Synonyms:—Thrush; stomatitis mycosa.
Definition:—A contagious fungous disease, specific in character, depending upon the presence of the saccharomyces albicans. It is characterized by the presence, on the mucous surfaces of the mouth, of small, soft deposits, or spots, whitish or yellowish white in color, but lightly adherent to the membranes, and tending to spread by coalescence until the entire membrane is covered.
Etiology:—The growth and development of the saccharomyces depends upon the presence of devitalized membranes and an acid medium. Children with unhygienic environment, poorly and carelessly fed, or those with disorder of the stomach or impoverished blood, are most likely to be attacked. It is more common among bottle-fed babies, and will occur during the progress of chronic diseases, as diabetes or cancer, or during convalescence from protracted fevers, especially typhoid and malarial fevers. This disease may be conveyed from one patient to another by the common use of knives, forks and spoons and bottle tips, and probably by kissing. A changed condition of the normal secretions, from alkaline to acid, is usually to be observed when thrush is present, causing an acid fermentation of minute particles of food.
Symptomatology:—Heat, or burning pain, or extreme soreness of the mouth, are the first symptoms observed. The membranes are dry and red, usually dark red or livid. The whitish spots first appear upon the tongue. They rapidly increase in size and coalesce until they cover the lips, cheeks and hard palate, and later the soft palate, tonsils, pharynx, esophagus, and even the stomach may be involved.
At first there is a slight elevation of the temperature and an acceleration of the pulse, with restlessnes and peevishness. Later there is anorexia and some diarrhea. Occasionally the gastro-intestinal disturbance becomes persistent and somewhat intractable, and the patient becomes emaciated and weak.
Diagnosis:—The dry mouth and whitish spots on a slightly raised base are readily distinguished from the dribbling or salivation, and bleeding ulcers of aphthous stomatitis.
The fungus, which is readily seen under the microscope, determines the exact character of the disease.
Prognosis:—In favorable cases with hygienic surroundings, the prognosis is always good, as the disease yields quite readily to treatment. Where marasmus or cachexia are present the disease is of more serious import.
Treatment:—A thorough cleansing of the mouth is important. This should be done with an antiseptic solution having an alkaline reaction. Sodium sulphite or sodium hyposulphite in solution are available, or lime water with a potassium chlorate solution. These may be used as mouth washes or as sprays. A solution of sodium bicarbonate, twenty grains to an ounce of water, to which a dram of specific echinacea is added, will be serviceable, or a solution of sodium biborate with tincture of myrrh.
Internally, the use of phytolacca, the acetate of potassium, two or three times daily, in from two to four grain doses, or baptisia and rumex crispus are necessary to correct blood faults; and hydrastis, nux vomica and quinin bisulphate should be given, both for their local and general tonic influence. Iron in some simple, easily appropriated form is essential.
It is important that the diet should in severe cases contain no starch or sugar, that acid fermentation be avoided, and the medicines must not be compounded with syrups. Milk alone, or boiled milk to which a little salt is added, or milk and lime water, may be given. Stale bread, thoroughly toasted, soaked in hot milk, may also be administered. The mouth should always be thoroughly washed at the end of every meal with some one of the solutions first named.