The geographical tongue certainly has nothing to do with syphilis, but the latter disease may have to be considered in differential diag nosis, as the secondary erythematous syphilide of the tongue may have a similar appearance on the surface. The syphilitic eruptions do not migrate, mostly ulcerate and yiekl promptly to antisyphilitic treatment.
The possibility of a parasitic nature of the disease,in analogy to similar skin diseases has been considered, without any definite proof however.
The niedical treatnient of the affection has no special object and is without perrnanent result. For cosmetic reasons the treatment recom mended by Seiffert may be used. This consists in the application of a strong solution of chromic acid for a few minutes and the subsequent washing with a solution of aluminum acetate.
A typical change of the tongue is often observed in children whose mouth contains carious teeth. The tongue suggests, in a measure, the alterations which we have learned in ulcerative stomatitis. The edge of the tongue is indented in places, which is really an imprint of the teeth. There is an inflammation of the marg,in of the tongue from the pressure and irritation of the sharp edges of the carious teeth. Occasionally a very painful ulceration may arise from this cause, but it heals promptly on removal of the cause.
Under the name erythematous inflammation of the side of the tongue in infants (glossitis marginalis erythematosa), \Vertheimer describes an inflammation which as a rule is characterized by a marked redness and desquamation of the epithelium. The affection attacks young, artificially fed infants and is attributed to the irritation from the act of nursing. This process, which must be considered almost a physiolog ical appearance, offers no further interest and on account of its harmless ness needs no treatment.
A greater interest is excited by those anomalies of the tongue which rest in an abnormal increase of its volume. Macroglossia is rare in chil dren as a distinct disease flymphangioma lingute) but frequent as an integral part of the symptom-complex in other diseases. In idiocy, myxxrdenia, mongolism and acronicgaly the enlarged tongue belongs to the syndrome of abnormalities which characterize these diseases.
The enlargement of the tongue in these diseases is due to an increase in the interstitial tissue. The organ in consequence of its increased diameter finds no place in the mouth and hence the anterior part pro trudes. In the very nature of the case, this voluminous tongue is dis turbed in its function in the act of nursing, as well as later in speaking; and its constant contact with the teeth and the atmosphere predisposes to inflammatory processes, which often result in a fissured and eroded condition if the tongue (Lingua dessicato).
The treatment of macroglossia lies in the province of surgery and consists in the excision of a wedge-shaped piece of the anterior part of the tongue and subsequent suture. The tongue enlargement resulting from diseases of Hie thyroid is favorably influenced by a specific organotherapy.
A few words concerning the inflammatory affection of the sublingual tissues must added. This condition was first described by Holthouse as subglossitis and later by IIenoch as "inflammation of the floor of the mouth." In these cases there is a phlegmonous inflammation of the submucous connective tissue at the border of the tongue, which spreads to the adjacent tissues and is attended by high fever and great local distress (enormous swelling, elevation of the tongue, salivation). It terminates with a discharge of pus under the tongue or externally.
The etiology was unknown to the observers. Nothing is known concerning the avenues by which the pyogenic agents enter.
The frenum is the seat of secondary morbid conditions more often than the tongue itself. The most common is the sublingual ulceration in whooping-cough (see Plate 40). The formation of the ulcer begins in the middle or at the side of the frenum. In the course of the process the v,hole frenum becomes eroded and in its place a broad deep ulcer is seen, which is covered by a white exudate and surrounded by- an elevated border. During the paroxysms of coughing the tongue is pressed and rubbed against the incisor teeth and th.is produces a decubitus ulcer of the frenum. A similar change of the frenum is sometimes seen as a complication of dentition in infants who are in possession of the lower central incisors only.