Another requirement in the general therapeutics of scrofula is sufficient and suitable nutrition for the children. Among the laboring classes the food is often insufficient and inadequate, and it is of the greatest importance in the treatment of scrofulous children to take good care of their nutrition. It is by no means necessary, nay, not even desirable, that the diet of such children should be principally nitrogenous. It is desirable that carbohydrates predominate: potatoes, white bread, green vegetables, rice, etc., should be given. Fats should be used for the scrofulous as a- source of energy. I would not advocate avoiding or limiting it as Czerny teaches. Fat is for such children no more injur ious than for children in general. The fat is to be supplied in the form of butter, cream, and milk. Undoubtedly codliver oil, that well-known and popular remedy, is indebted for a great share of its effectiveness to its fatty properties. Fresh fruit should also be included in the child's dietary. An exclusive milk diet is not recommended, in its stead a diet of good fresh vegetables alternately with milk is more suitable for the scrofulous patient.
Further general therapeutic results are obtained by stimulating the activity of the skin, the circulation, the respiration and the heart.
For this purpose salt and brine baths are very popular and pleasant. For stout, flabby children who are frequently found among the scrofu lous, such measures may prove of great advantage. By this means stimulation or acceleration of metabolism is produced, and without doubt an improved appetite, an increased vivacity and a better natured child results. It is necessary however to select carefully the children suitable for this treatment. Children who have been brought up in wretched circumstances and as far as nutrition is concerned have known nothing but want and misery, are completely unsuited for such a plan of treatment. Such children also require stimulation of their circula tion, increased skin activity as well as exercise to increase their powers of resistance, but the measures used to attain such results must be milder and comparatively gentle in their application. Of this we shall speak hereafter.
In general it may be said that brine and salt water baths are used too promiscuously. The method of giving the bath is simple: from two to four pounds of salt are added to the bath, which is to have a temperature from 95° to OS° F. The child is kept in the bath from five to ten minutes, the surface of its skin being lightly massaged when taken from the bath, the patient must be quickly dried with absorbent towels, quite vigorously rubbed and wrapped in warm blankets. The patient is then kept in bed for about an hour. If such baths are not available, similar treatment. may successfully be resorted to by inunctions of soft soap. Every day for five minute periods, the back of the body is rubbed with green soap applied with soft cloths, from the neck to the buttocks, and from the thighs to the popliteal space, and then washed off with lukewarm water. If the skin becomes irritated, it is well to omit the
treatment for a few days. This treatment may be continued from six to eight weeks, and again resumed after an intermission of from four to six weeks. The success attained by such an inexpensive and simple method is very often remarkably good.
In case we are obliged for reasons that have been mentioned above, to refrain from too active skin stimulation, then a gradual process of hardening the body may be employed. We begin with dry frictions of the whole body, once or twice a day of ten to twenty minutes' duration, and continue this process for two or three months. Then lukewarm ablutions may be started, passing gradually to baths and massage at a cooler temperature.
But we must be extremely careful not to apply any severe pro cesses of hardening to feeble scrofulous children, or to those suffering from the so-called erethistic type of scrofula. The patient's condition often becomes much worse with such inconsiderate treatment, and an aggravation of the is the disagreeable consequence of such faulty management.
To assist these therapeutic measures, climatic treatment can be added with great success. Sea baths arc mostly in vogue. Unfort unately the right methods are not always applied. As regards the feeble, poorly nourished and amemie children, a sojourn at the sea shore must certainly be beneficial. We must recollect that a sojourn at the sea-side is unquestionably of greater benefit than a stay in an inland region with good, pure country air. For children strong enough to endure the invigorating effects of sea climate, a residence on the coast. may prove a powerful curative factor. Of course such a visit must not be too brief. Cures lasting four, six, or eight weeks, almost always improve temporarily the general condition of the patient but rarely have a permanent effect. A sojourn of four to six months, or even a year or more is required to secure proper permanent results. The winter seasons especially are too little used. The fresh pure air • of the sea-shore, a fairly even temperature with rarely an excessively cold day, fit it particularly for a winter residence. In America, the well-to-do patient can make a protracted stay at several places on the sea-shore, during the winter season, for there are places which offer good accommodations and even medical attendance. For the children of the poorer classes, charitable organizations are beginning to make the sea-shore accessible and profitable. A rest at the sea-shore of four or eight weeks at most may result in temporary, but not permanent benefit. After his speedy return to unhygienic conditions, the advan tages acquired are soon lost and the relatively expensive sojourn has clone little for the child except to indicate the road to recovery without supplying him with the means to reach the goal.