As remarked with reference to diseases of nutrition, the adoption of measures for the prevention of this disease or the developent of the hereditary predisposition to it, is of the first importance.

The most effective measures of prevention would be some means of preventing the marriage of persons of scrofulous tendencies. The intermarriage of families with a well-marked scrofulous tendency, should be regarded as a culpable transgression of one of the plainest laws of nature. The children of such parents cannot escape a constitutional tendency which will surely result in an untold amount of suffering, and premature death. As this cannot be done, however, even when especial attention is called to the matter in cases in which the injunction is in the highest degree applicable, the best that can be done in most cases is to adopt such measures as will prevent the development of the inherited tendencies or the new production of scrofulous disease. The most efficient of these measures will of course be a careful avoidance of all exciting causes of scrofula, to which attention has already been called.

Where there is the slightest ground for suspicion of the inherited scrofulous constitution, preventive measures should begin with the very earliest period of infant life. The greatest pains should be taken to secure for the child proper food. The natural food of infants is milk, and this should be given until the period arrives when the development of the teeth indicates the propriety of adding other food to the diet. If the mother is consumptive, or has at any period in her life manifested a scrofulous tendency, or if she is for any reason unable to supply her child with its natural food, a wet-nurse should be employed. Great care should be taken to secure for a nurse a healthy person whose family history is wholly free from scrofulous or consumptive habits. If such a nurse cannot be obtained, as is many times the case, cow's milk is the next best substitute; but care should be taken to secure milk from cows in a healthy condition. No milk should be given to the child until a careful investigation has first been made of the character of the cow from which it is obtained, the condition under which it is kept, the character of the food, etc. Candy, and things of a like character, with which the friends of the little ones often supply them to their hurt, should be wholly interdicted. Excessive feeding should also be avoided, as scrofulous children often have a voracious appetite, and it is of the greatest importance that the digestive organs should be preserved in a healthy condition. Children should be very early accustomed to an abundance of fresh, pure air. Even when a very few weeks old, they should be taken out of doors and exposed to the fresh air and sunshine, in a moderate way of course, at first, and should sleep in rooms which are thoroughly ventilated, and not too warm, never being exposed for any length of time to a temperature above 70.

The eminent German author whose name has already been mentioned in connection with this subject, recommends very highly the employment of cold sponging, which he insists should be begun very early and practiced daily. We suggest, however, that it is unnecessary to submit infants to so disagreeable a process as that of daily sponging with cold water, as all of the beneficial effects can be obtained by water which is only a few degrees less than the normal temperature. In general, it will not be necessary to employ water of a lower temperature than 80 or 90, and it is bast to begin with lukewarm water, making it gradually cooler from day to day. By this process the skin will be fortified against the invasion of the irritating elements which are supposed, as we have intimated, to produce scrofula and to develop any latent scrofulous tendencies. As soon as the child is of sufficient age, moderate exercise in the open air should be secured. It should be dressed in such a manner as to secure thorough protection of the entire body, so as to maintain the equilibrium of the circulation, and then be allowed to play in the open air as much as possible-several hours a day at least. Too warm clothing, and especially too warm covering at night, should be avoided, as by this means the system is rendered susceptible to climatic and atmospheric changes which have a marked influence in exciting scrofulous affections. The measures of prevention suggested should also be employed in all cases in which the symptoms of the disease are already present, as they are equally efficient when applied as curative measures as when applied for prevention.

In the medicinal treatment of scrofula, nearly every remedy in the materia medica has at one time or another been recommended and highly extolled as a specific. Each remedy, however, has in its turn fallen into disrepute and been replaced by others of a different nature, and, indeed, of an entirely opposite character. Even remedies which appeal to the imagination alone have been used, and with marked success. One of the most popular remedies of this sort was the touch of the kings hand, which was supposed to expel the disease and from which this malady acquired the name "king's evil." Quacks have fattened on the sale of anti-scrofulous and blood-purifying mixtures which had no effect upon the user except to render the blood still more impure and render the constitution less able to institute a successful remedial process.

In modern times the remedy which has been most lauded for the cure of scrofula is cod-liver oil. This remedy is the oil obtained from the livers of codfish. The only way in which it differs from other fish or animal oils is the admixture with it, as an impurity, of considerable quantities of bile expressed from the liver. This remedy was first employed in Holland and in Northern Germany for rheumatism more than half a century ago. By accident it was first introduced as a domestic remedy for scrofula, and has by degrees attained to the eminence of being considered as the most potent of all drug remedies for this disease. That it is by no means a specific, however, is readily admitted by all who have had a large experience in its use and have studied its effects intelligently. Prof. Niemeyer well remarks that in many cases of scrofula, cod-liver oil "is absolutely pernicious." Iodine in some one of its numerous combinations is still employed by the great majority of physicians in all cases of scrofula, but it has long been abandoned by the most advanced and scientific members of the profession as a remedy of no practical value in the treatment of this disease. Even those who recommend cod-liver oil do not pretend to employ it as a curative agent, but simply as a means of counteracting the tendency to emaciation and deficient nutrition by which one class of cases is characterized. One of the most enthusiastic advocates of its use asserts that "no remedy has ever been so much abused as this one."

In the rational treatment of this affection it is of primary importance that the principle should ever be kept in mind that the patient is to be treated, and not the disease from which he is suffering. If a cure is effected it must be through the wonder-working operations of nature, and not through the agency of any drug or other remedy administered to the patient. Hence it will of course be utterly useless to attempt to apply any routine method of treatment to all cases of this disease. Indeed, it is essential to success that the most careful discrimination should be made in the treatment of different cases. It will be far better to do nothing more than to surround the patient with the most favorable hygienic conditions than to apply active measures of treatment not suited to his case. As a general principle of treatment, however, it may be said that the two varieties of scrofulous habit denominated as irritable and torpid, require the application of nearly opposite remedies in order to obtain good results.

In the first, or irritable class of cases, in which the patient is usually thin, inclined to be anaemic, and evidently suffering from deficient nutrition through imperfect assimilation of food and excessive waste, such measures should be adopted as will improve the energy and char acter of the nutritive processes. Care should be taken to supply the patient with an abundance of the most wholesome, simple, and easily digestible food, although equal care should be taken to avoid excessive feeding. All reducing measures should be avoided. Daily sun-baths, frequent inunctions with vegetable oil, tepid sponge baths daily or every other day, and, if possible, the tonic application of electricity, are especially indicated. If there is a feverish condition of the system, meat should be wholly avoided and the dietary of the patient should consist principally of fruits and farinaceous articles. Milk obtained from cows known to be healthy may be freely employed. The diet should in all cases be unstimulating and free from condiments and other irritating substances. Tea and coffee should be wholly abstained from. Acorn coffee may be used to advantage as a harmless substitute for these beverages, and one with which experience has seemed to connect some degree of remedial virtue.

For the opposite class of cases, those in which there is evident torpidity of the system, inactivity of the excretory functions, and retained excretions, the same measures of treatment should be employed, but iu addition more or less active eliminative treatment should be used, according to the requirements of the case. The German authorities recommend the wet-sheet pack and frequent cold bathing, the use of which is especially advocated by Schroth. We recommend caution, however, in the use of this active measure of treatment. We much prefer to employ such mild measures as the vapor or hot-air bath, administered at as low a temperature as will produce sweating, the warm full bath, and the electric bath. The pack may be employed occasionally, however, with benefit, but should never be administered cold, as it is usually employed in Germany. With reference to the use of water in these cases, the eminent Dr. Niemeyer remarks as follows: "In recent times the cold-water cure has earned for itself the most favorable reputation as a remedy for scrofula, and, indeed, a series of cases is on record in which complete and perfect cures have been obtained by this means after all other modes of treatment had been applied in vain. We are certainly justified in asserting that cod-liver oil treatment can not be substituted for the water-cure." A few remarks should be made in this connection respecting the treatment of local affections incident to this disease. Scrofulous skin eruptions seldom require in addition to the measures of treatment mentioned, the application of other remedial measures than those neces sary for cleanliness, and the application of simple vaseline ointment or carbolated vaseline. For scrofulous catarrh of the nose, the nasal douche is to be recommended as a means of applying mildly astringent washes such as are recommended for milder forms of catarrh.

For scrofulous sore eyes, the continuous employment of tepid applications two or three times a day will usually secure recovery after a time. For chronic discharges from the ears, a carbolic acid lotion composed of one part carbolic acid to three of glycerine or alcohol, and fifty of water, should be employed two or three times a day in the form of a douche, the mode of application of which is elsewhere described. A solution of permanganate of potash, consisting of a tablespoonful of the crystals dissolved in a quart of warm water, is a most successful remedy in some cases. With reference to the treatment of enlarged glands, Dr. Birch-Hirschfeld remarks as follows: "The application of the cold douche to scrofulous humors of the glands has in our experience several times produced a favorable result. Obstinate tumors of this kind, which have resisted all kinds of salves and plasters, disappear sometimes under the continued application of cold water." Much more certain results can be obtained by the application of the alternate hot and cold douche, as by this means we are able to intensify the effect of both agents, which, when employed separately, are very efficient in causing the disappearance of abnormal growths.

The bronchitis of scrofula, to which the person suffering from the irritable variety is chiefly subject, should receive the most prompt attention as soon as its presence is discovered, as by this means it is possible to prevent the fatal consumption to which sufferers from this form of scrofula are especially liable. The same importance is attached to the prompt and persistent treatment of derangements of digestion, which have a decided tendency to the production of mesenteric consumption.

We have dwelt thus at length upon this subject on account of its great importance as well as the great prevalence of erroneous views concerning it. Much more remains to be said concerning the numerous local affections which are connected with this disease; but this part of the subject can very well be left for consideration in the sections devoted to the several local diseases.