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mucous, membrane, seen, spores, condition and mouth

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is a parasitic disorder, and is due to a fungus which attaches it self to the mucous membrane of the mouth and gullet. The complaint is of importance, not so much in itself, for when it appears in a healthy child the vegetation is readily dispersed, as on account of the debility and seri ous intestinal and other derangements by which it is often accompanied. Strictly speaking, thrush is a symptom rather than a disease, and often in dicates a condition of the system which should give rise to most serious apprehension.

Causation.—Thrush is a cryptogamic growth which finds its nidus in altered secretion from the mucous membrane. It is most common in in fants during the first few weeks or mouths of life, and any derangement which involves the mucous lining of the mouth may tend to its production. In such subjects, the vegetation is the expression of a local state, and this local state may itself be the consequence of a cachectic condition or consti tutional disease. The development of the fungus is favoured by heat of weather, want of cleanliness, and indigestible food. It is consequently very common during the summer months amongst hand-fed infants, especially amongst those who are supplied with a highly fermentable diet, and are al lowed to suck their food from dirty bottles. In such cases, the passage through the mouth of sour fluid, and the derangement of the stomach which results from fermentation and acidity, maintain a state of constant oral ca tarrh which forms a congenial medium for the development of the parasite. In a severe form the complaint is never seen except in imperfectly nour ished infants, whose food is ill-selected, and whose general management leaves much to be desired. Imperfect ventilation, and general insanitary surroundings, are no doubt agencies which further the invasion of the fungus and assist its growth. New-born infants crowded together in Foundling Hospitals often suffer greatly from such influences, and in these institu tions thrush is a common and much-dreaded visitor. Even after the first infancy, the later stage of many acute and chronic forms of disease is liable to be complicated by the presence of the parasite, for in the young child a catarrhal condition of the alimentary mucous membrane often forms a necessary part of such illnesses.

In children suckled at the breast, the parasite is rarely seen ; and if, on account of some temporary derangement, it succeeds in establishing itself upon the mucous membrane, it is readily dislodged by suitable treatment, and quickly made to disappear. Thrush does not seem to be contagious in the ordinary sense of the term. No doubt, if the mycelium be purposely brought into contact with the mucous membrane of a child who is in a favourable condition for its reception, the plant may flourish in its new situation ; but in a child whose mucous membrane is in a healthy state, the experiment will be tried in vain.

Morbid parasitic growth which constitutes thrush, con sists of the mycelium and spores of a cryptogamic vegetation which was first described by Robin under the name of oidium albicans. The fungus has now been identified by Haller as identical with the oidium lactis which results from the acid fermentation of milk. The mucous membrane of the mouth is first seen to be red, and its secretion has a distinctly acid reac tion. Then, in the course of a few hours, little white points appear upon the reddened especially on the cheeks and the inner surface of the lips. These increase in number and in size, and by the second day are seen to have united into patches which cover a considerable extent of sur face. Even before the appearance of the white points, a gentle scraping of the mucous membrane reveals to the microscope many spores of the fun gus. These are elongated cells—egg-shaped bodies—which are often at tached to one another by their ends, so as to form groups of two, three, or four. The white points are found, on examination, to consist of these con nected spores, combined with scaly epithelium from the mucous membrane, detached spores and molecular deposit.

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