In these severe cases the general symptoms depend upon the intestinal catarrh, or other primary lesion, whatever it may be, which has reduced the infant's strength, and prepared the way for the invasion of the parasite. Often the illness ends in a profuse diarrhoea, but the bowels are.not invariably relaxed. In some cases, an attack of catarrhal pneumonia, or pulmonary catarrh, with collapse of the lung, may bring the life of the infant pre maturely to a close.
Diagnosis.—Thrush is not difficult to detect. We have merely to ex amine the mouth of the infant, and observe the white adl erent patches sprinkled over the surface of the mucous membrane. If a particle of one of these patches be detached and placed under the microscope, the charac teristic spores and filaments will at once be noticed.
It is possible that, in the rare cases where diphtheritic false membrane is seen on the interior of the lips and mouth, it may be mistaken for thrush, but diphtheritic membrane is thicker, tougher, and more leathery in text ure, less white in colour, and under the microscope shows no spores. Moreover, the superficial cervical glands are enlarged and tender in diph theria. In cases of thrush they are not affected.
Particles of curd clinging to the gums and cheeks of a child who has just taken his bottle have exactly the appearance of disseminated particles of thrush ; but they can be readily wiped off with a small brush or feather, and on their disappearance leave no redness of the mucous membrane.
Prognosis.—In cases of thrush, the probabilities of the child's recovery depend partly upon his general condition, partly upon the extent of surface covered by the vegetation. If thrush appear in the mouth of a sturdy, well-nourished child, as a consequence of some temporary derangement, the symptom is one of little consequence, and the parasite can be readily dispersed. In a child, enfeebled and wasted by chronic digestive de rangement or the victim of inherited syphilis, the appearance of thrush in the mouth is a symptom of the utmost gravity. In such a case, the child's only chance of recovery depends upon the rapid introduction of nourish ment into his system, but a deranged condition of the mucous membrane may neutralize all our efforts to improve the state of his nutrition. In an infant so reduced, the rapidity with which the fungus is seen to spread over the surface, may be taken as a measure of the severity of the digestive derangement. If it rapidly cover the whole interior of the mouth and throat, the child's chances of recovery in his weakly state are small indeed.
Treatment.—In mild cases of thrush, our first care should be to remedy the temporary gastric derangement which has allowed the parasitic growth to effect a lodgment on the mucous membrane. The diet must be modified as recommended in the chapter on infantile atrophy ; and if the bowels are relaxed, the looseness must be arrested by suitable treatment (see page 626). If not relaxed, they should be acted on by a dose of rhubarb, with a grain of gray powder. Afterwards, a draught containing a few grains of carbonate of soda, with an aromatic, should be given three or four times a day. If there is nausea, the stomach should be cleared out by
an emetic of sulphate of copper (half a grain in a teaspoonful of water), or a teaspoonful of ipecacuanha wine, given every ten minutes until vomiting is produced.
Fresh air is of extreme importance. If the weather is suitable, the child should pass much of the day out of doors ; and especial care should be taken that his sleeping-chamber is sufficiently ventilated, and that soiled linen is not allowed to remain in the room to vitiate the air.
With regard to local treatment :—Perfect cleanliness is indispensable. Directly the infant has taken the bottle, his mouth should be swabbed out with a piece of soft linen rag, or a large camel's-hair brush, moistened with warm water. Afterwards, the whole of the interior of the mouth should be brushed over with a solution of borax (half a drachm to the ounce) in water sweetened with glycerine. If this treatment be repeated after each meal, it will not be long before all signs of the fungus have disappeared.
In the more severe examples of the complaint the same local treatment must be employed. If the fungus be suspected to have passed into the gullet, the child may be forced to swallow a few drops of the wash diluted with water. If superficial ulceration are seen, ten grains of sulphate of zinc may be added to each ounce of the wash, for use as an application to the mucous membrane. The chief difficulty in these cases is to improve the child's nutrition and increase his strength. If the parents are in a position to supply a wet nurse, this method of feeding should be adopted at once. If the child is forced to trust to the bottle, ass' milk or the milk of the goat is preferable to that of the cow. Either should be given pancreatised according to the method recommended elsewhere (see page 606). White wine whey is a valuable resource in these cases, and if the infant be much reduced in flesh and strength, with small digestive power, he may subsist upon it entirely for the first few clays. A dessert-spoonful of fresh cream shaken up with each bottleful of the whey makes it more nutritious, and is a very digestible addition to the meal. In all cases, the internal treatment will depend upon the accompanying conditions, and es pecially upon the nature of the illness in the course of which the local com plaint has appeared. Often the child is the subject of a chronic intestinal catarrh. This must be treated as directed elsewhere (see page 640). If the purging is moderate, and there is no reason to suspect the presence of ulceration of the bowels, much benefit may be often derived from a powder containing one grain of rhubarb, with one grain of powdered bark, and three grains of aromatic chalk, given two or three times in the day.
Fresh air, with warmth to the belly, and the most perfect cleanliness, not only of the child's body and linen, but also.of all spoons, cups, feeding bottles, etc., used in his nursery, are essential to his recovery.