Scrofula shows itself in hard, indolent tumours of the glands in various parts of the body; but particularly in the neck, behind the ears, and under the chin, which, after a time, suppurate, and degenerate into ulcers, from which, instead of pus, a white, curdled matter, somewhat resembling the curds made from milk, is generally discharged.

The disease most usually makes its first appearance between the ages of three and seven; but it may show itself at any period between these ages and thirty; after which it seldom makes its first attack. It most commonly affects children of a lax habit, with a smooth, soft, and fine skin, fair hair, rosy cheeks, and a delicate complexion; but it is occasionally met with in those of dark complexions, but not very frequently.

The scrofulous habit of body may either show itself as the result of other diseases, or it may be hereditary. In some children this constitution is very early apparent. Those with lax, soft muscles, large head, great tendency to enlarged joints and the accumulation of fat, with a waxy colour of the skin, sometimes with a fine flush upon the cheeks, at others without it, and with enlarged bloodvessels on the membranes of the eyelids, evidently show this state of the system. In addition to these indications, the glands in different parts of the body are apt to enlarge, and when they gather and break, they seem to have little inclination to heal. Scrofulous patients are very subject to coughs, and a disordered state of the bowels. In most cases the bowels are relaxed, but sometimes they are costive. Teething, for the most part, is attended with considerable difficulty and irritation, and the teeth in general soon begin to decay. It is in children of scrofulous constitution that Water on the Brain and Consumption most frequently occur; and in all such there is a deficiency of activity in the circulation of the blood; the abdomen is tumid.

Scrofulous persons are often comely and handsome, and rather distinguished for acuteness of understanding and precocity of genius. They are however, seldom robust, or able to endure much fatigue without having their strength greatly exhausted, and their flesh much wasted; but when they once begin to regain these, their convalescence is usually rapid.

Scrofula prevails most in those climates where the atmosphere is cold and damp, where the seasons are variable, and the weather unsteady. From latitude 45 to 60 is the principal home of this disease. In the East and West Indies it is rarely met with, but when the natives are brought into a colder climate, they often suffer severely from it. A long continuence of inclement weather may increase a predisposition to Scrofula; and in persons much predisposed to it, any uncommon, although temporary exposure to wet and cold, is sometimes an exciting cause of an immediate attack. Besides climate and exposure to moist air and changes in the atmosphere, every other circumstance which weakens the constitution and impairs the general strength of the system, predisposes to Scrofula; thus breathing impure, tainted air, unfit for respiration, and living upon food of an unwholesome and indigestible nature, which does not afford proper nourishment to the body, favours an attack of Scrofula by reducing the strength of the system. The neglect of due personal cleanliness, and of proper exercise, indolence, inactivity, the want of warm clothing, confinement in cold, damp habitations, etc, may all be regarded as so many exciting causes.

Scrofula is not a contagious disease, but it is evidently of an hereditary nature, and is often entailed by parents on their children; but, like other hereditary diseases, it frequently passes over one generation and shows itself in the next.

The attacks of Scrofula seem much influenced by the seasons of the year. They begin usually some time in the winter or spring, and often disappear, or are greatly amended in summer and autumn. The first appearance of the disorder is commonly in that of small oval or round tumours of the glands under the skin, unattended by any pain or discoloration. These appear in general upon the sides of the neck, below the ear, or under the chin; but, in some cases the joints of the elbows or ankles, or those of the fingers or toes, are the parts first affected. In these instances we do not, however, find small moveable swellings, but, on the contrary, a tumour almost always surrounding the joint, and interrupting its motion.

After some length of time, the tumours become larger and more fixed, the skin which covers them acquires a purple or livid colour, and being much inflamed, they at last suppurate and break into little holes, from which, at first, a matter somewhat resembling pus oozes out; this changes by degrees into a thin glutinous discharge, much intermixed with small pieces of a white substance, resembling the curd of milk.

The tumours subside gradually, while the ulcers at the same time open more, and spread unequally in various directions; after a while, some of the ulcers heal, but other tumours quickly form in different parts of the body, and proceed on in the same slow manner to suppuration. In this way the disease goes on for some years, and appearing at last to have exhausted itself, (or rather the system having acquired sufficient strength to master the complaint), all the ulcers heal up, without being succeeded by any fresh swellings; but leaving behind them ugly puckerings of the skin, and scars of considerable extent. This is the mildest form of Scrofula.

In more severe cases, the eyes are particularly the seat of disease; they become inflamed, and sometimes the sight is lost altogether. The joints also become affected; they swell, and the swellings are accompanied by excruciating deep-seated pain, which is much increased upon the slightest motion. The swelling and pain continuing to increase, the muscles of the limb become at length much wasted. Matter is soon afterwards formed, and this is discharged at small openings made by the bursting of the skin. Being, however, of somewhat an acrimonious nature, it corrodes the ligaments and cartilages, and produces a decay of the neighbouring bones. By an absorption of the matter into the system, hectic fever at last arises, and in the end proves fatal.

The bones also of scrofulous persons partake of the general disease in the constitution; they seem to contain a smaller proportion of animal earth, and a larger one of gelatinous matter, than is contained in healthy bone, in consequence of which they are easily fractured, particularly the long bones, which, being unnaturally thin, are therefore mechanically weak, and break with very trifling force.

Treatment

In the present day, Scrofula is generally acknowledged to be a disease of debility. Therefore, in attempting its cure, our main efforts must be directed towards improving and strengthening the system. This is to be accomplished mainly by attention to the diet and mode of living. The patient should be warmly clad, always wearing flannel next the skin. She should live principally on mutton, poultry, milk, rice, and light and nourishing puddings; with one or two (according to the age) glasses of good sound wine, taken with a piece of cake or biscuit, every day between meals. She should take plenty of exercise, when the weather is fine, and go to bed early. Warm bathing in winter, and cold or tepid bathing in summer will be useful.

The medical treatment must consist of Tonics and alteratives. For a patient of, say ten years old, the following may be taken:-

Mercury with Chalk, (Hydrar: c. Cret:).....Five grains.

Powdered Cinnamon,.............................Five grains-Mix.

This may be taken, in a little preserve, every second or third night at bedtime. Take

Bi-carbonate of Soda............................48 Grains.

Tincture of Cascarilla.........................Six Drams.

Tincture of Orange Peel......................Six Drams.

Water sufficient to make half a pint. Take a tablespoonful three times a day, between meals.

After continuing these for a month, the patient may lay them aside, and take the following, for two weeks; after which she may return to the above, and continue them for a month or two longer. The doses here given are for a child of ten years old; for older ages the dose must be increased, and for younger ones diminished. Take of

Sulphate of Quinine.........................Eight Grains.

Diluted Nitric Acid...........................Twenty-four Drops.

Tincture of Orange Peel...................One Ounce.

Simple Syrup..................................One Ounce. - Water sufficient to make half a pint. Mix. A tablespoonful to be taken three times a day, between meals.

If the patient is restless at night she may take, according to the age, from one to three grains of Extract of Poppies, (not Opium), or the same quantity of Extract of Henbane, or the same quantity Bromide of Potash.

For grown-up persons, the Plummets Pill in five grain doses may be substituted for Mercury and Chalk. It must, however, be borne in mind, that no medical treatment whatever will be of any service unless the proper attention it paid to clothing, diet and exercise.

After the disease appears subdued, we may endeavour to strengthen the system by giving the following preparation of Iron; the dose mentioned being for a grown person:-

Citrate of Iron and Quinine..................Two Drams.

Tincture of Orange Peel.....................Half an Ounce.

Simple Syrup....................................Half an Ounce.-

Water sufficient to make three ounces. A teaspoonful to be taken three times a day, in a wineglassful of water.

At the time the swellings first show themselves, it is sometimes possible to disperse them, and if we can do that, we may prevent some very ugly scars. For this purpose the parts may be kept constantly cold by pieces of linen rag dipped in Solution of Acetate of Ammonia, or of Muriate of Ammonia (Sal Ammoniac), half an ounce, dissolved in a pint of water.

When the swellings are broken, they may be washed with a solution of Sulphate of Zinc, ( White Vitriol), half a dram to half a pint of water, and they may afterwards be dressed with the following Ointment:-

Take finely powdered Borax.............Half a Dram.

Spermaceti Ointment, or fresh Lard... One Ounce. - Mix. The sores may be dressed night and morning.