papilla was to be seen ; in a few days 

 (under the influence of iodide of potassium) 

 every papilla had reappeared, and the tongue 

 was in every way natural. This influence of 

 disordered stomach being the immediate and 

 exciting cause of the manifestation of the 

 syphilitic poison on the tongue, I have fre- 

 quently noticed ; a person who has a taint of 

 lues venerea can scarcely sustain the least dis- 

 order of the stomach or bowels without its 

 showing itself upon the tongue. These tu- 

 bercles of the tongue, when left to themselves, 

 are very apt to become fissured and form 

 rhagades ; the space between two of them is 

 liable to be the seat of an ulcerated fissure. 

 Deep circular ulcers sometimes form on these 

 tubercles. 



Phagedccnic syphilitic ulcers are seen occa- 

 sionally on the tongues of feeble debilitated 

 people. 



All these forms occur as the result of 

 the constitutional taint of lues venerea, at 

 various periods after the primary symptoms. 

 1 have known the glossy tubercle and 

 rhagades occur fifteen years after the primary 

 sore. 



Cancer of the tongue. The tongue is liable 

 to be affected with scirrhus, having all the 

 properties of genuine cancer. Mr. Travers 

 has given a very graphic description of cancer 

 of the tongue, which I shall take the liberty of 

 quoting in extenso. " This is not a smooth 

 and firm rounded tubercle, such as is often 

 met with in this organ, but an irregular rugged 

 knob in its first stage, generally situated in the 

 anterior third, and midway between the raphe 

 and one edge. It sometimes, but seldom, 

 exteds across the middle line, although it 

 often extends alongside of it. The hardness 

 is unyielding, inelastic, and the mucous surface 

 puckered and rigid. It also gives to the finger 

 and thumb of the surgeon the sensation of 

 solidity, or of its penetrating the entire mus- 

 cular substance, being perceived equally on 

 either surface. Sharp shoots of pain are felt 

 through the side of the affected organ, towards 

 the angle of the jaw and ear. The disease 

 tends to run backwards towards the base or 

 posterior edge. It sometimes acquires great 

 bulk before ulceration takes place, so as to 

 project the tongue from the mouth. In this 

 state a female patient of mine was seen some 

 time ago in St. Thomas's Hospital, in whom 

 the permanent projection of the diseased organ, 

 beyond the widely distended lips, was from 

 three to four inches. The ulceration often 

 extends from the edge of the tongue to the 

 membrane of the mouth and gums, when the 

 elevated and distended membrane at length 

 gives way, and ulceration is rapid. The sur- 

 face of the ulcer is very uneven ; clean and 



bright granulations appearing in parts, and in 

 others deep and sloughy hollows. The dart- 

 ing pain is very acute, but only occasional. 

 There is a dull aching always present, and as 

 constant a spitting as in deep salivation. It 

 happens to strong and hitherto healthy per- 

 sons, for the most part males from the age of 

 forty onwards. There is generally an evening 

 paroxysm of pain, and the nights are much 

 disturbed by the secretion accumulating in 

 the throat, which excites cough. Often the 

 patient is roused by a painful compression of 

 the tongue falling between the jaws. Speech 

 is much affected and painful. 



" Towards the fatal termination of the dis- 

 ease, occasional profuse haemorrhages take 

 place at shortening intervals, and alarm and 

 weaken the patient, who ultimately dies tabid 

 and exhausted, generally with symptoms of 

 more extensive disease of the mucous mem- 

 brane in other parts. 



" The period at which the sublingual and 

 contiguous lymphatic glands become affected, 

 and the extent of their change, are very vari- 

 able. I have known them form the base of 

 the tumor, the cauliflower fungus occupying 

 half the tongue, i. e. two or three inches long 

 and one broad ; after death the jaw was found 

 covered with fungus." (Medico-Chirurgical 

 Transactions, vol. xv. part i. p. 245.) 



The scirrhus is not infrequently at the very 

 margin of the tongue. Louis mentions a case 

 where there was a little circumscribed tubercle 

 of scirrhus, about the size of a filbert, at the 

 edge of the tongue : it was ulcerated. 



It occasionally shows itself early in life : 

 Arnott mentions a case where it was present 

 in a girl of fifteen. 



In a subject who died of lingual cancer, 

 dissected by myself, I found that the whole 

 of the right side of the tongue, right tonsil, 

 the upper part of the pharynx on the right 

 side, and the mucous membrane, extending 

 from the tongue to the epiglottis on the 

 same side, were removed by ulceration, and 

 the inner surface of the lower maxilla laid 

 bare. The other half of the tongue was 

 healthy, and only the ulcerated edge was 

 scirrhous. The lymphatics were enlarged, 

 and of a greenish-yellow colour : they con- 

 ained pus. 



Tumours of the tongue. A variety of tu- 

 mours have been met with in the tongue. 



Fatty tumours have been found by Mr. Lis- 

 ton on the under surface of the tongue. Mr. 

 Hale Thomson exhibited to the Westminster 

 Medical Society, in 1839, a fatty tumour 

 which he removed from the side of the tongue. 

 It consisted of fat contained in a cyst. 



Encysted tumours. Many of the so-called 

 instances of ranula* have been abundantly 

 proved by Dupuytren, Breschet, and Malgainc 

 to be simply serous cysts, and not obstructed 

 salivary ducts. They consist of dense mem- 

 branous cysts, containing a thick albuminous 



* The consideration of ranula belongs to the mor- 

 bid anatomy of the salivary glands, and not of t! : 

 tongue. 



4 E 3 



