The success of a course of treatment may evince itself in either the local or the general condition: the symptoms of scrofula (e.g., eye dis mse and eczema, inflammatory exudation, and rheumatic effusions) disappear; tuherculous or scrofulous glands diminish in size; and in the severe scrofulous conditions (e.g., of bones and joints) a relative cure may be attained if the necessary medical supervision has accompanied the course of treatment. which must be continued for months, or even for years. Conditions of exhaustion, ancemia, and chlorosis are often improved in a surprising manner by means of a suitable course of treat ment. To have been successful, however, every such course of treat ment must have raised the spirits and the general tone, produced greater elasticity of carriage and motion, and have increased the powers of endurance.
As a rule, too much importance is laid upon a simple increase in weight, although this usually occurs, and may be taken as an index of the success of the treatment. It must not, however, be taken by itself in judging of results. The amount of increase in weight depends upon the state of nutrition at the beginning of the course of treatment, upon the nature of the disease, and upon the age and sex of the patient, as well as upon the time of the year. Younger children increase less than older ones; girls more than boys; and girls at the time of puberty, when natural development is at its height, show the greatest gain of all.
difficult problem for the physician to over come is the necessity of prescribing drugs. This tendency should be counteracted by the enlightenment of the public, and the development of the physician upon the subject of general therapeutics. It is in pediatrics especially that the physical and dietetic measures are often more important than the chemical.
The loading of remedies in a single prescription, often caused by adherence to an inherited formula, not only makes a critical judgment impossible, hut also increases the cost of the medicine, thereby pre venting the poor from treating their children. Moreover, this is fre quently absolutely incorrect, since important constituents may remain undissolved (e.y.. alkaloids in alkaline solutions), or new combinations may be formed (alkalies forming salts with acids, or reductions or oxi dizations may occur). By the addition of correctives, unintentional collateral effects may occur, diarrhoea may result in young children, for instance, if fermentation has begun in the syrup which is used.
Again, the use of an ill-tasting medicine (the physician should have tasted, at least once, every medicine he may prescribe) may at the very outset of the treatment arouse antagonism in the child, which is all the more undesirable in that it might have been avoided. The medicine also may interfere with the taking of nourishment. The efforts of pharmacists to produce drugs in compressed form of exact dosage, or in tasteless chemical combinations, are of especial value for children. The tablets should be dissolved before administering them, inasmuch as they cannot be swallowed by children any more than can pills or capsules. In prescribing the tasteless combinations, it is necessary to take the bulk of the dose into consideration. The prescribing of decoc tions, emulsions, and even infusions may he avoided, or at least mini mized, by giving preference to solutions, extracts (fluid), and powders.
The time for the administration of medicines should be regulated by the contemplated action of the drugs. If, for instance, it is desired to treat a mild catarrh of the mucous membranes, it is necessary to bring the medicament into contact with them frequently (e.g., about every two hours). If the body is to remain under the constant influence of a drug, the frequency of the dose must be governed by the rapidity with which it is excreted; iodides, for instance, should not be adminis tered less frequently than three times lady, and phosphorus not more than once. Some drugs do not produce th6r full effect until a certain quantity has been taken, and it therefore becomes necessary to adminis ter them at short intervals until the effect becomes perceptible. Digi talis and veratrum virile are drugs of this character. Occasionally, it is necessary to give only one large dose to obtain an effect, as when it is desired to produce sleep or vomiting.
It is necessary to consider the relation of medicines to the meals. Those which are intended to stimulate the appetite should be given before meals; those which may easily irritate the mucous membranes of the stomach (e.g., iron and arsenic), toward the end of the meal; and those which should enter the intestines unaltered (e.g., anthelmintics, or drugs intended to combat an intestinal catarrh), should be given when the stomach is empty.