Beside the gastro-enteric disease, a simple stontatitis, often the result of too frequent sponging of the mouth, is a predisposing factor. Careful experiments have demonstrated that the direct or indirect transference of the thrush fungus upon the completely intact mucous 'membrane of healthy i»fants never succeeds (Epstein, •Soltmann).
specificity of the thrush stoninditis is definitely established since the discovery of the fungus in the deposits on the mucous membrane. The opportunities for infection are numerous on account of the abundance of the fungus. Almost from every stool of the breast-fed infant, from the mammilhe of the nursing woman, and from cow's milk, the thrush fungus may be cultivated. The fungus is relatively less frequent in the atmosphere, so that one must think of a direct infection by contact in thc first place. The fungtzs may readily be conveyed from one to the other, through filthy "pacifiers" and rubber nipples, through the act of drinking froni the breast, but especially through the objectionable washing of the mouth. The fungus is a com mon inhabitant of the healthy mouth, where it leads a saprophytic existence without, inducing a specific disease.
The classification of the thrush fungus into the plant life has offered great difficulties for many years. and has lead to a variety of polemical discussions. Accorffing to the exhaustive researches of Plaut, the fungus, which belongs to the order of layphomycetes, stands nearest to manilla candida. Its pure culture is most easily obtained on an acid solid medium, by which it is possible to isolate the fungus from its attending bacteria. Very remarkable is the great tendency of the thrush fungus to produce varieties (variety with small goniclia, liquefying variety, etc.). In the future it may be possible to establish the relationship of these varieties to the different forms of the disease.
The diagnosis seldom presents any difficulties. The differentiation of the colonies of the fungus from coagula of milk has already been explained. The surest proof in every case is offered by a microscopical examination, which alone can indicate the correct condition in those deposits confined to the tonsils, which resemble diphtheria, as previously mentioned.
The prognosis of this stomatitis depends on the condition of the afflicted infant. In a healthy vigorous nursling thrush disappears cer tainly in a few days, without causing any serious disturbance. In the
debilitated, the premature, or infants weakened by grave diseases, thrush may threaten life, because it interferes with the ingestion of food, which is already lessened, and because the resulting diarrlima and complications hasten the decline of the vitality.
If the described prophylactic regulations are accurately carried out in the modern hygiene of infancy, it is possible to be entirely exempt front the brush plague. The principle regulations are: desistance from mouth washing in the healthy infant, use of its own utensils, boiling the nipples, avoidance of unclean "soothers." removal of soiled diapers, and keeping the mother's nipples clean. It follows, therefore, that thrush is entirely absent from asylums conducted under model hygienic regulations.
Treatment. —Boric acid as a specific medicament against thrush continues to bold first place. Kehrer has shown that this drug has the power to inhibit the growth of the fungus. In order to avoid the dan gerous and inefficient washing of the mouth, Escherich introduced the ingenious boric acid teat. This has the shape of the old sugar-teat, and consists of a compress of sterilized cotton, which has been dipped in finely pulverized boric acid and then wrapped in gauze or fine batiste, forming a small ball, from a strawberry to a hazel-nut in size. Before its use, in order that it may be taken with relish, the teat may be dipped in a 0.01 per cent. solution of saccharin. The boric acid teat must be made to fit. the mouth, and must not be too large or too small. It must be often administered and must be shielded front contamination of every kind.
Most infants take this teat with relish, make vigorous sucking and chewing movements, and gradually dissolve the powder with the saliva. It is obvious, that this singular method of treatment is initoxious and that in this way a thorough mechanical and antimycotic cleanliness of the mouth may be obtained. If the thrush has just begun, or has not extended very far, the use of the teat will cause its disappearance in 24 hours. In obstinate thrush or in infants by whom the teat is refused, the infant should be allowed to suck a small brush dipped in nitrate of silver glycerin (Argem Mina. 2.0, glycerin 20.0, aqua destill., STO— Concetti) or a 2 per cent. solution of silver nitrate may be applied.