★★★★★
Medical Council – A Monthly Journal for the Physican and Surgeon. Volume 15, p. 293-295. 1910
Always look at the tongue. People expect you to do so; and besides, helpful information can occasionally be gleaned from such inspection, as may be apprehended from the following outline:
Movements. Slowly protruded and tremulous in typhoid and chronic lead poisoning; tremulous and smooth in chronic alcoholism; tremulous with fibrillar contractions in locomotor ataxia and general paresis; projected with difficulty in general and diphtheritic paralysis and progressive muscular atrophy; turned toward affected side in apoplexy and hemiatrophy; incompetent as to mastication and speech and not projectible in progressive bulbar paralysis or glossolabio-pharyngeal cerebral paralysis (cortical symptoms) ; rapidly protruded in nervous and excitable persons; constant rolling in feeble-minded; tongue may be involved in movements of hysteria, epilepsy, chorea or tuberculous meningitis; tongue-tie due to an abnormally short or broadly attached frenum.
SHAPE AND SIZE.
Narrow in typhoid; shrunken and pinched in functional dyspepsia and advanced fevers and inflammations; long, narrow and rounded when protruded (parrot tongue ) in dysentery, hepatic abscess or carcinoma, acute peritonitis and advanced tuberculosis; bilateral ог unilateral paralysis (crenated in later stages), hypoglossal atrophy in hemiplegia, glossolabiopharyngeal disease (softening, hemorrhage, tumor), progressive muscular atrophy, locomotor ataxia (surface ridged), general paralysis of insane and tertiary syphilis (smooth atrophy of base of tongue).
Broad and flabby in anemia, atony (edges turned upward) and biliousness (yellow coating; breath foul and heavy), severe acute infections, scurvy, ptyalism, acute articular rheumatism and chronic gastroenteritis; dark and swollen in passive congestion (heart disease, lung affections, compression of veins in neck); inflamed and swollen from irritant and corrosive poisons; excessively enlarged (macroglossia) with benign or malignant growths, cysts (mucous, blood, hydatid), gummata, congenital lymphangioma, inflammatory hypertrophy, acute glossitis (pain, tenderness, salivation), actinomycosis or Ludwig's angina (hard swelling of tongue and along inside of lower jaw, causing thickening of floor of mouth), myxedema, acromegaly, cretinism or idiocy; ranulae (cystic tumors of various size observed on either side of frenum) due to obstruction of Wharton's duct or ducts of Rivini.
MOISTURE.
Dry from talking or agitation, dyspnea and mouth breathing (most noticeable on waking), long continued fasting, tonsillitis and pharyngitis (path of dryness down central line); acute fevers (in proportion to height and duration-returning moisture a good sign); prostrating diseases (bare, smooth and polished), especially with hectic, cachexia and suppuration ; diabetes insipidus and mellitus, severe diarrhea, dysentery (bare), acute peritonitis or intestinal obstruction, dropsy, severe pneumonia (rough), cirrhosis, aneurysm, brain disease and with opium and belladonna. The tongue is smooth and glazed (dried mucus) when moderately dry. In pronounced cases of appendicitis it is dry, cracked, often brown- altogether out of proportion to temperature and abdominal symptoms.
Moist in acute rheumatism (white), hyper-chlorhydria (smooth), coma and collapse (leathery), Asiatic cholera (creamy and cold, becoming dry and brown with reaction), wean digestion (pale and white furred in patches), ptyalism, constipation (furred).
Color. – Red from slightest irritation in infants; red and moist in chronic debility; small, bright red spots in ecchymoses; red, inflamed and tender in stomatitis, diphtheria, truama (hot liquids) and chronic superficial glossitis (continuously sensitive; often smooth, shiny ovoid patches separated by deep furrows); red and irritable in severe acute gastritis; red, dry and harsh in advanced diseases of stomach, kidneys, lungs and liver; red, dry, cracked, irritable in diabetes; raw and beefy in severe abdominal disease, especially dysentery and hepatic abscess; deep dark red in septicemia; tip and edges red in typhoid (dusky in severe cases); strawberry, raspberry or mulberry color (tip and edges red at first; whole surface bright red by fourth or fifth day) with injected papillae in scarlet fever (somewhat similar appearance in pneumonia and influenza; also raised red papules in gastric irritation, exhaustion and lack of digestive power); angry red or yellow-brown, smooth, raised patch to one side of median line in "smoker's patch"; red, ringlike, spreading circinate patches with light yellowish edges in annulus migrams of delicate children (trophoneurosis; harmless anomaly); pale and swollen
in chlorosis and anemia (flabby and marked with teeth); white and blue-white opaline plaques in leucoma (coalescent), leucoplakia (isolated), ichthyosis and keratosis; yellow plaques on edges in xanthelasma; purple or bluish-black spots in Addison's disease and following glossitis; purple margins from malaria or plethora; dark discolorations from bruises, blood stains (purpura) or infarcts; livid and cyanotic in chronic nephritis, infectious fevers and cardiac, dropsical or pulmonary affections with defective hematosis; recurrent spreading dorsal black patch in nigrities (parasitic; mucor stains with Lugol's solution); soft, venous, somewhat elevated bluish tumors, paling on pressure, in angiomatous nevi; hyper-trophic papillae show a soft base, rarely ulcerating. Stained black by iron, bismuth, ink, charcoal, blackberries, mulberries, grapes, cherries or other pigments; brown from tobacco, licorice, nuts, prunes, cocoa or chocolate; orange in professional tea tasters; yellow from rhubarb or laudanum; shriveled and lemon-yellow in poisoning by nitric or chromic acid; pearly red or yellow and pulpy from caustic soda or potash; white or pearly in ammonia poisoning; white and glazed in corrosive sublimate poisoning ; puckered, with white or brownish spots turning red then black, in phenol poisoning; white and scalded from oxalic acid; white and parchmentlike, turning gray and black, in sulphuric acid poisoning; pearly eschar from silver nitrate.
Coating. – Normally whitish at birth and a few weeks thereafter ; nearly always dry-coated in old age; slight coating normally at back of tongue in smokers (thickly stippled, mornings); stippled with moist white points in non-febrile chronic debility; dry stippling in mild acute febrile diseases; thick, uniform plaster in acute febrile diseases with prostration; smooth, gray and moist, with sharply defined red patches, in gastroenteritis; thick, moist white fur in chronic rheumatism; heavy dry-brown fur on either side of median line in typhoid (may be cracks and fissures); grayish coating, like diphtheria, in mycoses (microscope shows fungus); sticky furring in chronic alcoholism; tongue usually much furred in migraine; white and sodden in neuroses and with anxiety and emotions; irregular white patches, with local heat and soreness, in thrush (oidium albicans under microscope); white, milky and glistening in mycosis leptothricia; rough and white in milk drinkers; white or bluish-white scarlike spots or notched patches in lepkoplakia oris (from irritants, such as use of pipe; moderate pain if ulceration ); horny, raised, whitish or slate-colored dots, lines and patches in leucokeratosis buccalis, lichen planus or scleroderma ; silghtly stippled or coated in simple dyspepsia and ulceration (clean tongue with dyspeptic symptoms suggests hyperchlorhydria or extra-gastric disease), autointoxication and acute obstruction of bowel; moist and white in acute articular rheumatism and onset of scarlatina (central, clearing away in a few days ); thick, soft, yellow-white fur in acute glossitis (may be dry, cracked or ulcerated) ; maplike appearance (from epithelial hyperplasia) in lingual psoriasis or tylosis (ichthyosis; keratosis; usually in smokers); uniform light yellow and pasty fur in biliousness, severe tonsillitis and acute catarrhal jaundice; encrusted, dry-brown tongue in cancer, phthisis, albuminuria and chronic nervous diseases ; more or less black dorsal patch in old persons weakened by digestive disorders (acidity; leptothrices); one-sided furring from decayed or ulcerating tooth, one-sided mastication, facial neuralgia, hemiplegia, disease of gasserian ganglion or injury to chorda tympani; opalescent white, central dorsal patch, highly acid, in influenza; thrush in advanced phthisis.
Fissures. – Stomatitis impetiginosa (sore, with tenacious exudation ) ; chronic gastritis of weak children and weak digestion of adults ( pale, moist, white fur in patches ) ; glossitis desiccans (gradually developed deep fissures and indentations, giving tongue an uneven, ragged look; syphilitic glossitis (deep furrows at edges in tertiary form); chronic alcoholism, tea-drinking or abuse of tobacco; chronic kidney diseases; foot and mouth disease (edema with vesicles and sometimes sloughs); febrile states (dry, brown and often fissured); chronic dysentery. Furrowed commonly in elderly persons as a result of past glossitis, or rarely hypertrophy (often smooth, shiny ovoid patches separate by deep furrows); indentations in swollen tongue in various forms of glossitis and states of debility; bitten in epilepsy (often nocturnal at first) and early stage of glossolabopharyngeal paralysis. Fissures without furring or dryness sometimes present in health.
ULCERS.
Simple. – Any age ; any part of tongue; smooth, red, glazed, irregular, sensitive; little or no hardness about base; tends to heal after re-moval of cause. Local irritation (ragged tooth, pipe, knife or fork); herpes and aphthae (preceded by vesicles; slight fever and fetor); psilosis (herpetic); stomatitis (very sensitive, with involvement of buccal mucous membrane and gums); Schoenlein's disease (cutaneous wheals and purpura); pertussis (frenal ulcer); acute infections; chronic superficial glossitis (dorsal superficial, with local swelling and soreness); foot and mouth disease (vesicles and ulcers on edges of tongue and inside of lips; infection from milk); chicken pox and other skin affections. Dyspeptic or catarrhal variety small, often circular, superficial, red, irritable, frequently about tip.
Tuberculosis. – Multiple, shallow, uneven, sinuous, ovoid or stellate, pale red, flabby, sensitive; usually near tip, spreading slowly and laterally; mucous membrane pallid; yellowish-gray muco- purulent secretion containing tubercle bacilli; nearly always secondary to pulmonary or general tuberculosis; lymphatc glands may be involved or not; lupous ulcers very rare.
Syphilitic. – Any time after puberty; dorsum or sides of tongue; previous manifestations of syphilis; edges well defined but not very indu-glands enlarged; therapeutic success of specific rated; slight soreness as a rule; posterior cervical treatment; chancre single usually near tip, with patches glazed, stellate and, if fissured, very sen-hard base-soon softens and ulcerates; mucous sitive ; gummata single or multiple, superficial or deep, usually on dorsum; tertiary ulcer deep, sinuous, punched-out.
Carcinomatous. – Usually 45-55; sometimes history of irritation from sharp tooth or short pipe; single; commonly at side or under tip of tongue; edges of ulcer everted-surface hard and covered with characteristic granulations; burning, darting, cutting pains; no tendency to heal; submaxillary and sublingual glandular enlargement. – Denver Medical Times.
