The Coated Tongue - Its Cause And Meaning Part Two
Dickenson remarks on the small amount of good medical literature in existence on this subject; that while every physician from the time of Hippocrates has habitually looked at the tongue of patients, it was done apart from any consideration of theory as to cause and effect. His own theory is that the tongue is an index of constitutional states, seldom of individual diseases. It seldom points to solitary organs or isolated disorders, but is rather a gauge of the effects of disease upon the system than an indication of the locality of it. It is often a guide in treatment so far as treatment is general not local; and it is an important help in prognosis (conclusion as to the course of the disease) . From the standpoint of the doctor it always speaks the truth and a language that is not foreign to the experienced physician. And how much truth is to be read on so small a page! Conditions of fever and of feeding; states of the nervous system; the maintenance or abeyance of vital secretions; failure of vitality al-though we may not be able to find out why; in one case that the patient is improving, in another that he is wasting—all these are discernible to the naked eye.
The two health factors which stand before all others as indicated by the tongue, are the heat of the body and the secretion of saliva. There is a remarkable correspondence between the heat of the body and the coating on the tongue. If the tongue is coated the indication is usually of fever without necessarily special reference to the stomach or liver, and points more to the general system than to the alimentary. The dryness, furring and incrustation are connected with the dearth of saliva, which is an indication always of importance. It is difficult not to infer that with the failure of the salivary glands to function there are other glandular failures, more especially of the digestive system. The speaker had often taken the dry tongue as an indication for peptonized food (predigested). On this subject, however, he had not reached a final conclusion. When the tongue becomes dry and bare, from lack of saliva, it is ill with the patient. He is not sure to die but likely to. The completely bare, red, raw and dry tongue is comparatively rare. The term denuded relates to the completeness of the loss of epithelium (the surface tissue) in certain places, not to its spread over the whole tongue. The indication of the red, smooth tongue is for tonics, stimulants and food, probably liquid but nourishing. The failing pulse does not more surely tell of weakness than, as a rule, does the dry, red and polished tongue. A glance may suffice to show whether it is on the road towards health or from it. When the tongue is approaching the condition of health, so, as a rule, is the patient, as is seen whenever the red, dry and bare tongue acquires moisture and clothing. In fevers the gradual recovery by the tongue of moisture and the exposure of a normal surface at the tip and edges, as the coat recedes, are favorable indications of the greatest significance. There is no better sign in diabetes than the resumption of the natural moisture by a tongue which has been dry. Something may be judged by the way an encrusted tongue cleans; if gradually and from the edges, well; less so when it scales, especially when the surface exposed is red and dry.'
One glance at a coated or plastered tongue may give an assurance which perhaps could not be otherwise obtained, that the disease is on the wane. If the thick coat in the center steeply shelves towards the sides and front, revealing a normal moist, not over-injected surface, the tongue is in process of cleaning; the natural friction is overcoming the coating process, and tongue and patient are on the mend. A tongue acquires a coat more evenly and generally than it parts with it. We can thus tell whether the coating is on the advance or decline and apply this rule to the disease' The dry tongue as an evil omen has long been recognized. Hippocrates 2 more than once refers to it. The speaker's cases, without any special selection, show with the dry tongue, be its origin what it may, a startling mortality, one of almost exactly 50 per cent—56 out of 113. Excess of urine in diabetes mellitus (secondary diabetes) is a cause of extreme dryness of the tongue. Out of 113 cases there were eight of this disease.
The last stage which may succeed the furred tongue or ensue independently, is where the papilla 3 are concealed by an incrustation, usually dark and dry by which the surface is overlaid. From this, the climax of addition, the scale descends through the process of subtraction. With some persons a coated tongue is habitual and not only consistent with health but a sign of it. On the other hand diseases like pneumonia, in which commonly the tongue is quickly and thickly coated, may fail to produce this result. There are peculiarities of the health which concern the saliva. An old woman displayed under capillary bronchitis (inflammation of the smaller tubes) a red, dry tongue (not coated), from which I was disposed to augur ill. She got well and the tongue remained the same. She assured me she had always been so, and I could only infer a want of saliva.'