Volume 1

The science and art of surgery : a treatise on surgical injuries, diseases, and operations / by John Eric Erichsen.

Erichsen, John.

Date:: 1888

Credit: The science and art of surgery : a treatise on surgical injuries, diseases, and operations / by John Eric Erichsen. Source: Wellcome Collection.

1174/1244 (page 1146)

$relief. The insides of the cheeks are not unfrequently affected iu a similar luanuer, or become the seat of mucous tubercles, which muKt |je treated as ha« already been stated. The TomjuG may be affected in various ways : when severely, its disease usually constitutes one of the tertiary manifestations of syphilis. In the early period of the secondary stage of syphilis, small papules, similar to those on the skin may a])i)ear. They are of little importance, and cause no inconvenience. Daring the second half of the first year of syphilis, and often at a later period, small superficial ulcers on the sides of the tongue, having an irregular or oval outline, and a grey surface, are not uncommon. They cause considerable discomfort. They are best treated by being touched twice a day with a solution of perchloride of mercury (gr. ij to 3]). The surftice must be previously dried with a handkerchief. Solid nitrate of silver is often as eflB- cacious. Another form of late secondary manifestation on the tongue is a small fissure, or crack, at one side, surrounded by a zone of thickened epithe- lium, which gives the macous membrane at the affected spot an opaque blue tint. These ulcers require the same treatment as those just described. Mucous tubercles are not uncommon on the tongue, but are less frequent than on the lips or cheek. At a later period the dorsal surface of the tongue, usually only in its anterior half, undergoes a chronic change. The epithelium becomes opaque^ ■\vhite, and thickened, sometimes in patches, sometimes uniformly, and if the tongue be dried and then examined, it will be observed that the papilla in the affected area have disappeared, the surface being almost smooth. The disease is a chronic inflammation affecting the corium of the mucous mem- brane, and the submucous tissue, with overgrowth of the epithelium covering the affected part. It has received various names, according to the appeai-ance produced : when the surface is smooth, and bluish in tint, it is spoken of as the smooth tongue^'' or chronic siojjcrflcial glossitis; when the opacity is greater it has been called psoriasis of the iongvc; and when the epithelium is heaped up so as to form scales, the term icthyosis lingim has been applied to it. These conditions most frequently result from syphilis, but cases are often met with in which no history of the disease can be obtained ; they are permanent, the normal pajtillary condition of the tongue never being regained. Simple ulceration is not uncommon in the opaque patches, and in later life epithelioma fi'equently attacks the diseased mucous membrane. The treatment of this condition is very unsatisfactory. Perchloride of mercury lotions are often of use. Internally iodide of potassium produces most effect. If it fails, and the patient is in a state to stand it, a course of mercury may be tried. The tongue is aflccted also in some cases by diffuse overgrowth of its connective tissue, occurring in patches and extending dee])ly into its substance from the mucous surface. More commonly it is the seat of gummata. These form, as a rule, in the muscular substance of the organ, and sometimes in the fibrous septum. They form indolent tumours, gradually reaching the mucous membrane, and im])licating it. They run the usual course of gummata, and when they soften and open on the surface, leave deep, foul ulcers, which may be Jnistaken for epithelial cancer. The diagnosis of these affections, and their treatment, will be more fully considered under the diseases of the tongue.$