THRUSH, AND ITS TREATMENT

2523. This is a disease to which infants are peculiarly subject, and in whom alone it may be said to be a disease; for when thrush shows itself in adult or advanced life, it is not as a disease proper, but only as a symptom, or accessory, of some other ailment, generally of a chronic character, and should no more be classed as a separate affection than the petechae, or dark-coloured spots that appear in malignant measles, may be considered a distinct affection.

2524. Thrush is a disease of the follicles of the mucous membrane of the alimentary canal, whereby there are formed small vesicles, or bladders, filled with a thick mucous secretion, which, bursting, discharge their contents, and form minute ulcers in the centre of each vessel. To make this formal but unavoidable description intelligible, we must beg the reader's patience while we briefly explain terms that may appear to many so unmeaning, and make the pathology of thrush fully familiar.

2525. The whole digestive canal, of which the stomach and bowels are only a part, is covered, from the lips, eyes, and ears downwards, with a thin glairy tissue, like the skin that lines the inside of an egg, called the mucous membrane; this membrane is dotted all over, in a state of health, by imperceptible points, called follicles, through which the saliva, or mucous secreted by the membrane, is poured out.

2526. These follicles, or little glands, then, becoming enlarged, and filled with a congealed fluid, constitute thrush in its first stage; and when the child's lips and mouth appear a mass of small pearls, then, as these break and discharge, the second stage, or that of ulceration, sets in.

2527. _Symptoms._--Thrush is generally preceded by considerable irritation, by the child crying and fretting, showing more than ordinary redness of the lips and nostrils, hot fetid breath, with relaxed bowels, and dark feculent evacuations; the water is scanty and high-coloured; whilst considerable difficulty in swallowing, and much thirst, are the other symptoms, which a careful observation of the little patient makes manifest.

2528. The situation and character of thrush show at once that the cause is some irritation of the mucous membrane, and can proceed only from the nature and quality of the food. Before weaning, this must be looked for in the mother, and the condition of the milk; after that time, in the crude and indigestible nature of the food given. In either case, this exciting cause of the disease must be at once stopped. When it proceeds from the mother, it is always best to begin by physicking the infant through the parent; that is to say, let the parent first take the medicine, which will sufficiently affect the child through the milk: this plan has the double object of benefiting the patient and, at the same time, correcting the state of the mother, and improving the condition of her milk. In the other case, when the child is being fed by hand, then proceed by totally altering the style of aliment given, and substituting farinaceous food, custards, blanc-mange, and ground-rice puddings.

2529. As an aperient medicine for the mother, the best thing she can take is a dessert-spoonful of carbonate of magnesia once or twice a day, in a cup of cold water; and every second day, for two or three times, an aperient pill.

2530. As the thrush extends all over the mouth, throat, stomach, and bowels, the irritation to the child from such an extent of diseased surface is proportionately great, and before attempting to act on such a tender surface by opening medicine, the better plan is to soothe by an emollient mixture; and, for that purpose, let the following be prepared. Take of

Castor oil 2 drachms. Sugar 1 drachm. Mucilage, or powdered gum Arabic half a drachm.

Triturate till the oil is incorporated, then add slowly--

Mint-water One ounce and a half Laudanum Ten drops

Half a teaspoonful three times a day, to an infant from one to two years old; a teaspoonful from two to three years old; and a dessertspoonful at any age over that time. After two days' use of the mixture, one of the following powders should be given twice a day, accompanied with one dose daily of the mixture:--

Grey powder 20 grains. Powdered rhubarb 15 grains. Scammony 10 grains. Mix.

Divide into twelve powders, for one year; eight powders, from one to two; and six powders, from two to six years old. After that age, double the strength, by giving the quantity of two powders at once.

2531. It is sometimes customary to apply borax and honey to the mouth for thrush; but it is always better to treat the disease constitutionally rather than locally. The first steps, therefore, to be adopted are, to remove or correct the exciting cause--the mother's milk or food; allay irritation by a warm bath and the castor-oil mixture, followed by and conjoined with the powders.

2532. To those, however, who wish to try the honey process, the best preparation to use is the following:-Rub down one ounce of honey with two drachms of tincture of myrrh, and apply it to the lips and mouth every four or six hours.

2533. It is a popular belief, and one most devoutly cherished by many nurses and elderly persons, that everybody must, at some time of their life, between birth and death, have an attack of thrush, and if not in infancy, or prime of life, it will surely attack them on their death-bed, in a form more malignant than if the patient had been affected with the malady earlier; the black thrush with which they are then reported to be affected being, in all probability, the petechae or purple spots that characterize the worst form, and often the last stage, of typhoid fever.

2534. In general, very little medicine is needed in this disease of the thrush--an alterative powder, or a little magnesia, given once or twice, being all, with the warm bath, that, in the great majority of cases, is needed to restore the mucous membrane to health. As thrush is caused by an excess of heat, or over-action in the lining membrane of the stomach and bowels, whatever will counteract this state, by throwing the heat on the surface, must materially benefit, if not cure, the disease: and that means every mother has at hand, in the form of a _warm bath_. After the application of this, a little magnesia to correct the acidity existing along the surface of the mucous membrane, is often all that is needed to throw the system into such a state as will effect its own cure. This favourable state is indicated by an excessive flow of saliva, or what is called "dribbling," and by a considerable amount of relaxation of the bowels-a condition that must not be mistaken for diarrhoea, and checked as if a disease, but rather, for the day or two it continues, encouraged as a critical evacuant.

2535. Should there be much debility in the convalescence, half a teaspoonful of stee wine, given twice a day in a little barley-water, will be found sufficient for all the purposes of a tonic. This, with the precaution of changing the child's food, or, when it lives on the mother, of correcting the quality of the milk by changing her own diet, and, by means of an antacid or aperient, improving the state of the secretion. Such is all the treatment that this disease in general requires.

2536. The class of diseases we are now approaching are the most important, both in their pathological features and in their consequences on the constitution, of any group or individual disease that assails the human body; and though more frequently attacking the undeveloped frame of childhood, are yet by no means confined to that period. These are called Eruptive Fevers, and embrace chicken-pox, cow-pox, small-pox, scarlet fever, measles, milary fever, and erysipelas, or St. Anthony's fire.

2537. The general character of all these is, that they are contagious, and, as a general rule, attack a person only once in his lifetime; that their chain of diseased actions always begins with fever, and that, after an interval of from one to four days, the fever is followed by an eruption of the skin.

CHICKEN-POX, OR GLASS-POX; AND COW-POX, OR VACCINATION.

2538. CHICKEN-POX, or GLASS-POX, may, in strict propriety, be classed as a mild variety of small-pox, presenting all the mitigated symptoms of that formidable disease. Among many physicians it is, indeed, classed as small-pox, and not a separate disease; but as this is not the place to discuss such questions, and as we profess to give only facts, the result of our own practical experience, we shall treat this affection of glass-pox or chicken-pox, as we ourselves have found it, as a distinct and separate disease.

2539. Chicken-pox is marked by all the febrile symptoms presented by small-pox, with this difference, that, in the case of chicken-pox, each symptom is particularly slight. The heat of body is much less acute, and the principal symptoms are difficulty of breathing, headache, coated tongue, and nausea, which sometimes amounts to vomiting. After a term of general irritability, heat, and restlessness, about the fourth day, or between the third and fourth, an eruption makes its appearance over the face, neck, and body, in its first two stages closely resembling small-pox, with this especial difference, that whereas the pustules in small-pox have _flat_ and _depressed_ centres--an infallible characteristic of small-pox--the pustules in chicken-pox remain _globular_, while the fluid in them changes from a transparent white to a straw-coloured liquid, which begins to exude and disappear about the eighth or ninth day, and, in mild cases, by the twelfth desquamates, or peels off entirely.

2540. There can be no doubt that chicken-pox, like small-pox, is contagious, and under certain states of the atmosphere becomes endemic. Parents should, therefore, avoid exposing young children to the danger of infection by taking them where it is known to exist, as chicken-pox, in weakly constitutions, or in very young children, may superinduce small-pox, the one disease either running concurrently with the other, or discovering itself as the other declines. This, of course, is a condition that renders the case very hazardous, as the child has to struggle against two diseases at once, or before it has recruited strength from the attack of the first.

2541. _Treatment_.--In all ordinary cases of chicken-pox--and it is very seldom it assumes any complexity--the whole treatment resolves itself into the use of the warm bath, and a course of gentle aperients. The bath should be used when the oppression of the lungs renders the breathing difficult, or the heat and dryness of the skin, with the undeveloped rash beneath the surface, shows the necessity for its use.

2542. As the pustules in chicken-pox very rarely run to the state of suppuration, as in the other disease, there is no fear of _pitting_ or disfigurement, except in very severe forms, which, however, happen so seldom as not to merit apprehension. When the eruption subsides, however, the face may be washed with elder-flower water, and the routine followed which is prescribed in the convalescent state of small-pox.

2543. COW-POX, properly speaking, is an artificial disease, established in a healthy body as a prophylactic, or preventive agent, against the more serious attack of small-pox, and is merely that chain of slight febrile symptoms and local irritation, consequent on the specific action of the lymph of the vaccination, in its action on the circulating system of the body. This is not the place to speak of the benefits conferred on mankind by the discovery of vaccination, not only as the preserver of the human features from a most loathsome disfigurement, but as a sanitary agent in the prolongation of life.

2544. Fortunately the State has now made it imperative on all parents to have their children vaccinated before, or by the end of, the twelfth week; thus doing away, as far as possible, with the danger to public health proceeding from the ignorance or prejudice of those parents whose want of information on the subject makes them object to the employment of this specific preventive; for though vaccination has been proved _not_ to be _always_ an infallible guard against small-pox, the attack is always much lighter, should it occur, and is seldom, if indeed _ever_, fatal after the precaution of vaccination. The best time to vaccinate a child is after the sixth and before the twelfth week, if it is in perfect health, but still earlier if small-pox is prevalent, and any danger exists of the infant taking the disease. It is customary, and always advisable, to give the child a mild aperient powder one or two days before inserting the lymph in the arm; and should measles, scarlet fever, or any other disease arise during the progress of the pustule, the child, when recovered, should be _re-vaccinated_, and the lymph taken from its arm on no account used for vaccinating purposes.

2545. The disease of cow-pox generally takes twenty days to complete its course; in other words, the maturity and declension of the pustule takes that time to fulfil its several changes. The mode of vaccination is either to insert the matter, or lymph, taken from a healthy child, under the cuticle in several places on both arms, or, which is still better, to make three slight scratches, or abrasions, with a lancet on one arm in this manner, ,,",, and work into the irritated parts the lymph, allowing the arm to dry thoroughly before putting down the infant's sleeve; by this means absorption is insured, and the unnecessary pain of several pustules on both arms avoided. No apparent change is observable by the eye for several days; indeed, not till the fourth, in many cases, is there any evidence of a vesicle; about the fifth day, however, a pink areola, or circle, is observed round one or all of the places, surrounding a small pearly vesicle or bladder. This goes on deepening in hue till the seventh or eighth day, when the vesicle is about an inch in diameter, with a depressed centre; on the ninth the edges are elevated, and the surrounding part hard and inflamed. The disease is now at its height, and the pustule should be opened, if not for the purpose of vaccinating other children, to allow the escape of the lymph, and subdue the inflammatory action. After the twelfth day the centre is covered by a brown scab, and the colour of the swelling becomes darker, gradually declining in hardness and colour till the twentieth, when the scab falls, off, leaving a small pit, or cicatrix, to mark the seat of the disease, and for life prove a certificate of successful vaccination.

2546. In some children the inflammation and swelling of the arm is excessive, and extremely painful, and the fever, about the ninth or tenth day, very high; the pustule, therefore, at that time, should sometimes be opened, the arm fomented every two hours with a warm bread poultice, and an aperient powder given to the infant.