Scrofula is a disease of early life."and when it does not exhibit any of its manifesta tions before the period of maturity it seldom shows itself afterward.
In all systematic descriptions of this disease, two varieties of the scrofulous habit or diathesis are given, viz., the sanguine or serous, and the phlegmatic or melancholic. In the sanguine,thefe is'a general want of muscular development, time limbs being soft and flabby; the skin is fair and thin; the features are delicate, time rosy hue of the cheeks contrasting strongly with the surrounding paleness; the eyes are gray or blue, and the eye-lashes long and silken; the hair fine and light-colored or reddish; and the ends of the fingers broad and expanded, with convex nails bent over them; the intellect is lively and precocious, and there is often considerable beauty. Lithe phlegmatic variety the skin is pale or'ruddy, dark, and often harsh ; the general appearance dull and heavy; the hair dark and coarse; and the mind usually slow and torpid.
Children in whom the scrofulous constitution is strongly marked Alen present that narrow and projecting form of the chest to which the term "pigeon-.breasted "-is com monly given; moreover, the abdomen is enlarged, time limbs wasted, and the circula tion languid, in consequence of which they are especially liable to chilblains. The digestive organs are so commonly affected—as is evidenced by irregular action of the bowels, fetid breath and evacuations, furred tongue, capricious appetite, etc.—that, in the opinion of the late Dr. Todd, " strumous dyspepsia presents a more characteristic feature of this habit of body than any physiognomical portrait that has been drawn of it," In the great majority of cases the scrofulous disposition is hereditary; indeed, there is no disease which is nearly so often transmitted from parent to offspring as scrof. ula. There is, however, scarcely any doubt that it may he acquired under the action of various unfavorable exciting causes, wider' may be ranked, improper "as causes of debility." Among them may be especially noticed (1) Insufficient and mproper food; (2) Impure air; (3) Iusufficieut exposure to direct sunlight; (4) Exposure to wet and cold, and to sudden changes of temperature, especially if the clothing be insufficient; (5) Excessive and continued fatigue, whether bodily or 'motel; and (6) Intense and prolonged anxiety or mental depmession.
We shall first lay down the f,eneral principles of treatment to be adopted with the view of improving the health in the case of a person presenting either merely the general indications of a scrofulous habit of body, or some of its local manifestations, and we shall then conclude with a brief notice of a few of those particular forms of the dis ease which most frequently come under the attention of the medical practitioner.
The diet should be nutritious and sufficiently abundant, and animal food should be given at least twice daily. Dishes containing eggs and milk may usually be taken with advantage. If the patient is not very young, a little bitter ale taken at an early dinner will often promote digestion; if, however, it causes flushing or sleepiness, it must be discontinued. A mother with scrofula should always provide a healthy wet-nurse for her child, as suckling in such a ease is injurious both to parent and offspring. Flannel
should always (both in summer and winter) be worn next the skin during the day, and the clothing must always be sufficient to keep the extremities warm. Constant residence in pure and dry air should be enforced as far as possible. Unfortunately, the climate of Great Britain is by no mean, favorable to those possessing the scrofulous habit, and it is often very difficult for the physician to decide as to the choice of the most suitable resi dence. On this subject, Mr. Savory, in his essay on " Scrofula" in Holmes's System of Surgery, vol, i., MG, remarks that " it is surely a mistake to suppose that a warm cli mate is the best adapted to all cases of scrofula. It is doubtless so in the great majority in which the disease [in the form of pulmonary consumption] is far advanced; but in many cases at an earlier stage, its further development is more satisfactorily arrested and the general health improved by a more bracing air. Children with tuberculous glands, but whose general health appears otherwise tolerably good, would perhaps profit less by transportation to Madeira or Egypt than by residence in the s.w. coast of England, where the atmospheric changes are less frequent and sudden than in other parts of the kingdom, and the winter is comparatively mild. Delicacy of constitution is sometimes iacreased, and mischief encouraged, by dread of exposure." Free exercise of the mus cles and lungs in the open air should be insisted on in fine weather, and if this cannot be taken, the best substitute is friction over the surface of the body with the flesh-brush. Patients who can bear cold sea-bathing during the summer and autumn months will de rive great advantage front it; but if a short invuerkion is not rapidly followed by a genial glow after drying the skin, such bathing is injurious, in which case warm salt-baths will be found useful. Too much stress cannot be laid up in the fact that in the case of chil dren the mind should be cheerfully occupied, but not over asked. The medicines most esteemed in the treatment of scrofula are iodine and its compounds, the salts of iron, bark. sarsaparilla. the alkalies and mineral acids, and, above all, cod-liver oil. As the choice of the individual remedy must ha left to the physician, we will merely remark that iodine and iron may often be advaintageoasly prescribed together either in the form of the syrup of time lodi le of iron, or of a well-known French preparation known as Blancard's iodide of iron pills; and that to derive full benefit from cod-liver oil, it must be taken for a long time. As Mr. Savory remarks, the oil should, be regarded as an arti cle of diet rather than a medicine. A tablespoonful may be considered as a full dose for an adult; but this quantity should be gradually arrived at, the close commencing with a teaspoonful. It is most easily taken when floating on a mixture of orange wine, or sonic other pleasant bitter fluid, with water The lightest and clearest oil is probably the best, and in cold weather it should be slightly warmed before it is taken, for it is thus rendered more liquid and more easily swallowed. If what are commonly known is " bilious symptoms" supervene, the use of the oil should be suspended for a couple of days. and a few gentle aperients should be prescribed.