A stay in the mountains is also very beneficial. For the older and stronger children, reasonable winter sports may be enjoyed there. Very feeble, erethistie children are not well adapted for either of these cli matic changes. Sparing the body, rather than stimulating it., should be the endeavor in these cases. Such children ought, if possible, to spend the winter in a mild climate.
The foregoing remarks may suffice to throw sonic light upon the subject of the dietetic and physical curative methods of scrofula in general.
As to medicinal treatment, there may be given, codliver oil, syrup of iodide of iron and similar preparations, as guaiacol carbonate 0.l 0.3 Gm. (11--5 gr.) in powders several times daily, or in codliver oil 3 : 200, a tablespoonful twice daily. Cresotal 6 to S drops may be given several times daily.
These drugs can aid in securing the therapeutic effect desired, but can hardly accomplish it alone.
Specific has been stated above, that nearly all scrofu lous children react to tuberculin; and sometimes we see remarkable improvement, as a result of judicious tuberculin treatment, not only in the localized processes, but in the patient's general condition as well. The treatment should be used only on patients that are free from fever. We begin with to mg. of old tuberculin; or possibly a little more, until reaction sets in; after its absorption, the injection is repeated S to 14 days later, with doses as above given, and continued until reaction ceases. Gradually the doses may be increased up to 1 mg. of the old tuberculin. After this a longer intermission may be allowed. in order to resume the treatment at the end of a year or later. In Heubner's clinic a few cases came under my observation, showing remarkable improvement, and at a later period complete cure.
Eyes.—Calontel powder, and yellow precipitate ointment, once a day. A contraindication is the presence of new infiltrates or progres sive ulceration. In these cases apply atropine until the inflammation has disappeared. With larger ulcers, and extensive corneal infiltra tions (suppurative keratitis) apply moist warm poultices several times daily for one to two hours. Bandages are only to be used if the corneal
ulcers are large, otherwise it is better to do without them.
Eczema occurring with scrofula is to be treated in accordance with prevailing methods. For details on this subject, consult the chapter on skin diseases. Scrofuloderma is most favorably influenced by tuber culin treatment. Internally, arsenic has been recommended. If ulcer ations are present, local applications of balsam of Peru, nitrate of silver, etc., may be resorted to, e. g. in the following form: Furthermore scraping with a sharp spoon, cauterizing, or surgical treat ment may become necessary. Lichen scrofulosorum hardly needs special treatment. For this disease, inunctions with codliver oil are indicated.
Glands of the neck are accessible to the knife, and it would seem reasonable to remove localized tuberculous tumors. It is true that prominent surgeons (Rueter) have earnestly advocated such treat ment. However, the removal is somewhat dangerous, for in the first place, the operation means more or less loss of blood, to which young children in general are very sensitive and particularly the scrofulous who are poorly nourished and antemic. Secondly, it is extremely diffi cult to make a complete removal and thereby avoid a recurrence of glandular hypertrophy (von 13ergmann). Thirdly, experience teaches us, that tuberculous meningitis, or general miliary tuberculosis may follow the extirpation of the glands. For this reason it may be mo"e judicious not to treat scrofulous glands surgically, except those very large disfiguring tumors, which are making firm pressure upon impor tant organs. Necrosed glands and other invasions originating from them, must, as a matter of course, receive surgical treatment.
Bones and Joints.—Extreme conservatism is recommended here. Immobilizing dressings, and Bier's passive hyperemia, must be men tioned. For particulars on the subject consult the text books on surgery.