— The tendency of the patient to expose his tongue to the air tends to increase the trouble by allowing desiccation of the surface. While he should be fully permitted to continue this practice, because it affords relief in various ways, the tongue should be kept moist and clean, by means of a mucilag inous solution containing 10 grains of boric acid to the ounce. This can best be clone by the patient himself with a cotton swab. When he can close his mouth small pieces of cracked ice are grateful, and the solution mentioned should be used as a mouth-wash several times an hour. When there is great in filtration, scarifications with a thin knife (under antiseptic precautions) afford marked relief if a couple of ounces at least of blood are drawn. Severe pain may be counteracted by painting the organ once in awhile with a 4-per-cent. solution of cocaine. When the ingestion of food becomes difficult a catheter in troduced on the side of the tongue into the pyriform sinus—i.e., alongside the larynx—can adequately serve for the ad ministration of liquid food. This ma nceuvre is given in detail under (Esorn AGE'S (volume v), in the treatment of cancer of that canal. Rectal alimenta tion is sometimes necessary. Trache otomy is occasionally demanded to avoid asphyxia. Saline purges early in the case tend to shorten the duration of the lingual inflammation.
Chronic Glossitis.—This condition, in many cases, is attributed to syphilis, when in truth it is but the result of to bacco irritation, or, as shown by Brocq, to gastric affections in rheumatic sub jects. Strong alcoholic drinks occasion ally represent the primary source.
SYMPTOMS.—The tongue is red and sensitive, especially near the edges, and oval grayish patches resembling those of syphilis replace papillae or epithelial cells, which have yielded to the super ficial ulcerative process. The resem blance to syphilis is further supported by deep furrows, which tend to separate the tongue into island-like, lobulated surfaces. A foul breath is often present, especially when the condition occurs in drunkards. The history of the case and the results of treatment alone facilitate the recognition of the true disorder present.
- Correction of dietetic errors are of prime importance. If syph ilis is suspected, a course of iodide of potassium with the copious use of water simultaneously will do no harm if no luetic trouble is present. Applications to the furrows of a nitrate-of-silver solu tion, 20 grains to the ounce, with a camel's-hair pencil (never the solid stick) soon improves them. The oral cavity should be kept scrupulously clean, and washed out three times daily with a saturated solution (one drachm to the pint) of chlorate of potassium.
The use of a Li-per-cent. solution of
silver nitrate. or a 5-per-cent. solution of chromic acid, simultaneously with the galvanic current, recommended. The method of procedure is as follows: After painting the affected tongue with either of the two solutions. the patient is told to hold the wet positive sponge electrode in one hand while the negative metal electrode is rubbed over the painted dis eased areas for from ten to fifteen min utes. This produces an excess of saliva, which is caught by a large piece of ab sorbent cotton held to the mouth. M. L. Ravitch (Jour. Amer. Med. Assoc., May 31. 1902).
Leukoplakia.—This oral disorder is assimilated by various authors to psori asis, herpes zoster, etc. While it may affect the entire mouth, it is usually most marked on the tongue, and consists of whitish, opaline patches of cicatricial as pect, which tend to disappear spontane ously and to reappear. It gives rise to no distressing symptoms other than slight pain at the seat of the lesions, which are, in reality, narrow, minute ulcers.
Leukoplakia occupies an important position in diseases of the tongue, since it is thought by many authorities to be a frequent precursor to epitheliomatous cancer of that organ.
Two hundred and forty cases of leuko plakia studied. Lesions believed to be, as a rule, epithelial thickening, resulting from mucous patches. Only two cases were in women, both syphilitic. Four grades of the affection are recognized: 1. Very slight changes at the corner of the mouth, generally unilateral; a dull, dry appearance, with slight epithelial thick ening. 2. Appearances more marked, thickening greater, white coloration. Similar small patches on mucous mem brane of cheek, lips, and tongue. 3. More extensive patches, with intense white enamel-like appearance, on angle of mouth, in cheeks and lips. The tongue shows everywhere white opaline spots, and often small cracks; thin, minute, painful ulcers, which come and go. 4. Changes most marked in the tongue. The whole upper surface is smooth, shining, enameled in spots, the papillo gone. In the largest proportion of cases the angle of the mouth, alone or together with some other part, was affected; the tongue alone in nine eases, the lips alone in three. In about SO per cent. of the cases there was a clear his tory of syphilis. In many of the other cases there Was a strong suspicion of such infection. In four or five cases an tisyphilitic treatment either cured or much improved the condition. Of 14S cases questioned as to tobacco-smoking, 47 smoked little or not at all, 101 moderately, and 2 excessively. Syphilis alone occurred in 30 of these cases, smok ing alone in 37, syphilis and smoking in 04, and neither in 11. IV. Erb (Milne!" med. \Welt., Oct. IS, '92).