Local treatment will consist in the employment of local analgesics. Cocaine dissolved in Glycerin (12 grs. to i oz.) may be tried, or tabloids of Cocaine or lozenges of Carbolic Acid may be frequently allowed to dissolve in the mouth.
The following combination is a V cry efficient pain reliever: It. Cocaine(' Ilydrochlor. gr. xv.
Glycerini Boracis 3Iisce.
Fiat a pplicatio. Signa.—" el little of this liquid to be brushed over the longue every hour or two hours during the day, and always a short time before taking food." Menthol is the local analgesic recommended by Butlin; it may be used alternately with the cocaine treatment. To prevent the decomposition of the salivary and buccal secretions due to the immobility of the tongue it will be necessary to wash out the mouth frequently, and the best wash for this purpose is a weak Carbolic Acid Lotion. Condy's Fluid may be tried when there is any decomposition. The sensitiveness of the tongue interferes with the feeding, and hence it is well to have the food adminis tered in the liquid form. Section or stretching of the gustatory nerve may be resorted to when the ordinary antineuralgic remedies fail, or an attempt may he made to inject the nerve with strong Alcohol.
Leucoplakia or " Smoker's Patch " may be regarded as a localised form of chronic superficial glossitis clue to the irritation of hot tobacco smoke or of some other local irritant. It is also known by a variety of fanciful names as Tylosis, Leucoma, Leukokeratosis, l'soriasis, and 1 chthyosis of the tongue.
It is most resistant to both local and constitutional agents, and is very liable to end in epithelial cancer. All treatment is useless till the source of the irritation has been removed. I I encc the extraction of any irritating tooth or teeth, or the filing down and polishing of their crowns, and total abstinence from tobacco and alcohol should be insisted upon. Very hot liquids are likewise to be forbidden, and all spiced foods and sauces avoided.
Though strong Nitrate of Silver, Lactic and Chromic Acids, Pernitrate of Mercury, etc., have been advocated, all strong caustics should be strictly avoided, as they only eventually end in stimulating the growth of the epithelial cells. The best routine is that ad \ ocated by Rosenberg,
who brushes a i in 5 solution of Iodide of Potassium over the patch and surrounding tongue surface, by which means sometimes the disease dis appears. The constant use of a Chlorate of Potash, Borax or Carbolic mouth-wash may be tried, or tabloids of these substances may he allowed to slowly melt in the mouth. A i in 5o solution of Bichromate of Potas sium is also a favourite local application to the patch. Leistikow applies a paste of 221 grs. Terre Silica, 45 grs. Resorcin, and i oz. Lard several times a day. In syphilitic subjects, Iodides and Mercury should be pushed. The method of Diathermy has been used for the removal of inoperable growths by Harmer. As soon as the failure of these agents has been demonstrated, no time should be lost in resorting to total ex cision of the diseased epithelial tissue, as in a radical removal lies the only prevention of malignant disease.
is remedied by the simple operation of snipping the frzenum, which is resorted to much more frequently than is necessary. The most satisfactory method of operating is to pass in the index-finger and the next one under the tongue, the framum being put upon the stretch between th m, and, with a curved scissors, the point being held downwards, the constricting hand is divided by a single snip, care being taken not to divide the ranine vessels as the child struggles. (For the treatment of Ranula, see under its own heading.) Wounds of the tongue are usually due to biting of the organ during an epileptic seizure. As a rule suturing is seldom the best procedure is to direct the continuous use of an antiseptic mouth-wash to prevent infection of the wound with micro-organisms. If haemorrhage is profuse, the organ should be pulled well forwards under a general anaesthetic and the spouting vessel secured after enlarging the original wound, which must then be closed with deep sutures.