CHAPTER IV.

SECTION OF GENERAL DIATHETIC DISEASES.

Lymphatic tissues in childhood.-Great activity and rapid spread are central thoughts or physiological canons of infantile lymphatic tissues. Spread is Spread is most rapid along tissues of similar embryological evolution: mucous membranes, nerves and skin, lymphatics and vessels being fair respective representatives of hypoderm, epiderm, and mesoderm. Peripheral mucous, or cutaneous irritation, causes greater glandular enlargement the younger or the more "scrofulous," the child. Abscesses are more easily excited in infants than adults. Adolescence is attended with a striking subsidence of lymphatic hyperplasia. This often proves of therapeutic interest. The rise and progress of disease dependent on lymphatic activity forms a frequent and interesting study in children. Thus: catarrh of mucous membrane, corresponding glandular enlargement, possible subsidence of catarrh, continuance of glandular hypertrophy, caseation of same, wedging of same in lung tissue, suppuration and ulceration into bronchus resulting in Bronchial phthisis, whose future course may be variable and fully as eventful as its etiology. The story is somewhat similar in the mesentery and elsewhere. Striking also is the sympathy or contagium vivum, or whatever it is that causes other adenoid structures to overgrow and caseate when one has done so. Spread of morbid and healthy action is not only easier, but more marked in infants and children than in adults.

SCROFULOSIS-LOCAL (? TUBERCULOSIS).

The well-known characters of scrofulous lesions of the skin, mucous membranes, lymphatics, and bones, together with their wide prevalence, render it unnecessary that in a work on applied therapeutics addressed to the practitioner the author should be at the pains of describing such common lesions. He will, therefore, neither meddle with their causes, symptoms, or diagnosis, more than is necessary for the purpose he has in view, which is simply to indicate the lines of treatment he has found most useful, and to give, he hopes, a satisfactory sketch of other treatment in vogue.

Treatment-Hygienic and Prophylactic.-The aim of treatment is to "alter the constitution," or to restore the working protoplasm to normal modes of action. In what chemical or physical way scrofulous molecules of protoplasm differ from normal ones we do not know. The scrofulous protoplasm is prone to develop chronic lesions from the slightest cause. Permission cannot be given such organisms to deviate from a life of routine where the pleasures and pains should be confined within the narrow limits of their powers. Early to bed but late to rise, implying long sleep, is beneficial, with this provision, that the air consumed in the clinical chamber be fresh and pure.

The influence of dampness, coldness, and impurity of atmosphere is greatest in scrofulous organisms. A welldrained house, and dry, porous soil are absolutely necessary. Cold and dry is not so injurious, and may be made beneficial, but cold and wet is a sure depressor of vitality.

Strict attention is to be given to habits of life. A few hours of work in a light and airy room, and perhaps not more than an hour at a time, with out-of-door life as much as possible in fine bright weather are of great importance. The foot covering must be sufficient to keep out the cold and wet; but a wet play-ground or soil should be avoided. Goloshes or

rubber boots are useful to prevent the foot getting damp and cold.

Climatology.-A sea voyage is very valuable provided the weather be fair and the whole day spent on deck. Attention to the ventilation of saloon and berth is most necessary. Direct observations have shown to what an alarming extent the living-rooms may be contaminated by organic emanations, including bacteria. High barometric pressure appears to have but little influence as a therapeutic agent for scrofula. Or rather we know but little about it. Some children seem miserable at the sea level, and happier when at a higher elevation. Mountain air, with its bright, germless atmosphere is undoubtedly valuable; but resorts where over-crowding and ill-ventilation obtain should not be chosen. The sea coast, with dry air, at a high elevation and well-drained, is ery good, with similar precautions about the impure air indoors. Dry inland air and farm-life suit some cases better.

A bracing sea air may be had along the east coastCromer, Southend, Folkestone, Broadstairs, Margate; a relaxing and warm climate at Penzance, Torquay, Bournemouth, Hastings, and Brighton in summer; a medium climate is met with at the above in winter time. The hill outside old Hastings is bracing even in summer. Ventnor, Undercliff, and the Riviera are also valuable resorts. In the selection of a suitable climate several factors have to be taken into account. A feeble circulation precludes the recommendation of very cold climates. But cold mountain air may greatly improve the circulation, possibly on account of the lowered atmospheric pressure. Nervousness or neurotic temperaments are sometimes worse, sometimes better at a great elevation. The assumed advantages of climate are: the avoidance of sudden variations in temperature, and therefore lessened demand on the vitality; the obtaining of fresh air,

free from septic and other germs, of sunshine that promotes nutrition, of protection from depressing cold east winds and continued unfavourable weather, of pleasant surroundings that also promote mental health and bodily nutrition.

Clothing should be adopted as recommended at page 7; this includes high-necked dresses, sleeves and drawers, &c.

Exercise is very valuable, but must not be carried to the fatigue point, or to the induction of palpitation. Massage. may be useful when exercise is not possible. Inunctions may be combined with massage. Neat's-foot oil or olive oil are more cleanly and less disagreeable than cod-liver oil. They are partly absorbed by the lymphatics, and act as food. Friction increases lymphatic circulation. The massage removes waste products from muscles, aids circulation, and increases the action of the skin, as indicated by the hyperæmia. I do not think inunction of much value, and the fat tends to block the sweat glands unless careful washing and cleaning be practised.

Gymnastics are very beneficial. For the mode of action of these agencies the reader may consult special chapters. The doctor has to pay attention to every system of the body. The health of the lungs is promoted by avoidance of chemical and mechanical impurities of air. Large cities and towns are therefore injurious. Stagnant and damp air favours decomposition and sepsis, with the formation of foul organic acids and development of bacteria. Therefore valleys and low-lying stations are to be avoided. Sunlight, by its action through the retina, stimulates nutrition, as has been physiologically proved in animals. Places with short daily duration of sunlight are not, therefore, suitable for the scrofulous. Gymnastics expand the chest, and the lungs act more efficiently as depurators of blood. That tendency to apical condensation, ever present in small chests, is likewise averted by exercise. Gymnastics in dusty rooms are, however, likely

to cause pulmonary irritation and phthisis. The inspired particles may establish or increase pulmonary catarrh.

Houses built on a clay soil should not be chosen for residence. They are less objectionable, however, if the soil has been extensively and completely drained. Dampness indubitably predisposes to, and perhaps excites the development of, phthisis. The muscular, and nervous, and circulatory systems are improved by gymnastics and massage. A healthy action of the skin and kidneys is also effected by the same means, for the blood pressure is raised by emptying the veins and filling the arteries.

Balneology and hydrotherapy.-The body must be soaped at least once a day, and the skin kept perfectly clean.

Cold douches, as directed for nasal catarrh, are good tonics. Sea-bathing is suitable in some cases, and has a more powerful, bracing, and tonic effect than fresh-water bathing. Certain foreign and home spas are in high repute for the removal of the scrofulous diathesis. The hot baths of Bath are certainly, with proper precautions, useful in older children. Chalybeate waters are drunk for the anæmic states of scrofula. Purgine saline waters, especially of Carlsbad and Friedrichshall, are decidedly beneficial in securing the daily alvine evacuation, and in promoting the action of the liver and intestinal glands; they thus cause a general good effect. A wineglassful may be taken by children of seven every morning before breakfast. Sulphuretted waters of Cheltenham and Moffat have also been recommended; also the iodobromated waters of Wiesbaden, Kreuznach, BadenBaden on the Continent, and Woodhall in England.

The bowels must be evacuated adequately once a day. Faulty habits and atony of bowel are the chief causes of constipation in scrofula. Massage to the abdomen is valuable, the hands stroking the belly and squeezing the deep parts always in the direction of peristalsis of the colon.