While the severe septic complications perhaps belong to the rarities of medicine and hence do not incite a great practical interest, it is ex pedient to discuss a group of phenomena accompanying the local process and forming a part of the clinical syndrome.
In the first place the intestinal symptoms already mentioned should be considered, which arise mostly in the form of an intestinal catarrh of varying severity. The question whether thrush is the result or the cause of this intestinal disease is not conclusively- decided. Experience teaches that a catarrh of the intestine, or at least a dyspep.sia, precedes the outbreak of thrush and that perfectly healthy infants., as a rule, do not become affected with thrush. Although this rule certainly has its exceptions, especially in breast-fed infants, it is not always easy to draw a line between the physiological and pathological variations of the stools; still it must be asserted that infants suffering with some intestinal dis order have an increased susceptibility to the local invasion of thrush.
One thing is certain, namely, that thrush may be the direct cause of complicating intestinal diseases. Masses of the fungus are swallowed in large numbers in this stomatitis, which find favorable conditions for vegetation in the acid condition of the intestinal contents and can give rise to a specific affection. The infection in some cases may take the form of a severe febrile enteritis, which only yields after the cure of the local process. The bacteriological aspect of the stools in such cases teems xvith elements of the thrush fungus and the normal flora occas ionally disappear almost completely.
The diarrheea which so often results from thrush is the cause of another complication, namely, intertrigo. It is not improbable that the masses of fun0 in the stools may participate in the production of this dermal inflammation, which develops further on the buttocks. The fung,i as a rule can be easily found in large numbers at that place.
A third complication may ensue: this is the frequent occurrence of Bednar's ulcers of the palate in infants afflicted with thrush. Their appearance is brought about by the efforts of swabbing the mouth for the purpose of removing the patches. These manipulations lead to
lesions of the vulnerable mucous membrane of the mouth.
Occurrence.—Thrush is peculiar to the age of infancy, and, further more, infants in the first two months of life are attacked most frequently. It is remarkable and gratifying to find that thrush is becoming more infrequent, and that the severe cases particularly, which were so consti tuted as to stamp thrush as one of the most dreaded diseases, even the very scourge of maternity hospitals and foundling homes, now belong to the group of clinical rarities. This is a triumph of tnodern hyg,iene and not the least good result from the discontinuance of the excessive washings of the mouth in healthy infants.
In older children thrush as a primary disease is rare. As a rule, the thrush fungus implants itself, as in adults, only during the course of some other severe disease which impairs the nutritive condition (as tuberculosis, meningitis, typhoid). Once only I found in a vigorous boy a white pultaceous deposit confined to both tonsils, which resem bled diphtheria, but which was composed of thrush masses (sprue diplitheroid).
The increased predisposition of infants to thrush is explained above all by the dryness of the mouth and occasional acid reaction of the mucous membrane. Both conditions favor the implantation and vegetation of the thrush fungus as experience has shown; while the normal alkaline saliva has an inhibitory effect on the growth of the fungus. Further more, it must be mentioned, the organs of the mouth in the infant remain mostly in a state of rest. The important act of self-cleansing the mouth, therefore, is deficient, a function which in later life is a very essential task.
The alimentation, whether natural or artificial, has no substantial influence. We find breast-fed infants, as well as those artificially fed on the bottle, attacked by thrush. In the former, however, the disease as a rule runs a more favorable course, which must be attributed to the greater power of resistance generally present in breast-fed infants.