To you, a tongue’s for wagging or tasting— to your doctor it's a barometer of the body
JOSEPH D. WASSERSUGMarch151947
JOSEPH D. WASSERSUG
THE OLD family doctor, who closely examined each patient’s tongue, was a shrewder clinician than many of his laboratory-trained successors imagined him to be.
With no X-rays to guide him and very few laboratory tests at his disposal, he learned to recognize, almost at a glance, scarlet fever, dysentery, and typhoid fever. For him the tongue was what stars are to the navigator.
Recently doctors have taken a renewed interest in the tongue. Most people who respond to the doctor’s command: “Stick out
your tongue,” imagine that all he wants to see is whether it is clean or coated. There are many more things he wants to find out about it. Doctors have rediscovered what had almost been forgotten: that the tongue is like a mirror of the body that reflects reasonably accurately its inner workings.
In his examination of the tongue the physician notes whether it. is coated or clean. He also makes a few mental notes about its size and shape, color, whether there are any discolorations or sores on it, whether it moves smoothly and symmetrically, whether it is slick, shiny or coarse, and whether it trembles as it is jerked forward. All of these points have some bearing on the diagnosis.
The tongue plays a triple role. First it is, with t he vocal cords and lips, an organ of speech. Consonant sounds, especially, are
almost impossible to pronounce without the use of the tongue. Just try to hold your tongue still and pronounce the words “knock,” “lingual,” “swallow,” or “rattle.” Some speech experts have said the difficulties experienced in learning a foreign language are due considerably to the fact that a tongue trained in the production of one set of sounds has to be entirely retrained to produce new ones.
Also, the tongue is second in line in the process of digestion. The teeth are first. When they are finished their chewing, the initial process of swallowing is taken over by the tongue. Actually, the tongue is divided anatomically into two parts, the most forward two thirds is developed for taste and the rear third for swallowing.
The back of the tongue (the part that you can’t see by looking in the mirror) is a muscular organ that leads the food down to the esophagus and gives it a shove to make sure that it goes in the right direction. Without the tongue the act of swallowing would be practically impossible.
The tongue’s third role, of course, is Continued on page 31
Continued on page 31
To you, a tongue’s for wagging or tasting— to your doctor it's a barometer of the body
Continued from page 24
that of taster. The primary flavors of everything that we put into our mouth are due entirely to the taste buds that are most numerous on the tongue. The sensation of salt, sour, bitter and sweet would be impossible without these taste buds.
The Body’s Barometer
But, in addition to being a prime organ of speech, swallowing and taste, the tongue is also like a barometer that registers favorable and unfavorable changes in the body. In cases of anaemia, for example, the tongue may take on a pale, pink appearance that mirrors the poor condition of the blood. In dehydration, from any cause, the tongue may appear dry and shrivelled and may even be a better guide to the real condition of the patient than the appearance of the skin itself. And the so-called “strawberry tongue,” even in this laboratory-minded age, is still regarded as an important aid in the diagnosis of scarlet fever.
Strictly speaking, Nature has endowed us not with one tongue, but with two. In its embryonic development, up to a time shortly before birth, the tongue exists in the mouth as two organs—or as a right and left half. These halves then fuse in the mid line and this point ,of fusion is indicated by the furrow down the middle of the tongue. At the base of the tongue (the swallowing portion) the formation is somewhat different—there is no partition and it is represented by one solid mass. If you look closely you will see that a V-shaped line separates the base of the tongue from the forward portion.
Each half of the tongue has its own cranial nerve that gives it motion. For a person to be able to thrust out his tongue straight ahead, he must have perfectly balanced nerve impulses pushing his tongue forward.
Let us imagine a situation where one of the nerves is paralyzed so that only
half of the tongue moves properly. Imagine a patient with this type of paralysis and ask him to stick his tongue out. As he does, his tongue is no longer pointing straight ahead. If the right nerve is paralyzed, the tongue muscles on the right will fail to act but the muscles on the left will thrust forcibly outward. As a result the tongue will behave like an automobile with its right wheels suddenly braked, and will veer to the right.
Where, in cases like this, the tongue veers definitely to one side or the other, it means there is paralysis of one side of the tongue. Such a paralysis is most often due to a cerebral hemorrhage or a shock, hence its great diagnostic value. A slight deviation of the tongue may be the only sign pointing to the fact that a patient has had a shock.
The tongue has been described as a “mucous membrane sac that has become stuffed with skeletal muscle.” The mucous membrane is its covering and it is to this that the tongue owes its finely granular appearance. It is as thin as skin and it allows the blood to shine through. That is why anaemia may be so readily detected by the appearance of the tongue. Looking at the tongue is the next best thing to looking at the blood itself.
The rough surface of the tongue is due to peculiar, tiny elevations on the mucous membrane that are called “papillae.” Examined under the microscope, these papillae appear in three different forms. They are either hairlike, mushroomlike, or are larger and are surrounded by a deep groove. To these three different types anatomists have given the descriptive names, filiform, fungiform and circumvallate.
Mass of Muscle
The first are the most numerous and account for the finely granular appearance of the tongue. Scattered among them, but most numerous near the tip of the tongue, are the fungiform papillae. And at the base of the tongue, along the V-shaped line, one can find a dozen or so of the largest papillae, the circumvallate. Countless taste buds
are scattered all over the surface of the tongue and especially at the sides of the papillae.
The tongue is a powerful and nimble muscle. In some people, like World War I reporter Floyd Gibbons and the comedian, Danny Kaye, lingual agility has been developed to a remarkable degree. But anyone who has had an opportunity to listen to back yard gossip or even to an afternoon bridge table conversation can testify to what rate just ordinary tongues can wag.
The tongue owes this remarkable agility not only to the muscles in its own structure but to three or more additional sets of muscles in and around it. The muscles in its own body run through its entire structure, move in all directions, are firmly interlaced and cross each other at right angles. This gives the tongue speed and a wide range of motion. The other muscles just outside the tongue are able to make it protrude or pull it down at its sides or pull it upward and backward.
Doctors are often asked, “Why is my tongue so coated?” The query is usually directed by some nervous person—the kind who examines it closely in the mirror for the slightest evidence of coating as if it were a stigma of some strange and baffling disease.
A coated tongue isn’t nearly as serious as some people think. It’s almost always due to local factors and not to a general bodily ailment. It doesn’t mean you have a serious infection. It is not the cause of bad breath, although it may occur in cases of halitosis. And it doesn’t cause a bad taste in the mouth.
What Coating Is
Late in the last century it was discovered from microscopic examinations of sections of the tongue that the coating consisted mostly of waste material and bacteria, mingled with accentuated papillae. In 1936 Dr. N. Henning examined living tongues under a lens that magnified 70 times. He was able to confirm that the coating was mostly waste, white blood cells and harmless bacteria. On coated tongues the papillae were long, thick, firm and tense. They seemed to be trying to grasp and hold the debris.
More recently two New York physicians, Drs. Burril B. Crohn and Rudolph Drosd of Mount Sinai Hospital, have tried to find out the exact causes of tongue coating. Was it constipation? They deliberately induced constipation in a small number of persons and in no case did a persistent coating on the tongue develop. Neither did they find that an upset stomach caused tongue coating.
How about that early morning blanket on your tongue? Drs. Crohn and Drosd are reassuring. It’s nothing more than the clutter of debris mentioned earlier, together with some dead and dying tissue from the papillae. Take a look at your tongue after breakfast, they suggest, and notice the difference.
Tongue Tells a Story
In the long run, Drs. Crohn and Drosd could find no specific causes for tongue coating. “We are therefore forced to fall back on the only tenable hypothesis,” they reported, “namely, the concept that the coated tongue is an intrinsic lingual phenomenon.” In other words, where you have tongues, you have tongue coatings.
The action of the papillae, however, was found to reflect the general condition of the whole body, “raising themselves to gather mass and debris
when all is not well; smooth and velvety and clean when conditions are appropriate for health and normal function.”
In some cases vitamin deficiencies can be suspected, if not actually diagnosed, by changes in the color of the tongue. The red, angry-looking tongues that doctors once regarded as showingevidence of inflammation are now being understood in their true light as manifestations of a vitamin deficiency state. This is particularly true of the complex of B vitamins.
Take, for example, a tongue that is red and smooth due to thinning and wasting away of the papillae. That may be due to acute pellagra, caused by a deficiency in vitamin B, especially niacin. Or just look at a tongue that is not quite so swollen, yet it is fiery red, especially at the edges and the tip. This tongue may look flatter than normal since the granular appearance may be lost. Such a tongue may indicate a chronic deficiency in niacin.
In other deficiency states, such as those caused by a lack of riboflavin, the tongue may also appear redder than normal but the redness is not fiery or scarlet. Rather, it is purplish or magenta. Here the papillae are enlarged and flattened, and the tongue may look furrowed or fissured. In riboflavin deficiencies the lips are also characteristically thin, dry and red, and there may be cracks in the corners of the mouth.
These various changes, it must be pointed out, are only suggestive of the various deficiency states, they are not absolutely diagnostic. Other conditions, such as anaemia, can cause many of them. If there is a deficiency in the diet of liver or of iron, it may, for some unknown reason, change the whole appearancte of the tongue.
There are other disorders of the tongue that are often frightening to the patient but are reasonably harmless in themselves. One such condition is known as geographic tongue or if you prefer to be technical, erythema migrans. The disorder gets its name from the fact that the tongue looks like a bas-relief map.
According to one expert, the condition is characterized by a “series of bare spots on the tongue, which are surrounded by rings of whitish fur, due to swelling and elongation of the papillae around the bare spot. As the papillae are shed, a bald spot results, which is slick, shiny and painless. As time goes on, the papillae regenerate, and this bald spot becomes normal again, since it is now coated, as is the rest of the tongue. The lesions tend to migrate over the surface of the tongue and present an ever-changing picture.”
No wonder that a patient becomes worried when he watches these mysterious, day-to-day changes in the appearance of the tongue! Yet the condition is of far less seriousness than the patient imagines.
On the other hand, many persons will often neglect a harmless-looking hard spot or an ulcer on the tongue. Unlike the common canker sores that come and go, one finds occasionally a hard white spot that remains or an ulcer that persists or even grows. Spots or ulcers of this type are a clear warning that all may not be well and a doctor’s advice and consultation should be sought at once.
Some of these ulcers may be caused by dirty, jagged teeth and good oral .hygiene is a good way to guard against them. At any rate, if one develops, it is a wise policy never to neglect an ulcer on the tongue, no matter how innocent it looks. it:
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