448 DISEASES OF THE MOUTH. 



ed with it ; but the germs of thrush, like those of mould, seem to be 

 very plenty and widely-spread, and to develop wherever they find a 

 suitable place and favorable circumstances. 



ANATOMICAL APPEARANCES. Whitish points, or a delicate frosty 

 coating, in severe cases a cheesy, smeary mass, looking much like cur- 

 dled milk, are found on the inner surface of the lips, tongue, and roof 

 of the mouth. At first these may be readily removed, subsequently 

 they are more firmly attached. From the mouth the coating occasion- 

 ally advances to the larynx, more frequently to the oesophagus ; in 

 some cases the latter has even been found filled with thrush deposit. 

 The disease scarcely ever extends to the stomach. On microscopical 

 examination of the milky deposit it is found to consist of young and 

 old epithelial cells, fat-globules, etc., between which peculiar round 

 granules and filaments may be seen. The first are known to be spores 

 of fungi by their oval form, sharp outlines, by the excavation which 

 is evident in the larger ones, and by their difference in size, indicating 

 their growth. The filaments starting from the spores are of variable 

 thickness ; they have sheaths and constrictions ; where the latter occur 

 they have branches, which go off from them at acute angles, and have 

 the same calibre as the trunks. These fungoid filaments form beauti- 

 ful tree-shaped figures, or, when very numerous, form a thick felt. It 

 often looks as if they perforated the epithelial cells, located at their 

 joints. At first the thrush-spores are in the most superficial layers of 

 the epithelium ; later they press in between them. They may even, 

 although this rarely occurs, grow into the mucous membrane itself. 



SYMPTOMS AND COURSE. Children suffering from thrush almost 

 always show that nursing pains them. Patients dying of phthisis, car- 

 cinoma, etc., complain of painful burning in the mouth, when they are 

 affected with sprue. It is uncertain whether these difficulties depend 

 on the injuries that the deposit causes to the mucous membrane, or 

 whether a coincident slight inflammation of the oral mucous membrane 

 excites these pains and causes the growth of the fungus. In children, 

 suffering from thrush, we often see diarrhoea, accompanied by pain in 

 the abdomen, with fluid, green, acid stools. At the same time there 

 are not unfrequently redness and excoriations about the anus, inside of 

 the thighs and nates. As this symptom also occurs in nursing infants 

 without thrush, and as many children having thrush have no diarrhoea, 

 many consider it as an accidental complication, while others, especially 

 French observers ( Valleix),h&ve considered diarrhoea among the symp- 

 toms of thrush. It is difficult to decide which is right. In many cases 

 the diarrhoea may be independent of the thrush. But, as we have to 

 ascribe so many cases of infantile diarrhoea to abnormal decomposition 

 of the ingesta, and as we know that, where microscopical germs form, 



