Black Tongue. BY FREDERICK J. LEVISEUR, M. D. REPRINTED FROM 3EI)c Netu York journal for January 12, 1889. Reprinted from the New York Medical Journal for January 12, 1889. BLACK TONGUE. FREDERICK J. LEVISEUR, M. D. In a recent interesting monograph,* Dr. F. Brosin, of Berlin, has given an exposition of the present state of our knowledge of a subject as yet but little understood—“ black tongue.” Lingua nigra, nigrities linguae, glossophytia, langue noire, nigritie de la langue, schwarze Zunge, schwarze Haarzunge, is a disease characterized by an enormous hypertrophy of the filiform papillae and their epithelial cover, and a grayish- black or fully black discoloration on the upper surface of the tongue. It usually appears in patches, which look as if covered with black hair or wool, matted together, or as resembling closely afield of wheat thrown down by the wind. Being a purely local disease, without any gravity, it is only liable to cause a feeling of dryness in the month of the pa- tient. When it covers the tongue to a large extent, as is sometimes the case, it is extremely annoying on account of the disagreeable-looking discoloration, which often proves refractory even to the most energetic treatment. The dura- tion of the disease may be from ten days to twenty years, or it may come and go for a period of years. Black tongue is one of those rare diseases which are liable to puzzle the * Erganzungsheft zu Dr. ITnna’s “Monatshefte fur prakt. Derma- tologie,” 1888. 2 BLACK TONGUE. physician, who, unaware of its existence, will invariably be inclined to treat the disfiguring discoloration as a trifling matter easily to be got rid of. But he will be surprised to see the patient come back to him after a time with the same amount of “ black tongue,” but with decidedly less confi- dence in the ability of his medical adviser. I therefore think it is not only of theoretical but also of practical interest to call attention to this peculiar affection, which may often escape medical observation, and, in fact, is probably not so rare as the statistics seem to indicate. A case of “black tongue” which I have recently seen was in a patient of the New York Hospital, out-door department, to whose abnor- mal condition of tongue Dr. L. D. Bulkley kindly directed my attention. A young man, about twenty-eight years of age, came to the skin department with florid symptoms of syphilis. Under ade- quate specific treatment the maculo-papular eruption which was present promptly disappeared, but numerous mucous patches began to develop on the lips and tongue. These latter proved very refractory to treatment. In spite of the most careful and skillful cauterizations with nitrate of silver and chromic acid and the repeated application of solutions of chlorate of potassium, sulphate of copper, and permanganate of potassium in varying strength, and though internal specific medication and hygienic measures were not neglected, the mucous patches were very slow to disappear, and new ones kept on showing themselves. The affection finally seemed to yield to treatment, there remain- ing only a diseased spot in the center of the organ of the size of a five-cent piece. When the patient returned a week later his tongue presented the appearance described above. A spot, looking as if covered with short, black hair or wool, was situ- ated in the middle of the tongue, extending a little to the right, irregularly shaped, about an inch in length and three quarters of an inch in width, with its base towaid the root of the tongue. Some of the black mass, which was removed with a pair of curved scissors, proved under the microscope to consist of enor- BLACK TONGUE. 3 mously elongated filiform papillae, covered with hypertrophied epithelial cells, loosely overhanging each other, not unlike an ear of corn the grains of which have been taken out. (See figure.) The unstained specimen had a diffuse sepia-brown colon the epithelia, however, having a darker hue than the underlying connective tissue. Elongated papillse covered with hypertrophied epithelia, showing diffuse pig- mentation. x 200. I had no further opportunit}7 of following up the case, but what I had seen of the clinical as well as microscopical aspect of the case was sufficient to convince me that this con- dition was “ black tongue.” There are about forty cases of this peculiar disease on record. They include both sexes and all ages, but show that “black tongue” principally affects those who are debilitated by age or disease. First described by the famous Rayer in 1835, then by Hyde Sal- ter (London, 1849), Eulenburg (1853), St. Germain (1855), 4 BLACK TONGUE. it has been made the subject of observation by Raynaud, Clarke (18*73), Fereol (1875) and others, Lancereaux, Des- sois in 1878, Rayer (1883), Sell (1885), Schech (1886), etc., and recently by Dr. Brosin as mentioned above. Dr. Solis- Cohen, of Philadelphia, is, so far as I know, the only Ameri- can writer who has reported a case of “ black tongue.” In regard to the {etiology of the disease, it has been main- tained, especially by French writers, that “ black tongue ” is caused by the vegetation of a peculiar fungus. Dessois described spores (sporules) of about 0-005 millimetre diame- ter, surrounding the elongated papillae principally on their bases. Inoculations of the micro-organisms on tl\e author’s tongue, and another on the arm of a patient, had a negative result. Only very large accumulations of these'spores ex- hibited a sepia-brown color. Dr. Brosin, who, like others, found the same micro-organisms, has proved, by carefully cultivating and examining them, that they are a form of Oidium cdbicans poorly developed. The result of his re- searches is, furthermore, that neither the hypertrophy of the papilla? nor the black color is due to parasitic vegeta- tions. The black color is caused by the accumuljitiorr'of pig- ment, the nature of which is not definitely known. It is (as it was in my case) diffusely distributed, not granular, and of a light-brown color—facts which indicate that it is of that kind of pigment which, not the blood, chemically does not contain iron, but a cotytftlerable amount of sulphur. It is probably the same pigment which, as Dr. Unna has shown, produces the black color in come- dones or in ichthyosis histrix seu nigricans. The analogy which the latter disease presents with “black tongue” is most strikingly apparent, hypertrophy of the papillae and horny modification of the epithelial layer forming the main features of both pathological processes. It can not be BLACK TONGUE. 5 denied that the drying or oxidizing influence of air, the chemical properties of certain food, and numerous drugs play an important part in bringing about the black color, which (it has to be borne in mind) is absolutely different from a superficial and accidental stain. That the agencies above mentioned are liable to have this peculiar effect only on those places where there is a pronounced degeneration of the papilla} and their epithelia seems to prove that the pathological condition is the conditio sine qua non of the black pigmentation. I will conclude these few remarks with the suggestion that there is no reason why the exces- sive growth of some fungus, traces of which may be found in every mouth, should not act very much in the same man- ner as chemical preparations, and consequently, in some in- stances, be an essential tetiological factor. 681 Lexington Avenue.