Mucous Membrane Color Changes in the Nose and Mouth as a Guide to the Patient’s Nutrition

Clinical Signs aid Diet Diagnosis Mineral Content of the Daily Food Selection is Discussed in

By D. C. Jarvis, M.D.

For the past five years a correspondence study group, which I serve as secretary, has been discussing the relation of biochemistry to clinical conditions of the body. Nutrition plays a large part in this discussion, more especially the mineral content of the daily food selection.

Instead of the term diet, we find ourselves using the term food selection. The individual’s day is one of selection. He selects from the morning paper that which he wishes to read. He selects his friends, his motor car and how he will spend the hours of the day. The term diet implies that he has some illness of the body which prevents him from eating one or more foods or some particular class of foods, while the term food selection implies that he can eat any food he wishes, but from the many foods round about him for some reason or other, he has fallen into the habit of making a wrong selection for his particular type of body.

As a result of this wrong food selection he eventually finds himself in the midst of a nutritional disaster, and an appointment with his dentist or physician naturally follows. Patients more readily understand and accept the term nutritional disaster for they are familiar with disasters on land and sea and in the air. When informed that as a result of a wrong food selection they are now in the midst of a nutritional disaster and you wish to outline a different food selection, one does not meet the opposition to cooperation that often is present when the statement is made that you wish to put them on a diet.

The Don’t Method

Most of us inherit our food selection in much the same manner we inherit our religion. A child is born into a family and with the passing of time is taught to eat the family food selection. If in the kitchen guided by instinct, a child grabs a raw vegetable from the table while food is being prepared, and starts eating it. He is often scolded and told the vegetable should only be taken when cooked. And later at the family table if the child guided by instinct refuses all or part of the food served it is again scolded until it finally succumbs to the wishes of its parents and accepts the food selection of the family.

This food selection is generally maintained until such time as the child leaves home. By this time this food selection has become a habit with him. If this food selection happens to be a good one all may go well with him his whole life long but if it happens to be a faulty food selection, then in due time he is very apt to find himself in the midst of a nutritional disaster. With all this may mean in the way of lowered physical efficiency.

One method of advising the patient about his food selection is the Don’t method, which is often based on the likes and dislikes of the one advising. The patient is told to don’t eat this and don’t eat that until his food selection is limited. If he follows this limited food selection based on the Don’t Method he will often discover in the course of a few years that he has exchanged one set of physical troubles for another equally as troublesome.

The Trial and Error Method

A method often used by those who wish to do something for patients along the line of a different food selection is the Trial and Error Method. In following out these methods several printed diet lists are kept close at hand and these are dispensed on a hunch that a certain printed food selection might be of value in this particular case. This hunch is often strengthened by the degree of success resulting from the use of any one food selection list.

A high protein, low carbohydrate food selection may be tried first. If this does not bring about the desired improvement, then the ketogenic diet which consists of a large amount of fat, adequate amounts of proteins and a minimum amount of carbohydrate may be tried. This failing, an alkaline ash or an acid ash food selection is advised. In event of continued failure a food selection in which proteins, acids fruits and vegetables are combined at one meal. While starches, sugars and vegetables are combined at another meal is tried. The patient, each meal, has his choice of eating a protein meal or a starch meal but both starches and proteins are never taken at the same meal.

The Trial and Error Method leaves much to be desired because its results are so often of the hit and miss variety. There is no index to serve as a control except the statements of the patient. The patience and endurance of both patient and dentist or physician are often tried, and when the hoped for results do not follow within a reasonable length of time both patient and adviser become discouraged.

The Diagnostic Method

In applying the Diagnostic Method, a supposedly correct diagnosis is made after which reference is made to a book which aims to treat disease by diet. On looks for the diagnostic heading corresponding to the diagnosis made and notes the list of foods under this heading to be taken when this particular clinical condition is present. A copy of this list is made and handed the patient. All may go well but if subsequent events make the first diagnosis untenable and show the necessity making another, then the one in charge is faced with the embarrassment of acquainting the patient with this fact food selection list and the substitution of another in its place. This does not make for feeling of confidence on the part of the patient.

Mucous Membrane Color Method

With mucous membrane color changes serving as a control, and indicating the mineral balance of the body, the prescribing of food selection for the patients becomes more definite and less haphazard. This mucous membrane color may be studied in the nose and mouth or any other part of the body where mucous membrane may be studied. In the nose the mucous membrane covering the nasal septum is most often studied, especially the anterior portion of the nasal septum which is often referred to as the cartilaginous portion of the nasal septum.

In the mouth the patient is asked to bring the front teeth together. The lower lip is then grasped with the thumb and first finger and everted over the first finger so that the mucous membrane color of the areolar mucosa between the alveolar gingiva and the muco buccal fold is studied, this color serving as an index. The mucous membrane color over the areolar mucosa in the mouth is not so pronounced as the mucous membrane covering the cartilaginous portion of the nasal septum. It is well to accustom yourself to studying the color of mucous membrane both in the mouth and nose.

My own practice being limited to eye, ear, nose and throat. I naturally study the nose in detail but I also study the areolar mucosa in the mouth as well, because it gives information from the appearance of the tiny blood vessels that I am unable to obtain in the nose. A Bosworth nasal speculum is best adapted to the examination of the front part of the nasal septum, the light being thrown into the nose by means of light reflected from a head mirror, a fountain pen type of flash light or a small light such as is used in transilluminating the face to show whether a diseased antrum is present.

Mucous Membrane Color

Continued observation of intranasal mucous membrane discloses two facts. First, different individuals may show a difference in color. Second, an individual may show a difference at subsequent examinations. This color may be one of three shades of red, ranging from pink and bright red to a crimson redness, or it may be one of three shades of pallor ranging from a pale pink to an almost paper white, or it may be a mixed type showing a pale mucous membrane on one side of the nasal septum and a red mucous membrane on the other.

For the purpose of record the three shades of red have been designated plus one plus two and plus three, while the corresponding three shades of pallor have been designated minus one, minus two and minus three.

Plus Three Red Mucous Membrane

This shade in the nose shows a crimson red mucous membrane of the red flannel shirt variety. At no time anywhere is there a suggestion of anything but a vivid red. This shade of red is what I see most up here in Northern Vermont.

Plus Two Red Mucous Membrane

This shade in the nose while red is not the vivid crimson red seen in the plus three red mucous membrane. As one studies it, one will observe that is more of a vivid pink in color. It appears to be made by using three parts of red and one part of white.

Plus One Red Mucous Membrane

In this shade we find a pink mucous membrane with a pallor showing thru. The color is still pink but it is not difficult to catch the underlying pallor ready to quickly show itself if the red shade of the color happens to be a bit diminished. It appears to be made by using two parts of red and one part of white.

Plus-Minus Mucous Membrane

In this shade we observe a mucous membrane slightly towards a pale shade or perhaps on its way to pink. It appears to be made by mixing equal parts of red and white.

Minus One Mucous Membrane

There seems to be no great difficulty experienced by those having contact with the subject for the first time in recognizing the three shades of pale. This minus one shade while retaining a suggestion of pink presents a dominating pallor which makes it possible to decide without difficulty just where it belongs.

Minus Two Mucous Membrane

In this shade all pink or red color has vanished and the mucous membrane takes on a distinct greyish color.

Minus Three Mucous Membrane

Shade three being almost paper white readily stands out as such and as a rule no difficulty is experienced in classifying it correctly.

Mucous Membrane Color in Nose and Mouth Index to Mucous Membrane Color in Other Parts of Body

A comparison of the color of mucous membrane in other parts of the body with that in the nose shows that mucous membrane color in the nose may well serve as an index to the color of mucous membrane in other parts of the body.

Dr. Howard Stitt of Cincinnati, Ohio, one of our group members nationally known for his work on bronchial lavage, tells me that as far down in the bronchial tree as he is able to see with a bronchoscope, the color of the mucous membrane matches that in the nose.

Dr. John Shea of Memphis, Tenn., who this past year was chairman of the section on Otolaryngology of the American Medical Association became interested in checking up the color of the mucous membrane of the rectum with that of the nose with one of his colleagues. He tells me that when the mucous membrane is red in the nose, it is also red in the rectum and when it is pale in the nose it is pale in the rectum.

Dr. C.E. Wooding, an internist of Cincinnati, Ohio, and a group member, became interested in comparing the color of the mucous membrane of the nose with that of the vagina and inside of the bladder. He tells me that when the nasal septum shows a red mucous membrane, the vagina and inside of the bladder also shows a red mucous membrane. When the nose shows a pale mucous membrane, the vagina and bladder both show a pale mucous membrane. From these observations one may conclude that the color of mucous membrane in the nose and mouth may serve as an index to the body.

The Effect of Menstruation on the Color of Mucous Membrane

In several instances an error in estimating the color of mucous membrane has been made due to the commencement of menstruation there is often a temporary shift towards redness. This will partially balance a pale nasal septum. A neutral septum may become red or a slight imbalance to the red side will become exaggerated.

With the commencement of menstruation the color of the nasal septum returns to its usual color plus a slight shift to the pale side. The natural inference would be that this paleness is due to loss of blood but from the point of view of the autonomic nervous system it may be evidence of an autonomic shift, or both factors may share in producing the result.

Red Mucous Membrane Syndrome

Let us have contact with an individual showing a marked increase in redness of mucous membrane and listen to his clinical story. He complains of being tired all the time. Everything he does ends in more fatigue. He is tired in the morning, tired at noon and tired at night. The day’s work instead of being a joy to him represents a round of duties to be gone thru with. He is irritable when he does not wish to be. He is a bit hard to live with when that is his least desire. He goes about with a hair trigger type of temperament and is easily offended by others.

During the middle of the day when he should be most awake he is drowsy. When bedtime arrives and he should be drowsy he is most awake and at his best. His night’s sleep brings him only a moderate amount of refreshment, coming to the beginning of the day’s work as a rule a bit tired. He has indefinite symptoms of short duration in various parts of his body. He is subject to constipation. His skin is inclined to feel dry. His hair comes out a bit more than he wishes. All in all he feels a long vacation of some sort is necessary before he can possibly feel right again.

In handling this syndrome clinically one may venture after deciding the mucous membrane of the mouth and nose shows an increased redness to say to the patient, your mouth and nose suggest you are tired all the time and everything you do ends in more fatigue. Is it possible this is true? You can add to the statement made to the patient as much of the complete syndrome as you wish. You will find as you learn to handle the red mucous membrane syndrome better, you will outline the complete syndrome to the patient. In the majority of cases the patient will reply, “You have described how I feel better than I could myself.”


                Then again a shorter appointment should be made if the patient shows an increased redness of mucous membrane while a fairly long appointment may be made with a pale mucous membrane individual. The red mucous membrane individual is jumpy and nervous and will almost bite your head off, so to speak, at times while the pail mucous membrane patient will be calm and often say very little will the work is done. Knowing and expecting trouble from the red mucous membrane patient you are not a bit surprised when he “blows up” only saying to yourself “running true to form as expected.”

Food Supplements

There are two food supplements which are very useful when the patient travels, eats in a restaurant or boarding house and is unable to control his food selection as he wishes. One of these is powdered spinach grown in South Carolina and marketed in tablet form under the trade-name Spintrate by the Spinach Products Company of Columbia, South Carolina. This is to be given to pale mucous membrane individuals the dose being two to four tablets at one or all three meals of the day. The patient will soon sense, after a month or two, by his state of well being when he needs to take spinach tablets and when he is able to do without them.

The other food supplement is powdered seaweed marketed in tablet form under the trade-name Seaweedate by Philip R. Park, Inc., of San Pedro, California. This is to be given red mucous membrane individuals the dose also being two to four tablets at one or all three meals of the day. The patient will soon sense after a month or two by his state of well being when he needs to take Seaweedate tablets and when he may omit them.

Medicinal Helps

There are two medicinal helps that are of value. One is dilute hydrochloric acid to be prescribed for pale mucous membrane patients in a dosage of from fifteen to twenty drops at one or more meals in a glass of water to be taken in the middle of the meal so as to have the teeth protected by food before and after the taking of the acid. The patient after one month of the acid at all three meals of the day will soon be able to tell by the way he feels whether he needs the dilute hydrochloric acid one meal or all three or may omit it for that day.

A second medicinal help is organic iodine made from sea moss and marketed under the trade-name of Amends Solution of Iodine by Thomas Leeming and Company, 101 West 31st St., New York City. Three to five drops in a glass of water, in which an even teaspoonful of sodium bicarbonate has been dissolved, is prescribed at one or more times during the day at 10:00 A.M., 3:00 P.M. and 8:00 P.M. depending on the need of the patient. The patient will soon sense when he needs the iodine solution. The dentist or physician determines the dosage and frequency on the appearance of the mucous membrane at the first and subsequent visits.

General Considerations Relating to Treatment

With a pink mucous membrane representing the normal and the ideal to be attained, one strives in one’s treatment to approach this normal color. It is not necessary to actually bring about a pink color as clinical results will come when this color is approached. The patient should be told that three months will be required before the value of a change in the mineral content of the food can be estimated because the rate at which a change in body chemistry takes place varies in different individuals. Ten days to two weeks will often bring improvement but the patient should be made to realize that the element of time is a factor in securing results.

After trying many methods of handling patients in whom one wishes to bring about a change in body chemistry, I have found the following to be most satisfactory. The patient is requested to come to the office for five visits at two week intervals. Following these five visits he is requested to come to the office every three months for one year in order that he may be supervised during the four seasons of spring, summer, fall and winter. After this he is requested to come to the office every six months indefinitely for a check-up and advice.

First Office Visit

If the mucous membrane shows an increased redness the organic iodine solution is prescribed one to three times a day at 10:00 A.M., 3:00 P.M. and 8:00 P.M. in three to five drop doses in a glass of water in which a level teaspoonful of sodium bicarbonate has been dissolved. If the mucous membrane is pale the patient is given a prescription for one ounce of dilute hydrochloric acid with instructions to take fifteen drops in a glass of water in the middle of each meal. This is continued for at least one month and longer if it seems advisable to do so. Eventually unsweetened lemonade because of its citric acid content is taken at one or more meals of the day instead of the dilute hydrochloric acid and this may be continued indefinitely. A diet history form to be filled out at home is given patient. A food diary covering a two week period is given patient to be kept at home.

Second Office Visit

At the second visit the mucous membrane color of the mouth and nasal septum is again studied. The temperature by mouth and blood pressure are again taken. The diet history form filled out by the patient at home is studied and the required changes if needed are made in accordance with the color of the mucous membrane. If the mucous membrane shows an increased redness the patient is requested to increase his daily intake of potassium iodine and calcium foods and reduce his daily intake of sodium, phosphorus, and chloride foods. The proper food supplement is prescribed, spinach tablets for the pale mucous membrane patient and seaweed tablets for the red mucous membrane patient.

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