TREATMENT.—The treatment consists, for the most part, in methods of prevention and palliation. The tendency to disease of the lymphatic glands in scrofulous children is so constant that it is important to remove all sources of irritation and to combat all influences likely to hasten or promote the localization of the constitutional condition. All chronic discharges and diseases of the skin and mucous membrane, the continuance of which might produce glandular complications, should be cured as speedily as possible, slight colds should receive prompt attention, and catarrhal inflammations of the respiratory organs should be arrested as quickly as the resources of science will permit. The alimentary tract demands constant and careful observation. Trivial disorders should not be neglected: the causes should be ascertained and removed. Digestion and nutrition should be maintained at a healthy standard. The hygiene of person, dwelling, and sleeping apartments merits constant and intelligent supervision.
As stated above, tabes of the mesenteric glands is so frequently secondary to other diseases of a scrofulous nature that the danger lies in the failure to arrest or cure such affections. It is unfortunately too true that some of them are often beyond the resources of medical skill, but in many cases the initial manifestations of the strumous diathesis are either entirely neglected or inappropriately treated. In many such cases the final and fatal complication of mesenteric phthisis could be prevented. The treatment of these affections belongs properly to the subjects of tuberculosis and scrofula, to be found in other parts of this System of Medicine.
Localized tuberculosis of the mesenteric glands is so often, either directly or indirectly, connected with catarrhal inflammations of the gastro-intestinal mucous membrane that the cure of these affections cannot be too strongly insisted upon as an effective method of prevention. This is especially true with children exhibiting the physical signs of the strumous diathesis. When it is inherited from a diseased mother, it may be necessary to resort to artificial feeding before the proper time for weaning has been reached. In such cases no uniform rule can be arbitrarily followed. The condition of both mother and child must be considered, and cases will occur which will demand the exercise of the most cautious discretion and diligent observation.
When the disease has become established but little can be accomplished. In such cases the treatment refers to the palliation of symptoms and the maintenance of nutrition. Pain, when present, must be relieved—if necessary by anodynes, either given internally or applied in the form of cataplasms. Most often it is due to the coexisting disease of the intestinal mucous membrane or to the ingestion of unsuitable foods. The diet should be regulated and limited to nutritious and easily-digested articles. Sometimes, even in cases of advanced degeneration of the glands, great benefit may be temporarily obtained by attention to the diet. Diarrhoea should be controlled, but when dependent upon tuberculous ulcerations of the intestinal mucous membrane but little can be done toward delaying the fatal termination. When a large number of glands are affected, it will be necessary to limit the diet to such nutrient fluids as may be absorbed from the stomach.
The medical treatment is confined to a few remedies. Faulty nutrition is the predominant factor, and the drugs employed should be directed to the improvement of the assimilative functions. The lacto-phosphate of iron in the form of syrup, or the phosphates in the form of the compound syrup, sometimes prove valuable tonics. The lacto-phosphate may be given in combination with cod-liver oil. This latter, either internally or by inunction, is the most valuable and universally applicable of all remedies. The mistake is very frequently made of giving too large quantities. Few children can digest as much as a drachm administered three times a day. In Washington it is usually given in the form of the phosphatic emulsion, and has proved in the service of the Children's Hospital a valuable and effective remedy in the nutritional disorders of children. Of the chalybeates, the syrup of the iodide of iron is by far the most valuable; this may be given alone or in combination with cod-liver oil. It is specially indicated when anæmia is a marked characteristic. Some recent reports favor the employment of pancreatized foods. The ointment of the iodide of lead has been highly extolled as a local application to the belly. The nature of the disease should be constantly borne in mind, and all depressing agencies should be sedulously avoided.
INDEX TO VOLUME II.
A.