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CHAPTER V.

THE TONGUE.

THE part next most frequently selected as the seat of cancer is the uterus, but as there is a special class of practitioners who devote themselves entirely to the study of the functions and disorders of this organ, I prefer, for the present at least, to leave the subject in such good hands; and pass on to the contemplation of the diagnosis and treatment of cancer and its counterfeits as affecting the tongue-the organ which stands third in point of precedence, although certainly first in importance, considering the physiological uses which are put in jeopardy by any injury to this important member.

The diseases of the tongue, and its value as a pathological indicator, deserve the devotion of a special pathological enquiry. At one time I had intended to make this organ my peculiar study in the few moments of leisure afforded by an active professional life, but circumstances obliged me to enlarge the sphere of my observations; and that which I have now to offer, is, I feel, but a skeleton of what might be done, if a whole professional existence could be devoted to this subject.

Putting aside altogether the medical aspects of the tongue, although of the very highest pathological importance, there are many lesions which come under

the notice of the surgeon, the correct diagnosis of which often makes or mars the reputation of the practitioner, and suffices either to cure the patient or to make his life miserable. To illustrate the latter remark, I will mention, en passant, a case which recently came under my care at the Hospital. A young man presented himself who had an ulcerated tongue. He had lost all his teeth, and as a consequence his appearance was that of an old man. He had been under thirteen different medical men, some of considerable surgical reputation, and each had persevered in directing his teeth to be extracted, under the idea that the tongue could not get well as long as it rubbed against them. When he came to me, the teeth, as I have said, were all gone, but the tongue, nevertheless, had not healed. It had been condemned as cancer. I shall have occasion to refer to this case again, and therefore I will only now say that it was at once apparent to me that a mistake had been made. It was not cancer, and it was thoroughly cured in one month by appropriate treatment. course it might have been so cured without the extraction of a single tooth, if the real nature of the disease had been, as it ought to have been, previously recognised.

Of

I will offer no apology for inserting here a slight sketch of the anatomy of the tongue, as it often happens that in anatomical works the muscles and vessels and nerves are described in different chapters, and there is no little trouble in bringing the mind to bear at once upon all the parts of an organ, so as to appreciate thoroughly its pathology as well as its physiology.

The roughness of the tongue, by means of which we

tickle our palates, is produced by what are called papillæ, and these having different shapes and uses have received separate names.

The papillæ of the tongue are :—

The circumvallate, which are large nipple-shaped elevations at the posterior part of the tongue. These, deriving their nervous power from the glosso-pharyngeal nerve, are devoted to the sense of taste.

The fungiform are scattered over the sides and tip of the tongue, and on the dorsum in front of the circumvallate. They are implanted amongst the filiform, and are distinguished by their red vascular appearance. To these papillæ is attributed also the sense of taste.

The conical are scattered all over the tongue, and form a connecting link between the fungiform and the filiform. They are very numerous at the tip, and being there but slightly covered with the peculiar hairy prolongations of the filiform, are believed to be most especially endowed with the sense of touch.

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The filiform cover the whole of the anterior twothirds of the tongue, and constitute the fur: these processes are said to be true hairs, and only differ from other hairs in being short and imperfectly elaborated. These papillæ are called by Dr. Hyde Salter, 'protective' in distinction to the sentient' qualifications of the other papillæ. These filiform papillæ act as a clothing to the other papillæ, by their friction stimulate the others to their duties, and by their roughness impart a certain prehensile power, enabling the tongue to take hold of and move readily what is placed on it.

The muscles of the tongue are of three sorts, intrinsic, extrinsic, and accessory. They assist in the per