The sensation conveyed to the fingers by fcal masses is very different to that furnished by enlarged glands. Faecal accumulations can be readily studied in cases of typhoid fever where there is no cliarrhcea, and the child is taking milk. Here we find elongated masses of moderate size lying with their long axes in the direction of the bowel, and situated at some point in the course of the colon. They are never very deeply placed, and can be always readily reached by slight depression of the abdominal wall. By firm pressure they can be indented by the finger. If any doubt is felt in such a case, the effect of a copious enema should be tried. Faecal masses are readily removed by this means ; while lumps due to any other cause are only made more evident by the injection ; for this by removing gaseous distention and fcal matters, renders a full exploration of the abdominal cavity more easy than before.
Prognosis.—It is the exception for scrofulous children to die from the direct effects of the disease. In fatal cases death usually results from acute tuberculosis ; the outbreak of the tubercular malady being deter mined by some mysterious process of infection through softening cheesy matter or slowly ulcerating bone. Again, children the subjects of this diathesis are more sensitive to the ordinary causes of disease. They catch cold very readily, and therefore are apt to suffer from various chest affec tions. These, besides their own special dangers, may lead to evil conse quences by causing enlargement and caseation of the bronchial glands. Pneumonia, again, has a risk of its own in its propensity to undergo only partial absorption, and so to induce chronic changes in the lung.
Scrofulous children are singularly susceptible to the influence of conta gion. Few such children exposed to the infective principle of zymotic dis ease will be found to escape, unless protected by a previous attack. Such diseases, too, have a special power of intensifying the cliathetic taint. They leave the child not only depressed by his late illness, but also more exposed than before to suffer from the consequences of his constitutional weakness.
Enlarged bronchial glands, if sufficiently advanced to cause serious pres sure upon parts around, must always occasion anxiety. If there be lividity of face or attacks of dyspncea, a very guarded prognosis should be given. Still, when placed under favourable conditions such children often do well.
Enlarged mesenteric glands, if unaccompanied by ulceration of bowels or signs of tubercular peritonitis, are in themselves of little importance. If signs of intestinal ulceration be present, the case is more serious, and the prognosis depends upon the amount of diarrhoea, the presence of dis ease in other organs, and the effect of the lesion upon the nutrition of the patient. This subject is considered in another place (see page 665).
Amyloid disease of organs set up by chronic suppuration is of moment, as tending to induce anaemia and lower the strength. Still, in childhood,
if the primary suppuration be arrested and the scrofulous disease removed, the amyloid degeneration often undergoes a surprising improvement (see "Amyieid Liver ").
Treatment.—The constitutional tendency to scrofulous lesions is best attacked by measures which encourage and maintain healthy nutrition. The causes which excite the dormant cachexia have been stated to be ex posure to cold and damp, insufficient and unsuitable food, impure air, and want of exercise. It is therefore evident that a careful regulation of the diet, combined with warm clothing and daily exercise in the open air, must be the first measures to be adopted.
With regard to food, the child should be fed liberally ; meat, fresh eggs, and milk should enter largely into his diet, and his stomach should not be overloaded with puddings and starchy matters to the exclusion of more strictly articles of food. Fresh vegetables are a valuable addition to his dietary, but potatos must be given with caution, although they are not to be entirely excluded. If the appetite be poor, a small amount of stimulant is often of service, and the child should be allowed a good wineglassful of sound claret diluted with an equal quantity of water to his dinner. It is needless to say that cakes and sweetmeats be tween meals must be strictly forbidden. In the case of infants born of scrofulous parents, a healthy wet-nurse should be provided if the mother be unable to suckle her child. If this be impossible, the utmost vigilance must be exercised in the feeding and general management of the baby. Directions are given elsewhere for the healthy rearing of infants, and the reader is referred to the chapter on "Infantile Atrophy " for fuller informa tion upon this important subject.
Climate is a matter of great moment for children who are, or are likely to be, the subjects of scrofula. A bracing air is indispensable to the suc cessful treatment of these cases. Residence in low-lying clay soils does much to encourage the predisposition, while sandy or gravelly places, with a dry air, are of the greatest benefit iu increasing the vigour of the consti tution. On account of the tendency to catarrhs in this diathesis, a dry air is of especial importance ; and a place which is sufficiently warm during the winter months to allow of the patient passing a large part of his time out of doors is of the utmost service. Large towns, with their smoke and vitiated air, are bad residences for scrofulous children. When compelled to live in cities, care should be taken that the child is warmly clothed and sent out as much as possible for exercise in the large open spaces with which most towns are now provided. For children of both sexes healthy out-of-door games should be encouraged ; and they should be early trained in suitable gymnastic exercises, such as develop the muscles and expand the chest.