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Scrofula and Tubercles - 1

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SCROFULA AND TUBERCLES - 1. Serefults.—There are some specific forms of malnutrition, derived, in all probability, in a majority of instances, from here ditary taint, of which the scrofulous and the tubercular diatheses are the most important. Along with general derangement of health and imperfect growth of structure in childhood, the lym phatic glands tend to enlarge and to form an ill-organized yellow deposit in their interior, which readily suppurates, and unhealthy pus. This condition is most readily noted in the superficial glands of the neck, where casual exposure to cold is very likely to excite the • quasi-inflammatory action which leads to the enlargement.

The history of the case probably shows that the child was always delicate, suffering more than usual from teething, perhaps liable to convulsions ; or, if itself healthy, other members of the same family have suffered in this way. The ailment comes on insidiously, without any assignable cause; and when first seen, there may be unhealthy discharges of an acrid and semi-purulent character from the eyes and nose ; or abscesses may have formed on various parts of the body, of an indolent character, which, when they open, leave unhealthy ulcers. Very often cutaneous eruptions, particularly of an impetiginous character, are found spread over the head and face ; these are obstinate andintractable, and are not unfrequently the cause of the enlargement of the cervical glands. To this general state we give the name of scrofula.

The tongue is often habitually coated, and the intestinal dis charges unhealthy; such children are very liable to be infested with ascarides;. the aspect is generally characteristic ; the skin is clear and thin, the face often anaemic; the limbs soft and flaccid, and the belly tumid ; the upper lip is sometimes thickened and projecting, but this would appear to be chiefly a result of acrid discharges from the nostrils. A scrofulous child may very readily become tubercular, but the two diseases are seldom fully devel oped together.

§ 2. Tabes Mesenterica.—Sometimes, in conjunction with some of the external symptoms of scrofula, emaciation proceeds to a greater extent than usual ; the limbs dwindle, the skin becomes dry and shrivelled, the abdomen is hard and tense, and the little patient appears to suffer pain when pressure is made ; the evacua tions are very offensive, and the bowels irregular in their action; there is a tendency to diarrhcea, which may become urgent and obstinate. In such a ease we have great reason to believe that scrofulous or tubercular matter, or a mixture of both, in what has been called scrofulous tubercle, has been deposited in the glands of the abdomen, and especially in the mesenteric glands : hence the name tabes mesenterica has been applied to this form of the scrofulous cachexy.

§ 8. Phthisis.—Trne tubercle has the peculiarity of being chiefly developed in the lungs : it may exist in other internal organs, but it is very unusual in such cases to find the lungs wholly exempt. Its commencement is always insidious, and its subsequent progress is sometimes tardy ; but, more commonly, it proceeds with considerable rapidity.

This circumstance has given rise to the division into acute and chronic phthisis ; the distinction being based upon the extent of structure simultaneously attacked, and the rapidity with which it spreads to surrounding parts, and not on any difference in the nature of the disease. It is practically useful because of the dif ferent train of symptoms set up by a speedy invasion of the whole lung, or a gradual disintegration of successive portions of it. Ex posed as all ages are to the ravages of this disease, it especially prevails soon after puberty, when both forms are constantly ob served, and seem to merge into each'other. In elderly persons acute tuberoulization never occurs; and, on the other hand, it may at least be said that true chronic phtbisis is extremely rare in children.

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