An important circumstance yet remains to be noticed respecting the cure of Gout, the discovery of a medi cine which is supposed to have a specific effect upon the disease, so as to remove it by a kind of operation which we cannot refer to any general principles. The medicine was introduced into practice in the form of a secret recipe, but it appears to be ascertained that its essential ingredient is the colchicum autuninale. his is one of those substances which, when taken in a large quantity, prove highly deleterious ; but in moderate doses, it may be taken without danger, and usually operates by producing an evacuation either from the bowels, the kidney, or the skin. It affords almost a unique example of a remedy being introduced into practice under an empirical form, which maintained its reputation alter its composition had been detected ; for we seem to be in possession of the most unequivocal evidence of its power, both in preventing and remov ing the gouty paroxysm. Sometimes the salutary ef fect ensues without any sensible operation, but gene rally the benefit is more apparent, and there is sup posed to be less danger of any deleterious action on the vital powers, when some kind of evacuation has taken place. Cases have occurred, in which, by giving the medicine in too large a quantity, or in an improper state of the system, it appears to have produced almost the immediate destruction of life ; but by using the proper precautions, we conceive that the colchicum may be administered with safety and advantage.' In the order of the Cachexix we shall find some of the most formidable diseases which attack the human frame, both from the extent of the mischief which they occasion, and the little power which our remedies pos sess over them. The first that we shall notice is Scro fula, to which, as indicating pre-eminently baneful influence, the name of evil has been popularly applied. The term scrofula has, we think, been used in too vague a manner, so as to include a variety of anomalous affec tions, which have little connexion either in their seat, their symptoms, or their termination. We conceive that it ought to be restricted primarily to an affection of the absorbent glands, producing, in the first instance, enlargement, with some degree of inflammation, after wards a hardened or compacted state of them, in which they are no longer able to exercise their appropriate functions ; and, lastly, an ulceration, attended with a peculiar train of symptoms, which sufficiently distin guish it from all other inflammatory affections. Scro fula is a disease which especially attacks certain consti tutions or habits of body ; the subjects of it are generally persons of fair skins and smooth complexions, and fre quently possess great delicacy of feeling and brilliancy of mental powers, indicating what has been termed the sanguine temperament. Its first invasion is during childhood; it is most severe about the period of puber ty ; and after the adult age, if the frame can bear up so long against its ravages, it gradually declines. It usu ally makes its first appearance in the glands of the neck, where it forms large ragged ulcers, that are very diffi cult to heal, but which are often productive of no incon venience, except the unsightly scars which they leave behind them. It has indeed been supposed, that the discharge from these ulcers is favourable to the general health, by giving vent, as it were, to some humour, which otherwise might produce more dangerous conse quences, by affecting some vital organ ; but this opinion we are disposed to regard as derived from a false theory, and as not sanctioned by experience. Other glandular parts are, however, often affected, which are more concerned in the exercise of the vital functions, of which those of the mesentery, or other parts more im mediately connected with the vital organs, are the most important. When these become the subjects of Scro fula, they prove destructive to health, by preventing the due supply of chyle, and induce a species of atrophy or tabes, which is characterized by a hard and tumid abdo men, and by the extreme emaciation of the face and extremities. It is under this form that Scrofula proves fatal.
It is now generally agreed that it is not a contagious disease ; that it is endemic in those countries which have a damp and cold atmosphere ; that its exciting cause is improper food, impure air, want of exercise, and a deficiency of clothing ; and that these causes act the most powerfully upon the individuals who are pre disposed by an hereditary taint, or by previous weak ness, but from the influence of which probably no one is entirely exempt. We have stated Scrofula to consist essentially in a disease of the absorbent glands, and we believe that, In every instance, its commencement may be traced to an affection of these organs, but it fre quently happens that in the progress of the complaint, glands of other descriptions become diseased, and even parts which are not glandular ; two of the most fre quent of these varieties are certain affections of the eyes and of the bones. How far these should be strictly called Scrofula, or whether they might not, with more propriety, be considered as distinct diseases brought into action by Scrofula, is a question we shall not now discuss. The same remark applies to the lungs, the glands of which likewise frequently become affected in Scrofula, and give rise to the fatal disease of Phthisis pulmonalis ; but this affection is one of so much impor tance, and is characterized by so many peculiar symp toms, that whatever may be our opinion respecting its nosological character, we must make it the subject of a distinct section.
Many hypotheses have been formed respecting the proximate causes of Scrofula, but we are disposed to think, that they have thrown no real light either upon its nature or its treatment ; indeed, with respect to the latter circumstance, we conceive that the doctrines of the humoral pathology, which taught that Scrofula de pended upon a morbific matter existing in the blood, which was to be corrected or removed by rigid absti nence, or by a long continued course of purgative me dicines, was often productive of serious injury. Indeed the management of Scrofula, although so frequently an object of the greatest interest to practitioners, is a point concerning which the art of medicine has yet mane but little advance, and respecting which we arc still left in a state of great ignorance and uncertainty. It is sufficiently ascertained that our great objLet must b• improve the general health, and every one wi:l se propriety of carefully removing the excitint! • where it can be ascertained, but beyond flu= • we have little upon which we can build NV; • : degree of confidence. Whether it be the the effect of the scrofulous disposition, a deranged s.atc.. of the alimentary canal is a usual attendant upon the disease, so that purgatives will be frequently found a necessary part of our treatment ; and in that variety, where the mesentery is peculiarly affected, the torpor of the bowels often makes it necessary for us to employ the most powerful drastics. The weakness of all the vital powers, which characterizes the scrofulous constitution, suggests the employment of tonics ; and they have ac cordingly, under some form or other, generally made a part of every plan that has been proposed for the cure of the disease ; but the peculiar disposition to inflamma tion which belongs to the sanguine temperament, and the liability which local inflammation has, in those pre disposed to it, to assume the scrofulous aspect, always renders their employment critical. This remark applies particularly to cinchona and iron, which, under various forms, have been long prescribed as the grand remedies for this complaint, but which, although they may be be neficial in certain states, where the system is exhausted by long continued disease, probably possess no specific power in counteracting the scrofulous action, and seem but little adapted for the constitutions which are the most disposed to its attacks. In a chronic affection, and in one of so general an operation, we are naturally led to regard the effect of diet as an important agent in the re-estabiishment of the health ; yet on this point very opposite plans have been adopted in the disease now un der consideration, for, while a strict antiphlogistic sys tem has been strongly enforced by some practitioners, others have equally insisted upon the importance of a nutritive and even a stimulating regimen. Both these extremes we believe to be injurious, and on this point, as well as respecting the articles of the materia inedica, we have perhaps no more explicit rules to guide us than that every thing should be directed towards the establishment of the general health ; if the patient be languid and emaciated, we are to supply him with as much nourishment as the digestive organs will admit ; but if, on the contrary, he be of an inflammatory habit, we most proceed, although with caution, on the oppo site system. The use of sea air, of sea bathing, and of the cold bath generally, respecting which so much had been said in Scrofula, may all be referred to the same principle. To the inhabitants of large towns, who generally pass their time in close apartments, and arc immersed in smoke and impure air, the freshness of the sea breezes must be highly salutary ; but we appre hend that there can be nothing of a specific nature in the air of the sea, and that many inland situations are even preferable, as being less liable to dampness and moisture. For bathing, however, salt is perhaps al ways preferable to fresh water, and it has been sup posed that sea-water has a beneficial effect upon scrofu lous ulcers as a local application, although the evidence for this opinion be not very decisive. In speaking of the remedies for Scrofula, we must not pass by in si lence the alleged virtues of mercury, and especially of calomel, which has been held up as a kind of specific in that variety of the disease, where we suspect there to be a scirrhous state of the mesenteric glands. Ilow far mercury, in any form, possesses the power of resolv ing glandular tumours, we are scarcely prepared to de cide, but we are much disposed to refer a great share of the benefit which has been gained by the use of this medicine merely to its power in promoting the opera tion of the purgatives with which it is usually combin ed. With respect to all the specifics that have been proposed for Scrofula, the acids, alkalies, earthy and metallic salts, and various vegetable extracts, we con fess that we are extremely sceptical as to any benefit that has ever been derived from them. The manage ment of the local affections, whether scirrhous glands, ulcerations, enlargement of the bones, or in whatever form the disease makes its appearance, falls under the especial province of surgery ; we shall only remark con cerning it, that their treatment appears as difficult and uncertain as is the constitutional form of the disease ; and that notwithstanding the numerous plans that have been brought before the public with so much confidence, the cure of these complaints must still be considered as one of the great desiderata of the art.