Catarrhs of the nasal passages leadino. to ozmna, and even destruction of bone, may be seen. Obstinate discharge from the nose in a baby is generally of syphilitic origin ; in a child of two and a half years and up wards it is much more commonly due to the scrofulous cachexia. It is very obstinate, gives rise to a distressing and perhaps unavoidable habit of snuffling, imparts a nasal character to the voice, and leads to cracking and excoriation of the upper lip.
The eyelids and eyes may be affected with tinea tarsi, pustular ophthal mia, and keratitis, with intense lachrymation and photophobia.
Pharyngeal catarrh is a very common affection. It is also a very im portant one, for it is accompanied by some enlargement of the tonsils, and considerable swelling and thickening of the posterior nares and back of the fauces. Consequently there is occlusion of the Eustachian tubes and deafness. On inspecting the back of the fauces in such cases we find the mucous membrane of a deep red colour. It is swollen and velvety, and is covered with a thick muco-purulent secretion. The closure of the Eusta chian tube is not due to enlargement of the tonsils, but to the swelling of the mucous membrane. Children so affected present a peculiar appear ance. They have a vacant look, hold their mouths half open, and, hearing but imperfectly what is said to them, hesitate and are confused when spoken to. They are not really wanting in intelligence, but on account of their deafness appear to be so. On examination of the ear the tympanum is seen to be drawn in, but it retains its translucency, and there is no tinnitus.
Otorrhcea is very often met with in scrofulous children from catarrhal inflammation of the meatus. The inflammation may spread to the inner ear, in which case perforation of the membrane always takes place. Severe primary otitis may also occur as a. result of cold or injury, or as a sequence of scarlatina, measles, and small-pox.
Pulmonary catarrhs in strumous subjects may become chronic and give rise to winter cough, with emphysema of the lungs and persistent hyper secretion ; or- the catarrh may spread to the air-cells, inducing chronic catarrhal pneumonia with all its possible consequences.
Various skin affections occur in subjects of this diathesis, and are gen erally the earliest manifestation of the constitutional tendency. Acute eczemas are common, and slight depressing causes may give rise to an outbreak of impetiginous or ecthymatous pustules. Little scratches are apt to run into festering sores which may be slow to heal. Occasionally we find rupia, pemphigus, or lupus, but these are rare in childhood. A not uncommon form of affection of the skin is seen in babies and children under two years of age. This as a small lump—hard, painless, and of the size of a pea or a small nut. It is seated iu the subcutaneous tissue, and the skin over it is at first freely movable and is natural in colour.. Gradually an adhesion forms between the little mass and the integument The skin gets red, and after a variable time gives way, and the cheesy contents of the abscess are evacuated wholly or in part. After discharging
for a longer or shorter period, the sore heals ; its hard base becomes ab sorbed ; and a deep cicatrix is left at the site of the abscess. Several of these abscesses are usually seen at the same time in various stages of prog ress. They are seated on the arms, legs, or abdominal wall, and run a protracted course, passing very slowly through their several stages. They seldom occur except in children of pronounced strunious tendencies. When seated on parts where the skin is in close contact with the bone, as on the fingers, periostitis may be set up with exfoliation of bone ; but elsewhere they have no injurious local consequences.
Disease of the bones and joints is a very common consequence of the scrofulous diathesis. These affections enter more particularly into the de partment of the surgeon. Still, there is one form of bone disease which is brought so frequently under the notice of the physician that it may be properly considered in connection with this subject. This is caries of the bodies of the vertebra, in its early stage, before it has led to curvature of the spine. The reason why we so often see such cases is that the pain, which is one of the earliest symptoms of the malady, may, by its seat and by the cramp-like character it sometimes assumes, give little indication of its being generated in the spine. Like the pain of pleurisy, the pain of ver tebral caries is often referred to a region far distant from the seat of the disease. When the atlas and axis are affected, the pain is referred to the occipital region. In the case of the lower cervical vertebra, it is felt in the shoulders, down the arms, or even in the upper part of the breastbone. If the caries occupy the dorsal spine, the only discomfort complained of may be in the sides of the thorax, the middle line of the chest in front, or the epigastrium. In disease of the lumbar vertebra the pain is reflected to the pelvis, or to the lower limbs as far as the knees, or even to the feet. But wherever the pain is felt, and whatever may be its degree of severity, its cause may usually be distinguished by noting the increase to the child's discomfort when he moves about, and the relief he experiences when he lies down. Sometimes, however, slow cautious movement may be made without uneasiness ; for if the spine be braced up and steadied by the sur rounding muscles, the patient may be able to move carefully about with out communicating any jar to the vertebral segments. But movement when the child is taken at a disadvantage, with the spinal muscles relaxed, is always distressing, and therefore it is important to inquire as to the effect of coughing, sneezing, riding in a carriage, or making a false step in walking.