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inflammation of the intestine. It lasts a greater or less time, disappears rather easily, and is in like manner reproduced until the cure or the Ideath of the child.

Thrush also appears in the course of pneumonia, or of pulmonary phthisis, in children who do not present any changes in the alimentary canal. I have observed it in the course of chronic hydrocephalus, and no other reason could be assigned for its origin except the cachexia of the child.

To resume, then it is observed that there are two varieties of thrush, Resume the idiopathic and the symptomatic.

Both of these forms are allied to a general disposition of the individuals; the first depends on a bad state of the constitution, and the second on a disturbance of the health caused by an organic disease.

Thrush has no symptoms but those which result from the inspection of the mouth, that is to say, the local symptoms.

The general symptoms do not appertain to thrush; they are those of the diseases in the course of which this production is developed. Uusually these symptoms are those of enteritis; but those of pneumonia, of tubercular phthisis, of hydrocephalus, &c., have been sometimes observed.

Evolution and duration of thrush. It is important to be acquainted with the evolution of the product which constitutes thrush. Apart from the general symptoms which result from the derangements of the organism, or from the varied alterations occurring in the organs, and which for these motives we pass in silence, phenomena are observed in the mouth which it is necessary to mention here. These phenomena relate to the evolution of the cryptogamic plant. Their successive appearance should be regarded as the true progress of the disease.

Thus, taking into consideration the general condition of the individuals, the different organic modifications which derange their health; raising these causes to the degree of a powerful influence, the force of which is in relation with its more or less remote origin, an influence which dominates over the patients, and disposes them to the germination of thrush; let us see what takes place in the mouth.

The mucous membrane becomes acid, red, hot, and painful; its sy plaa epithelium smooth and very shining. Four and twenty hours after

wards, or at most after three days, one or more cones of cryptogamia

appear, under the form of small white specks, scarcely visible. Each on. of these is formed by the Sporotrichium of which we have spoken; it increases by intussusception, forms a larger cone, which becomes less and less adherent, and becomes detached naturally in the space of four days. As many cones, so many phenomena similar to those we have just described.

As their germination is not instantaneous, and as this operates in

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

l'ento one who does not examine very perfectly, thrush lasts from ten to twelve or fifteen days, because it is detached and reproduced in other situations.

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The whole of the concretions of thrush readily disappear in those children who are but slightly indisposed, and who have idiopathic thrush. These cryptogamia disappear with the same facility amongst C children attacked with symptomatic thrush, but they are reproduced, and thus return three or four times in the course of the disease. 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.

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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.

The presence of these cryptogamia is, then, a serious sign. However, it 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 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 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.

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 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

*Clinique des maladies des enfants nouveau-nés. Paris, 1838; p. 202 et suiv.

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:

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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, &c., 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.

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The substitutive medication, recommended by Boerhaave, Van Swieten, recortion Stoll, Sauvages, &c., 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.

Dr. Hencker has recommended the solutions of the sulphate of zinc, in the dose of fifteen grains to 3j of lettuce water. A. Duges suggests the employment of applications, in the composition of which the vegetable acids, vinegar, lemon juice, &c., enter. M. Bretonneau has found good results from calomel mixed with powdered sugar, and

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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 cryptogamia 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 be 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 it treatment suffices. It is only in symptomatic thrush that these means

become necessary. They are then employed, less against the lesions of the mouth than against the lesions of the intestine, of the lung, &c., 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 foetor of the breath, quite peculiar, described under the name of gangrenous foetor.

246. The extreme fœtor 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 DIARRHEA.

Diarrhoea 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

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