The treatment consists in removing all sources of irritation, particularly smoking, and in employing mouth-washes. Butlin recommends antiseptic ointments applied before going to bed. In some cases painting the patches with chromic acid (10 grains to the ounce) or lactic acid (20 per cent.) is useful in removing the excess of epithelium, but stronger caustics are to be avoided. Constitutional treatment is of little use even when the patient has suffered from syphilis. The best results have been attained by the use of radium.
The “smoker's patch” consists of a small oval area on the front of the tongue from which the papillæ have disappeared. It is slightly raised, smooth and red, and may be covered with a yellowish-brown or yellowish-white crust. It causes no discomfort unless the crust is removed, when a raw, sensitive surface is exposed. The condition is liable to spread over the tongue if the patient persists in smoking. It may eventually assume the characters of leucoplakia. The treatment consists in stopping the use of tobacco, and painting the patches with chromic acid, tannic acid, or alum, and employing a chlorate of potash mouth-wash.
Tuberculous Disease.—The tongue is rarely the primary seat of tuberculosis. The majority of cases occur in adult males, who suffer from advanced pulmonary or laryngeal phthisis, the tongue being infected by bacilli from the sputum or through the blood stream. In other cases the infection is due to direct spread of lupus from the face or nose.
The condition may begin as a firm, painless lump, seldom larger than a hazel-nut, on one side of the tongue, or near its tip. At first the swelling is covered by epithelium; in time caseation takes place, the epithelium gives way, and an open sore is formed.
The tuberculous ulcer is the form most frequently met with. The surface of the ulcer is uneven, pale and flabby, and is covered with a yellowish-grey discharge, with here and there feeble granulations showing through. The edges are shreddy, sinuous in outline, and there is little or no induration. The surrounding parts are slightly swollen, and may be studded with small tuberculous foci. The ulcer may be quite superficial, or it may extend into the muscular substance, and the tip of the tongue may be completely eaten away so that it looks as if it had been cut off with a knife. As the disease advances there is severe pain and usually profuse salivation. The submaxillary glands may be, but are not always, enlarged. The ulcer may heal, but tends to break down again.
Unless there is advanced pulmonary disease or other contraindication to operation, the ulcer should be excised under local anæsthesia. Care must be taken to avoid reinfecting the raw surface. When excision is impracticable, it is only possible to palliate the symptoms by dusting with orthoform, or applying local anæsthetics, and by attending to the hygiene of the mouth and removing all sources of irritation.
Syphilitic Affections.—A primary lesion on the tongue is accompanied by marked enlargement and tenderness of the submaxillary lymph glands on one or on both sides. It is most common in men, infection usually taking place through the medium of tobacco pipes, or implements such as the blow-pipes of glass-blowers.
During the secondary stage—particularly in the later periods—mucous patches and ulcers are common, and they may assume a condylomatous or warty appearance.
The tertiary manifestations in the tongue are sclerosing glossitis, gummas, and gummatous ulcers.
Sclerosing glossitis is the term applied by Fournier to a condition in which there is an abundant new formation of granulation tissue in the substance of the tongue, leading to the appearance of tuberous masses on the dorsum. These tend to be oval in outline, are elevated above the normal mucous membrane, and present a dull red mammilated or lobulated surface, comparable to the surface of a cirrhotic liver. They are firm, elastic, and insensitive.