ETIOLOGY— CLINICAL VARIETIES 



1743 



less frequently of the Monilia bronchialis Castellani type and other 

 types, while Monilia albicans Robin sensu stricto is seldom found. 



In cases of thrush in London Castellani isolated in 191 3 fungi of the types 

 Monilia pinoyi Castellani, M.parapinoyi Castellani, M. londinensis Ca.?,te\\2L.ni, 

 M. metalondinensis Castellani, M. hronchialis Castellani, occasionally M. tvopi- 

 calis Castellani. and rarely other types. 



Fungi oj Genus Oidium Link. — The following fungi of the genus 

 Odium have been found in a few cases of thrush :• — Oidium mafalense 

 Castellani, Oidium rotundatum Castellani, Oidium asteroides Castel- 

 lani. The same species have been found in the expectoration of 

 certain cases of bronchitis, and Oidium rotundatum and Oidium 

 asteroides also in the faeces of certain cases of enteritis. 



Fungi 0/ the Genus Hemispora Vuillemin.' — The fungus Hemispora 

 rugosa Castellani, found by Castellani in certain cases of subacute 

 tonsillitis and cases of bronchomycosis, has been recently observed 

 by Pi j per in a peculiar case of thrush in South Africa. 



Fungi of Genus Endomyces Link.— Vuillemin in old cultures of 

 so-called Oidium albicans Robin found asci, and, therefore, con- 

 sidered the thrush fungus to be an endomyces, Vuillemin's findings 

 were not confirmed, and Landrieux created a new species for the 

 fungus in which Vuillemin found asci : Endomyces vuillemini Land- 

 rieux. 



Predisposing Causes.- — General weakness, marasma, and the late 

 stages of tuberculosis and diabetes, favour the development of 

 thrush, though at times perfectly sound individuals may suffer 

 from it. 



Symptomatology. — On the mucous membrane of the cheeks, soft 

 palate, and tongue, white small spots appear, which gradually 

 spread. There is often a certain degree of inflammation, and the 

 oral mucosa may be red and swollen and the saliva very acid. 

 Nursing and chewing are painful, and infants and children with 

 thrush have often diarrhoea. Certain authors, however, maintain 

 that the severe signs of stomatitis are not due to the thrush 

 fungi; bacteria and other organisms would be the real cause of the 

 oral inflammation, which would prepare the ground for the fungus 

 to thrive, and by abundantly growing produce the white patches. 

 Thrush not rarely spreads to the pharynx and the upper portion of 

 the oesophagus. It is interesting to note that the fungus grows from 

 the surface downward fairly deep into the mucous membrane. 

 It was believed at one time that thrush never affected cylindrical 

 epithelium. Thrush runs a variable course, and in many cases shows 

 little tendency to spontaneous cure. 



Clinical Varieties. — In cases of thrush due to Oidium rotundatum, 

 Oidium asteroides, and Monilia zeylanica, the colour of the patches 

 may be yellowish instead of creamy white. The same appearance 

 has been recently noted by Pijper in an interesting case of thrush 

 he has carefully described in South Africa, due to Hemispora rugosa 

 Castellani. 



