The Coated Tongue - Its Cause And Meaning Part Three
Microscopic examination of the coated tongue shows the papilla (of the surface) are prominent. There is scarcely an acute or sub-acute disorder at some period of which the tongue is not coated. Want of wear must have some effect in producing this elongation of these papilla. Not only are the tips, to which the wear only applies, elongated, but so in many cases are the deeper parts of the column which are unexposed. Coating therefore is the result in part of disuse, want of rubbing and washing but chiefly of morbid overgrowth. Cases requiring a restriction to a liquid diet are seen daily. The physician is guided chiefly by the presence of fever and the state of the tongue; the more coated the tongue the more liquid the diet. If the tongue be dry the diet is wholly liquid and alcohol a part of it. As the acute disease abates the tongue cleans. Solids are then added and may help the process, but the cleaning comes first. The influence of food and mastication can be considered as no more than of secondary importance'
As to constipation some forms of it or disease associated with it are undoubtedly connected with changes in the tongue. It is not difficult to cite cases where the tongue has remained natural under long constipation either functional or connected with chronic obstruction. On the other hand where the obstruction is acute, the tongue early becomes stippled or coated and dry. The determining factor seems to be the presence or absence of constitutional disturbance which is often not present with simple constipation, or chronic obstruction where the tongue is natural.
Kast gave lycopodium powder in sealed capsules to a number of persons and was able to recover the typical spores of the powder in the mouths of most of them the next morning.
Alvarez has confirmed these experiments. He cites the fact that Grutzner, Sweieznski, Reach and Hemmeter, all German experimenters, have shown in animals and in man that lycopodium spores, or other finely divided and easily recognizable material, given in enemas, will travel in a few hours from the rectum to the stomach. Uffenheimer and Dieterlen, also German investigators, have found that bacillus prodigiosus injected into the rectum could be recovered from the pharynx (in the throat) a few hours afterwards. Alvarez has observed that long before fecal vomiting a brown coating appeared on the patient's tongue with a typical fecal odor. Hence, he thinks it probable that many coated tongues are due to the regurgitation of gastric and intestinal contents, especially during the night. This view, he thinks, is strengthened by the fact that the coating is often heaviest at those times when belching, regurgitation and the feeling of biliousness are most pronounced. He also thinks it probable that the odor of bad breaths comes from actual intestinal material deposited on the back of the tongue, although he does not attribute all coated tongues to such reverse currents. There are other factors, such as the nose, mouth, teeth, pharynx and salivary glands, which must be studied in individual cases. Alvarez gives an instructive instance of a constipated infant who regurgitated so much that her pillow was always wet. After a few weeks her bowels suddenly became a little loose, and the day on which this occurred the mother was surprised to find the pillow perfectly dry. It remained that way for over a week until the bowels became again obstructed. Apparently the establishment of a good current downward instantly stopped all regurgitation upward.
The presence of much bile in vomitus is frequently mistaken by physicians as the cause of the emesis (vomiting). Our author rejects this theory and quotes six German experimenters who by surgical operations on lower animals caused all the secretions of the liver and pancreas to pass through the stomach and there was no vomiting. Hence Alvarez was of the opinion that the presence of bile-stained fluids in the stomach which had been emptied a few minutes before can be taken as regurgitation from the bowel, and that the back flow and the vomiting have the same cause.
He also rejects the view that heartburn indicates a state of acidity of the stomach, quoting E. Schutz, a German authority, J. D. Steele and G. G. Stockton, American authorities, in support of his opinion. The true theory, he thinks, is that expressed by Reichmann, a German authority, who had people swallow a little gelatin-coated sponge on the end of a string. After leaving it for ten minutes in the lower esophagus (just above the stomach) it was pulled out and relieved of its contents by squeezing, when it was found that the liquid was acid in persons who had heartburn and alkaline in normal controls. He concluded therefore that heartburn was due to the regurgitation (expulsion upwards) of the gastric juice (of the stomach).