This inclination to tuberculous infections which positively exists in scrofulous children, teaches us of course, that the prognosis in this respect depends entirely upon whether a child is obliged to live with a person afflicted with phthisis, or whether measures are taken in time to remove it from its dangerous surroundings.' The scrofulous organism is already infected with the virus of tuber culosis and if its power of resistance is further weakened by unsanitary surroundings or by unhealthy and insufficient food, the original infec tion may then assume more dangerous forms.
The relation of this statement to the prophylaxis and therapeutics of scrofula will be explained below. Besides the two etiological factors mentioned, it is still necessary to consider a few other agents active in the development of severe cases of tuberculosis. Any of the infectious diseases will attack the scrofulous organism more violently than the healthy one; in particular measles and whooping-cough are to be most feared. Both of these infectious diseases greatly favor the transfor mation of a latent mild case of tuberculosis into a florid and severe one. Consequently scrofulous children who have the misfortune to acquire either of these two maladies, are to be regarded as in great peril.
All the consequences resulting from unhygenic surroundings, asso ciation with the tuberculous, etc., as mentioned above, are doubly effec tive under these circumstances, and in case it is not possible to remove. these pernicious factors thoroughly and quickly the prognosis is strongly influenced for the worse.
The danger in the complication with measles is present not only during its brief acute period, but even after this infection is past, so that children who have had the measles under good hygenic conditions, for instance in a hospital, must be still protected from all injurious influ ences. Whooping-cough which may last for months, endangers the patient during the entire period of its course.
Prophylaxis.—We can hardly discuss the prophylaxis of scrofula. because the mode of its origin is unknown to us. Even from the view point that every case of scrofula. is founded upon an infection with tubercle bacilli, it still remains unexplained where this infection has taken place. If we accept the theory of the inheritance of scrofula—a theory which according to most recent researches cannot be rejected— then prophylaxis is impossible. In the majority of cases however, the infection may possibly take place outside of the uterus, then naturally precautionary measures against such infection may be taken.
The more we are inclined to share von Behring's point of view that. tuberculosis acquired in the earliest period of life may for a. long time remain latent, the more we are forced to believe that young babies. should at once be removed from any association with the tuberculous, and that children whose parents have active tuberculosis should be separated from them as soon as possible. Among the very poor the removal of the infant means at the same time a departure from unhy gienic surroundings which favor an infection with tubercle bacilli and an outbreak of scrofula. Such prophylactic measures can very easily be carried out with illegitimate children. With legitimate children the problem is more vexatious. Only rarely will parents make the sacrifice of an early separation from their child.
Attention must be called to the fact that sanitary improvements in the housing of the poor are everywhere necessary and that scrofula and tuberculosis could be more successfully combated by such super vision. In this respect the prophylaxis of scrofula and tuberculosis so completely harmonize that a special discussion is superfluous. We must refer the reader to the article on tuberculosis.
Therapeutics.—Primarily remove all those pernicious influences which have been mentioned under prophylaxis. Narrow, damp and badly lighted dwellings must positively be avoided. Among the poor these precautions can but seldom be observed; and it may in these circumstances be advisable to place the child in a well organize'. insti tution. In addition to other therapeutic measures, of which we will presently speak, it is evident that improved hygienic conditions alone will have a far reaching influence upon the condition of the suffering child.
It is self-evident that only such hospitals for children are consid ered here as have been built and organized in accordance with the principles of modern hygiene. It is a most gratifying fact that much has been done to meet these demands. Well organized homes and hos pitals for children have been erected, and in the large cities there are ever-increasing movements afoot to further these humane endeavors. Plans have been made to send children to the country into the open air: forest recreation retreats, and forest schools have been established for them.