PATHOLOGY. 
118 
rableaffeftion, it is manifefted moil frequently in children. 
It happens fometimes immediately after birth ; at others 
in the firft years of infancy. In both cafes this deformity, 
be it from birth or accidental, degenerates gradually, 
when it is not remedied in its beginning, into an habi¬ 
tual difeafe, which increafes with age; and many have 
been afflifted with this deformity for life. An author of 
the fixth century, Gafpar Peucer, is the firft who has 
laid he had feen children come into the world with the 
tongue out of the mouth, and “hanging on the chin, 
like that of a calf recently (lain.” Such is his exprefiion. 
He confidered this vicious conformation as a phenome¬ 
non, in fome meafure foreign to the art; as an incurable 
monfirofity. The fame cafe has been obferved, with a 
little more exaftnefs, by Zacchias; this phyfician fpeaks 
of having feen, in 1628, at Rome, a new-born child, very 
Jtrong and well formed, who had the tongue out of the 
mouth, the length at lead of three fingers breadth ; it 
was a little wider and a little thicker than it ufually is at 
that age; when the child moved it, and drew it in, one 
could judge how much it exceeded the opening of the 
mouth. Neverthelefs, it fucked pretty well, provided 
the nurfe’s nipple was large and elongated ; for it could 
not execute the fame fundtion with another nurfe, whofe 
nipple was (hort and thin. Arrived at the age of about 
fourteen months, it ate and drank pretty freely, although 
it had, night and day, a portion of the tongue out of the 
mouth ; it began even to pronounce fome words, when it 
died,without Zacchias having known the caufeofits death. 
The firft appearance of the difeafe is generally loon 
after birth, though inftances (fee the Memoir of Citizen 
Laflus in the firft volume of the National Inftitute of 
Science and Arts in France) are not wanting to fhow 
that the difeafe has exifted before birth. In either cafe, 
however, the point of the tongue tumefies, is prolonged 
by little and little out of the mouth, till it is found ex¬ 
tending even upon the chin. Suffering the child to fuck 
much increafes this elongation ; and, in proportion as the 
tongue extends and tumefies, it draws with it, by its 
weight, the os hyoides and the fuperior part of the la¬ 
rynx, which contributes to render deglutition ftill more 
difficult. The continual and very-abundant effufion of 
faliva, which is no longer retained in the mouth, induces 
third and drynefs of the throat; the incifive and canine 
teeth of the lower jaw are thrown forward, and partly 
quit their alveoli; the tongue, rubbing againft thefe dif- 
placed and worn teeth, excoriates and bleeds; the lower 
jaw always hangs down, and projefts a little forward ; 
the under lip reverfes, and projefts; the fuperior edge of 
the lower jaw is hollowed by degrees in its middle, de¬ 
prived at length of teeth by the preflure and motion of 
the tongue, which forms there a kind of furrow to lodge 
itfelf; in fine, this organ, at times more, at others lefs, 
tumefied, hangs conftantly out of the mouth. Such are 
the fymptoms which charafterife this difeafe when it is 
inveterate; at the fame time, it does not abfolutely pre¬ 
vent f'peech and deglutition ; but the found of the voice 
is harlli, and deglutition is always more or lefs reftrifted. 
The firft attempts which were made to cure this difeafe 
were by amputating the protruded part of the tongue; 
and the fear of haemorrhage alone reftrained the hands of 
the furgeons of the fifteenth century. It feems that we 
have no occafion for this violent praftice ; for it has been 
Ibown by Laflus, in the Memoir above mentioned, on the 
deareft grounds, that, in nine cafes out of ten, the pro¬ 
truded tongue is reduceable by gradual prelfure, and that 
a bandage fo placed as to keep the mouth fliut will gene¬ 
rally be fufficient to cure the difeafe. This, however, 
•can only apply to thole cafes in which fimple congeftion 
or inflammation is prefent, in confequence of the return 
of blood beiiig prevented by the unnatural pofition of 
.the organ. Of courfe, when degenerations of ftrufture 
have occurred, the morbid enlargements will require the 
application of ligatures or extirpation with the knife. See 
■Surgery. 
| 3 . D. ranula, is an intumefcence under the tongue, 
named from its fituation in the vense raninas, or 
perhaps from its altering the voice of the patient. This 
tumour is feated on either fide of the fraenutn. It is 
round, of a greyifh colour like an hydatid, foft, compref- 
fible, indolent, and, in the early ftage, almoft tranfparent. 
At firft it is of about the fame fize as a nut or a cherry ; 
but by degrees its volume becomes much more confider- 
able. This alfo is very frequently met with in young 
children : its occurrence in adults is more uncommon. 
It confifts of a fucceffive dilatation of the excretory tube 
of the fubmaxillary or elfe of the fublingual gland, the 
orifice of which duft is by fome caufe or another flopped 
up, or obliterated ; fo that the confined faliva accumu¬ 
lates, becomes vifcid, and ceafes to flow in the ufual 
manner. In proportion as the ranula increafes, the inci¬ 
pient ftate of it having been neglefted, its enlarged fize 
raifes up the tongue, and forces it backward ; the confe¬ 
quence of which is, that maftication, deglutition, and 
refpiration, are obftrufted. The voice becomes indif- 
tinft and hoarfe ; the motion of the tongue is reftrained : 
it cannot be put out of the mouth. By degrees, the in- 
cifor and canine teeth of the lower jaw are loofened; the 
layer of mufcles, compofing the lower parietes of the 
mouth, is deprefled; and the dwelling, having attained a 
confiderable fize, makes a very manifeft prominence be¬ 
neath the chin. In this advanced ftage, that is to fay, 
when it has exifted ten or twelve years, as praftitioners 
occafionally fee inftances of, the appearance of the fwell- 
ing is quite altered from wdiat it originally was. The 
tumour is now hard, elaltic, painful, and ulcerated : it 
is as large as a turkey’s egg, and not fituated at the fide 
of thefrumum, but anteriorly under the tongue, to which 
it is clofely adherent. The mouth emits a very fetid 
fmell; and the breathing is fo much obftrufted, that the 
patient, through fear of fuffocating, is obliged to lie with 
his mouth wide open, when he goes to fleep. 
While a ranula is recent, the fluid which it contains is 
a vifcid faliva, refembling the white of egg, but fome- 
times of rather a yellow colour. In time it is gradually 
changed, becoming turbid and puriform ; and, in certain 
inftances, foft, friable, greyifh, concretions, from the fize 
of a pea to that of an almond, commonly called falivary 
calculi, are found in the kind of cylt, which is produced 
by the dilatation of the falivary duft. Thefe calculi ef- 
fentially conlift of a large proportion of the phofphate of 
lime, united with a mucilaginous fubftance. 
The tumour is often of a fcrofulous kind, and con¬ 
tains a thick purulent matter. It has been ftyled a hyda¬ 
tid, and is laid by Siebold to be an expanlion of Whar¬ 
ton’s duft. When it grows fuddenly, both the fpeech 
and fwallowing are impeded, with much pain ; but it ge¬ 
nerally increafes gradually, and its effefts are not violent. 
Inftances, it is laid, have occurred of thefe tumours de¬ 
generating into cancers; but this is highly improbable. 
They are with great difficulty difperfed or brought to 
fuppuration, and generally require the knife for their 
removal. And indeed it has been afferted on refpeftable 
authority, that a ranula, whether recent or inveterate, can¬ 
not be cured except by a furgical operation. SeeSuRGERY. 
The fpecies is found occafionally as a fymptom in bron- 
chccele and other caufes of external preflure. 
Genus IV. DipJ'afis, [from to be thirfty.] Mor¬ 
bid thirft ; the defire for drinking exceflive or impaired. 
This genus contains two fpecies. 
1. Dipfofis avens, conftant thirft with acidity of the 
fauces. This fpecies is generally found in fevers, fluxes, 
dropfy, &c. Many cafes are on record in which this af- 
feftion has reached an aftonifhing height. There are 
fome authentic records which feem to fhow that it is an 
idiopathic difeafe. See the London Medical Journal, 
vol. iii. a cafe by Dr. Dyce; and vol. iv. of the fame 
work, the cafes of Dr. Domeier and Tuaam Peaal. In 
thefe, aridity of the fauces and pharynx, the probable 
4. caufe 
