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scrofulous, tendency, causes, disease, constitutional, child, influence and diathesis

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scrofulous diathesis is one of the most common of the morbid types of constitution which we meet with in the child. It is found in all ranks of life, and in almost all parts of the world. It is, however, especially fre quent in the temperate zones, being far less common in very cold or in tropical climates. This vice of constitution is often hereditary, and is then handed down with singular persistence from generation to genera tion. Sometimes, indeed, it is seen to pass over certain members of a family, but even those who escape may not transmit complete immunity to their offspring.

A child who has the misfortune to be born with this unhappy predis position is liable to very widespread evidences of the constitutional fault with which he is burdened. His skin, his mucous membranes, his bones, joints, organs of special sense, lungs and lymphatic system are all excep tionally sensitive to the ordinary causes of disturbance, and may all or any of them become the seat of obstinate derangement or even of incurable dis ease. These manifestations of the constitutional tendency usually take place early, so that scrofula is especially a disease of childhood. Infants, indeed, are in great measure exempt from its attacks ; but after the third year it begins to be common, and from that age until the fourteenth or fif teenth year the diathesis is most active. At puberty its energy sensibly abates, and strumous disorders are less and less frequently met with as the individual advances towards middle life.

of the most important of the causes of scrofula is he reditary influence. When the parents are actually suffering from the ca chexia, or have suffered from it, the child is hardly likely to escape a share in the constitutional predisposition ; but when no such manifestation of the tendency has been seen in the father or mother, there is a hope that by careful management and attention to the laws of health the same freedom may be extended to their offspring. But besides actual scrofulous disease, other debilitating influences in the parents may determine the strumous constitution in their children. Thus, the cancerous and tubercular ca chexim will do this. Syphilis in the third generation is apt to manifest itself by scrofulous disorders ; and age in the father, or imperfect nutri tion in the mother during her period of gestation, are also held to be deter mining causes of a congenital tendency to strumous complaints. Whether

mere nearness of relationship on the part of the parents will exercise the same influence is a question which has been often debated, and many writers hold that it can do so. I do not think, however; there is any satis factory proof that such a result can follow in cases where there is not already a tendency to scrofula in the family.

Besides being hereditary, the diathesis, it is commonly held, may be acquired under conditions favourable to its development. It is true that we frequently see patients who exhibit all the signs of a scrofulous lesion without any discoverable family history of scrofulous disease ; but it is often difficult to trace out hereditary taints, especially when the transmitted ten dency has been mild in its manifestations, or has skipped over one or two generations. It is more probable that in such cases latent scrofula is developed by debilitating influences in children, who, under more favoura ble circumstances, would have escaped altogether.

The causes which are thus capable of developing the cachexia in chil dren whose constitutional tendency is comparatively feeble, are all the various agents which impair the nutrition of the body by weakening diges tion, checking assimilation, and interfering with the escape of waste mat ters from the system. Repeated exposure to cold and damp ; an habit ual coarse and indigestible diet ; absence of fresh air, and confinement to close, ill-ventilated rooms ; deprivation of sunlight and want of exercise —the continued operation of these causes, if it cannot set up the disease where no predisposition exists, has at any rate a powerful influence in exciting the cachexia in children who have been born the subjects of the diathesis. Even grown up persons exposed to such unhealthy conditions are often found to become scrofulous. Therefore causes which are capa ble of reawakening the cachexia in the adult, after the age most prone to it has passed by, must act with still greater energy in the child. Certain fevers have the power of developing or re-instating the disease in suita ble subjects. Measles and whooping-cough have a wonderful influence in this respect. Unmodified small-pox used frequently to be followed by ob stinate scrofulous disorders ; and scarlatina can count the same complaints amongst its sequelre. Where the predisposition is strong, it is probable that any disease of a lowering tendency may suffice to develop it.

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