The skin should be kept perfectly clean by a daily bath, but cold douches are often too depressing for such subjects, unless employed ac cording to the plan recommended for delicate children (see Introduction). The bowels must be attended to, and habits should be inculcated of regu larity in the use of the close-stool. When aperients are required drastic purgatives should be avoided. It is better to employ mildly acting drugs, such as the compound liquorice powder, or to combine an aperient with a tonic, as in giving the infusion of senna with the infusion of gentian or orange-peel.
In treating children in whom the cachexia has become developed, the above matters must be carefully attended to. Great stress should be laid upon the value of a suitable climate in aiding the child's recovery of health. If possible, the patient should be sent to winter in a dry air sheltered from cold winds. There, dressed from head to foot in warm, woollen clothing, he should spend the greater part of his time out of doors. Cod-liver oil is usually prescribed indiscriminately in these cases, and while some children appear to be greatly benefited by the prescription, others seem almost in sensible to its effects. It may be laid down as a rule that the stout scrofu lous children are not the best subjects for cod-liver oil. It is the spare framed child with an active, nervous system who derives most benefit from the use of the drug. The oil should be given in doses of one teaspoonful two or three times a day, and its use must be continued for months to gether. If the child appear to be nauseated by this constant dosing, the oil may be remitted for a few days at a time, but must be shortly resumed. On the Continent much value is attached to acorn coffee, made by roasting together a mixture of acorns and coffee beans and grinding them in the usual manner. This coffee is generally given as an adjunct to the oil. It is especially recommended in cases where there exists a chronic catarrh of the bowels. Cold bathing, when employed with proper precautions to in duce a healthy reaction, is of vast importance in the treatment of many cases of scrofula. These precautions are described elsewhere (see Intro duction). Cold douching is most useful in the case of stout children—those who derive little benefit from cod-liver oil.
The iodide should be given in fair doses. The above is suitable to a child of five years of age, and is better than the ordinary syrup of the iodide of iron, the sugar of which is so frequently found to disagree. Some practitioners prefer the common tincture of iodide, given in doses of three or four drops freely diluted with water.
Violent attacks of dyspncea from pressure of enlarged glands upon the nerves of the chest are best treated at the time by strong counter-irritants. After the attack has subsided gentler counter-irritation may be continued. I have thought benefit has been derived from the careful and continued use of the iodine liniment to the front of the chest.
Enlarged cervical glands are sometimes reduced by rubbing into them twice a day the cadmium ointment of the British Pharmacopoeia diluted with an equal quantity of lard. The oleate of mercury salve is also of ser
vice. This application should be used of the strength of fire per cent. It must be smeared on the part, not rubbed in It can be used twice a day for the first five days ; then at night only, and afterwards every other day. When the gland suppurates it should be opened with as little delay as possible, in order to avoid unnecessary scarring of the skin. It is im portant, however, to anticipate the suppurative process, if ,possible, and avoid the dangers of a chronic discharging sore. Therefore if the meas ures adopted to cause absorption are seen to exert little influence upon the size of the swelling, it is advisable to call in the aid of the surgeon. Dr. Clifford Allbutt strongly advocates free incision and enucleation of the caseous matter ; and Mr. Teale states that he has successfully treated many such cases by scooping out the cheesy contents of the gland, merely leaving the sound portions with the enclosing capsule.
If softening has taken place and the abscess formed continues to dis charge and often reinflames, the nightly administration of a powder con taining one grain of hydrargyrum cum creta to eight grains of peroxide of iron is often attended with surprising benefit. This powder should not be given longer than for a week at a time. The sulphide of calcium in doses of one-fifth of a grain, given every two or three hours, is also re commended. This, however, is a very uncertain remedy. Sometimes it succeeds, but more often it fails completely. The chloride of calcium in doses of five grains every four hours is sometimes successful. An im portant point in the treatment of enlarged cervical glands is warmth. During the whole time that local applications are being used the swellings should be carefully protected from the cold. A good plan is•o cover them with a thick pad of cotton-wool.
Lugol ' has spoken highly of iodine in all forms of scrofulous lesions. He used the drug as a salve to the swellings, as a lotion to the ulcers, as an injection to the sinuses and fistulous sores, and as a bath for the cure of the affections of the skin and subcutaneous tissues. Iodine tinctures and ointments are still favourite applications to all glandular enlargements. They should be used, however, with caution. I have seen serious slough ing set up in a child's neck by the too energetic inunction of an iodine ointment into the skin over a caseous gland.
Chronic discharges from the various mucous surfaces are best treated with astringent injections. Otorrhcea from catarrh of the auditory mea tus, if limited to the part outside the tympanum, is readily cured by the following lotion : In using this application the passage must be first thoroughly cleansed by injection with warm water, and then half a drachm of the lotion must be poured into the ear and allowed to remain. This can be done two or three times a day. It is important to cure a discharge from the ear as quickly as possible. The old notion that otorrhcea in children should not be checked too quickly is one which if acted upon may have serious con sequences.