Symptoms.—In a well-marked example of the scrofulous diathesis the constitutional tendency often expresses itself in an unmistakable manner in the build and general appearance of the child. He is stout and heavy, and looks as a rule older than his age. The subcutaneous fat is usually over-developed, and in places remarkably so. His face is broad and fat, with a thick upper lip, and a wide nose. The limbs are stout, with thick ends to the bones, and the abdomen is inclined to be large. But although the adipose tissue is relatively increased, there is a want of firmness about the child's flesh, and his limbs feel soft and flabby. Such children are not necessarily •ll-favoured. The general want of delicacy and refinement in the features is often redeemed by the large size and dreamy expression of the eye, by the high colour in the cheeks, and by the redness and fulness of the lips.
Such characteristics are, however, seen only in pronounced cases of the diathesis, and even then are not always to be found. All the tendencies of the scrofulous constitution may be active in a child without his presenting any such peculiarities of face or figure. Indeed, in many strumous cases the child is seen to have a spare frame, with delicate features and a thin transparent skin—a type which conforms more to the tubercular variety of constitution to be afterwards described. But whether he be stout and coarsely built, or thin and delicately framed, there is one indication of the diathetic state which is seldom absent in a strumous subject. This is the singular activity of all the epithelial structures. The hair is soft, thick, and luxuriant; the eyelashes and eyebrows are well marked ; and in many cases there is a remarkable development of fine down covering the ears, cheeks, shoulders, and spine. The skin, moreover, is apt to be rough and scaly, and the nails grow fast. This peculiarity marks one of the es sential features of the scrofulous diathesis, viz. : a tendency to rapid pro liferation of all the epithelial and cellular elements of the body.
It has been said that the scrofulous diathesis is not in itself a disease. It is a tendency to disease—a tendency to derangements of structure or of function which finds expression under suitable conditions in a variety of lesions. All these bear a common character, and vary in gravity according to the tissue or organ affected. The lesions are inflammatory in their na ture, and are characterized by rapid cell-growth and rapid decay of the newly formed elements. They are not distinguished by any special ana
tomical characters which stamp them at once as of scrofulous origin. In appearance they do not differ from similar derangements occurring in chil dren of a healthy habit of body. Their constitutional origin is shown by their tedious course, for if not stopped -at once they soon pass into a chronic state ; by their sluggish response to treatment ; and by their proneness to relapse when apparently cured. The disturbance originates under the in fluence of some trifling and temporarily exciting cause ; and the length of its course is often dependent upon the hygienic conditions surrounding the child at the time of the attack. If these are satisfactory, the derangement may be quickly recovered from, although it readily recurs when a similar cause is again in operation. If they are unsatisfactory, as is usually the case amongst the poor, the derangement becomes a chronic disorder, and increases in severity and obstinacy as the clays go by.
The parts which are prone to suffer in this diathesis are : the mucous membranes, the skin, the bones and joints, the organs of special sense, and above all the lymphatic glands. In whatever tissue the lesion is seated, the neighbouring lymphatic glands are liable to suffer ; and this is a fact so generally recognized that amongst the public the term " scrofula " is understood to mean simply a chronic enlargement, with tendency to suppuration, of the glands.
The mucous membranes in all strumous children are especially sensitive and subject to catarrh. Gastric and intestinal catarrhs are very common ; and we find besides, coryza, ophthalmia, catarrhs of the throat, ear, and air-passages, and in girls of the vulva. All these, beginning as catarrhs, pass quickly into chronic inflammations very difficult of cure.
The affections of the gastric and intestinal mucous membranes will be considered in another place. They do not differ from the same derange ments as they occur in healthy subjects except in the fact—and it is a very important one—that in scrofulous children such catarrhs are always accom panied by fever. This is seldom the case with healthy children. If pyrexia be present with a simple gastric catarrh, it affords a strong pre sumption that the patient is of a scrofulous constitution. Catarrhs of the intestine in these children often up ulceration of the mucous mem brane. This is an obstinate lesion and may lead to serious consequences (see Ulceration of the Bowels).