§ 118. Thrush, aphtha.

This exanthem always affects the inner mucous membrane. It consists of small, white, elevated, lar-daceous, sponge-like little ulcers in the mouth, on the tongue, palate, in the fauces, sometimes covering the whole intestinal canal down to the anus, burning violently, sometimes existing only a few days, sometimes however for weeks and months, new ulcers making their appearance as the older ones disappear. They are accompanied with a number of local and consensual symptoms, which are more or less violent and dangerous, such as: angina, painful deglutition, irritation in the trachea, nausea, hiccough, cardialgia, vomiting, colic, diarrhoea, dysentery, discharge of detached aphthae, enteritis.

Precursory symptoms: dryness in the mouth and throat, thirst, sensation, as if a foreign body had lodged in the throat, nausea, retching, vomiting, irritation inducing cough, roughness, stinging in the throat, hoarseness, anguish, pressure in the praecordial region, heartburn, stupefaction.

Aphthae may become dangerous by terminating in angina, gangrene, enteritis. They not only affect infants, but may occur in persons of every age as symptoms of various acute and chronic affections. They are most frequently induced by gastric derangements, suppressed secretion of the skin, rheumatic and catarrhal metastases, and are very rarely a critical symptom. Aphthae generally occur in the colliquative stage of phthisis, and in gastric-putrid fevers.*

§ 119. As a primary disease, Aphthae are less difficult to treat than as a symptom. In the former case, the nipples of the mother are liable to be affected with the disease, for which the most suitable remedy is Borax, particularly when the child is very peevish, cries a good deal, starts up from sleep as if in affright, throws its arms about, looks pale and livid, has a flaccid skin, does not want to nurse, and when the mucous membrane of the palate and tongue, which exhibits reddish vesicles and aphthae, looks shrivelled. I use with great benefit the strong sulphuric acid, one or a few drops in one ounce or an ounce and a half of water, which the child takes in teaspoonful-doses. The attenuations will do as well if the children enjoy otherwise good health. If there be considerable angina, Mercurius sol. is an excellent remedy, which is frequently to be followed by Sulphur, particularly when the child's rest is very much disturbed, starts up from sleep with great cries, when there is ptyalism and the aphthae bleed readily, etc. (The latter symptom furnishes likewise an indication for Borax.)

Mercurial aphthae on the tongue or palate are most speedily removed by Sarsaparilla, Borax, Nitr. ac, Thuj., Iodium, Agaricus, etc. Aphthae which are accompanied with considerable debility in fevers, should be treated with Arsenic, Sulphur, Acid, sulph. Aphthae accompanied with rhagades in the white-coated tongue, are cured by Cicuta. When the salivary glands are very much affected, secreting a tenacious mucus, Mercury is the best remedy, (provided the disease have not been caused by it). When complicated with tuberculosis, Iodium and Sulphur will effect certain cure.

* They occur very frequently in persons suffering with nervous irritation, and have, in such cases, to be treated with Aconite. - Hempel.