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a successive manner, it thence results that, to a certain extent, and

to one who does not examine very perfectly, thrush lasts from ten to

. twelve or fifteen days, because it is detached and reproduced in other

The whole of the concretions of thrush readily disappear in those '■cLtuA children who are but slightly indisposed, and who have idiopathic

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thrush. These cryptogamia disappear with the same facility amongst Vl4(/<( children attacked with symptomatic thrush, but they are reproduced, and thus return three or four times in the course of the disease, if. Trousseau and myself have observed children attacked with enterocolitis for some months, who had had thrush at four different intervals, and who died still having thrush; not that they were poisoned by this cryptogamic plant, but because they had either a very advanced inflammation of the digestive canal or a chronic disease of the lungs.

Prognosis And Terminations.

. The germination of thrush always indicates, amongst children who

are attacked by it, a decided degree of innate weakness, or a serious

morbid state produced by acute attacks, or lastly, a more or less

advanced cachexia, the consequence of a chronic disease.

! i L > i / The Presence of these cryptogamia is, then, a serious sign. However,

. , -rit must be observed that it adds nothing to the state of the children,

that it does not aggravate their position, and that it is just the same

... ,. , i thing with the disease, before and after the appearance of the thrush.

» When it supervenes in a chronic disease, it always indicates that the

* «•'>. *< termination will be speedily fatal.

There is only one circumstance in which thrush can of itself be of

any consequence, or should merit our attention; this is when, by the

^ , J confluence of the vegetations, it presents a material obstacle to the

introduction of nourishment into the stomach. With the exception

of this accident, which is very rare, thrush is very innocent in its

nature.

/, i . It has never caused death; and the statistics formed on this disease

'can be scarcely comprehended. It is said, M. Baron has observed

140 children attacked with this disease, and 109 have died. According

to M. Valleix,* from whom this extract is borrowed, he himself had

twenty-two deaths in twenty-four patients. This is no wonder, since

all laboured under entero-colitis, complicated in eight of them with

m , _ pneumonia, and in the ninth with meningitis. One might die from

a less amount of disease; and certainly the cryptogamia of the mouth

•■*'" '>'•/'-"'* 'did not in the least contribute to this result.

In fact, death is never the consequence of the disease which is called thrush. To enunciate such an assertion, is to be deceived in

, •. ." , * Clinitpie da maladia da enfant) nouvcauna. Paris, 1838; p. 202 et juiv.

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the strangest possible manner. In forty-two patients whose cases I collected at the Necker Hospital, fourteen laboured under idiopathic thrush, and not one has died. In the others, the appearance of this cryptogamic plant was symptomatic of a visceral disease. Twenty died: twelve of these had chronic entero-colitis, complicated in five by tubercular pneumonia; four had acute entero-colitis; three pneumonia; and one hydrocephalus. The remaining eight were affected with enterocolitis, or worn out by phthisis. They left the hospital still labouring under thrush.

In the children who died, we cannot hesitate as to the cause of death, nor for a moment waver between the vegetable parasite, situated on the mucous membrane of the mouth, and a visceral disease which always precedes the appearance of this product.

[The same error in ascribing to thrush a frequent cause of death, is observed in English practice, for on reference to the returns of the Registar General, I find the following cases registered:

Total of the

[table]

Total in the different jrean .246 249 207 214 178

And in 1849, for the whole of England, 567 males, 565 females; making a total of 1132 cases.

And in London, during the same year, 91 males, 88 females; making a total of 179 cases.—P.H.B.]

Treatment.

Local therapeutical agents are sufficient to cause the disappearance of idiopathic and of symptomatic thrush. ,

The mucilaginous decoctions and infusions of marshmallow, linseed, /[{_uu i. r Arc, are proper to make use of in the form of injection, or of a gargle when the patient is of an age to be able to use them.

The substitutive medication, recommended by Boerhaave, Van Swicten, «^ ^ yJi, u, Stoll, Sauvages, tfec, is much more suitable and is very rapidly successful.

M. Guersant recommends the use of a mucilaginous decoction, to which he adds a fourth part of the liquor of Labarraque, or of lemon juice. It is applied by means of a pledget of lint, which is introduced into the mouth of the children. This physician has also derived some advantage from a weak solution of alum. •"^'a.iA itu1

Dr. Hencker has recommended the solutions of the sulphate of zinc, in the dose of fifteen grains to 5 j of lettuce water. A. Duges '; \'." '•'• suggests the employment of applications, in the composition of which .'; / rthe vegetable acids, vinegar, lemon juice, <fec, enter. M. Bretonneau has found good results from calomel mixed with powdered sugar, and /")"•

placed in the mouth, in the dose of half a grain, three or four times a day.

At the Necker Hospital, M. Trousseau constantly employs the following application, it is always followed with~ success:

Borax, honey—of each 75 to 225 grains.

Mix: to be applied three or four times a day to the diseased parts by means

of a pledget of lint.

I have very often seen this topical medication employed, and under its influence the cryptogaraia of idiopathic and of symptomatic thrush, shrivel, and become detached in twenty-four or thirty-six hours.

Thrush seldom resists these means. If it should do so, it should then be attacked by cauterization with the nitrate of silver, in order to arrest it before it becomes confluent.

In thrush the diet need only be restricted when the disease is allied to a serious acute malady; otherwise the children should bo nourished as much as possible.

The general therapeutical means which we are obliged to make use of

in this disease, do not appertain to thrush, for in simple thrush, local

/■ ft { treatment suffices. It is only in symptomatic thrush that these means

become necessary. They are then employed, less against the lesions

't- i i I i i .Tipf the mouth than against the lesions of the intestine, of the lung, <tc,

so frequently complicated by the presence of this product.

It is useless to speak of the treatment of these diseases; it will be found detailed in the most suitable place.

''' ^ APHORISMS.

■ . 238. A gaping mouth, separated, dry, blackish lips, are indications

of ulcerous stomatitis.

239. Frequent cauterizations very quickly cure ulcerations inside the mouth.

240. Gangrene of the mouth is a disease of childhood.

241. An aphtha become gangrenous is always the starting point of the sphacelus which invades the walls of the mouth.

242. Gangrene of the mouth is usually developed in enfeebled children, imperfectly nourished, lymphatic, and situated in the midst of unfavourable external hygienic circumstances.

243. Gangrene of the mouth is sometimes epidemic.

244. Gangrene of the mouth often coexists with gangrene of the anus and of the genital parts.

245. Gangrene of the mouth is announced by fcetor of the breath, quite peculiar, described under the name of gangrenous festor.

24G. The extreme fcetor of the mouth, united to an acute and circumscribed engorgement of the buccal wall, indicates the invasion of gangrene.

247. Gangrene of the mouth, involving a large portion of the skin of the face, is fatal.

248. Gangrene of the mouth, extending to the face, may lead to the mortification of the gums, the detachment of the teeth, and the necrosis of the maxillary bones.

249. Gangrene of the mouth can only be effectually cured at its commencement under the influence of a deep cauterization, repeated two or three times a day, and performed by a brush moistened with hydrochloric acid.

250. Pure hydrochloric acid is preferable to all the other caaustics in the treatment of gangrene of the mouth.

251. The particular stomatitis which modifies the secretion of the buccal mucus and renders it acid, engenders thrush.

252. Thrush is a vegetable production which is developed in the follicles of the buccal mucous membrane before spreading itself over the surface of this membrane.

253. Small whitish, discrete or confluent granulations, similar to specks of curd, and scattered on the mouth, characterize thrush.

254. Thrush is rarely a primary disease in children.

255. Thrush usually appears towards the termination of all the serious acute diseases, and in the course of chronic diseases.

256. Thrush usually indicates a serious general condition.

257. The thrush which appears on the adult, announces an approaching death.

BOOK IX.

ON THE DISEASES OF THE STOMACH AND INTESTINES.

CHAPTER I.

ON DIARRHOEA.

Diarrhcea is a very common disease amongst the newly-born, and amongst children at the breast; it is often very difficult to appreciate its nature with exactitude. It presents itself under the most varied forms; sometimes it results from functional derangements of the intestine without organic change of its tissue, sometimes these alterations are present. It is important, however, to know how to distinguish between these varieties, to prevent the commission of the most serious errors in therapeutics.

With this view, and in order to obviate the inconveniences which might result from a mistake, the history of the diarrhoea of young children will be described, taking care to separate from it in the work that which is the result of various inflammations of the intestine. This is the only method of conveniently studying and of comprehending all which relates to this morbid phenomenon.

Diarrhoea is characterized by tlfe frequency of the alvine dejections, modified in their physical and chemical qualities. There is an augmentation of the products of the secretion of the intestine, and a mixture of these products with the excrementitious matters.

History.

In the latter ages, most authors who have traced the history of diarrhoea have evidently taken the diarrhoea of adults as a model, without taking into consideration the varieties which this phenomenon presents when it is developed amongst children. Some of them have described, in a more special manner, the diarrhoea of dentition, the diarrhoea dependent on worms (Sennert), the diarrhoea of sucking children (Sauvages), the mucous diarrhoea, or mucous fever, verycommon in attenuated children and those subject to worms.—(StolL '/ < I*,•> t Aphor. 376.) Not one has made the diarrhoea of infants the object ^J of a particular study.

The special treatises date from an epoch near to our own. They

are all distinguished by a common character which is the uncertainty

of the diagnosis of the disease. Their authors too often unite catarrhal

diarrhoea with inflammatory diarrhoea. But wo have no right to be

7 . . jm . j. severe; the very limited state of our knowledge on the pathological

anatomy does not permit us to do better. Thus, what Etmuller refers

1 * j j /T> to lymphatic fever is applicable to these two varieties of diarrhoea.

The remittent fever of Armstrong, Butter, and Underwood, comprehends

, , them both. The same may be observed of the gastric fever of Hufeland,

.•".- . , . and of the description of the diarrhoea given by Gardien.*

In this age, authors have generally fallen into the opposite extreme. / In their too exaggerated teudencies of localization, they have referred to ^5 - enteritis a considerable number of cases of catarrhal diarrhoea which do not involve anatomical modifications of the tissue of the intestine. .*"f A Thus, Billard admits four kinds of inflammation of the gastro

intestinal mucous membrane susceptible of bringing on diarrhoea. The first is, erythematous enteritis, to which the thrush of the mouth ia

* Traiti (i'licconchrmcnt.

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