The Varieties of Sore Mouth. — It is scarcely possible for one commencing to investigate the different varieties of stomatitis, not to be somewhat perplexed by the multiplicity of terms that are used by different authors to express the varied form of the disease.
This discrepancy has arisen in part from recent pathological and microscopical investigations, and in part from the difficulty in drawing the line of demarcation between the different diseases themselves. A simple stomatitis may progress to the follicular variety, and thus under certain circumstances may merge into the ulcerative form of the affection.
Condie* [“Diseases of Children,” p. 126.] states that the disease of the mouth occurring in children during the period of suckling, in which the inner parts of the buccal cavity are covered by minute portions of a curdy matter, is the Muguet of the French, the Thrush, or Aphthae infantilis; whereas Churchill† [“Diseases of Infants and Children,” p. 427.] states that Muguet and Thrush are very different affections, the latter being true aphthae or follicular stomatitis, while the former is held to be a pseudo membranous affection. His words are as follows: “By many it (Muguet) has been and still is confounded with vesicular aphthae or thrush, though no two diseases can be more distinct, Muguet being an abnormal secretion upon the mucous membrane of the mouth, and thrush constituting a vesicle or pustule formed beneath the epithelium.” And Mr. Bird, in his translation of Bouchut,* [A practical treatise on the “Diseases of Children and Infants at the Breast,” etc., translated from the French of M. Bouchut, by Peter Hinckes Bird, F. R. C. 8. L. London, John Churchill, 1855.] omits the term muguet entirely, or we should judge probably translates the word muguet in French to the English thrush. This appears was evident from a quotation given by Churchill in his chapter upon muguet, which in the translated text appears under the head of thrush.
Teste† [“Diseases of Children,” p. 229.] also states that muguet and aphthae or thrush are often confounded, but that they are separate affections. Churchill again makes a difference between muguet and simple erythematous inflammation of the mucous membrane, which, however, appears to me to be only a difference in intensity more than in essential characteristic. The other points in the diagnosis of the forms of stomatitis will be noticed as each is taken up, and upon reflection and experience we would divide the whole class into
This form of the affection is very frequently observed by any practitioner who enjoys a moderate opportunity for treating the diseases of infancy and early childhood. Probably the first symptom that calls the attention of both parent and physician is the restlessness and fretfulness of the patient; there is but slight fever, Sometimes none at all, but in many instances acidity of the stomach and the regular pains ensuing therefrom. There is often considerable thirst, the child is eager to take the breast, but ceases to suckle after a few mouthfuls have been drawn. If the mucous membrane be now examined, it will be found much inflamed and red, the whole mouth is hot and dry, or perhaps only parts thereof may be involved, as the cheeks, or the inside of the lips and gums. A bland saliva flows from the mouth, and the inexperienced physician and the young mother often decidedly agree that the infant is precocious in cutting its teeth, and examine the alveolar arches to ascertain the eruption of the masticating organs. Perhaps some have gone so far as to “lance the gums,” to give vent to the supposed mischief makers. So far there may be no exudation observable, and a case of simple erythematous inflammation of the mucous membrane of the mouth is made out. If the child, however, somewhat older and the period of first dentition has arrived, then it behooves the practitioner to examine more particularly the condition of the gum and ascertain if it be the pressure of the teeth that assists in the establishment and extension of the inflammatory action, and to take the requisite steps to remove so much of the exciting cause.
The disorder, however, may progress, and small points or patches of a curdy material are observable in different parts of the mucous membrane. We have then a case of muguet before us, whether the flocculi are deposited in the form of white points on the tongue, of shreds in various parts of the oral mucous membrane, or in a large pseudo membranous formation involving almost the entire cavity of the mouth. — There can be no doubt that this form of the affection which we are now describing is held to be, nay is very commonly called, both by nurses and physicians, thrush although doubtless the term is a misnomer as pathological investigation has shown.
When the disease is mild it is readily amendable to proper homoeopathic medicines, although under some peculiar circumstances the inflammatory action continues, the patches become larger in size and the constitutional symptoms are of a more grave character, and a slimy watery diarrhea assists in the prostration of the patient.
The disease may occur at any period of infantile life, it is, however, much more frequently noticed within the first few months, the slime is hot and dry from the beginning to the termination of the attack, although the pulse is not very much increased in frequency. Billard, to whom with Valleix, Guersent and Selut, we owe many additions to our knowledge of the nature and pathology of the disease, “counted the pulse and beating of the heart in fatty children, aged from one to twenty days, affected with it, and found fifty, sixty, sixty-four, eighty, and in one instance one hundred pulsations to the minute.”
Some authors assert that not only the esophagus and stomach may be affected, but that the whole tract of the intestines may be involved. Billard and Guyot have remarked instances of this kind, while Vernon maintains that it is never met with beyond the esophagus. Dr. Condie is of the latter opinion, and Dewees and Eberle make the same observation.
Pathology. — The difference between muguet, or the erythematous inflammation of the mouth and aphthae or thrush, consists in the different parts of the mucous membrane which are affected. In the former the exudation is upon the epithelium, in the latter the deeper parts are affected; in the former, in the majority of instances, the epithelium remains intact, while in the latter an ulcerative action is observed when the crusts are thrown off.
Dr. Teste gives the following strong quotation from Billard: “I have given the closest attention to the examination of the seat of this excretion, and I have never found it below the epithelium, upon the surface of which it is always seated. It is external to the membrane and coats it over like the mucus, of which the muguet is really but a morbid concretion.” Guyot regards the “curds” in somewhat the same light as Billard, only that the coagulated mucus is modified by an excess of fibrin.
Most Pathologists agree, however, that there is a parasitic growth in the exudation, and I shall here requote from Mr. Churchill's work some passages which really have an important bearing on this point.
M. Bouchut gives the following extract from the report of the “Academie des Sciences,”* [The report was prepared for the Academy of Sciences by the Micrographic Naturalist M. Gruby. See Bouchut on “Diseases of Children,” p. 408.] the exactness of which he states that he has many times proved. “A portion of muguet being placed under the microscope, it is seen to be composed of a mass of cryptogamic plants. It consists of conical elevations of twenty-five millimetres† [Carpenter on the “Microscope,” p. 540.] in diameter, each one consisting of separate portions, provided with roots, branches and sporules. The roots are implanted in the cells of the epithelium, they are cylindrical and transparent of 1/400 of a millimetre in diameter; and in their development they perforate each series of cells composing the epithelium to arrive at the surface of the mucous membrane. The trunks or stems which grow from the surface of the epithelium are equally transparent, interrupted at distances by divisions and enclosing in their cavities corpuscles. Like the roots they are cylindrical and rectilinear, one-fourth of a millimetre in length, and 1/400 of a millimetre in thickness. These stems are divided into branches which again subdivide, bifurcating at a very acute angle. The branches are composed of oblong distinct cells, enclosing in their interior, one, two or three transparent knots (noyaux), their sides here and there exhibit sporules, of which there is a great number at their extremity. The diameter of these sporules is from 1/200 to 1/400 of a millimetre. Cryptogamia have considerable analogy with the mycodermia of the porrigo-favosa, and resemble the genus sporotrichium of botanists.”
Much more could be said and many more quotations could here be introduced to prove that there certainly exists a fungoid growth in the form of stomatitis which is now under consideration, but however interesting such might be to the scientific inquirer into microscopic anatomy, they would perhaps be rather distasteful to many who read medical works, not so much for the sake of minute knowledge as for practical suggestions. We would only therefore introduce here a few words on this very subject from Dr. Carpenter, who, speaking of these affections, writes: “In these and in similar cases two opinions are entertained as to the relation of the fungi to the disease in which they present themselves; some maintaining that their presence is the essential condition of these diseases, which originate in the introduction of the vegetable germs, and others considering their presence to be secondary to some morbid alteration of the part wherein the fungi appear, which alteration favors their development. The first of these doctrines claims a strong support from the fact that the diseases in question may be communicated to healthy individuals through the introduction of the germs of the fungi by inoculation; whilst the second is rather consistent with general analogy of what is known of the condition, under which the various kind of fungoid blights develop themselves in or upon growing plants.”
M. Baun believes that the disease is not contagious. — Billard agrees with him when he says, that “he has seen children not affected with muguet drink from the game spoon with children who had it, without contracting the disease.” Churchill, Guersent and Marley think that though in ordinary cases there is no contagious property in the affection, yet that under peculiar circumstances the disease may be transmitted from one to another. This accords with my own observation and with that of those of my own professional friends with whom I have conversed in reference to this subject.
Berg believes that the disorder is, if not produced, readily increased by the saccharine matter in the food, but this would scarcely hold good in those children who are exclusively fed by the bottle or spoon. The disease may also prevail epidemically and frequently does so in crowded localities or hospitals, or among the poor who are crowded together in lanes or small streets without ventilation, care, or the requisite amount of food.
Mr. Churchill has given quite a long quotation from Valleix,* [“Mal des Enfans,” p. 167.] who gives a summary of twenty-four cases. Of this I shall only give the latter portion as evidencing to what stages the disease may progress; it reads thus: “towards the end of the disease all the symptoms seemed to diminish, but it was only to give place to collapse. The erythema became less vivid; the ulcerations were covered with crusts; the diarrhea diminished or ceased entirely; the infant refused the breast and would scarcely drink; the muguet diminished and ordinarily consisted only of a few grains on the tongue. The pulse fell to eighty, seventy, or even sixty in a minute; the heat was succeeded by chilliness, at first of the extremities and afterward of the whole body; the agitation gave place to almost complete insensibility; the cries were changed into groans; the emaciation and pallor became extreme and the face acquired the appearance of decrepitude. About this period were developed, in certain cases, inflammations, not very acute, characterized by edematous swelling, obscure redness and pain; they occurred in the nose, lower lip and neck. At this time, also, abscesses, occasionally numerous, were formed in different parts of the subcutaneous cellular tissue, and in one case gangrene of the integument of the limb occurred; at last death closed the scene without pain.”
Treatment. — The great desideratum in the treatment is to prevent the erythematous inflammation from developing itself into true muguet; one of the chief resources to accomplish such a desired end is frequent ablutions of the entire mouth with cold water. There are many nurses and many mothers who are extremely careful regarding the cleanliness of their children, who have them regularly washed or bathed two or three times a day, and yet do not think the cavity of the mouth should receive the care of which the harder integument is the constant recipient. The tender mucous membrane of the mouth should be washed three times a day, and the ablution should be carefully performed. A piece of whalebone with fine linen cambric, part of a worn pocket handkerchief for instance, tied to one extremity should be inserted into the mouth, and the tongue, gums, and hard palate carefully cleansed. By this method there will scarce be danger of the simple erythema, proceeding to the exudative form of the affection. If this does not arrest the inflammation, the medicines are Caps., Nit. acid, Phos., and Sanguin. I speak of the idiopathic form of the disease. I have used Sulph. acid also with benefit. Very frequently, however, the physician's interference is not considered necessary by the nurse or those who have the care of the child, and a weak solution of Borax, with additional care in washing, cures the affection. If the disorder arises from disordered or acid stomach, and is accompanied with colic, which is often the case in very young children, Nux vom., Calc. or Sulph. are the most appropriate medicines. I have been in the habit of treating these affections thus: I use a palliative treatment for the severe colic, and a regular constitutional treatment for that condition of the stomach upon which the colic depends. I know very well that Cham. is the great medicine recorded in all the text books, and more particularly in the Domestic Physicians, for colic and restlessness of children; the medicine has been so often repeated in different periodicals, etc., that many are prone to believe it a specific for colic, deranged stomach, restlessness, etc. Now this is not the fact according to my observation. Cham. does no doubt possess a wonderful influence over some children; it almost immediately relieves colic pain, and produces refreshing slumber. Every physician has had abundant experience of this. In typhoid and other fevers I have known a few doses of this agent produce quiet; but there are other, very many other cases, where Cham. is not the medicine at all, and he who would place implicit reliance upon it in every case will very soon discover his mistake, as he will likewise if Nux vom. is administered for every case of constipation and Puls. for amenorrhoea.
As a general rule I select according to the symptoms, either Nux vom., Calc. carb., or Sulph., and have about six or eight pellets of the most appropriate given three times during the day, and leave with the patient Cuprum met., third trituration, gr. 3, Aquae font. z3 vi, and have a teaspoonful given every thirty minutes during the paroxysm of pain, or, perhaps, in some cases Coloc, dilution third, gtt. xx, Aquae z3 vi. dose as above.
On this subject Teste* [“Diseases of Children,” p. 231.] remarks, and very truly, “I do not know of anything in our homoeopathic literature which has direct reference to muguet; authors, in general, confound this affection with aphthae, which does not demand precisely the same treatment.” He recommends Cinnab. and Merc. sol. in a high dilution and later China.
|Source:||The American Homoeopathic Review Vol. 03 No. 09, 1863, pages 402-411|
|Editing:||errors only; interlinks; formatting|