ANOMALIES OF THE TONGUE AND THE FRENUM It is a fact well known to the physician, as well as the laity, that the surface of the tongue at the onset told during the course of various diseases becomes covered by a whitish coat. The coated tongue played a very prominent role in older medicine. As the tongue forms the first portion of the digestive canal, it was easily de.duced that changes on the surface were caused by some digestive disturbance, The older physicians even entertained the fantastic conception that the arrangement of the deposit in the surface of the tongue could be utilized to locate the diges tive disturbance.
While no one to-day would attempt to solve the problems of disease by the shape and character of the coat on tbe tongue, its significance should by no means be entirely discarded. On account of an inflamma tion of its tissues the tongue assumes a characteristic appearance in certain infectious diseases, as scarlet fever and typhoid, which change becomes a valuable aid in diagnosis. In fevers of an ephemeral nature, in which other local syinptoms are absent, a very marked coating of the tongue must not only be regarded as an attendant of the fever, but should also raise the suspicion that the gastro-enteric tract is the source of the fever. An intense acetone odor emanates from the mouth during its inspection and a more careful inquiry will show that some error in diet has been made. But in general, the coating of the tongue as a diagnosic aid has correctly assumed a subordinate position.
A more important change in the surface of the tongue is that which is known under the name of geograpHeal tongue (lingua geographica). This name, as well as the synonyms, annulus migra»s, glossitis areata exfollativa, clearly express the remarkable appearance and partially the nature of this disease. At the outset it should be stated that this singular anomaly of the tongue in childhood is different from that form described under the name of leucoplakia or psoriasis lingua, but theless is frequently placed in the same elass as the latter affection.
On the surface of the tongue, most commonly at the edge. a grayish vzhite spot appears, which rapidly enlarges. Its growth is usually in the direction of the dorsurn of the tongue, rarely toward the base. At the same time the gray-ish white color in the centre disappears and a red discoloration takes its place, which seems encircled by the peripheral remains of the white deposit. The grayish white border mot-es onward in concentric rings, reaches the middle of the tongue and occasionally passes over it. When several such irregular figures coalesce, the char acteristic geographical map is formed. In the further progress of the disease, the reddish discoloration of the encircled areas becomes pale, so that only the white stripes remain. The rest of the tongue inay be coated.
These changes, which never lead to ulceration, remain localized on the surface of the tongue, as a rule, and run a chronic course with fre quent and rapid changes of the formations. The grayish discolored parts consist anatomically of circumscribed epithelial hyperplastic areas, while the subsequent red color is produced by the exfoliation of the epithelium and the epitheloid processes of the filiform papilla, and by the projection of the fungiform papilla. The process advances with an infiltration and exudation and is confined chiefly to the upper layers of the epithelium.
The disease attacks mostly children between the first and fourth year of age. The disease according to all appearances seems to be independent of the presence of teeth, since it has been observed in toothless infants.
The geographical tongue must be regarded as a partial phenomenon of a constitutional anomaly. Bohm declared that he found the geo graphical tongue most frequently in scrofulous children, but the investi gations of Carow recently tend to throw some doubt on this observation. Czerny saw- the disease especially frequent in children afflicted with the exudative diathesis.