Treatment.—The treatment of amyloid degeneration consists, in the first place, in attending to the cause of the disease, and removing any long standing suppurations and exhausting discharges which may be increasing the cachexia and adding to the weakness of the patient. If necrosis of bone or suppuration of a joint be present, the aid of a surgeon is required. Fibroid induration of the lung, or a chronic fistulous opening in the chest wall, must be treated as directed in the chapters referring to these sub jects. We must do our best, in the next place, to remove any secondary complications which may be helping to reduce the strength of the child. The bowels must be attended to ; diarrhcea, if present, must be arrested, and if there be any reason to suspect scrofulous or tubercular ulceration of the intestinal mucous membrane, suitable remedies must be employed, as is elsewhere described. Vomiting must be checked by bismuth, dilute prussic acid, and the sucking of ice.
For the liver itself, the preparations of iodine are very generally rec ommended ; and as there is always more or less annria, iron may be judiciously combined with this treatment. I prefer giving the drugs singly, and have often prescribed (for a child of five years of age) five drops of the tincture of iodine to be given freely diluted before food, and five grains of the exsiccated sulphate of iron in glycerine directly after each meal. If the intestinal mucous membrane be healthy, this preparation of iron does not irritate, and given in sufficiently large doses, is of great value in the treatment of cachectic conditions in the child. If ulceration of the bowels be present, it is less suitable. The syrup of the iodide of iron so often disagrees, promoting acidity and flatulence, that I have long since abandoned its use. Iodide of potassium, combined with the citrate of iron,
may be employed ; but the iodide should be administered in appreciable doses. It should be rarely given in smaller quantities than one grain for each year of the child's life. I cannot remember ever seeing any uncom fortable symptoms, such as are common in the adult, produced by this remedy. Gardiner's syrup of hydriodic acid (Fri xv.—xxx.) is also applicable to these cases. Dr. Warburton Begbie speaks highly of the effects of mu riate of ammonia in the adult. It may be given to the child in ten-grain doses freely diluted.
The dropsy, being the consequence of the anaemia, must be treated with iron ; and the chalybeate diuretic of Dr. Basham, recommended else where,' is here also of service. If the bowels are healthy, an occasional dose of the compound jalap powder will further the removal of the subcutan eous effusions.
The child must be put on a liberal diet suited to his age and powers of digestion ; and if the kidneys are not implicated, he will be benefited by stimulants. The St. Raphael tonic wine is useful in these cases. A suit able climate adds greatly to the patient's chances of recovery. Dr. Begbie recommends a lengthened sea voyage ; and there is no doubt that condi tions under which the child, warmly clothed, can pass the chief hours of the day in a fresh, bracing air, are the most favourable to permanent im provement. German writers speak highly of the sulphurous springs of Aix-la-Chapelle, and the waters of Ems and Weilbach, in their influence upon this form of hepatic enlargement.