1158 



TONGUE. 



fluid, and not inspissated saliva. They are 

 situated in the cellular tissue immediately 

 under the mucous membrane, where they 

 sometimes grow to an enormous size. Mr. 

 Earle has described curious little vesicular 

 tumours, which he found in the tongue of a 

 boy : " Clusters of very minute semitrans- 

 parent vesicles pervaded the whole thickness 

 of the tongue, occupying nearly one-half, and 

 projected considerably both above and below 

 that organ. The slightest injury caused these 

 to bleed profusely, and in some places the 

 clusters were separated by deep clefts, which 

 discharged a fetid, irritating sanies." (Medico- 

 C/iirur. Trans ^ vol. xii. pt. ii.) The tongue 

 was quite restored by the use of internal 

 medicine. 



A mulberry-like tumour has been described 

 by Mr. Probart. It formed on the tip of the 

 tongue of a boy four years of age. It was of 

 a peculiar granulated appearance, resembling 

 a half-ripe mulberry, feeling hard and free 

 from pain. It grew gradually : at two months 

 it was the size of a nutmeg ; but after that, in 

 five weeks, it rapidly increased till it was of 

 the bigness of a hen's egg, protruding nearly 

 two inches beyond the lips, which were sepa- 

 rated widely by it> preventing the little patient 

 taking any thing but spoon meat, and that 

 with difficulty. It was highly vascular, and 

 bled profusely from innumerable vessels, which 

 nothing but the cautery would arrest, when 

 amputated. There was no return of the 

 disease. 



Polypus-like tumours have been met with 

 on the tongue, consisting of a fleshy mass, 

 like the rest of the organ, attached to it by a 

 pedicle. Louis mentions one of these about 

 the size of a nutmeg, which he removed from 

 the tongue of a young man eighteen years of 

 age : it was situated on the middle of the 

 dorsum of the tongue. A more remarkable 

 example is described by Dr. Huie. The case 

 was that of an old maiden lady, in whom a 

 tumour formed, about three months after a 

 catarrh and inflammation of the fauces, upon 

 the root of the tongue, and gradually increased 

 for twelve months, when " the smooth 

 rounded form of the tumour conveyed, at 

 first sight, the idea that it was of an encysted 

 kind ; but, upon examination with the finger, 

 it was found to be as hard and unyielding as 

 the substance of the tongue itself, and evi- 

 dently of the nature of polypus." (Edinb. 

 Med.-Chlrur. Trans., vol. iii. p. 72.) It filled 

 nearly the whole pharynx, and moved with 

 the tongue, to which it was attached by a 

 pedicle. Ligature was subsequently applied, 

 by which it was removed. " The tumour, 

 which is in the Museum of the Royal College 

 of Surgeons (of Edinburgh), was of an oval 

 form, weighed exactly an ounce, and mea- 

 sured five inches in its long, and four in its 

 short, circumference. It was broadest op- 

 posite the insertion of the pedicle, which 

 entered at the distance of an inch from the 

 upper part of the tumour. A longitudinal 

 incision, which has been made into it, displays 

 a firm cartilaginous nucleus, as large as a 



chestnut, surrounded by a nbro-cartilagtnous 

 structure, forming the rest of the tumour." 

 (Loc. cit., p. 76.) I strongly suspect that all 

 these pedunculated tumours of the tongue 

 are hypertrophied fungiform or circumvallate 

 papillae. 



Hypertrophy and prolapsus of the tongue. 

 This is a singular affection, which usually 

 commences in infancy, and is sometimes con- 

 genital. It generally begins and progresses 

 slowly by an enlargement of the organ within 

 the mouth ; it afterwards projects perma- 

 nently between the lips, and then advances 

 more rapidly, and the tongue, which was 

 before of normal, though hypertrophied, struc- 

 ture, becomes parched and fissured on the 

 upper surface, and ulcerated beneath. Some- 

 times the amount of tongue that is protruded 

 is enormous. The os hyoides and larynx are 

 drawn up, whilst the jaw is depressed, and 

 the incisors are pushed out in a horizontal 

 direction. 



Dr. Wells, of Columbia, has given a good 

 case, of which the following is a condensed 

 description. The patient was a little girl, six 

 years old, with an enormous enlargement of 

 the tongue ; otherwise she was in good health, 

 and a fine robust girl. The following are the 

 dimensions and state of the tongue at the 

 time : length, as it remained at rest and 

 hung down over the chin, from the superior 

 incisors to the apex, two and a half inches ; 

 circumference just in front of the lips, six 

 inches ; breadth, from one angle of the mouth 

 to the other, a little more than two inches. 

 It had undergone a very considerable change 

 in structure, was much more dense than na- 

 tural, and not subject to change in its dimen- 

 sions by the action of its own muscles, or, if 

 at all, very slightly so. Its motions other- 

 wise were sufficiently free : upper surface 

 smooth ; inferior covered with the cicatrices 

 of old ulcers, several of which, where the 

 tongue rested upon the alveolar processes of 

 the lower jaw, were but imperfectly healed ; 

 colour darker than natural. Within the rnjmth 

 the tongue had undergone no apparent change 

 except a moderate increase in width and 

 thickness. The front teeth had been dis- 

 placed from the lower jaw by the long- con- 

 tinued pressure of the tongue. The lower 

 lip was folded downwards. The anterior por- 

 tion of the superior maxillary bone had under- 

 gone a slight curve upwards ; the inferior a 

 much greater curve downwards; so that when 

 the back teeth came in contact, the front were 

 an inch asunder, or, rather, the space between 

 the upper teeth and the corresponding alveolar 

 processes below was something more than an 

 inch. This condition of tongue commenced 

 by an attack of glossitis in infancy. A portion 

 of the organ was removed by ligature, and 

 she completely recovered. 



Mr. Crosse mentions a girl of six years old, 

 in whom the tongue was prolapsed three or 

 four inches ; and this was completely reduced 

 by pressure and leeching. 



Mr. Listen has described an instance in 

 which the tongue projected three or four 



