TONGUE. 



1161 



destitute of papillae : it was white, smooth and 

 opaque on the surface. I have already men- 

 tioned the obliteration of the papillae in the 

 glossy tubercle of syphilis, and it also occa- 

 sionally occurs in lues venerea, independent 

 of the tubercle. 



I have seen the tongues of old people re- 

 markably bald, especially as it regards the 

 filiform papilla? : as a general rule, these pa- 

 pillae are less prominent in the aged. 



Effusions into papilla;. The fitngiform pa- 

 pillae are liable to be the seat of little extrava- 

 sations of blood. I am acquainted with a medi- 

 cal gentleman who has himself frequently had 

 tins trivial affection. It has always occurred to 

 him in the night, and is indicated by a sharp 

 pain, as though the tongue were stabbed by a 

 red-hot needle, caused, doubtless, by the pres- 

 sure of the blood upon the nerves in the papilla. 

 Upon examining the tongue a papilla is seen 

 to be distended into a minute capsule of blood, 

 at first red, and afterwards black. The coagu- 

 luin is absorbed in a few days, and the papilla 

 resumes its former appearance. 



Lymph of a grey or ash-colour is apt to be 

 deposited in and under the papillae, in the 

 tongues of persons tainted with syphilis. 

 When this occurs on the dorsum, it gives a 

 grey speckled appearance to the patch, some 

 of the papillae in the spot being unaffected. It 

 looks as though this circumscribed surface 

 had been rubbed with chalk. The patches 

 vary in size from a split pea to a fourpenny 

 piece. Occurring under the tip and along the 

 under edge of the tongue, the appearance is a 

 whitish even spot, of gristly texture, and not 

 presenting a speckled appearance, the papillae 

 here being invisible, and covered up uniformly 

 with epithelium. This is the most common 

 situation for these spots, which after a time 

 become fissured, and ulcerate. 



Lymph, effused into a fungiform papilla, is 

 the commencement of the common little cir- 

 cular ulcer on the tip and edge of the tongue. 

 1 have snipped off, and examined under the 

 microscope, one of these papillae. It was filled 

 with a yellow, opaque, granular, sub-fibrous 

 mass. The papilla is not only enlarged by 

 this effusion of lymph, but is altered in form ; 

 its pedicle is elongated, and its head flattened. 

 When the papilla does not ulcerate,but returns 

 ' to a healthy state, its contents are absorbed, 

 it diminishes in size, and the summit of the 

 papilla becomes pitted in the centre. It then 

 gradually assumes its natural size, shape, and 

 colour. This may be easily seen by watching, 

 every few hours, a patient's tongue through 

 an ordinary pocket lens. 



Denuded papillae. The papillae are occa- 

 sionally denuded by the effusion of serum be- 

 tween the basement membrane and epithelium, 

 by which this latter is raised into a blister, 

 and is subsequently rubbed off by the motions 

 of the tongue, leaving the red naked papillae 

 beneath. This denuded surface is red as com- 

 pared with the surrounding, and smooth, but 

 when viewed through a magnifier the small 

 naked papillae are seen to be regular and per- 

 t. This surface is not ulcerated, but feels 





sore when touched. I have lately seen a 

 patch, the size of a shilling, thus denuded in 

 a patient suffering from diarrhoea. 



Far. The fur of the tongue is the epithe- 

 lium, principally of the conical and filiform 

 papillae, variously altered. It is most abund- 

 ant where these papillae are most plentiful, 

 and it will be found, by inspecting minutely a 

 furred tongue, that the fungiform papilla? have 

 undergone very little, if any, change. I be- 

 lieve, with M. Piorry, that the fur of the 

 tongue is chiefly dependent upon the con- 

 dition of the saliva and mucus of the mouth : 

 and, holding this view, it is easy to understand 

 how it is that the filiform and conical papillae 

 are principally affected ; they hang among the 

 fluids of the mouth, exposing a large super- 

 ficies in proportion to their bulk ; their sur- 

 face is uneven and broken, and this, with the 

 imbricated state of the epithelial particles, 

 make them quickly and thoroughly imbibe, and 

 become saturated with, any fluid into which 

 they are immersed. In all this they contrast 

 with the fungiform papillae, whose surface, in 

 proportion to bulk, is small, and whose epithe- 

 lium is spread in a thin, even sheet, smoothly 

 over their surface. It must have been ob- 

 served by every one, that the colour of the 

 papillae of a brown typhoid tongue is identical 

 with that of the sordes around the teeth, which 

 is nothing more than the saliva and mucus, in 

 which these papillae have been bathed, inspis- 

 sated, and is doubtless the source of their 

 colour. The white fur consists of a white, 

 opaque, soft, sodden epithelium, which, when 

 viewed under the microscope, differs from the 

 epithelium in its ordinary state, in no other 

 particular than its opacity. When the fur is 

 brown, the epithelium presents the appearance 

 of being simply and evenly stained. There 

 are no opaque pigmentary particles in the 

 cavity of the cell. 



The various amounts and characters of the 

 fur ; the different arrangements of it in dif- 

 ferent diseases and at different stages ; the al- 

 terations, form, and size of the tongue, &c. ; all 

 s}'mptomatic of morfoid changes elsewhere, 

 and belonging rather to the physician than the 

 morbid anatomist, I shall not stop to describe. 

 But it must not be forgotten that, in health, 

 many of these conditions are natural to some 

 persons: in some, the tongue is habitually 

 furred, in others it is chapped, ragged, and 

 irregular. 



The healing and reparation of the papillary 

 surface of the tongue is not a little remark- 

 able. I have known the surface of the tongue, 

 after it has been immensely disfigured, es- 

 pecially in syphilitic cases, by tubercles, and 

 rhagades, and ulcers, restored almost to its 

 former condition. After iilceration it would 

 seem that the cicatrix contracts to a mere 

 line, while the surrounding mucous membrane 

 becomes extended, and either fresh papillae 

 form, or else the minute simple papillae in- 

 crease in dimensions, and become complicated, 

 for the papillary surface is ultimately quite 

 restored. 



I shall conclude these observations on the 



