SCROFULA.
This is the name given to tuberculous disease of the lymphatic glands. Under Lymphadenitis the various methods of treatment indicated for the enlargement of the glands about the jaws, in the neck and axilla have been already discussed.
Constitutional is of more importance than local treatment. The mistake is too liable to be made of regarding the enlarged glands as being always the result of some peripheral lesion through which the bacilli have gained admission. The author has shown in his Cavendish Lecture (1908) that the cervical lymphadenitis is often caused by the introduction of the bacilli through the intestinal route. It is always of the bovine type.
The constitutional measures to be pursued are those which have been detailed in the article on Phthisis, and whilst open-air life, over-feeding, and general hygienic measures and the administration of drugs are to be persistently carried out, experience has proved that Vaccine treatment gives much better results in scrofula than have been obtained in phthisis.
The remarkable tendency of the gland lesions to remain circumscribed or confined to the lymphatic system, when not interfered with by efforts at removal, is becoming more widely realised. The routine practice of the excision of the glandular enlargements should be abandoned. The great majority after operation die of phthisis or acute tuberculosis. Only in very special cases is the operation justifiable. These will be found in the very chronic type of case associated with great indolence and marked hardness, where the disease remains confined to a small group of glands, which remain movable and without any tendency to implicate the neighbouring lymphatic chains. Partial operations should always be avoided, and curetting condemned, save in the case of a solitary gland which has already suppurated. (See also the article on Tuberculosis.) The Vaccine used should be prepared from the human type of bacillus.