membrane, mucous, mouth, sometimes, white, appearance, lips, temperature, parrot and seen

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The white, newly-formed membrane coats the interior of the mouth and gullet ; but is usually confined to parts covered with scaly epithelium, for it avoids the nasal passages, and seldom penetrates into the larynx. Par rot, however, states that he has seen evidence of its presence on the vocal cords. The advance of the membrane down the alimentary canal was for a long time supposed to be arrested at the cardiac end of the stomach ; but Parrot asserts that the fungus is occasionally to be discovered in the stom ach and bowels. Li these situations it presents a peculiar appearance. In the stomach it is seen as small granules, separate or grouped, and vary ing in size from a millet-seed to a particle invisible to the naked eye. The smaller are pointed ; the larger are slightly depressed in the middle. In colour, they differ little from the mucous membrane on which they are placed, but some have a faint yellow tint. They adhere firmly to the sur face, and cannot be scraped off or washed away. The thrush granules affect principally the posterior surface, especially the neighbourhood of the pos terior curvature, and lie nearer to the cardia than to the pylorus. Sur rounding them, the mucous membrane retains its colour, or is of a rose or violet tint. Parrot examined sections of the gastric mucous membrane, and found the more superficial portions of the glands to be destroyed by the parasitic vegetation, which had penetrated into their interior, and had also advanced, although to a less extent, into the intervening tissue. Ac cording to Wagner, the spores and filaments can be sometimes detected within the blood-vessels of the part.

In the intestines, Parrot states that he has succeeded in discovering the fungus only in rare cases. In each instance its seat was the ccuni. Whether the growth has the power of attaching itself to the anus, is not clear, for an examination of the whitish pultaceous matter sometimes found at the orifice of the rectum, revealed merely pavement epithelium in strati fied layers, with some doubtful cells which presented a certain analogy with the filaments of thrush. On the mucous membrane of the mouth, the thrush membrane is at first white, and firmly adherent. After a few days its colour becomes browner, and its connection with the mucous surface less intimate, so that it can be readily wiped away with a brush or piece of wet rag.

In all cases of death from the serious intestinal derangement or the con stitutional cachexia of which thrush is a chief local expression, extreme atrophy of the tissues is a striking phenomenon. The infants are usually in a state of profound malnutrition, and present, according to Parrot, fatty degeneration of the kidneys, the lungs, and the brain, sometimes ul ceration of the stomach, and, not unfrequently, haemorrhages within the cranial cavity.

Symptoms.—In cases where the parasitic growth attaches itself to the mucous membrane of a sturdy infant, the appearance of the white points is preceded by redness and soreness of the mouth, and a rise of temperature. The child is noticed to suck with difficulty, and, if hand-fed, may refuse the bottle. He seldom, however, declines the breast for this reason. Often he makes movements with his lips, cries if a finger is introduced into his mouth, and is evidently uneasy. His temperature often rises at night to 103° or At the same time there may be a little looseness of the bowels, preceded by colicky pains. The motions are slimy or green, but not very offensive. Often they are acrid, and cause some redness and excoria tion of the Dates. This is looked upon by nurses as a satisfactory symptom,

being considered to indicate that the thrush " has gone through " the child. In many cases there is derangement of the stomach, and vomiting.

The above constitutes the whole of the symptoms. Although the tem perature is raised, the stools have an innocent appearance, and the face ex presses no distress. In the mouth, the thrush is limited to a few white patches, looking like particles of curd adhering to the mucous membrane. They are seen on the inner side of the cheeks and lips, on the tongue, some times on the hard palate, but seldom, in these cases, at the back of the throat. They may be removed with a little trouble, and leave the mucous surface on which they had been seated raw-looking.ancl bright red. When thus removed, similar little patches quickly appear in their place, but after a few days the surface cleans, and the child is well.

This simple variety is the shape the complaint assumes in ordinary cases, and practitioners whose experience is collected entirely from families in easy circumstances may have observed it in no other form. In hospitals and asylums where infants are admitted it is seen as a much more serious complaint. In babies who have been neglected or fed injudiciously, and confined to dirty, ill-ventilated, foul-smelling rooms—poor, miserable little objects, who have sunk from these causes and the consequent bowel derange ment into a state of extreme atrophy and weakness, the whole of the interior of the mouth and fauces is often completely lined by the white thrush mem brane. The layer adheres closely to the mucous membrane, and can only be detached with great difficulty. If this be done, the mucous surface beneath is seen to be raw, and sometimes ulcerated. According to Valleix, shallow the hard palate may precede the appearance of the para sitic vegetation. An infant so affected cannot suck, and, indeed, often can hardly swallow. His mouth is dry ; his lips are red and dry-looking, and at the surfaces where they come into contact, white scattered particles of thrush can be perceived, even when the lips are almost closed. The child's eyes and cheeks are sunken ; his face is pale and haggard, and marked with a well-defined nasal line which becomes a deep furrow on any movement of the lips. The buttocks and genitals are often covered with an erythematous or eczematous redness, and ulcerations may be noticed on the internal mal leoli, and sometimes also on other bony projections. His skin is loose and is excessively inelastic, often lying in lax folds upon the belly. The child whimpers feebly, but never cries. His mouth has a sour, or even a Cadaver ous smell. The motions, more or less profuse, are equally offensive. He gets weaker and weaker, and gradually sinks Out of life. Sometimes the con dition known as " spurious hydrocephalus " is noticed before death. The temperature varies. Sometimes, on the first appearance of the parasite, the internal temperature is found to be 101°, or higher, although the extremi ties feel cold ; but after a time the temperature falls below the level of health, and may be only 96° or 97° in the rectum. In many of these cases, the secretion of urine is diminished. According to Parrot, it often contains albumen ; and this pathologist is disposed to attribute the cerebral phe nomena which are apt to occtu- in these cases to toxic causes, from retention in the blood of urinary elements.

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