[A lecture delivered before the Homoeopathic Medical College of Pennsylvania and published at the request of the class.]

By C. G. Raue, M. D., Philadelphia, PA.

Much attention has always been paid by the physicians of all schools to this important organ. Indeed it often presents characteristic, diagnostic and therapeutic indications, the most important of which I shall bring before you.

1st, Its color. It is either too red all over, as in scarlet fever, with considerably raised papillae, whence the name strawberry tongue, or red and dry as in inflammation of the brain and its membranes, in inflammation of the thoracic viscera and the mucous membranes of the stomach and intestines, or red on the edges, and on the tip, or a red, dry streak in the middle as in typhoid fever, or red, clean and glossy, indicating great fever, heat, congestion to the head, impending delirium, and gastric fevers the transition into the typhoid state, if chapped at the same time, ulceration of the bowels. A pale tongue is found in chills, in spasms, after loss of vital fluids, in chlorosis, dropsy, and general exhaustion. If it sets in in exanthamatic, gastric or bilious fevers it denotes a fatal issue. A lead-colored tongue is found in cholera, in mortification of the lungs and stomach, in schirrus of the tongue. Lead-colored, covered with aphthae denotes impending death under all circumstances. A blueish tongue is a sign of impeded circulation of the blood, whence it may be found in paroxysms of asthma, whooping-cough, croup, bronchitis, pneumonia, heart diseases, dropsy of the chest, and cyanosis. It is also found in scurvy and mercurial inflammation of the tongue.

2nd, Its humidity. A moist tongue is generally a favorable sign; but in putrid fevers with exhausting perspiration it has no such favorable meaning. A constant moist tongue in soporous conditions denotes great exhaustion. A dry tongue is found in a great many different affections, especially in feverish conditions. Great dryness of the tongue in typhus cerebralis is, according to Schoenlein, an unfavorable sign. Dryness of the tongue in infants is a forerunner of aphthae or internal inflammation.

3rd, Its temperature. A hot tongue is found in congestion and inflammatory states of different parts of the body; in infants before aphthae appear. A cold tongue is found in chills, violent spasms, after great loss of blood, internal mortification, apoplexy, and cholera. In fevers it denotes greatest prostration and impending death.

4th, Its covering and coating. We must bear in mind, that the tongue is coated or furred without indicating any disordered state of the system; in the morning by an empty stomach, after siesta, after night watching, and with habitual smokers of tobacco. A coating at the root of the tongue does not mean much, almost everyone has it in a slight degree, even in the best of health. A coating on the tip of the tongue is said to be found in phthisical persons. One-sided coating is said to be found in one-sided complaints as prosopalgia, paralysis, in one-sided lung diseases, in affections of the liver or spleen. A patchy or map tongue is often indicative of considerable irritation or even partial inflammation of the stomach. I have seen it also in lung diseases. A thick white coating exists to its greatest extent in affections of the fauces, but also in gastric derangements. A yellow coating is generally believed to be bilious. Single yellow streaks on a white coated tongue indicate obstinacy of the disease. A peculiar buff leather appearance is presented in cases of enteritis and hepatitis. A dark brown coating exists in malignant fevers and hemorrhages from the mouth. A black coating in dysentery, indicates exhaustion, mortification and death. In jaundice it denotes organic diseases of the liver and spleen, as induration, tubercles, abscesses. In small-pox it is an unfavorable sign.

5^th. Its form and size. We find a large, long tongue most conspicuous in chronic hydrocephalus and Cretans. A small tongue if not congenital, in atrophy, consumptive diseases and chronic, long-standing paralysis of the tongue, especially if resulting from an irritation of the brain or spinal marrow. A sudden diminution in size denotes in inflammatory diseases of the lungs or the liver, formation of abscesses, also general exhaustion, especially in putrid and typhoid fevers. A gradual decrease in acute disease, denotes severity and obstinacy of such diseases, and is a bad sign, showing that the brain is dangerously affected. A broad tongue is found in rachitis, scrofula, disposition to abdominal affections, and in intermittent fever. A narrow, pointed tongue is said to be found in persons who are subject to spitting blood, tuberculosis, and internal inflammations. ..A thick, swollen tongue is found in rachitis, Cretans, chronic dropsy of the head, in obstinate dyspepsia and chronic inflammation of the mucous membrane of the stomach; also in intermittent fevers, in catarrhal affections, mercurial salivation, in inflammation of the tongue, in old drunkards after death from strangulation or suffocation. A swollen and heavy tongue in old age and in drunkards is the forerunner of apoplexy. In fevers, if associated with dryness and stammering speech, it denotes congestion of the brain. In croup, pleurisy and pneumonia it is a bad sign just as bad as its sudden diminution without improvement of the other symptoms. (Hippocrates) A thin, like a small tongue, is found in atrophy and consumptive diseases. Tumors on the tongue if hard, red brownish, with blueish bloodvessels interwoven, are of a schirrous nature. Single lumps and fleshy excrescences on the tongue are found in elephantiasis.

6th, Its consistency. We find a hard tongue associated with great dryness of the tongue in congestion, inflammation, fever, tonic spasms, in schirrus and other degeneration of the substance of the tongue. A soft tongue we find in catarrhal affections, in chronic mucous diarrhea, gastric derangements and in paralysis of the tongue. When soft and somewhat swollen, the teeth generally show their imprints on its sides, often to be found after mercurial poisoning, and in catarrhal affections. In brain diseases a soft tongue is an unfavorable

7th, Cracks and fissures on the dry tongue, sometimes deep, bleeding and suppurating, are found in typhoid fever, small pox and dysentery.

8th, Paralysis of the tongue, which manifests itself by an imperfect and stammering speech, is most always in consequence of apoplexy or softening of the brain. Its immobility and trembling are signs of torpor of the brain, especially in typhoid conditions.

These are the most important of the objective symptoms of the tongue, which an every-day's practice brings before the eyes of an observing physician, and I have given to each of them its diagnostic meaning, as near as this can be done. For, all these symptoms must be considered cum grano salis, id est,, with discrimination and comparison with other symptoms, if we want to gain a nearly right conclusion as to their bearing and signification.

A red tongue, all over, with considerable raised papillae, indicates Belladonna and Tartar emetic. A red tip in shape of a triangle, Rhus tox. A red indefinite tip, Sulphur. A lead-colored tongue may indicate Arsenicum, and a bluish tongue, Digitalis, Arsenicum, and Acidum muriaticum. A whitish coat on one side of the tongue, indicates Rhus tox,on both sides Causticum, in the middle, Phosphorus and Bryonia, on the root, strongly marked, Sepia, and a general thick white coat, Bryonia, Antimon. crud. and others. A map tongue indicates Nat. mur., Ars., Lachesis, and Taraxacum, and a yellowish coated tongue, a number of remedies. A dry red, tongue, cracked at the tip, indicates Lachesis. A dry tongue without thirst, Bryonia and Pulsatilla. A soft tongue with imprints of the teeth, Merc. and Stram. A clean tongue with gastric and other derangements, Cina and Digitalis. Trembling of the tongue, when the patient is requested to put it out or inability to do so, indicates, in typhoid fever, Lachesis. A heavy, perhaps trembling tongue in typhoid conditions, especially if the lower jaw commences to sink down, Lycopodium. An involuntary darting of the tongue out of the mouth and moving between the lips to and fro, indicates, in similar conditions, Lycopodium. Complete paralysis of the tongue, Baryta carbo.

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