Cornet in his well-known work on scrofula, devoted an entire chap ter to predisposition to scrofula, and explains its cause in the greater permeability of the skin and mucous membranes, to bacteria, and the greater number of lymph-passages. He tries to prove that this per meability in the organism of the child, as compared with that of the adult, is naturally greater, and is enhanced in certain individuals, fur nishing thus the predisposition to scrofula. He calls this condition Increased Infantilism or Embryonalism. Unfortunately however, ana tomical findings are lacking to verify this embryonal condition in scrofulous individuals. While Cornet completely rejects the theory of a predisposition affecting the entire human system. Czerny endeavored to find this predisposition in the chemical composition of the organism, asserting that for a predisposition to infectious diseases, we must. assume an alteration of the chemical compositions of the body. But no chem ical examinations to substantiate this theory have as yet been made. It may be here briefly mentioned that Czerny's idea differs greatly from the generally accepted conceptions of scrofula. Only that which can be proven histologically or bacteriologically as tuberculous is actually tuberculosis and is to be distinguished from scrofula. Czerny's defini tion of the term scrofula did not lead to a clearer understanding, nor to a better classification of the affection ; on the contrary, an old name, which, heretofore, was applied to other conditions, was made to serve as a name for a sympton-eomplex. Recently however, Czerny has re nounced the name scrofula, for his special series of symptoms and classified the respective signs in accordance with his new theory, under the name "exudative diathesis," which will be spoken of in another part of this book. It must be mentioned here, that a part of the patho logical phenomena, arranged by Czerny under the name "exudative diathesis," are still embodied under the old name scrofula. Others how ever, may be believed to be conditions, which, according to Heubner, could be called Lymphatismus. Czerny's ingenious interpretations show very clearly our perfect ignorance of what the real nature of this diathesis actually is. Classify these conditions as one will, future chemical examinations may show better criteria; until then we must be content with such terms as: "peculiar tendency," "diathesis," etc. That hereditary influences may play an important part in the develop ment of "scrofulous tendencies," is perhaps universally acknowledged. And indeed, it will be noticed, that those children are mostly attacked by scrofula, whose parents had the same disease or tuberculosis in their youth, and the appellation, "scrofulous families," as used by the people at large must be acknowledged as justified. As has been noted laymen even now consider tuberculosis of the joints, bones and skin as mani festations of scrofula.
Owing to the extraordinary influence of heredity, Soltmann made an attempt to explain the predisposition to scrofula and the tendency to tuberculosis in such individuals, and it is worth while to mention it. Before I consider this theory, I wish to state that "heredity in tuber culosis" will be treated in the chapter on tuberculosis. Soltmann assumes that not the actual bacilli enter into the fcetus, but rather the toxins produced by the tubercle bacilli, and these toxins, passing through the placenta, poison the developing organism. The result of such poison ing it is believed, is the cause of a scrofulous constitution with a ten dency toward acquiring tuberculosis. The diathesis would have to be at once diagnosticated as a sign of tuberculosis, in the sense of a toxic infectious disease, and the tendency for such individuals to take tuber culosis, would be nothing more than an over-sensitiveness of the already poisoned organism to the tuberculous virus—a theory well shown in this disease from our knowledge of tuberculin.
Of course all this is only hypothetical, and as yet entirely unproven, inasmuch as it presupposes the circulation of tuberculous toxines in the body of the pregnant mother. This is hardly a plausible assumption. But suppose we were inclined to reject such a direct influence as ity, we must still admit that children of tuberculous parents are very frequently subjected to the possibility of infection from tubercle bacilli and for that reason very frequently become ill; even this opinion is not to be accepted without reserve for not all parents supposedly afflicted with tuberculosis, and whose children fall ill with scrofula, have culosis in such a form as to infect their surroundings with tubercle bacilli. It must be remembered, that in recent times, the view expressed by von Behring on the subject of infection by tubercle bacilli in lings is receiving greater confirmation, but it does not by any means follow that a true case of tuberculosis results, instead it often happens that the infection remains latent. Under such circumstances the devel opment of a case of scrofula is a sign that an infection with tuberculous virus has taken place.
All these speculative arguments make it clear that at present there is no explanation for the hereditary influence that undoubtedly exists; in other words we must accept the theory of an hereditary predis position although nobody can tell in what it consists.
The question now arises, What are the relations of the individual symptoms of scrofula to tuberculosis? It has been said that so far as the glands are concerned, their tuberculous nature is generally con ceded, but opinions differ greatly as to the conditions found in allied inflammations of the skin and mucous membranes. It is true that in such cases tubercle bacilli are not found, but a great variety of other bacteria, as staphylococci, etc. Such bacteria when found on the sur face of the skin and mucous membranes, prove nothing at all. At best, they may be of secondary importance, inasmuch as the inflamed and diseased surface facilitates or favors their penetration. That the staphylococci, etc., may cause suppuration and abscesses, is readily understood; but it is not by any means evident that the symptoms diag nosticated as scrofula are caused by these bacteria. On the contrary, this is even highly improbable, for true infection with pus cocci in a young child shows different characteristics. Compare for instance the course of a scrofulous disease of the eyes, as described below, with the suppura tive condition: In the latter we do not find a circumscribed focus, the vesicular eruption, but a diffuse catarrh, accompanied by an abun dance of secretion. The prototype of this condition is the gonorrhceal inflammation, which never, even in most stubborn cases, assumes any - thing like the characteristics of a scrofulous eye. The same may be said of other pyogenic agents, the staphylococci, for example. I'lllamina tions present a good opportunity to study such infections of the eye, manifesting themselves by a deficient winking and closure of the eye , lids in severe intestinal affections. In case we succeed in keeping such a child alive, the ocular suppuration may extend over the entire period of convalescence, which may last for weeks, but it never assumes such characteristics as might cause it to be confounded with scrofulous disease of the eves.