380 PSEUDO-LEUKEMIA 



is frequently beneficial in scrofulous glandular tumors. Ordinary green 

 soap (sapo kalinus venalis) or the somewhat more agreeable fluid potassium 

 soap (sapo kalinus) may be employed; of the former, according to the size 

 and number of the enlarged glands, a piece the size of a cherry to that of a 

 walnut, of the latter a teaspoonful to a tablespoonful and more, may be daily 

 rubbed into the skin with a pellet of cotton until redness and burning are 

 produced, when the rubbing is stopped and is not resumed until these irrita- 

 tive symptoms have disappeared. 



Since it is often impossible to determine the nature of the glandular swell- 

 ing, as I have previously stated, it is well to add to the soap substances which 

 have a more or less specific action in particular diseases, for example, iodo- 

 form in certain tuberculous processes (and also in many syphilitic ones). 

 The potassium in the soap loosens the epidermis and the cement edges in the 

 skin, and in this way the direct entrance of iodoform into the diseased tissue 

 is facilitated. An inunction of this kind that I have used in other affections 

 consists of: Iodoform 5.0, sapo kalinus and lanolin or unguentum adipis lanae 

 or vaselin, aa 20.0. 



Extirpation of the glands, in so far as they are susceptible to operative 

 interference, is unquestionably indicated in those eases in which a single gland 

 or the pressure of several glands in this area causes disturbance or becomes 

 dangerous. Opinions differ as to whether extirpation is advisable at an early 

 period when only one or a few glands are slightly afl^ected, since the results of 

 such early excisions have varied. Some observers believe that extirpation of 

 the glands, performed once or several times, induces a slower course or a long 

 cessation of the disease, while others, on the contrary, have observed a more 

 rapid growth of the glands to follow. The explanation of this variation may 

 be that frequently, besides the external visible glands that may be reached, 

 others lie more deeply hidden, or cannot be reached by the knife of the sur- 

 geon, and the operative removal of the former, perhaps also of others which up 

 to that time had not been implicated in the morbid processes, causes irritation. 



Early extirpation, therefore, can only be looked upon as an experiment 

 which may meet with success, and this is the more likely the earlier it is 

 attempted. 



Besides this treatment which is especially directed to the glandular swell- 

 ing we must try by every means to reduce the anemia and improve the gen- 

 eral condition. Above all, the patients should have the advantage of the most 

 favorable hygienic conditions, nutritious food, fresh air either in the country 

 or other suitable climate, as well as such measures as are possible in the indi- 

 vidual circumstances for stimulating metabolism from the skin, such as fric- 

 tion, baths, etc. 



All this may be most readily secured in properly chosen sanatoria. The 

 most popular among these, probably on account of their well-known effect 

 upon scrofulous glandular affections, are the sodium chlorid springs {particu- 

 larly the stronger salt springs) , &nA especially the iodin- and bromin-containing 

 salt springs, such as those at Hall in Upper Austria, Kranhenheil, Kbnigs- 

 dorff-Jastrzemb, Kreuznach and others. These springs are used for bathing, 

 tor poultices, and, with necessary caution, also for drinking. 



