On the Appearance of the Tongue.

Selected writings of John King:

Dr. King was the earliest to publish studies that led to the formulation of the doctrine of specific medication. This study of the conditions of the tongue as indicative of certain abnormalities and the adaptability or non-adaptability of remedies therefor may be considered the pioneer paper in the study of Eclectic specific medication, though not then known under that name. The original paper in full was replete with theories concerning the electrical action of the fluids of the liver and digestive tract that are now known to be erroneous. It matters little now in what manner Dr. King attempted to account for such conditions and the effectiveness or failure of remedies, a common habit with physicians of the past as well as of the present time, the fact remains that his observations of conditions and the effects of remedies thereon were sound and are as tenable to-day as when first penned. This, so far as we are aware, is the first instance showing the indications for alkalines, and partially for acids, in medication in Eclectic or other forms of medical literature.

Dr. King's part in the formulation of these indications is conceded by Professor Scudder, who devoted the following editorial to the subject, giving Dr. King full credit for these observations, which have so long stood the test of time and experience:

"Among the goods which have been deemed mine, and which some other parties have been disposed to appropriate, is the diagnosis of an alkaline and acid condition of the blood, and the rational use of acids and alkalies. How many persons have known the facts before my day I can not say, but certainly some, and probably hundreds of physicians, maybe thousands, have been guided by the same rules for the administration of one or the other or both. When I was a boy in medicine, our Professor King gave the alkalies for the very same reason, and guided by the very indications that we follow today. His teaching was explicit— 'If the tongue is pallid give an alkali, usually bicarbonate of soda.' But of acids he only said this— 'If the person desires an acid, give it; especially in typhoid and other low grades of fever give hard cider.' According to Chambers, muriatic acid was used with great success in the treatment of typhus and typhoid fever in England, and yet in answer to an inquiry they could only say that 'they gave it because it seemed to be useful in such cases.' So far as I know, I was the first to point out the relation between the deep red tongue and the beneficial action of acids. Others may have noticed the fact, and doubtless some physicians were guided by it, but it failed to get into journals or books. It is a good thing to know that acids and alkalies are valuable remedies; it is very much better to know that the pale or pallid tongue asks for an alkali, and the deep-red tongue asks for an acid." (Editorial in Eclectic Medical Journal, 1886, p. 89.)—Ed. Gleaner.

ON THE APPEARANCES OF THE TONGUE.—Messrs. Editors: I wish to direct the attention of Eclectics to several appearances of the tongue, and their indications, during the progress of the various forms of fever; from which, in connection with the other symptoms usually present, some information of a practical nature may be obtained I am aware That "to feel the pulse, and look at the tongue," are with many physicians an indispensable part of their practice,—yet after having thus performed they remain in as much obscurity concerning the condition of their patient as before. There is no propriety in looking at the tongue, unless we intend to gain some correct information from its appearances, which will be of advantage in our subsequent treatment.

It is from this organ that we can ascertain with exactness certain conditions of the internal changes progressing, and thereby be enabled in a majority of febrile affections to treat them with promptness and success. In fact, there are no symptoms attending fever which I watch with so much care and anxiety as the changes in the condition of the tongue, which are to me at all times some of the most important of febrile indices.

I can not too strongly call the attention of practitioners to this subject, which has been comparatively neglected, and particularly by the regulars; they find such variations in the appearances of the tongue, for which they can not satisfactorily account, that they fain would have us believe that they, or their indications, are not to be depended upon. . . .

During the commencement of a fever, or in its first stage, a torpid or slightly congestive condition of one or more organs takes place, as evinced by chills, headache, backache, yawning, restlessness, languor, etc. During this stage the tongue will generally be found pale and moist and the pulse slow and irregular, or if the term may be used, "it is sluggish." One or two, emetics at this stage, followed by cathartics, and then some sweats, will in almost every instance break up the disease at once. . . .

In the second stage of fever, quick pulse, nausea, pains in various parts, difficult respiration, etc., and in some congestive forms, sudden death, the tongue will be generally found coated white, indicating an excess of acid or negative matter in the alimentary canal. This coat is sometimes complicated with other appearances.

1st. A white fur, body of tongue pale, indicates a mild grade of fever, and particularly if moist.

2d. White fur, sides of the tongue red, indicates inflammation of some portion of the alimentary canal, most commonly the stomach. If dry, the inflammation will be more intense.

3d. White fur, sides of the tongue slightly red, febrile pulse, with at times chills and intermissions, indicates a very torpid condition of the biliary organs, with a disposition to active inflammation of some portion of the intestines, and is very apt to prove a tedious and trouble-some disease. It requires very energetic treatment. Emetics must be daily administered while there is sufficient strength in the system to bear them, or until some favorable change has taken place.

4th. A white fur, with a circular portion of the center of the tongue red, and sometimes its edges and inferior surface, indicates inflammation of the stomach and spleen, in proportion to the redness manifested.

5th. The sides of the tongue white, or rather the whole upper surface white; but the center, and particularly towards the root, covered with a brown or yellow fur, pulse small and quick, indicates a disposition to debility, or a typhoid state; this appearance is sometimes met with in patients who have a tedious convalescence, though the pulse will be found more natural. . . .

It is sometimes the case that during the whole course of a fever the tongue will remain coated white, indicating a mild degree of the disease; and in such cases many physicians have highly extolled alkaline agents, which of course would be beneficial. Others having upon these recommendations employed alkaline remedies in similar fevers, have spoken of them as rather injurious than beneficial; these opposite results were owing to the fact that in the last instances these preparations were, administered when the tongue was yellow or brown furred, and consequently were contraindicated. Similar results have happened even in yellow, bilious, and typhus forms of fever.

It is in this stage of fever that torpidity of the liver exists; the tongue being coated white, indicates the presence of acid or negative matter.

The third and last stage of fever, and the glossoscopia. of which principally prompted this communication, is characterized by one of two conditions of the tongue; it becomes either red, or else coated brown, yellow, or black.

1st. When red., moist, and presenting a rawness of the surface, it is indication of inflammation of the mucous coat of the stomach and of the intestines.

2d. If red, dry and chapped, it indicates intense inflammation, and the disease will prove fatal, unless energetically treated upon Eclectic principles.

In all severe forms of fever I am always, pleased when I perceive the tongue to be permanently coated brown or dark, and pronounce my patients safe. . . . At this stage patients almost invariably crave negative drinks, as cold water, acids, etc., . . . I allow my patients to drink tamarind water, lemonade, orange juice, lime juice, and even cider and vinegar. In typhus cases cider will be found very beneficial, as its slightly stimulating properties very much lessen the disposition to prostration. As soon as the tongue loses its brown coat, and assumes the white, all acids must instantly be forbidden, and resumed only when the brown coat is fully established.

I have often had patients with the bilious and typhus forms of fever, with tongues coated very dark, who, when asked if they would drink lemonade, orange juice, or cider, would quickly brighten up, and eagerly exclaim, "Yes, yes, but I would not ask for it, Doctor, expecting you would not allow me to have it." . . .

I am aware that many authors recommend acid drinks in fever; not however as a remedial agent, but as a harmless, pleasant, and grateful beverage, and principally from the fact that patients invariably crave such drinks; I believe, however, it has never heretofore been advised upon the above grounds.

It is essentially necessary that the physician should know when to allow and when to interdict acids, for if allowed previous to the brown or yellow coat, and particularly if already coated white, all the febrile symptoms will certainly be aggravated, and That stage of the disease. considerably prolonged.—J. KING, M. D., Western Medical Reformer and Eclectic Medical Journal, 1847.

The Biographies of King, Howe, and Scudder, 1912, was written by Harvey Wickes Felter, M. D.