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A bored physician looks at the tongue of an old lady; suggesting the waste of physician’s time by hypochondriacs. Credit: Wellcome Library, London.

Miley Cyrus must, by now, have the most photographed tongue in history. My friend Jennifer Marotta recently  sent me this link about the diseases that Miley might pick up or spread by licking sledgehammers, mirrors and so forth. Although Jennifer had asked whether there were any nasty early modern equivalents, I became mesmerized by the sight of Miley’s tongue… and the secrets that it might reveal. Checking the tongue was a crucial part of diagnosis in early modern medicine.  

One of Hans Sloane’s correspondents, Giorgio Baglivi, was an Italian physician known for his work on medical practice. Baglivi, like Sloane, believed in the importance of bedside observation. In The Practice of Physick (1704), Baglivi outlined what a full medical examination should entail: “the Sick Persons Excrements and Urine, his Tongue and his Eyes, his Pulse and his Face, the Affections of his Mind, his former way of living, and the errors he has been guilty of in the way of Conduct” (30).

Physicians, of course, had no way to see or hear inside the human body. Examining the tongue was perhaps the best tool available, as it would provide

“a more certain and naked view of that state of the Blood than any other Sign”.

This included the taste, colour, “and other qualities of the Tongue” (157). In their letters to Sloane, several patients mentioned the state of their tongues.

Tongues were variously described as moist, clammy, or dry. Mrs Conyers, who had stomach pain, wheezing and shivering, apparently had a moist tongue and hands. In 1710, William Derham wrote that his wife had a “moist, & not very white” tongue, but by the following morning the tongue had become drier. Thomas Isted, according to his doctor, suffered from a clammy tongue, as well as sweating and sizy (viscous) blood.

Taste was also an important detail. Mr Campbell, who “had indulged his palate and rarely exercised as his business was very sedentary”, suffered from a foul and dry tongue. This was in addition to terrible urine (“thick and muddy”, “foul and turbid, gray, ropy and tough”) and a “muddy complexion”. The foulness had spread throughout his body.

The colour of tongues was most often described as black or white. In 1720, Dr Allen had several chest and stomach problems that were on the mend, but he also had a “slow fever, a brown but afterwards black Tongue” and low spirits. A “young gentleman” in 1725 had a violent peripneumonick fever accompanied with a “dry black tongue”; his strength was failing so rapidly that the physician did not want to try bleeding the patient. Sir William Thomson, in 1739, had a dry throat and “soon after the edge of the tip of his tongue grew hairy, white and almost transparent”. The physician believed “that an aphthous [blister] crust would creep down the throat and probably pass as a thorough thrush to the anus”. Unpleasant.

These details revealed the body’s interior. As Baglivi noted,

“if the Tongue is moist, so is the Constitution of the Blood; if dry, than the Blood is of a dry inflammatory Nature”.

An acidic taste, for example, revealed an acidic blood, or a salty taste meant salty blood (296). A canny physician could also make a prognosis, based on the evidence. For a patient delirious with an acute fever and a parched tongue (signs of inflamed viscera), the physician should avoid applying blisters, otherwise the patient would likely be “seiz’d with Convulsions before they die” (424). In malignant fevers, “a foul Tongue and trembling Hands are always dangerous in acute Diseases” (165). Black tongues were a bad sign. When a patient had an acute disorder, “a black Tongue is almost always followed by a Delirium” (88). Worst of all, though was a cold tongue: “Death follows soon after” (174).

Although displaying the body is part of the act for many female pop stars, the visibility of Miley’s tongue allows us to see inside her body in a surprisingly intimate way. The good news is, she is at present no danger of a mortal distemper.

The bad news is, her tongue does appear a little white. (Others have provided modern diagnoses here and here.) Baglivi did not mention white tongues specifically, but white-coated blood suggested inflammation of the internal organs. In any case, I sincerely hope that Miley doesn’t develop Sir William Thomson’s creeping thrush.