Quite recently Bartel has attempted to describe the histological picture of the lymph-nodes in the latter disorder. He states that we have to deal with the consequences of a faulty development which is found originally not so much in the lymphocyte tissue as in the connective tissue; only later will the secondary atrophy of the follicular apparatus be noticeable. The frequent concomitant hypoplasia, of the blood ves sels might play a leading role genetically in the under-development of the connective tissue of the lymph-glands which dates back to embryonal life and also of other coordinated symptoms (such as insufficient develop ment of the genital organs, malformations of all kinds: "the hypoplastic constitution").
Treatment. --In conformity with the very ancient recognition of the fact, that faulty feeding, especially over-feeding, and other faults in the method of living produce the symptoms of this disorder, we can ob serve that through the therapeutics of the different decades and the different nations runs like a red thread in a fabric the treatment with diet, fresh air, baths and change of climate.
Comby, who regards this affection as a degeneration due to civiliza tion, recommends the " ret our a In nature" all along the line, long-eon tinned breast-feeding for infants, principally vegetarian diet for older children (not more than 3 meals daily, consisting of bread, soups, eggs, milk, vegetables, pastry, fish and white meats, stewed fruit,—but without spices, acids or too much sugar), further hygiene of the skin with hydro therapeutic measures, gymnastics, sun-baths, etc. The spas recom mended are La Bourboule, Chatcl-Guyon, Contrexeville, Mont-Dore, Vichy and others, the drugs employed are alkalies, the alkaline salts of organic acids, nux vomica, digestive ferments, etc.
Czernv recommends the following diet in exudative diathesis: During the first two years of life we give the smallest amount of milk on which the infant can thrive; in breast-babies we must. therefore reduce the number of meals and the length of each meal; should considerable fat be deposited in spite of this limited supply of milk, then we will have to replace part of the milk by carbohydrates, soup and vegetables as early as the second quarter and at 11 or 11 years we give the diet for older children, which latter should be principally vegetarian, though we add small amounts of milk (1 to 1 pint daily) and of meat. Eggs are
not permitted, nor cream, butter or sugar. This will sound familiar to those who remember the directions Lahmann used to give.
Following is the sample of a menu for a child in the second year of life according to Czerny: First breakfast, milk diluted with coffee or tea with bread or rolls without butter; second breakfast, fresh fruit; dinner, thick soup (especially the purée of the legumes), minced meat, fresh vegetable (spinach, carrots, cauliflower, salad, string beans); afternoon, milk diluted with coffee or tea, rolls; supper, minced meat with bread (or potatoes or rice) and (very little) butter; as drink, weak tea or water.
Czerny also considers psychic treatment of the greatest importance. Tie claims that not only the nervous symptoms proper but also asthma and skin-affections (obstinate eczemas covering almost the whole body) can be cured rapidly by improving the child's mind; that it is necessary first of all to distract the child's attention from its somatic condition, and that rest cures are bad and fattening or similar cures still worse; that medicinal treatment., also, is of no use. One must not show any special anxiety nor bring up the child with the idea that it is ill. Frequently a radical change in the child's mode of living and education is needed: removal from its home and attendance by strangers; it is also of great importance that it should be thrown together with children of its own age and not with its brothers and sisters only.
Prophylaxis is almost identical with the treatment itself as it is only possible to recognize the condition from its manifestations. By avoiding dust and smoke in the air and also the exposure to contagion we are able to prevent the causative infectious diseases. A favorable climate (but not a spa according to Czerny) for a prolonged sojourn in summer is advisable.