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     PRIZE ESSAY

          ON


  SCKOFTJLA:

       SUBMITTED TO THE

MEDICAL SOCIETY OF TENNESSEE,
         May 1846.
      BY


W. L. SUTTON, M. D.
    LOUISVILLE:
I'RENTICE AND W E I S S I N <i E H .

      1846. 
PRIZE ESSAI
SCKOFTJLA:
SUBMITTED TO THE
MEDICAL SOCIETY OF TENNESSEE,
         Mat 1846.
BY
W. L. SUTTON, M. D.
   CO ':   ...■-;'

    LOUISVILLEi
PRENTICE AND VVEISSINGER
1846 
        /84-t.



/""•A.  <P^«£  i*e-~,  2.. 
       PRIZE  ESSAY

                ON

SCROFULA.
   When we reflect on the immense amount of suffering oc-
casioned by  Scrofula in  its endless variety of forms,—-that
from a sixth to a fourth of the human race is carried off by it,
a sufficient reason why it should be regarded by  the medical
profession  with intense  interest,  becomes at once evident.
We accordingly find that some of the brightest geniuses in the
profession  have spent much time in investigating its causes,
nature and treatment.  After the labors of a Laennec, a Por-
tal, a Louis,  an Andral,  a Lugol,  a  Carswell, a Stokes, a
Graves, and various others of equal standing in Europe, to say
nothing of their compeers in our own country, it would seem
                            1 
4
 that little could be left to be learned; or if anything were left,
 that the hopes of success were faint indeed after they had failed.
 But the importance of the subject is so great,  the benefit re-
 sulting from any improvement in correctness of views, either
 of the  causes, pathology,  or treatment, so widespread,   that
 we are  imperiously  required to continue our research,  not-
 withstanding all discouragements.  Nothing was ever made
 by despair; on the other hand, circumstances which, upon full
 examination,  have appeared utterly hopeless,  have yet  been
 retrieved by perseverance, aided by well-directed efforts.  In
 this state of the case, not pretending  to know  more of the
 disease than my fellows—on the  contrary,  duly sensible of
 the difficulty of the undertaking, and of my own inability to
 do anything like justice to the subject,  I yet propose to  offer
 a few remarks upon this important disease.  I do this because,
 although I am not able to offer any thingne w respecting the  com-
 plaint, yet if Hook at the subject in alight in any degree different
 from others, or even arrange my ideas in trains somewhat dif-
 ferent,  even that may have the effect of stimulating the en-
 quiries of others,  and good may result.  I have  reason to
 hope, then, from the difficulties admitted to belong to the sub-
ject, and the liberal feelings of the profession, that  this hum-
 ble effort of an obscure member of the profession may be re-
 ceived with indulgence.

  It not unfrequently  happens that words, even  professional
 words and phrases, are taken in very different lights by differ-
ent members  of the  profession.   Perhaps this is as true of
 Scrofula as of any  other word or  phrase.    It is  impor-
tant, then,  that each man delivering his opinions upon   this
 subject should take some pains to show in what sense  he un-
 derstands the term; and  it is equally important that his read-
 ers  should  keep the writer's  definition in view,  else, whilst
 reading, he may apply the terms to states of the  system  very
different from that  which the writer intended.
  I shall divide my subject into three heads, Scrofulous  Dia-
thesis,  Scrofulous Affections,  and Scrofula.   I am fully sensi- 
ige 4, line  5 from bottom, for "readers" read "reader."
"  5,  "  io  "     "     "  "of train" read "train of."
"  6,  "  11  "    top    "  "scurvy" read "scurfy."
u  n  k  36  (t     <c     <t  "has" read "have."
"  io.  "   3  "     "   after "scrofula"  insert "West. Jour.  Med,
                                  and Surg. Vol.  5, p. 285."
"  <<  "   n  "     "   omit "West. Jour. Med. and  Surgery, vol.
                                  5, p. 285, from N. Y. Med. Gaz."
((  c<  «  j2  "     ««    for "112" read "113."
"  20, last line,            "  "garden des Plants" read "Jardin de.s
                                  Plantes."
"  20, 59, and 61, after "Med. Chir. Rev." insert "New Series.''
"  27,  line  5 from  top  for "19" read"17."
"  31,   "  23   "    "   for "purpura" read "furfuraceous."
"  32,   "  12,  "    "   for "purpuraceous" read "furfuraceous."
"  33,'   "   5  from top  for "where" read  "whose."
"  34}   «••   8   "    "   for "suitable"  read "situated."
"  36,   "   5   " bottom after "flocculi." insert "Cooper's Surg. Die.
                                  vol.  2, p. 295."
"  " last line            for "tathe" read "at the."
"  39,  line 33   "   top  for "enables" read "enable."
"  40,   "   27  "   "    for "appears"  read "appear."
"  49,   "    S  "   "   after "esteemed" insert "as."
"  " '   last line,          "  "diversity" insert "of opinion."
"  50,  line 21  from  "    for "Varieties" read "Variation."
u  5]j   a   jo  «    "    for "5-4" read "5-14."
"  53'   u    3  "    «   for "iodine" read  "iodide."
<c  «'   ci    5  u    tt   for "1-52,  1-54" read "1-54,  1-32.'
ct  cc   cc   ]5  it    ce   for "1 J" read 1-18."
tc  53   a   03  tt    n   for "removed" read "renewed." 
 
5
ble  of the  objections  which  lie against  this division, as
well as the difficulty of keeping the heads separate; yet am  I
equally sensible,  that some such division is  necessary,  and
that, in the main, this  division is right.
   As regards the scrofulous diathesis, I apprehend I shall not
differ from those who  recognise its existence as distinct from
scrofula itself.   It is usually marked by thinness and delicacy
of skin, having a sufficiency of redness,  perhaps,  but yet  a
tinge of white not altogether agreeable to the practised eye;
a  thickening of the upper lip and of the columna nasi,  also of
the edges of the eye-lids; eyes very  frequently blue, the con-
junctivae covering  the scleroticae, having a tinge of the same
color; with usually a want of firmness of the muscular parts
of the body, or rather, perhaps, a slight intumescence and
want of firmness in the adipose substance.  There is frequent-
ly an enlargement  of  the  joints (particularly of the fingers,
the ends of which are enlarged or clubbed), with  a real or
apparent diminution of the shafts of the long bones; a tumid
abdomen;  an inability to endure much bodily fatigue.
   Such, in general, are the features of the  scrofulous  diathe-
sis;  but we find a strong tendency to scrofula in persons in
some respects differently marked; for instance,  we see thoje
of dark skin, and black hair and eyes, frequently suffer with
the disease.
   Such persons, whilst this state  of things continues, cannot
with propriety be said to be diseased, much less to have scro-
fula.   Under a favorable of  train  circumstances, they may
even pass through life without becoming diseased.   Yet such
persons certainly are more liable to have the disease  produced
by a train of unfavorable influences  than others.  Therefore,
we say that they have a scrofulous diathesis, tendency, or pre-
disposition.

   Scrofulous Affections.—On the score of diathesis, I do not
presume that  there will be any controversy; but I am not
sure that I  shall have the united suffrages of the profession up-
on what I shall say respecting scrofulous  affections.  By this 
6
phrase I mean certain disorders  occurring in those of a scro
fulous diathesis, which, although not in  themselves indicative
of scrofula,  are more apt to arise in such habits, or are ma-
terially modified by this diathesis.
  In this class I put certain eruptions of the  scalp or skin in
general, lice in the head or upon the body, intestinal worms, im-
perfections in various parts of the body, malformations, inflam-
mations,  &c.  All of these affections may occur in persons
who are not scrofulous; but some of them are much more apt
to occur in persons of that tendency.  We see a child with a
dirty, scurvy head, and say the mother is a slut,  and careless
of her children.  It may  be true.  It may  however  be  true
that the head of that child is  affected with a scaly  disease,
which requires a great degree of care to keep it in  tolerable
order.  Lice may be found in the head of any child;  but it
has been known from time immemorial,  that some children are
much  more infested with them than others.  Upon noticing
such children, they will generally be found to have the  char-
acteristics of the scrofulous diathesis.  The remark applies to
those infested with intestinal worms.  So true is this,  that a
thick upper lip, tumid belly, and pallid countenance,  are, in
popular estimation, constantly  associated with  the  idea of
worms.  These, however, are amongst the most constant at-
tendants upon this predisposition.  We  will find, too, by care-
ful and extensive  examination, that various  imperfections of
the body, as hare-lip, spina bifida, &c,  although not confined
perhaps to the scrofulous diathesis,  are  much more apt to oc-
cur in habits of that character  than in those of the reverse.
In the course of the last  eight or nine years  I have attended
at the birth of two  anencephalus infants,  and in each  case
there was a scrofulous taint in the family.   I do not now re-
member a single case in which I have  operated for  hare-lip,
where there was clearly no such taint.  On the contrary, in
some cases, it was  decidedly evident.   In every case, too, of
spina bifida, which has come within my knowledge, there has
been good grounds for suspecting such a predisposition.  The
same was true of a case which I saw in which there was a de- 
7
ficiency in the walls of the abdomen, constituting what,  for
want of a better name, I called a spina bifida of the navel.
This  coincidence  is  the more remarkable,  because in this
community scrofula is by no means a frequent disease,  com-
pared with its prevalence in other countries.
  Inflammation is not, I think,  more apt  to occur in scrofulous
habits than in others; perhaps even less so.   Still  it may  oc-
cur in such habits without, as I conceive, scofula being pre-
sent.  I am fully aware that many,  perhaps most physicians
will be disposed to question this.   1 shall, therefore, take some
pains to be understood upon this point.
  Inflammation, when once set up, has a termination by reso-
lution, effusion, suppuration or gangrene.  If it end in resolu-
tion or gangrene, we are not apt to suspect scrofula;  but sup-
puration or effusion may attend scrofula.   The  question  then
occurs, is there any difference in the course of inflammation
occurring in  scrofulous habits, and  that formed by scrofula?
I think there is.  We have an abscess formed, upon the neck
if you please;  upon  its being opened, it  discharges what sur-
geons call a laudable pus, a yellowish white fluid  of uniform
consistence and color, so far as it  is unmixed with blood, and
of a consistence something thicker than cream.  This case I
should call one of simple inflammation, if it occurred in a hab-
it untainted by scrofulous diathesis—scrofidous inflammation,
if in one  thus tainted.  It may be asked, why in  one case I
call it simple, and, in the other,  scrofulous inflammation?  I
answer,  that although very similar, the cases are not identical.
That which occurs in the scrofulous constitution will be found
to be materially modified by its presence; there will be more
tumefaction, less heat  and pain, and the process of suppura-
tion and cicatrization will be more tardy than in an inflamma-
tion producing the same quantity of pus, occurring in a healthy
constitution.   Abscesses thus  originating,  although longer in
healing, are not apt to degenerate into ill-conditioned ulcers.
A person of a strumous diathesis may have abscesses of this
kind at divers  times, yet not have  scrofula developed in his
system.   But  I was  about  to shew the  distinction, in  my
                            1 * 
8
opinion, between the product of scrofulous inflammation, and
that of tubercular inflammation.   Instead of the pus  above
described, tubercular inflammation produces a pus of unequal
density, a part being made up of curdy, flaky, or granular por-
tions, the remainder of a fluid more or less serous.  One por-
tion being decidedly more consistent  than healthy  pus, the
other as decidedly less so.  This difference, 1 hold,  is caused
by the presence of tuberculous matter along with the product
of inflammation.  It  will be observed that I have  used the
terms  scrofulous  inflammation  and  tuberculous inflammation
in contradistinction.   I am not  aware  of any authority  for
so doing.  So far indeed is this from  being the case, that wri-
ters upon scrofula define by scrofulous inflammation  just what
I propose to define as tubercular;  leaving  what I call  scrofu-
lous inflammation undesignated, or rather confounding it with
the other.   Thus, 'in the commencement of scrofulous dis-
orders, it deserves also to  be remarked, that the inflammation
which occurs has often so great a resemblance  in its symp-
toms to simple inflammation, as to render it difficult, if not im-
possible, to distinguish between these two states.'  [Thompson
on Inflam. p. 106.]  Again: 'The pus in these (scrofulous) ab-
scesses is often  serous and curdy, though in many instances I
have found it quite healthy in its consistence and color.'  [lb,
p. 128.]  In the first quotation there is  an  implied acknow-
ledgment of a difference between simple  inflammation, and
that occurring in 'scrofulous  disorders,' with  a  directly  ac-
knowledged difficulty in marking  that difference; in  the other,
there is, I think, a confounding of two states materially differ-
ent.  At least there is no  attempt to show any cause for the
different effects  resulting from the same cause.  I shall, there-
fore,  give my reasons for it.  I think it necessary that  there
should be a  term distinguishing  inflammation as occurring  in
scrofulous habits, from that occurring in those usually denomi-
nated healthy.  It is true, we might use the phrase 'inflamma-
tion occurring in the scrofulous diathesis.'   But this would be
more circumlocution than we  would like to repeat often.   I
have, therefore, proposed  to appropriate to this state the term 
9
Scrofulous inflammation.''   But it is necessary to have a  term
designating that inflammation which occasionally accompanies
scrofula, properly so called; I propose to apply to it the  term
Hubercular.''  Not that tubercular is different from scrofulous,
inanimation, but that both these states occur in scrofulous con-
stitituons, one necessarily implying the existence of scrofula,
the other only a predisposition to it. Just as we have words in
English  which  have come to mean distinct things,  though
originally there was no difference—e. g. transjer  and trans-
late.  So, too, we have a want of precision in some  profes-
sional terms, which ought to be obviated.  I will instance the
phrase  'compound luxation,' which  is  used to  signify two
states very different—one a luxation of a joint, attended by a
fracture of a bone connected with that joint, as of the ulna
or fibula, in luxations of the wrist or ancle;  the other  a  luxa-
tion attended with protrusion of  a bone  through the  integu-
ments.   If this distinction should not  appear satisfactory to
my reader, I hope, nevertheless, he will keep it in mind, and
when a more satisfactory  nomenclature shall be invented,  I
shall  always be ready to adopt it.

   Scrofula.—By scrofula I mean the  formation of  tubercular
matter  on or in some part of the body.  Whenever tubercu-
lar matter is produced upon any  of the  mucuous surfaces, or
in any  texture of the body, then is scrofula  present.  Before
that takes place, there may be a strumous diathesis, or scro-
fulous affections; but scrofula,  properly so called,  is not de-
veloped.  I know full well that some of the highest authorities
in the profession are against me as to this  division, at  least  a
fair interpretation of portions  of their  writings would so in-
dicate.   Yet are there others of  equal authority which coun-
tenance this  as the true definition of scrofula.  Further, some
of those who appear against it,  at other times  appear to re-
cognise it.  Thus Lugol,  who  certainly appears to have paid
as much attention to this subject as any other man, and who
ought to have clear ideas upon it, says in  a lecture delivered
at the Hospital St. Louis, on tubercular scrofula;  'This is un- 
10
doubtedly the most important form of scrofula;  tubercles co-
exist with all other forms of scrofula, they are the emblems of
the disease—they  are  scrofula.  We can only say that the
existence of this vice, whatever it may be, is always congeni*
tal, and is  always revealed  by the development of tubercles;
in fact,  this production is scrofula  itself,  its anatomical  and
pathognomonical sign;  this alone  characterizes it and gives
value to all the other symptoms.'  Lugol on Scrofula, preface,
p. 9.   West. Jour. Med. and Surg. vol. 5, p.  285—from New
York Medical Gazette.  Again: 'Now tubercles and  scrofu-
lous inflammation occur very continually in the same individu-
als.''   Watson's Prac. p. 112.   'A scrofulous abscess will form
in the glands of the neck, and pus and tubercular  matter will
be discharged.'    lb.  p. 116.    Again: 'Next tuberculous or
strumous disease  is extremely  common  in  the digestive or-
gans.'   lb. p. 117.  Again, Alison, as quoted in Cooper's Sur-
gical Dictionary, says:  "In most cases in which scrofulous dis-
eases are fatal, the diseased action is in internal parts, and the
first symptoms  are  obscure and equivocal.  The chief and
certainly mbst characteristic  appearances on dissection are
tubercles in different  stages of their progress.'   Page 294.
Lastly, MM. Rilliet and and Barthez, in a work upon the dis-
eases of children,  said to be of great  merit,  have  labored to
'prove  the identity of scrofula and  tuberculization?  Med.
Chir.  Rev., Oct., 1845.  By tubercular matter I mean 'a  pale
yellowish or yellowish gray, opaque,  unorganised substance,1
frequently  of the  appearance and consistence of half-dried
mortar,  at other times in small particles mixed or suspended
in pus.

   Causes of Scrofula.—Having, as I hope, given a clear ex-
position of my  views  on  the  division of the subject, I will
now speak of the causes.  First, I will take up hereditary de-
scent as a  cause of scrofula.  That  children are  sometimes
born with  scrofula upon them, I am well satisfied; but  most
commonly they only receive from their parents a predisposi-
tion more or less strong.  Whilst admitting the existence of a 
11
predisposition inherited from  parents, I must beg leave to ob-
serve that I think greatly too much stress is laid upon it,  as a
cause  of disease.   Thus Lugol:  'So deeply  does scrofula
modify the whole organization,  that persons  afflicted with it
may be considered as a  variety of the human  race.'  Lect.
Hosp. St. Louis—West. Jour.  Med.  Surg., vol.  5,  p.  285.
Those, too,  who have read his late work on scrofula, will be
aware that he inculcates forcibly the opinion that the disease
is transmitted by hereditary descent; that a man free from the
disease cannot acquire it himself, but may acquire a predispo-
sition and transmit the disease to his offspring, who,  of neces-
sity, transmit it to theirs, until in three or four generations the
family becomes extinct.  In a population where  scrofula is
very  common, it is perhaps  more difficult to arrive at correct
ideas as to the precise  influence  of  particular causes,  than
where it is rare.  It so happens that I am acquainted with the
history of one family for five generations, which, it appears to
me,  throws  some  light upon the influence of some of the
causes of scrofula.   D. C, having  enjoyed good health, lived
to the age of 109 years.   His wife, also   of good general
health, died  at an advanced age.   Their son,  D. C. 2d,  died
middle-aged  of bilious  colic, leaving  a  number of sons.   His
wife, in good health, lived to an advanced age, having raised
all her children, one of whom was an infant at her husband's
death.  Thus far, there is no appearance of any form of scro-
fula, nor of any of the causes which are enumerated as giving
rise to a predisposition.  Of their children,  1st, J. C. married
and lived to middle age,  a healthy, stout, industrious, and am-
bitious man.   After a hard day's work on a hot day, (a heavy
rain  and considerable diminution of temperature taking place
in the evening,) he took  cold, and afterwards died of consump-
tion.   His wife, E. C, is now alive,  aged about 55, in good
health.   He had two children who died of consumption.  One
born  before  the day's work which  was supposed to have
caused his death,  the other after.  He has a son now 35 years
old, stout and in good health.   2d. C, now  75 or 80 years old,
active and in good health.  His family healthy, no chronic dis- 
12
ease among them.  Several other brothers lived to  the  ordi-
nary  rates of life, without  any  manifestation of  scrofula.
D. C. 3d, is now about 65 years old,  married and  had eight
children.  Of these, three are now alive, of the ages of 36, 34,
and 18, in good health.  One died when  young of  a violent
injury  received; one  at the age of 35, of ulceration of  the
bowels, occurring in typhoid fever; one at the age of 34, of
consumption; one at the age of 20, of consumption;  and one
at the age of 17, of consumption.  Of the eight children, three
only have married, two of whom are now dead; one of these
lived in wedlock eight years, leaving two children, now 5 and
7 years old, in good health;  the other lived  in wedlock four
years, leaving one son, now  4 years old in good health.   The
third married into a family  tainted  with  scrofula, has five
children apparently  healthy.   The  mother of these eight
children died suddenly at the age of 55,  having,  as was sup-
posed, labored under a hepatic derangement  for a long  time,
say  from  the  age  of 30 up.   For a number of years  prior
to death,  she enjoyed an improved state of health.   She had
been affected, however, for a number of years with what  ap-
peared, from its history and condition when I first  saw it, to
be an enormous bronchocele.  Her sister, who also was wife
to J. C. above named, is now alive, about 55, and also affect-
ed  with a similar tumor,  but not so large.   Several of  the
children of D. C. also have  had slight  enlargement of the
thyroid glands.  They  live, however, in a locality where
that affection is more general than in any other region within
my personal knowledge.
   The father of these  two Mrs. C.'s, Mr. H.,  lived to the  age
of 85  years, having  generally enjoyed  good  health.  For
about fifteen years before his death, he had been sensible of a
tumor of the size of a filbert in the middle of the right side of
the neck, supposed to  be an indurated cervical gland.  About
six months before his death, this tumor commenced enlarging
very rapidly, and at his death, which appeared to  be caused
by it, it was nearly as large as his head,  having pushed  the
trachea very much to  the left, the thyroid cartilage being in a 
13
line with the left ear.  Before death he had expressed a wish
that  it might be removed after his decease.  I complied with
his request, and found the tumor to embrace full half the cali-
bre of the thrachea, notwithstanding its displacement,  and to
enclose completely the right carotid and subclavian arteries.
This tumor was mostly of a cartilaginous consistence; in part
approaching suppuration; but in no portion  of  it was there
anything of a tubercular character.  His wife, Mrs. H., is  still
alive,  about 80 years old, and as healthy as  persons  of that
age can reasonably expect to be.   In addition to the two Mrs.
C.'s, they had one son, now  about fifty years old, who has suf-
fered extremely with rheumatism, having been confined to his
bed for eight or ten years  at one  time  with it,  and again
for the last  five years.   Nothing of a tubercular  charac-
ter having affected him at any time.  He has raised a large
family of children, who, thus far at least, have enjoyed good
health.  His wife died five years ago,  having previously  re-
quested that her body might  be inspected after death,  in con-
sequence of several of her family having died similarly affected.
Accordingly  the late Pro£ Richardson  and  myself attended to
that duty.   We found her liver enormously enlarged  and  dis-
eased, a large amount of fluid in the abdomen and also in the
thorax.  The stomach externally  appeared  healthy,  but on
the internal surface, near the pylorus,  were two tumors,  one
as large as half a walnut, the other as large as half a nutmeg.
Lungs healthy;  no  appearance  of tubercular  matter any-
where.  I have introduced the history  of this family because
it  comes to me in a perfectly authentic form, and extends  far-
ther back than we can often trace families  with certainty;
and  because  it appears  to  me to bear on several points re-
specting hereditary diseases.   My opinion  is that  scrofula is
very  generally  transmitted  from parents  to offspring; but  I
do not believe that the child  of a scrofulous father or mother
will  necessarily be scrofulous; nor that a child,  whose  father
and mother are free  from the taint, will  necessarily  escape
scrofula.  Children generally have a greater  or less  resem-
blance to the father  or  mother,  and  the  child that  resem-
bles the father will be more liable to Is affected  with that dis- 
14
 ease  to which the father is more liable.  The same principle
 is true of that  child  which  resembles the mother.  If, then,
 both  father  and  mother are liable to the same disease,  the
 children will be very  apt to suffer from it.  But it occasional-
 ly happens that a child  does  not favor either of the parents.
 Such child will be less likely  to  suffer from any  disease to
 which the parents may be predisposed.  Or if both  parents
 are healthy, he may by  his conformation be born with a pre-
 disposition to some disease,  till  then unknown in  the family.
 This will  readily be admitted by certain physiologists  as to
 the reputed parents; but they will say that it is not true of the
 real parents.  Thus M. Lugol in such cases  calls in the aid of
 adultery to maintain the truth of his  theory.  Some men have
 very little  confidence in the  chastity of females; and Lugol,
 residing where  adultery is confessedly common, may  be ex-
 cused for his scepticism.   In  this country, however, cases of
crim. con.  are very rare, and I am satisfied that adultery is not
 the besetting sin of our ladies, yet the same facts are observed
here as at Paris.  Neither do I see why  we  should reject a
 law respecting  mankind which is  known  to be true as to
brutes.  We will take for example the hog.  A male and fe-
male will produce a litter of some eight to twelve.   It may be
that the whole litter will resemble the sire in form; or it may
be they will all resemble the mother; or a part may favor one,
 and a part the other; or, again, they  may partake of the form
 of both.   It is quite likely that some  one or more of the  pigs
may be found in each  category.  Again, now  and  then  a pig
 is found  having  no appreciable  resemblance to either.   By
 taking advantage of such cases, and using some  care, a man
 can in a short time completely  change  his breed of hogs,
without any extraneous  cross.   The same is true of other
 animals.
   But certain conformations and appearances of the body are
found to be attended by  predisposition to  certain diseases-
 and as such conformation  is similar to that of the parent, and
 as the parent is liable  to the same disease, the  predisposition
 or the disease is said to be inherited from the parent.  This is 
15
as true of some  other diseases  which  are  not considered
hereditary, as it is of scrofula.  The family to which Mrs. II.
above  mentioned  belonged, was  predisposed to hepatic dis-
ease.   ] have seen a number of families in which, I was clear-
ly satisfied, the same affection was transmitted from parent to
child.  Again, a certain conformation is known to predispose
to apoplexy.   A son frequently gets  this  conformation  from
his father,  and with it a liability to the disease.   But nobody
considers hepatic disease  or apoplexy as hereditary.  This
principle is very clearly  elucidated in the history  of various
females brought forward by Lugol  in his woik on scrofula, in
which various members of  a family are found affected,  with
not only the same disease,  but in the same form, and affecting
the same parts.
   It will be seen, that whilstl believe that very generally scrofula
is transmitted from parents to offspring, I do not believe it to the
same extent as some others.   I do not believe that  a man is
necessarily scrofulous because his father or mother and divers
brothers and  sisters  are so; nor  the converse.  I have en-
deavored also  to give my  rationale of the matter.   Whether
there is  any  difference  between my views on this point and
those of others, I am not prepared to say.  In the family, the
history of which is detailed above, there is no appearance of
scrofulous affections for three generations on the fathers side,
and none for two on that of the mother; unless the bronchocele
ahould be so considered.   This affection  was at  one time gen-
erally  considered scrofulous; but I  believe the opinion is losing
ground.  There is a  region  of country  in  this  vicinity  in
which bronchocele is quite common;  and it certainly appears
in persons who have no appearance  of scrofulous taint.   It is
«lso true that there lived a family  in  that region which  ap-
peared predisposed to scrofula, none of whom, so far as  my
knowledge extends, was troubled with this tumor.  It may be
noted, however,  that the two daughters of  Mr. H. were af-
fected with it, and each had children who died of consump-
tion.   But it may  be  remarked further,  that  the  tumor of
which the Lther  died, at thj time I saw  it,  only a few day*
                            2 
16
before his death, resembled very strikingly those on the necks
of his daughters, only being greatly larger.   It is possible, too,
that in the daughters these tumors may  have commenced  in
some situation other than the thyroid gland.  His tumor dif-
fered also from theirs, in remaining long  stationary, and  then
growing very rapidly; and also in showing some disposition to
ulcerate.  It is true, however,  that the children of Mrs. S. C.
who had swellings on their necks, had them in the situation ol
the thyroid gland.   None of those thus  affected have  shown
any disposition to consumption or any other form of scrofula
Now did those children of D.  C. and S. C, who died of  con
sumption, get their predisposition from their parent*?   1 thinl
not; and this opinion is, I think, justified from  the  facts  de
tailed.  With the first who died, I had little acquaintance, an<
will therefore say nothing.  The second  was decidedly leuco
phlegmatic in temperament, a good deal disposed  to bloat, di
gestion bad; apt to be troubled with flatulence; menstruatioi
came on tardily  and  imperfectly.  She appeared to be im-
proving under the use of iron and iodine, when she was seizei;
with a violent  attack of typhoid fever, from which she imper
fectly recoved only to have pulmonary consumption fully de-
veloped; from  which  she died in six months.  The third die
not appear to be so much predisposed, but was of slender deli-
cate frame, and appeared to have contracted her disease fron
exposure to cold.
  But it is said that a man who has never been affected  with
scrofula, or even predisposed to it,  may have a predisposition
generated  by  various diseases,  as syphilis, &c., and  thai
children born of such parents,  after such event,  will have scro-
fula developed in them; whilst those born previously will not.
Lugol,  in his work on scrofula,  gives  several  instances  in
which the disease was transmitted in this way.  I  must con-
fess, however, that I do not  appreciate  the  force of his rea-
soning.   In the first place, to say that a child inherits from his
father that which his father never had, appears to me  very
much like a solecism.   Again, if the transmission is of a specfic
character, it seems to be wrong.  We know that a man may 
17
 have syphilis and be, to all appearances, cured,  yet transmit
 that disease to his offspring, but not scrofula.   Lugol's opinion
 appears  to be different,  if I understand him correctly.  And
 lest  1  should misrepresent him, I will quote his words: 'But
 wme years afterwards,  his habits became dissipated;  at that
 time, whilst exhausted and syphilitic, having also infected his
 wife, he had  a third,  who  was born scrofulous.'   Lug. on
 Scrof, p. 100.   'Syphilitic  cachexia and  after  it scrofulous
 cachexia, have  progressed much more rapidly in Spain, be-
 cause the venereal disease has been generally neglected there,
 or is treated by remedies too inert to produce a radical cure.'
 lb. 230.  The same sentence is repeated on  the 232d  page.
 How these passages, as well as the   general  scope  of  his ob-
 servations in his article on  the syphilitic  origin of scrofula.
 tally with  the following  sentence at page 167,  each  reader
 will judge for himself;  for myself I must acknowledge they do
 not appear to me to agree very  well:  'Scrofula also has relations
 with syphilitic diseases, and very frequently with erysipelas;
 but all  the relations it may have with these diseases are  onlv
 complications; they may favor its development,  but it  is cer-
 tain they can never produce it.'
   I can very well imagine that the injury inflicted on the con-
 stitution by  protracted syphilis, and by the  treatment neces-
 sary to cure it, may leave the  body in  a condition  favorable
 to the evolution of scrofula;  but 1 do not see  how  it  would
 cause it of necessity; and  I must repeat, if I have  received
 his idea correctly, it is not in accordance with the experience
 of the profession  in this country.  If,  however,  it is  meant
 that the  constitution may be so much injured as to bring on
 premature  decay,  I agree to the proposition.  Children born
 after this, may be of an imperfect organization—may  be pre-
 disposed to scrofula, or may have it developed;  but I do not
 believe  they will necessarily have scrofula.  I shall  hereafter
 have occasion to express my opinion  that the  improper  em-
 ployment of mercurials is a very powerful cause of the devel-
opment of scrofula.  And it is  not at all unlikely  that  much 
18
of the blame thrown on syphilis in this matter, is in truth due
to the remedy used to eradicate it.
  The excessive use of mercury is, I think,  a more  frequent
cause of scrofula than a syphilitic taint.  It is well known that
an inordinate use of that  mineral will  produce a leucophleg-
matic appearance  of the  face, attended with  tumefaction of
the  lips  and face generally.  A superabundance of white  tis-
sues is developed,  and a deterioration of the red  globules
takes place in the blood.   Frequently, too, there is some tume-
faction of the abdomen.   In short,  a state is produced  ver)
analogous to a strongly marked scrofulous  diathesis.  A per-
son whose general health is good, may have  this  state   pro-
duced, and it may pass away without  the  production of the
disease; but if the powers of life are languid, he will run con-
siderable risk, if this state continues any time, of  having his
health permanently injured,  and scrofula  may be produced.
During  the late mania in the use  of calomel  many persons
had their health ruined; and not a few had scrofula developed,
in whom no other  assignable cause  appeared.
  Somewhat similar to the effects of undue  mercurialization,
are those of excessive bleeding, whether  practised for  the
cure of  disease, or as  occurring in the form of hemmorrhage
The consequence of great Ijss of blood is necessarily a  want
of a due proportion of red globules.  The  same  anemic  ap-
pearance takes place as is observed after excessive salivation.
Indeed there  is so great a similarity between the  two states,
that they may be considered identical.
  There are numerous other causes which produce imperfect
sanguification, and therefore are more or less active in predis-
posing to scrofula; but it is scarcely  necessary to enumerate
them, as I hope the principle which I wish  to inculcate is suf-
ficiently evident.
  No age can be said  to be exempt.  The foetus  in  utero is
found affected, and the man of old age is occasionally afflicted.
The disease is, however,  more commonly met with from the
age of two or three years to that of thirty or thirty-five.   Al-
though any form of scrofula may  appear at any age, yet  some 
19
forms are met with more frequently at some ages  than  at
others.   In <a-ly life, say under ten years, the skin, the nose
and lips, the brain, and the  lymphatic and  mesenteric glands
are most apt  to be affected.  From puberty to twenty-five
the lungs  are especially  obnoxious in white persons; but 1
think that negroes are as apt to be affected in their abdominal
viscera at this age as in the  thoracic.  I do not know  how the
experience of others agrees with mine, but I have found the
osseous  system more  frequently affected in those  from ten
to fifteen years or age.
   Both sexes are liable; and perhaps each is^er se equally apt
to have the disease developed; but our domestic habits, in my
opinion, have an  influence  injurious to the female.   Her sed-
entary habits, the want of a due exposure to  air and sunshine.
are calculated to exert an unfriendly influence upon her health
in general, to prevent due vigor and activity in the chylopoi-
etic viscera,  and to render her unable  to withstand  sudden
changes in circumstances calculated to affect the health.
   Climate  was at  one  time  considered as  particularly  effica-
cious in developing scrofula; but it is found  prevailing in  all
climates; so that we are  compelled to exonerate  particular
oix -  from  the opprobium of producing it.  It is  found,  how-
ever, that a sudden transition from one climate to another ma-
terially diilerent, is very favorable  to the  development  of  the
disease.  Neither docs it matter,  except in  degree,  whether
this change is from a cold to a  hot  climate,  or  the  reverse.
The  opinion  that the removal of scrofulous, and  especially
phthisical patients to a southern climate is very  favorable  to
convalescence, has been so common,  that the idea advanced
bore  will  be  by many considered as absurd.   Many things.
however, equally  absurd in appearance,  have been  by strict
investigation  proved to be true.  The best test upon  this sub-
ject will be one in which satisfactory  information as  to  the
health of large bod es of men, in other respects similarly  sit-
uated, can be l.a 1.  Such test the British  troops, situated in
the United Kingdom and those situated in the West Indies.
furnish. 1 quote from a statistical report made by th2 medi-
                            2* 
20
cal department of the British army to Parliament.  Med. Chir.
Rev., vol. 30, p. 59: 'As an instance how much more prevalent
consumption is in that country than in  Britain,  we may state
that  of an aggregate strength of  51,567 serving in  Jamaica,
there have been 661 treated for that complaint, being at the rate
of 13 per thousand annually; while outof an aggregate strength
of 44,611  dragoon guards  and dragoons serving in the Uni-
ted Kingdom,  there have been treated only 286, or between
5 and 6 per thousand annually.  * * *  The baneful influence
of the climate  of the West Indies in accelerating the progress
of consumption, has often  been  remarked  by  the  medical
authorities; but it does not seem to have occured to them, nor
indeed had  they the means of ascertaining, that  at least twice
as many cases of it originate as at home, though those catar-
rhal  affections to which  they are  generally attributed  are
there comparatively so rare.'  Again, p. 52: 'In respect  to
pulmonary  affections,  though the  admissions under this head
are less than at home in the  proportion of  115 to 148,  yet the
mortality  is greater, 10} per thousand of  the whole strength
having perished by lung affections.   The average per thousand
in the United Kingdom was  8}.'   'In the West  Indies,  1,023
cases of consumption  occurred in an  aggregate strength  of
86,661; being  12 per thousand annually.  In the United King-
dom  the  proportion was 5\ per thousand.'  'This,' says the
reviewer, 'we should think may open the eyes of some phy-
sicians who think a hot climate a panacea for diseases of the
lungs.'   Page  59.   Why should there  be a greater mortality
from consumption  in the same kind  of persons  in  the West
Indies, than in England?  I  think mainly because of the high-
ly injurious influence  exerted  upon  the  constitution by the
great change in climate.  There will be but little difficulty ia
believing that  a change from a warm to a temperate  or cold
climate  exerts a prejudicial influence on the health.   In con-
firmation of it, I shall  refer to two cases only,  the great pre-
valence of scrofulous  diseases in our  negro race, and  the
equally  frequent occurrence of them among the animals in
the garden des Plants in Paris.   I am not sure that I ever saw 
21
but one native of Africa; and he died of tubercular consump-
tion.  It is known, too, that the African race in this  country
suffer much more severely from scrofulous diseases than the
whites.
  A damp atmosphere has been  thought favorable to the pro-
duction of scrofula, but  numerous  observations have demon-
strated  that moisture alone is  not  sufficient to generate it.  1
can readily believe, however,  that a cold moist  atmosphere
will be more favorable to its development than one of an op-
posite character.
   Of the seasons, the latter part of winter,  spring,  and the
forepart of summer, are found to exhibit the disease most fre-
quently.  Indeed it is very common  for scrofulous affections
to appear duiing this period, gradually disappearing during the
Bummerand fall, and re-appearing the nextspring; thusconform-
ing to the seasons, for years.  From this we  infer, not that
spring in itself is more favorable to the evolution of scrofulous
diseases, but that cold is a  powerful  agent in its development.
It may  be  asked,  if cold is the active  agent in this matter,
how it happens that the increase in the disease does  not take
place during the cold of winter?  My answer  is,  that many
effects do not appear until long after their causes  have passed
away.  The tides do not keep pace  with  the  sun and moon,
but follow them.   The weather does not begin to grow waim
at the winter solstice, but some sixor eight weeks after.  You
may  travel a horse two or three  hundred miles, and at the
end of  your journey you may  not be aware that he  has lost
flesh; yet will he fall off'afterwards,  though  you use him not
and feed him  well.   So the effects of the winter are generally
produced,  and do not  appear  in full  force   until  after the
cold weather has passed away.
   This explanation appears to me  more satisfactory than that
offered by Lugol.   'It is only, says he, 'when there  is a mor-
bid predisposition that the  animal  economy is unfit to receive
the salutary  influence of the  return of light and heat, and
that this influence,  instead of being profitable, lights up the
germ of hereditary diseases, or favors  their  progress  when 
22
they  have already attacked.'  Op. cit. 241.  Again: 'So, too,
with all scrofulous diseases in general,  they seem to  redouble
their  activity when nature awakes after the sleep  of winter.'
Page 240.  Again:  'This recrudescence, considered generally,
presents a movement of increase and decrease; it commences
in the first days of January, it has its apogee in the month of
March, and it decreases till the month of June inclusively.   In
nine-tenths of the scrofulous patients the disease increases du-
ring this semestrial period, which embraces the whole period
of the year that the sun remains longest in our horizon.' Page
240.  It appears  to me,  if the return of light and heat pro-
duced an invigorating effect upon the disease, rather than up-
on the constitution  of the patient,  that  that  increase in the
strength of the disease should continue until fall or winter un-
abated—in fact, augmented.  It seems to me strange that M. Lu-
gol should say that this semestrial period from January to June
embraces the whole period of the year that the  sun remains
longest  in our horizon; when, in fact, the sun  remains just as
long in our horizon during the other 'semestrial period.'  From
March to September is 'the period that the sun remains long-
est in our horizon.'   But the influence of the cold weather re-
mains for a given period;  the returning light  and  heat begin
to exert  their  invigorating influence  upon the constitution;
the disease gradually feels this influence  and  begins to give
way;  and a gradual improvement of health necessarily takes
place.   By the bye, I hold this to be no mean argument against
the idea that scrofula is an inflammatory disease.
  But imperfect nutrition is perhaps  the  most  potent of all
causes in the  development of scrofula.   The heat and light of
summer follow  the cold of winter, and to a great degree  re-
pair the  injury sustained  during the  latter  named  period.
When the body has sustained a temporary detriment,  as by-
profuse  hemorrhage or salivation, there is a vis melicalrix na-
tural,  a restoring power  in the system, which most frequently
is sufficient, afler  a shorter or longer time, to bring it back to
healthy  action; but imperfect nutrition is an ever-acting, ever-
powerful a^ent of evi, the existence cf which, and  the ex- 
23
tent of which, it is frequently extremely difficult to appreciate.
This cause may be divided into  two  modes  of  action,  one
caused by improper food, the other by a  deficiency in  the
powers of digestion,  by which  even  healthy food is not as-
similated.  There are few  subjects in the treatment of dis-
ease upon which it is more important to arrive at the  truth,
or more difficult, than what is the quality and quantity of our
patients' diet.  Some persons are not  satisfied if an invalid
does not eat  at least as much as a laboring man should; others
again think an invalid should be  starved to any degree  short
of death.   Hence in one instance we will be told that the pa-
tient 'eats nothing at all,'  and in another that 'he eats a plenty
for a person in his situation.' Whereas when, by cross ques-
tioning, we approximate the truth,  we m y  form a very dif-
ferent opinion.   As  regards climate,  so  of diet; a sudden
change from  a full to a spare diet, or even the reverse, is  un-
friendly to health, and especially so in those whose tendencies
are towards scrofula.  This may be accounted for, in the one
instance, by  the want of  a sufficiently healthy  nourishment,
by  which the body is imperfectly  supplied with  materials of
renovation; in the oth°r,  by injury done to the powers of di-
gestion, by taxing them beyond their strength, by which  the
same  result takes place.   It matters  little how good the fuel
is,  if  placed  under  circumstances  so that it cannot  burn, no
heat is evolved.
  Such are the causes which I esteem most prominent  in  the
development of  scrofula.   Of some others adduced by Lugol.
as excessive venereal indulgences, the  husband being too old,
or disproportioned in age to his wife,  or not having  the rela-
tive strength of his  sex,  &,c,  I do not see the  force.  The
bringing forward of such  causes appears to be a very strong
evidence of  the whims  into which a man may be betrayed,
whose attention is devoted almost exclusively to  one subject.
In reading that part of his book, I  was forcibly reminded of a
certain quack who declared his patient's disease to have been
brought on by the use of mercury.   But, doctor,  said the  pa-
tient,  'I have taken no mercury.' "Did you  not take a dose 
24
of calomel?'  'No.'   'Ah!  your doctor  gave it to you in dis-
guise, for sure as  death  you've got it in you.'  'But 1 have
taken no medicine at all.'  'I do not mean at this time,'  re-
plied  the quack,  'but  it  may have been years ago.'  'I  tell
you,' answered the patient, 'I never took a dose of medicine
in my life.'  'Did  you ever have the itch?'  'No.'  'Nor ever
rub mercurial  ointment on you for anything?'  'Never.'   Af-
ter a pause:  'Have you eaten any beef in the last yeai?'  'Oh
yes.'  'That is it; I knew  I should  get the clue after a while.
That beef when a calf was lousy and mercurial ointment was
rubbed on it,  and  you got the mercury  by  eating  the beef.'
Let me not be charged  with a want of respect for Lugol.   No
man, who has labored as long and as diligently for the promo-
tion of science as he has, can be held in indifference  by  me.
I only wish to avoid  being swayed by his influence  beyond
due bounds.   In a population  where  scrofula is present on a
large scale, a man may take any position in regard to it,  and
find  circumstances  to  bear him out.  One great difficulty in
our profession consists in separating that  which is  true from
that which is  plausible.
  I have introduced the history of a family  for  five genera-
tions, because, as then stated, [ received the account in a way
which satisfied me as to its correctness; and  because  it  ap-
peared to me to bear somewhat upon the causes of scrofula.
The gentleman who gave me the information, and who is now
about 65 years old, and one of the  parties,  removed to this
country  from  New Jersey when a young man.  He married
here a wife who had also come from the same region as him-
self.   No scrofulous taint was known in the  family  of either,
and none occurred until the fourth generation on his side, and
the third on the side of his wife, (as appears from the account
of his family and my own personal knowledge of hers.) unless
the bronchocele on the  neck of his  wife, and also  on that of
her sister, be considered such?  Some will consider them as
scrofulous, and the facts in the case of S. C.'s children may
be adduced in support of it, viz: that  some  of her children
had small enlargements of  the  thyroid  glands, and some of 
25
them died of phthisis.  Again, those  who died  phthisical, at
least one of thein, favored the mother's family.  But there is
another view to be taken of this matter.  It is very common,
as is abundantly shown by  the  observations of Lugol, that
scrofula is generally observed to affect the different members
of the same  family in the same  way.  Now  although  those
who died phthisical favored the mother's family,  those who
had goitre did not.  I have said that  I did not believe  that this
family was affected  by  inheritance.   Others  may  perhaps
think differently, and  adduce the development of the tumor on
the neck of Mr. H. at his advanced age, as an evidence.  Such
may be the truth.
   Here I  will mention the extreme caution  with  which  it is
necessary to investigate the history of families; and as an in-
stance is  better than  a description, I will give one.  About a
year ago, 1 was called to see a little  boy who labored  under
some of the symptoms of coxalgia.  As I was not acquainted
with the family, I thought it my duty to go into an  examina-
tion of its history.  The mother was considerably nettled that
I should suppose that there was  any  taint in her family.  Yet
upon investigation I found that sev. ral of the family had died
of consumption; and she herself died of the same disease in
less than  a year.  A friend of mine also highly  affronted a
whole family by saying that a case to which he  was  called
was one of cancer.  Self-love  and family pride will hide many
things from our eyes.
   But to return to our history.  This family was  in easy cir-
cumstances, lived well,  and  had  the usual comforts of the
country.   It is true that when they first removed to this coun-
try it  was quite a new one, and much labor was necessary to
open firms, &_c.   The different  members of the family were of
course exposed to all the circumstances attending the  settle-
ment of a new country, but to no inordinate degree.  The
change of climate had not been great,  indeed within a range
which would have been considered as exerting a prophylactic
influence, if any.  They were all of temperate habits; were
guilty of no excesses tf any k.nd.  There wasa suitable  corree- 
26
pondence of age between man and wife.  In short, there was no
evident cause for the development of the disease. The good health
of the family was like the'common law''of which the memory ol
man goeth not back to the contrary.'  Yet we have phthisis
developed in the family.   Why?  Some will say because ol
the taint of the mother.  But with the exception of these  tu-
mors about the neck,  that branch enjoyed as good health as
the other.  I would say that  disease  appeared  in  the fourth
generation, of which we have an account, because in that gen-
eration children were  born  having the marks of the strumous
diathesis upon  them, which  were quickened into existence by
exciting causes.  This brings me to enquire,  can  a healthy
man beget a scrofulous child?  In a practical  point of  vievr
there is another question  nearly allied to this,  inasmuch as it
is frequently very difficult to determine under which to place
a given case; but in their nature they are  entirely  different,
viz: can a child  born   free  from scrofula  become  so?   We
sometimes see  children which can be  pronounced  scrofulous
at birth, but very  frequently  there are no marks  by which
such judgment could be given.   These last afterwards  have
the disease developed, and it may be a question,  the parent*
being free from disease, whether they were born scrofulous, or
became so after birth.   I entertain the opinion that a child of
healthy  parents may  be born predisposed to scrofula.  1 am
fully sensible of the difficulties which lie in the way of coming
to a  correct conclusion  upon this point.  But reasoning by
analogy  from  what is known to be true of animals,  as ad-
verted to in the forepart of this essay, and from facts so far
as human observations can  be depended  on, I  think the  testi-
mony is ample.  Whilst Lugol,  by  the  general  drift of  his
work on scrofula, negatives the idea,  he  yet  furnishes  facts
which go to prove it.   Thus 'A. Bodin, in his statistics of the
Dep: r:ment du Nord,  says  that the inhabitants of Lille  have
scrofulous offspring when they intermarry, which  is  not the
ease when they marry strangers.'  Page 235.  Again, speak-
ing of a  population intermarrying, he  say:-: ^Hence the race
was debilitated,  and  after a  certain number  of successive 
27
generations the scrofulous state ensued.'  lb. 234.  Dr. Stokes
says, in a lecture on scrofula: 'It sometimes, on the other hand,
happens that healthy parents may have children of a strumous
habit.   This, however, is the rarest case.'  Amer. Jour. Med.
Science, vol. 19, p. 476.
   The other question, viz: can a  person,  born healthy,  ac-
quire scrofula?  is to  be answered in the affirmative also.   Lu-
gol recognises the truth of this answer when he says:  'Ascro-
fulous nurse never renders her nurseling absolutely scrofulous,
but gives it only the predisposition to  this  disease, which is
developd at a late period.4  Op.  cit. p. 101.  Stokes, loc. cit.,
speaking of animals, says: 'If we look at those animals  in
which tubercles  are found, we see that they are often those
which have been brought from a hot to a  cold  climate,  and
kept in a state of confinement for a long  time.'  Lugol, too,
speaking of animals, says: 'Thus, too, most of the foreign  ani-
mals in our menageries die in  a very short time from pulmon-
ary  tubercles.'  Page 239.  Now it would be truly  strange
if those  engaged  in catching wild beasts  should get hold of
those affected with tubercles  alone,  and let all  the  healthy
beasts of the forest  escape.  I will make but one more quo-
tation in support of  this  position.  'Butler was of a family in
no manner a prey to scrofula; in spite of the ills of venereal
debauch, his constitution rallied and  overcame  until  angina
from aneurism hindered him in the duties of his office.  Until
then, almost pampered with the goods  and  comforts  of  this
life,  heat  length could no longer earn his  daily  bread; pov-
erty, want and distress came upon him as the storm upon the
<*oodlv bark.  He was shattered  in health, and  the ill habit
presided over the economy, and acute tubercle settled in the
lung.'   Dublin Journal Med. Sci., vol.  20, p. 19.
   Another question of vast importance to  those affected with
scrofula  is, can a scrofulous parent  beget a healthy  child?
Can the  child of scrofulous parents be so managed as to afford
a reasonable hope that it shall  enjoy a fair  amount of health?
I think that prudence would point out to those who are  de-
cidedly  of a scrofulous habit, the propriety of abstaining from
                             3 
23
marriage.   The strong  probability  is,  that  notwithstanding
their utmost care,  their children will be born to disease and
misery, and  probably  will,  most  of them  at  any rate, die
young.  Yet the children of such parents, at least where one
is not affected by the disease,  are not to be considered as be-
yond  hope.  Some of the children may reasonably be ex-
pected to conform in  their organization to the healthy parent.
By rigid adherence to rational  training, too,  much may  be
done to invigorate the constitution and ward off the approach
of the disease.  By putting the child to a healthy nurse, if the
mother  is tainted, by  a free exposure to a pleasant dry atmos-
phere, by constant invigorating exercise, and by great atten-
tion to the chylopoietic viscera, much may  be  accomplished.
Notwithstanding the gloomy prognostics which Lugol applies
to all  persons affected with scrofula, he yet admits the  possi-
bility of an improvement in the health of such families,  when
sufficient  pains  are taken to secure that end.  'In the most
fortunate  cases,'  says  he, 'those  where we can believe that
the diseases anterior to  puberty are completely arrested, scro-
fula may  be transmitted hereditarily, and it is not till after
several  generations and happy alliances that the  scrofulous
habit  ceases to  be  perpetuated in families.'  Op. cit.  p. 86.
•So, too, parents born in communities  where  scrofula  exists
endemically, if they are affected with this disease, do not pro-
tect their children from it by emigrating to more exposed and
healthy situations; on  the contrary,  they carry the disease
with them.   * * *   This emigration does not bear its fruit, till
after several generations, and only in cases where the children
have good nurses,  and  where marriages are made discreetlv.'
Page 231.   Stokes  advances  the   same opinion: 'But on the
other hand we sometimes find scrofulous parents beget healthy
children.  This appears to be an anomaly,   but it may be ex-
plained by the circumstances of the child having a good healthy
nurse,  living in  a pure air and having  comfortable  warm
clothing, all circumstances calculated to develope  the red tis-
sues and therefore strengthen the system.   Thus a scrofulous 
29
taint may  be completely  worn out in a few generations.'
Loc. cit.
   If the preceding views be correct, the prospects respecting
scrofula will be rendered in some respects darker, and in some
lighter, than we have  been accustomed to  consider  them.
Whilst a source of danger not hitherto recognised is shewn to
•exist,  a  source  of hope is  equally established; no materia!
change, upon the whole, being effected,  except such as arises
from a more definite and correct knowledge of the grounds of
those dangers and hopes, and consequently a more reasonable
reliance upon the means used to  ward off one, and  to secure
the other.

   Pathology.—It may appear somewhat absurd  to  speak of
the pathology of a diathesis,  a predisposition;  but as this state
cannot be said to be one of pure  health or of disease, I do not
know any term better suited to express the idea.
   Upon looking at a person having a  strongly marked  stru-
mous diathesis, we are sensible  of an aspect of countenance
materially  different from what is common.   There is in cer-
tain parts an undue tumefaction;  the color of the face is either
not  sufficiently red, or there is not a  suitable distribution of
that color.   The cheek is perhaps sufficiently colored, perhaps
rather too much so over a certain portion,  but it is too cir-
cumscribed, or it is more or less marbled, especially after ex-
posure to the cold; the remainder of the face being disagreea-
bly pale.  The eye may be animated;  yet is there an expres-
sion  about it partaking of languor; the  sclerotic portion is
too  white,  or has a tinge of blue.   The skin may be soft or
harsh; in either case there is something of an unpleasant as-
pect.  The circulation is said to be 'languid'—a somewhat in-
definite epithet; according to my observation, the pulse is usual-
ly more frequent and weaker than usual; the digestive powers
are  either  weak  or irregular  in their action; the mind may
be dull or sprightly, not usually susceptible of long-continued,
close application to a single object of study.   The impression 
30
derived from the general appearance  is  that  there is  a defi-
ciency in the powers of the constitution.
  Look into the organization of the  body, and  you perceive
all those  parts of the body naturally of a red color to be less
highly colored than is usual; whilst the white  tissues are de-
cidedly augmented in volume.  This we  hold to be the char-
acteristic of a strumous diathesis, a want of balance in  thered
and white tissues, the latter predominating.  Naturally there
is a portion of the white tissues mixed with the rest,  and pos-
sibly the want of color observed in the last  may be owing to
the increased mixture of the white.  But in many portions of
the body there is no admixture of  red color; hence they  are
called  white tissues.   There is a difference of  opinion  among
physiologists as to the precise  manner in which these  white
tissues are formed and nourished.  The opinion that there are
two kinds of blood sent out by the heart,  one  red  and  the
other white—thkt these two bloods remain mixed  until  they
arrive at the capillaries and then separate,  the  red to  be dis-
tributed to the  red  tissues and then returned  to the heart by
the veins, the white to be distributed to the  white tissues and
then returned by the lymphatics, appears to be gaining ground.
Supported as this opinion  is by Graves and Stokes, of Dublin,
by Jackson and Gerhard, of Philadelphia, and many others of
the first men in the profession, and  plausible and captivating
as it is rendered by their  expositions,  yet I am not  prepared
to give into  it.   But as no practical views as to scrofula would
be affected by establishing the truth or error of  this opinion,
I shall not go into an examination of it.  Let it suffice to state,
that in healthy blood there are found,  in due proportions,  the
elements necessary to form and nourish every texture  of the
body,  and that  in  every  texture  there is an apparatus by
which these elements are separated and appropriated for such
nourishment; that the growth of any organ will  be  affected,
in a great degree, by the amount of such elements brought to
it by the blood-vessels,  and also by the healthy  condition of
the apparatus of assimilation.
  I do not remember any observations which go to shew any 
31
 difference in the relative size of the blood-vessels in persons of
 a lymphatic temperament, as compared  with  those of  other
 temperaments; but there is evidently a want of red  color on
 the surface of the body, and we might infer a similar state in
 the interior.   Andral and other physiologists have shown that
 in all alterations of the blood, as  one element is  increased
 some others are diminished; indeed, if it  had never been de-
 monstrated,  common sense would  have taught that it could
 not have been otherwise.   The amount of blood,  then,  re-
 maining about the same, and there being a want of those ele-
 ments necessary for the nourishment  of the red tissues,  there
 must be a superabundance of other elements, amongst which
 are those necessary to form the  white, which are accordingly
 developed in an inordinate degree.
   It will be seen,  then, that I understand the state  of predis-
 position to scrofula  to  consist  in  an  undue  predominance of
 the white tissues, attended and caused by an imperfect sangui-
 fication.

   Of Scrofulous Affections.—I have spoken of some affections
 as being much more apt to appear  in those of a strumous dia-
 thesis, and of others as being very much modified by that dia-
 thesis.   Amongst the  first,  I  would enumerate  intestinal
 worms,  pediculi, certain purpura eruptions,  particularly  of
 the scalp, enlargements of lymphatic  glands,  &c.   Amongst
 the latter, the exanthemata,  hooping  cough,  hydrocephalus,
 inflammations of any part of the body, in which the ordinary
 results of inflammation of such parts  follow,  unattended  by
 the formation of tubercular matter.  I remark  here, that I by
 no means attempt  to give a complete list of either class,  and
 also  that many affections not only are more apt to appear in
 strumous habits, but are also very  much modified by that dia-
 thesis.
  I do not feel competent to settle the long-mooted point, how
 worms first make their appearance in the intestines, and there-
fore shall not labor it.  We know that they are very  apt  to
appear in children  of a lax fibre,  of a pale sallow complexion.
                           3 * 
32
tumid abdomen, &c.   We know, too, that such  children  are
apt to have an undue amount of mucus in the bowels.  Now
whether we believe that worms are introduced from without,
in embryo or otherwise, or that they are formed within by
some kind of spontaneous generation, we know that in such
cases  there is a great aptitude for their fecundation and multi-
plication, and though we may  expel vast numbers of them,
they are continually apt to reappear in  equal numbers.   We
are not so apt to consider pediculi as of spontaneous produc-
tion, yet we know that in some children it is almost  impossi-
ble to keep clear of them.  In such there is very commonly a
dirty, purpuraceous state of the scalp, which we may consid-
er as bearing the same relation to pediculi, as mucus in the in-
testines does to worms.   I am inclined to think  that whatever
is true as to the production of worms, is also true  as  to  the
production of pediculi.
   Another  affection extremely  apt to appear in children of
a strumous tendency, is enlargement of the lymphatic glands,
particularly  those of the neck.  I apprehend these  frequently
take place without inflammation being present, being caused by
acrid  matter  taken up  from some scurfy eruption upon the
head and carried to them by the lymphatics,  causing irritation
there.
   If I mistake not,  M. Lugol dignifies these  enlarged glands
as 'cervical  tubercles?  I infer this from the  general  tenor of
his remarks,  as well as from some special remarks, in which
he speaks of their being  dissipated  in  a period  which we
cannot conceive sufficient to remove tubercular matter.  See
page 170, op. cit.   At other times  these enlarged glands  are
truly inflamed.
   The eruptive fevers are all seriously affected  by  the scrofu-
lous diathesis; measles and small-pox perhaps to a greater de-
gree than the others.  It is mainly owing to this diathesis that
a very common  remark  as to measles is so true, viz:  that
measles is not so dangerous in itself, as it is the source of other
fatal diseases, as phthisis, &c.   Yet this diathesis renders the
treatment of measles itself more difficult, and its termination 
33
more doubtful.   Hooping cough is another disease often  ren-
dered  tedious  or fatal  by  a predisposition to scrofula,  and,
like measles, frequently  lays the foundation for phthisis,  or
some other incurable disease.
  But  there is perhaps no  disease where complication  with
scrofula  is more to be dreaded than syphilis.  If attended  to
promptly and  treated with great caution and discretion, the
patient may recover without much permanent  injury; but if
suffered to progress to any extent,  or if  due caution in the
treatment be not observed,  there is no telling the amount  of
wretchedness which may result.  Several circumstances con-
spire  to render  this complication a source of great mischief.
1st. However flippantly  we may talk of the ease with which
we can distinguish one disease from another, it is sometimes
very difficult to distinguish scrofula from syphilis; so much so
indeed, that the highest authorities in our  profession have ac-
knowledged that they had confounded them, and treated one
when  they  thought they were treating the  other.  Even Lu-
gol, who, from his almost exclusive  devotion to the study of
scrofula, might be supposed to know it well when he saw it,
acknowledges  his occasional mistakes, and that his diagnosis
was only rectified  by the effects of medicines.  2d. There is,
to a very great extent, an antagonism in the treatment of the
two diseases.  Thus if a particular  symyptom  be referred to
one disease,  and treated accordingly, when in fact it belongs
to the other, we not only do no good, but very probably we
do great harm.   3d. Although we discriminate correctly and
appreciate properly what is due to each  disease, yet  there is
great difficulty in adjusting our treatment so as  to bear in due
degree upon each.
   The scrofulous diathesis, then, appears to modify most  other
diseases, by  rendering them  either more suddenly fatal, orelse
more tedious in their course, more difficult of medication, and
more doubtful as to the  result.  In post-mortem examinations
 of such  cases, little or no difference  will  be observed  from
 what occurs in such diseases, ending fatally in healthy consti-
 tutions. 
34
  Of Scrofula.—I have defined scrofula to  consist in a de-
posit of tubercular matter in some portion of the body.   I have
defined tubercular matter to be a pale, yellow or yellowish gray,
opaque, unorganized substance.   It is true I have  seen con-
siderable scrofulous  disease, and made a good many dissec-
tions of bodies  which  had died of that disease; but I by no
means feel competent to settle various points of its  pathology,
upon which men, better able to judge and  better suitable to
observe, differ so widely.  I shall therefore  briefly  state my
opinions, and let them pass for no more than  opinions.   I con-
cur mainly with Dr. Carswell, that tubercular matter  is de-
posited as a morbid secretion, in a state approaching solidity;
that inflammation is not essential to its formation, although it
many times precedes its production, and conduces to it; that
in very many cases inflammation is caused by  the presence of
tuberculous  matter; that  there is no disposition or cause in a
mass of tubercles to soften, but that that effect  is produced by-
causes extraneous  to it; that this softening commences at the
circumference,  not at the  centre.
  It is known that M. Lugol thinks tubercles true parasitic
animals, produced  probably in the same way as acephalocysts.
Owino- to the great experience and opportunities for observa-
tion enjoyed  by that great man,  his opinion  is certainly en-
titled to great weight.   But there are  some  circumstances at-
tending tubercles which, although not conclusive, are yet suffi-
ciently potent in my opinion to render that explanation impro-
bable.  In the first place,  acephalocysts do not have a decided
disposition to induce inflammation in parts where they are lo-
cated.  Secondly,  when inflammation is set  up in their imme-
diate vicinity, such  inflammation  produces  no effect upon
those parasites.  On the contrary,  tubercular matter  has  a
strong tendency to produce inflammation, and that inflamma-
tion reacts powerfully  upon the integrity of the  tubercular
mass.
  Inasmuch as we first recognise  tubercular  matter  in  the
form  of semi-solid points,  we are  justified in concluding that 
35
it is deposited in that form until it shall be detected in a more
nascent state.
  In addition to observations made by others, which go to
show that tubercular matter does appear without an apprecia-
tion of previous inflammation, I would observe that I have seen
divers  instances in which large numbers of  small  tubercular
masses  were  scattered over the peritoneum,  some of which
were surrounded by areola? of distinct inflammation, whilst
others  had not the slightest appearance of that state.  Now,
it is clear that if inflammation is essential to the formation of
tubercles,  it must  have subsided  before  death in the latter
mentioned masses.   But inflammation is not so apt to appear
about very small masses,  as about those of some size.  But
why should tubercles be caused by inflammation  exclusively,
and yet that inflammation disappear to  be  subsequently re-
produced by the  effect of its previous  action.   The theory
does not work well.  Besides, tubercles  are frequently found
in situations in which no inflammatory action had ever been
suspected, and which exhibited no evidence of its having ex-
isted, if the tubercles themselves are excepted.
   Although inflammation is not essential to  the production of
tubercles, yet  it frequently  precedes  that  production,  nay
lays the  foundation of that action, upon which their produc-
tion  depends.   We must keep in our minds the difference be-
tween  concomitants,  and  cause  and  effect;  also between
causes which act occasionally, and those which act universal-
ly.   I will exemplify my meaning in reference  to inflamma-
tion by the aid of syphilis.   A certain number of persons pre-
disposed to scrofula contract syphilis, and afterwards scrofula
is developed in them, probably its development is occasioned
by the effects produced by the syphilis, which may have been
cured,  or may still exist.  Here we may say truly that syphi-
lis is the  immediate  cause of scrofula.  But not every man,
not even a majority of those who have,  or have had syphilis,
are afflicted with scrofula.  Again, a majority of those affected
with scrofula have  not  had syphilis; then there is no necessary
connection between them.  Precisely so as regards inflamma 
36
tion.  It may precede scrofula, may produce a state favorable
to the development of it, but it may exist without  being fol-
lowed by scrofula, and scrofula may exist without being  pre-
ceded or attended by it.
  But  scrofula frequently gives  rise to inflammation.   When
a tubercular mass has acquired a given size, irritation is set
up in the contiguous structures,  which is sooner or later fol-
lowed by inflammation, just as it  would  take place  if any
other foreign body were introduced.   The object of this pro-
cess is to expel the offending  body.   The  description given
of scrofulous inflammation by Mr. John Burns, (but  what  I
have proposed to call tubercular inflammation,) appears to set
this matter in the proper light.  'Scrofulous inflammation,  says
he, is marked by a soft swelling of the affected  part,  which
very frequently is one of the lymphatic glands.   The covering
or coat of the  gland becomes slightly  thickened, and its sub-
stance more porous and doughy;  the  swelling increases  and
the doughy feel changes  by degrees into that of elasticity  or
fluctuation, and a firm  circumscribed, hardened margin can
be felt round the base of the tumor.   If at this time an incis-
ion or puncture  be made, either  no matter  or very little is
evacuated;  the lips of the wound inflame and open, displaying
a sloughy looking substance within; and between this  and the
skin a probe can often be introduced  for some  way all around.
If, however, the disease should have advanced further,  there
is  very  little  elasticity in the tumor; it is  quite soft,  rather
flaccid, and fluctuates freely; the skin becomes of a light pur-
ple color, and small veins may be seen ramifying on its sur-
face.  Sometime after  these  appearances,  the skin becomes
thinner at a particular part, and here also it is generally  ren-
dered of a darker color.  It afterwards bursts, and discharges
a  thin fluid,  like whey, mixed  with a curdy matter  or  thick
white flocculi.'   This description explains satisfactorily sever-
al points of the pathology.  1st. The tubercular mass,  being
a foreign body, causes  irritation and inflammation for  the pur-
pose of expelling such body.  That inflammation,  of course,
begins tathe surface of the body to be  expelled.  A  fluctua- 
37
tion occasioned by the presence of pus  around  the mass is
felt, and the hard edges marking  the  bounds of suppuration
are evident.  But if an incision be now made, very little  pus
Ls discharged; but there is a sloughy looking substance within,
between which and  the skin a probe can be introduced for a
considerable distance.  Why this?  Because although little mat-
ter has been found, yet that little is spread all over the surface of
the tubercular mass; therefore  a probe can be passed  freely
round it.  But when the disease is farther advanced, when the
surrounding parts  have  had time to pour out fluid sufficient
to soften the whole  mass, then fluctuation is free, and the pus
when discharged is mixed  with  softened tubercular matter.
   Laennec  taught that tubercles commenced softening in the
centre; but as his observations were  made  upon the lungs,
his facts and observations  admitted of two explanations, either
of which might  be true; to-wit: upon making a section of the
lung, various branches of the bronchial  tubes and  air  cells
would be divided; some of these might contain solid tubercu-
lar matter, others might contain a considerable portion of the
same matter, with  the centre  containing  more or less fluid.
 His explanation was  that the whole had  been solid,  but the
 tubercles had begun to soften in the centre.  Dr. Carswell ex-
 plains it differently; that the deposit of tubercular matter com-
 mences on  the mucous surface of the vessels and air cells;
 that, as fresh portions  are deposited,  that  first  excreted  is
 forced nearer to the centre,  until the vessel or air cell, as the
 case may  be,  is  completely filled; that  when this cavity in
 the  centre is observed, it  is because the cavity  has  not yet
 been filled;  that instead of being  in a  more  advanced  state
 than those  which are filled with solid tubercles, it is  in truth
 less advanced.   This appears  to me the  more rational  solu-
 tion, the more  especially  as tubercular masses found in the
 brain and cellular substance do not show  this  disposition  to
 soften in the centre.  It is not denied that occasionally spaces
 may be found in large tubercular masses; but these  depend
 upon deposits beginning at various points and  approaching
 each other  by continued aggregation. 
38
   There is no structure of the body in which  tubercles  may
 not be deposited.   The mucous membrane lining the air ves-
 sels, the parenchyma of the  lungs,  the  mucuos and  serous
 membranes generally, the cellular tissue, the brain and nerves,
 the  bones, any or all, may be invaded by them.

   Treatment during  the state of predisposition.—We are not
 very apt to be consulted during this state,  unless in families
 in which several of the members have already fallen  victims
 to some  form of the disease.   Then there will probably be a
 very decided tendency to the development of the  complaint.
 I doubt the propriety of giving much  medicine during this
 state;  but  cases may  occur in which more  or less  will be re-
 quired.  But much can be done to.ward off the disease  by
 due  observance of hygienic rules.   Two things are of para-
 mount importance.   1st.  To keep the digestive  organs in a
 state of  health.  2d.  To supply them with  a due quantity of
 digestible nourishing,  not stimulating food.  One  very  potent
 means of keeping the  digestive organs in a healthy  state, con-
 sists of a due amount of exercise taken daily in the open air,
 in the  blessed light of heaven.  It will not  do that a  given
 amount be  taken  every  week or  month; it should be taken
 every day, at least every day which ordinary prudence will
 permit going .out; not less than three or four hours daily of
 such exercise as can be borne  without  fatigue.   It may be
 said, and there may seem to be reason in it,  that the  patient
 is unable to bear the desired amount of exercise; but much of
 this  depends on  a sufficient effort not being made.   Manv
 persons can go abroad very well, who are fatigued in return-
ing home.  We can all bear more fatigue when  in pursuit of
anything that interests or amuses us, than  when we have no
object in view.   We should, therefore, give our patient every
chance to profit by his exercise.  It should be made to inter-
est and amuse him.  Let him labor moderately at any  handi-
craft for which he may have a taste; work in  a  garden- en-
gage in botanical or geological  explorations in his neighbor-
hood; hunt game; anything, which will cause him to spend a 
19
considerable portion of his time upon his feet and in the open
air. This will invigorate his muscular system, his circulatory sys-
tem, and indeed all the organs of the body.  Let him by no means
forget that the light of the sun is a powerful agent in the pre-
servation of health.   Most persons are fully  aware  that the
light of the sun is indispensable to the  health of vegetables,
but many seem to  think that animals can do very well without it.
I will here relate a case, the parallel of which may be found al-
most any day when search shall be made.  Some years ago,
I had a child born during the fall.  My wife continued very
much indisposed  during  the  winter;  so much so, as to keep
the house.   Our family room was quite dark.  In consequence
of the  child being confined so long without exposure to light,
he was very fair  and delicate in his appearance, yet sufficient-
ly plump and lively, indeed having every appearance of good
health, except a suitable complexion.   Having noticed  this,  I
caused him to be  taken into the open air every day when the
weather  would  by  any means admit.  His complexion soon
began  to  improve,  and in a month or two he had as  rosy a
face as there is any need of.  Butchers,  too, are aware that
animals when  fattened  in dark places furnish a meat much
fairer than when  fattened in the light.   Light, then,  is as ne-
cessary to the  health  and  perfection  of animals as  it is to
those of vegetables.  In  his labor or exercise, let him  avoid
exposure to cold  damp air whilst he is in a state of inactivity,
©r insufficiently  covered;  especially let him avoid getting his
feet damp and cold whilst inactive.   A man might wade in
water for  hours without inconvenience, provided he dry and
warm his feet when he quits, whereas one-fourth or one-tenth
•f the  time spent standing upon damp cold ground  may give
an attack  of colic, of pleurisy, or some other serious disease.
In the first instance, the  warmth  and  vigor  imparted  to the
body by the exercise of walking enables it to ward off  the in-
fluence of cold, but in the latter case there is no such prophy-
lactic.   Let him sleep in  a dry, large chamber of suitable tem-
perature.   Excessive cold, say from  15° or 20° downwards,
skould  be avoided, especially during sleep? but even thattem-
                             4 
40
 perature  may  be safely borne  when  due exercise  is taken.
 Let his mind be kept in activity, but not harrassed long at any
 one time, and as pleasantly occupied as circumstances will ad-
 mit.  If the family has suffered from scrofula, or indeed  from
 any single disease, his mind should not be allowed  to  dwell
 upon such occurrences.  All  possible   means  should  be re-
 sorted to to divert his thoughts from cases of a fatal character,
 which  may have occurred in  the family.   He should  never
 hear any remark as to his  resemblance to any member of the
 family who may have died. He  should never be  permitted
 to  talk about the ill  health of the family.  On the contrary,
 he  should be encouraged to engage in pleasant enlivening con-
 versation. Some forty years  ago, it was usual for young peo-
 ple of both sexes to romp a good deal.   It very rarely, if ever
 happened, that this was carried to such excess as  to be liable
 to cause severe cold, as is too frequently the  case  after  dan-
 cing.  It was  more enlivening and less dangerous  than this
 latter; and really 1 do not  know that it was less genteel  than
 waltzing.  Gentility,  however,  has put  its  ban on  romping,
 without furnishing us with  anything so good, at least so well
 adapted to preserve health in  the present  state of  society.
  Nothing perhaps is of more importance in  the preservation
 of health, than a due regulation of the bowels.  Nearly every
 function of the body is to  be  performed  at stated intervals.
 Atsuch intervals there is almost always a distinct prompting on
 the part of nature, if not a full performance.  The intervals be-
 tween the times for expelling the feces appears to  have  been
 fixed by nature at twenty-four hours.   So true is this,  that it
 may be said to be universal; and it is  extremely   uncommon
 that there is any exception   depending on  nature.  Every-
 man, who has not by his own  neglect or mismanagement bro-
 ken up this circle of action, feels at a given hour  every day
 an inclination  to pe-form that  act; and so long as  he attends
 to the promptings of nature, so long his bowels will remain
 regular.   Then it is a  matter of great importance  that all
young persons should be impressed with the absolute necessity
vi attending to these promptings, and the  preservation of this 
41
regularity.   This is the more especially true as regards those
who have any tendency to delicacy of health.  All the func-
tions of the body are more or less intimately associated; the
derangement of one having a tendency to derange some other;
and the preservation or re-establishment of one having a like
power to preserve or re-establish the healthy action  in some
one or more.  But there  are exceptions to the universality  of
this law, perhaps, however, depending on some degree of dis-
ease.   If disease can be detected, that must be treated  ac-
cording to  its nature; but if no disease can  be ascertained,
we must address ourselves to remove the irregularity.
   We will  suppose it is a child, who is troubled with costive-
ness.   It will many times be sufficient  to rub the hand gently
over the abdomen for ten or fifteen minutes,  three  or  four
times a day.  If that should not suffice,  then an injection of
warm water, administered daily, at a given hour, will  answer.
After a few days the injection may be delayed somewhat be-
yond the usual hour,  (but the  frictions continued,)  to ascer-
tain the impression made  upon the habit.  If necessary, the
same treatment may be  resumed.   These means  alone, in-
deed the frictions upon the abdomen alone, will very frequent-
ly suffice;  and I hold it a matter of  great moment  to restore
healthy  action in the organs by treatment purturbating in the
least possible degree. If the patient  be of age sufficient  to
understand directions, he should be  taught  to  perform  these
abdominal   frictions for himself, and then to retire at a stated
hour  every  day,  and endeavor to procure  a motion from his
bowels.  He must be impressed with the great importance of
his perseverance and success  to his  subsequent  health.  It
must be confessed that it is very difficult to make  children
and young persons appreciate the vast importance of success;
but on the  other hand, as the habit of costiveness is not usual-
ly inveterate in  such patients, less time is necessary to secure
success.  From much experience, I am fully satisfied that this
alone is sufficient to break up any habit of costiveness, which
does not depend upon disease.   1 have never known a failure
where a fair trial had been made. 
12
  Besides securing a healthy condition of the chylopoietic or-
gans, we must see that they are supplied with a due quantity
of suitable food.  There is  something peculiar  about many
stomachs which will enable  them to digest  particular articles
of food, which are usually found difficult of digestion;  or, on
the other hand, incapacitates them  from  managing articles
which are usually considered easily digested.  Such peculiari-
ties ought  always to be ascertained and attended to.   Any-
thing which disagrees with the stomach is to be avoided, no
matter how easily it may be digested by others; and occasion-
ally an article, which  to most stomachs is highly  indigestible,
may be taken without injury, or even with  advantage.  Bear-
ing these remarks in view, most of our vegetables, milk,  eggs
boiled so that  the  whites  only  are done, nearly  all  flesh
usually  eaten  as food  may be  taken  in  moderation.   All
flesh should be cooked so as to be juicy, and not highly  sea-
soned; none  that is dry or crisped should be touched.   Sau-
sages and all high-seasoned gravies should be prohibited with-
out qualification.  Minced pies, and indeed pastries in general,
should also be under ban, rice and bread puddings  being ex-
cepted.
  Important to health as is a proper   condition of the  chylo-
poietic viscera,  that of the skin is no  less so.  Hence great at-
tention must be paid to it.   Flannel  should be worn next to it
at all seasons.  In summer this may  be thought oppressive, or
at least not necessary.  But nothing is more effectual in  pre-
serving the skin in a healthv, perspirable condition.   Although
it may be somewhat unpleasant in very hot weather, yet that
is precisely the kind of weather in which free perspiration is
liable to  occur,  and when it. has taken place much injury is
frequently  done by a sudden impression of cold.   The cloth-
ing being separated from the body for a short  time,  becomes
sensibly  cooled,  and upon reapplication,  if it is of  materials
which conduct heat  readily, communicates  a sensation de-
cidedly chilly,  and that to  a degree  sometimes  sufficient  to
produce  disease.   But the  flannel protects the body not only
against sudden  vicissitudes  of weather,  but also  against  such 
43
occurrences as that just mentioned.  The surface of the body
should be kept clean.   Bathing should be used two or  three
times a week, or even every day.  Scarcely any one who is
not diseased  will be injured by the cold bath when prudently
used.  A cold bath should never be used when  the body  is
fatigued  by  long-continued  exercise.   In  cases now under
consideration, it is doubtful whether it should be used at any
time when there is free perspiration or the body much heated.
The danger will consist in  the suddenness of the shock, and
dubiety  of reaction.  As a  general  rule, the application  of
the water should be very short, as in the shower or plunging
bath; after such, the reaction is much more  apt to take place.
It is thought, too, that salt  baths are less liable, ceteris paribus,
to be fol'owed  by imperfect reaction.   One general  remark
should always be held in remembrance,  viz: if, after the bath,
a pleasant sensation of warmth ensues,  benefit  may  be ex-
pected from  it: on the contrary,  if the  body feels chilled and
uncomfortable,  no good, but injury, may be expected from a
continuance  of the practice.
   Daily  friction of the surface  is  another  important means of
preserving  it in a healthy condition.   By  friction, much of
the  old  dry cuticle is removed, and thereby a free elimination
of the  insensible perspiration allowed.  The vessels of the
skin also are thereby stimulated to healthy action.
   It only remains that I say a  few words as to climate.  We
shall generally have to treat the disease where we find it; yet
all places are not equally  favorable to  the  successful  treat-
ment of this  disease.   Hence   when circumstances admit of
change of location,  it may occasionally be  made with great
advantage.   As a general  rule, a situation  having a dry,  sa-
lubrious air  is to be preferred.  Some  obseivations recently
made  would seem to indicate that a location where intermit-
tent fever is common, would  be  advisable for phthisical  pa-
tients; and if so,  it would appear probable that other varieties
of scrofula  would also  be benefitted  by the same location.
This would seem opposed  to what is  pretty well ascertained
 ;ss to scrofula.  One or the other must be wrong.    Nature ner-
                            4  * 
44
 er teaches one thing and philosophy the opposite.   I am there-
 fore inclined to think that the observations referred to have
 been hastily and imperfectly made,  and therefore will be set
 aside when more extensively and thoroughly tested.   Scrofu-
 lous persons do not generally bear cold very  well, therefore
 removing a few degrees  south,  taking care to secure a dry
 and healthy location, may be safely advised.   Change of  cli-
 mate, like mercury, may be the  means of doing  much good
 when used with  discrimination, and therefore  within due
 bounds;  but will almost certainly do much harm  when  car-
 ried to excess. Damp locations must be avoided.  It is well
 known that both damp cold air and  damp warm air, are much
 more oppressive than dry air at  the same temperature.
  From  what has just been stated, it would  appear that be-
 cause a location in Florida benefits  a patient  from Virginia, it
 does not follow that  it would be  equally beneficial  to one
 from Maine or Canada; or that the Virginian would have been
 more, or as much benefitted by a similar location  in the West
 Indies/  To secure the best result from change of climate we
 must judge of the  capability  of each patient to bear  that
 change, and to be  benefitted by  the air of the place to which
 we  send him. Some will require a greater change than
 others.   I think less discrimination has been exercised  on this
 point than is desirable.

  Treatment  of Scrofulous Affections.—It will most frequent-
 ly happen that we will not be consulted until  the  period of
 predisposition  has passed away, and some of  the thousand af-
 fections which go under the name of scrofula  have made their
 appearance.  Although scrofula  properly so  called,  at least
 such as I have defined it, may  not be present, yet it is evi-
 dently approaching.   This is the time to  do good,  if ever.
 To  do good, it is necessary to take a very patient and  scruti-
 nizing view of our patient's condition.   In common language
 he has scrofula, but cases of scrolula may differ as widely as
 cases of  fever.  Here we find the great difficulty  in  arriving
at just conclusions.   Scrofula  has been considered a  specific 
45
disease, and the profession have been looking out for a specific
remedy; and in pursuance of that object, have  thrown com-
mon sense overboard, and put themselves under the influence
^of old wives'1 fables.''  Hence the vacillation in the estima-
tion of divers remedies at various times.   One  patient was
benefitted, possibly cured, by mercury, and forthwith mercury
was the catholicon.  Soon after, another was  injured,  or at
least got worse during the use of this remedy, therefore it was
anathematized.  Anon cura famis was all the rage.  If indeed
it  had turned out cura  it had been well.  But alas! the disease
proved no more amenable to fames than to mercury.  It were
bootless even to enumerate all the humbugs (to use a common
political term,) played off upon the profession from the days
of mercury down  to those of iodine and walnut leaves.  To
my mind  it appears pretty clear that much of the reputation
which each article in succession enjoyed,  was due to the im-
agination of  the man who employed it.  And yet I doubt not
that many of these panaceas did in truth do good and cure
patients, when the disease ivas adapted to  the remedy; for I doubt
very much whether the time has yet arrived when the remedy
is  adapted to the disease.
   It would be endless  to take  up all the varieties of scrofulous
affections in  detail; I  shall therefore mention only a few.   I
will suppose a case, in which there is considerable swelling of
the cervical glands,  attended  by bloated face, thickened up-
per lip and of the  '•columna alaeque nasi"1 and tumid abdomen.
These cervical glands  may be inflamed, or they may be only
irritated by acrid matter taken up from  the scalp or some ad-
jacent part.   It is evident, however,  that unless something is
done to improve the health, serious disease will ensue.  A lit-
tle examination will shew us that the digestive powers are de-
ranged,   and  that  sanguification is  imperfectly  performed.
Mucus or worms,  or both, may be oppressing the bowels, or
they may be costive, the liver  acting imperfectly; or there
may  be  gastric derangement, causing a  secretion of tough
glairy phlegm, or of salt or acrid matter,  often  attended by
the presence  of tough phlegm about the larynx, which occa- 
46
sions a disposition to cough frequently, and as it is separated
with difficulty, retching is often produced.  These secretions
also frequently produce flatulence of the stomach, cardialgia,
and tenderness of the epigastrium.   In any of these  events,
some purging is necessary, and mercury in some form should
be an ingredient,  used more or less frequently for that pur-
pose.   Iha\e enumerated mercury as one of the prominent
causes of the development of scrofula.   Some may think,
therefore, that there is an inconsistency in recommending itas
a reme'.'v: and I will not deny  that the  e may be extreme
cases in which, owing to idiosyncrasy, no amount of mercury
can be taken without danger.  Indeed we ought always to be
on the loo'c out for such cases among scrofulous patients, be-
cause of  the great injury which may result from irregular or
excessive action  of mercury.  But I speak of the overwhelm-
ing majority of such cases.  Lawyers have a maxim 'that the
abu^e of anything is  no argument against  its proper  use.'
The principle is as true in medicine as it is in law.  The pur-
gatives should be repeated at  suitable  intervals, until the
stomach  and bowels shall be re'ieved of worms or mucus; and
until they, together wiih the other  digestive  organs,  become
in a healthy  condition.  We shall many times  receive  much
advantage by premising two or three emetics,  or by alterna-
ting them with t!:e purgatives.  As an emetic in such cases I
prefer ipecac to  tartar emetic.  This course alone will some-
times suffice, when the diathesis  is  weak and  application  is
made early.   And such, I apprehend,  has been the  cause of
the credit that mercury and  emetics  have  respectively  en-
joyed at different times in the cure of scrofula.
   Here,  I will say a word as to  the  employment of emetics
and cathartics.   A number of physicians, respectable both as
to nuuiocr and talents, depend almost exclusively upon emet-
ics as a remedy for scrofula.  Of these, one portion give  them
at shorter or longer intervals, almost indefinitely,  or at least
till the disease gives way, or else they arrive at the conclusion
that the disease is incurable.  The result  of this course  is
sometimes very fortunate, especially where  the case is  not a 
4?
severe one, and the stomach recovers  pretty  well  from  one
emetic to the other.   If, however, the disease be grave,  and
do not yield readily to emetics, and they be repeated at too
short intervals, considerable irritability of the  stomach  may
be induced,  which will add greatly to the trouble in the sub-
sequent management of the disease.  Another portion of those
who rely exclusively upon emetics, give them until they pro-
duce  '•yellow, green or blue bile,"1 that appearing to be the object
of their administration.  My own belief is, that when carried
to the extent of producing green or blue bile they have  been
pushed too far.  I do not say that when green or blue bile is
produced  by vomiting, such emetic was  improper.  I know
such is not necessarily  the case.   Such bile is an evidence of
irritation, or some unhealthy action in the liver or prima)  viae,
and an emetic may discharge from the stomach the offending
cause; or it may  communicate an  impression to  the  liver
which shall tend to  correct  that irritation there.   What I
maintain is, that when  this result  takes place as the  effect of
vomiting in such cases, we  should not look upon it as a fortu-
nate  result, Jbut  the  contrary.   Therefore I would in  such
cases, so far from being encouraged to persevere in their use,
feel myself called  upon to suspend them,  and  use  means to
remove the irritation  which I had caused.
   We are directed, too, to use purgatives  until the  feces be-
come of a healthy character.  But it  unfortunately  happens
that purgatives, like emetics, are not free from danger in  their
indiscriminate  employment.  'Stools of  considerable consis-
tence and of a dark green color' are considered as a favorable
result of mercurial cathartics.  This is true, provided the 'dark
green' is of the right color, and the stools composed of bile.
But this description of such stools will not secure the young
physician  against an  error of momentous consequence.  I
have seen physicians of considerable age and experience per-
severing in the use of mercurial purgatives, when there was
a great quantity of dark green  mucus  discharged,  (the  color
being  something darker than that of Jamestown weeds and
•f a shining appearance,)  wondering all the time that the pa- 
48
tient should continue to grow worse under 'such good mercu-
rial purging.'  This kind of purging I hold to be caused by ir-
ritation.  It takes place when no calomel  is given, to be sure,
but is likewise frequently produced  by it.   In the employment
of mercury in this disease, we must  avoid two things,  too
much irritation of the bowels, and the constitutional effects of
mercury.    It  is only  when  such  effects  follow its use,
more especially the latter, that it acts deleteriously in scrofu-
lous habits.
  If the disease be somewhat grave,  it will not yield to sim-
ply putting the digestive apparatus in good order.   It will  be
necessary to keep  it so  for a considerable  period,  and  in the
mean time  correct  and invigorate  various other  functions.
To assist us in this,  we shall need, among  other things, tonics.
Various articles of  this  class have been, at different times, es-
teemed, if not as specifics in this  disease, very nearly  ap-
proaching that character.   Although we may  reasonably  be-
lieve that articles of this class are occasionally of much bene-
fit,  it would be difficult  to point out any peculiar qualities in
any one article, which would indicate its right to be consider-
ed greatiyr above others as a remedy  entitled  to a  monopoly.
Bark and iron are perhaps more to  be relied on  than  others,
unless indeed we put iodine in the list.  Bark was at one time
very  popular,  but  like  other articles,  being taxed  above its
ability,  it fell into  disrepute because it could not  accomplish
imposibilities.  Yet is it a valuable  tonic in such cases as have
been duly  prepared for its use,  by  properly  correcting  the
condition of the digestive organs.  It, or rather quinine,  should
be given in moderate doses, say two grains for an adult three
times a day, an hour before each meal,  and  continued for a
considerable time.  An occasional emetic or cathartic  should
be  interposed, as  may be indicated by  the condition of the
stomach and bowels.   Iron is a tonic which appears well suit-
ed  to many cases of scrofulous affections.  In cases in which
worms  or mucus have loaded the bowels, and  have to a con-
siderable extent been evacuated by purgatives, iron is particu-
larly well suited to strengthen the bowels, and prevent the re- 
49
accumulation of such sources of oppression.  Indeed, tf itself
it will frequently expel the worms.  Hence, with  some phy-
sicians, it is  highly esteemed a vermifuge.  As there is most
commonly an imperfect sanguification, iron, by furnishing an
ingredient necessary to the blood,  may be considered as an
article of diet, as well as a tonic.   Of the preparations of iron
we should choose one, the dose of which is small,  which pos-
sesses considerable activity, which keeps well, which  is not
apt to oppress the sfonuu.-h, and  upon  which the stomach acts
readily.  These qualities are possessed in a high degree by the
Pilules Ferri Carbonatis, U. S. P., or VallelCs Ferruginous
Pills.  Given in the  quantity of 10 to 30  grains  daily,  they
exert a most invigorating effect upon the health, increasing the
amount of coloring matter in the blood, they favor the devel-
opment of the red tissues, and of course  improve  the  com-
plexion.   It is true that  Dr. Elliston,  of London, has  used,
with much benefit, the Rubigo Ferri in doses  of from  3ii. to
 %\., but it does appear to me that this must be a very disgust-
ing mode  of using a  good article, and one  very much  calcu-
lated to oppress the  stomach.  I think that when medicine  is
to be taken for a long time, it is very important that it be ren-
dered  as little  disagreeable as  possible.  1 believe that un-
pleasant sensations occasioned by the administration of medi-
cines,  are a great drawback upon the  ability of the stomach
to act upon them beneficially.  After all, the benefits resulting
from medicine depend, not so much upon the quantitv taken
as upon the mutual action and reaction of it and the stomach
on each other.   When in the course of treatment  it becomes
necessary to use an  eccoprotic,  I have given with much sat-
isfaction a pill composed  of Sulph. Ferri  Iliera, pier a,  each
 3ss., jalap, myrrh, each 3i., made into pills of common size,
of which  two  or three may be  taken  at night.  Whilst these
pills co-operate in the general plan of treatment, they appear
to me to possess one very important quality, that  instead  of
requiring the dose to be increased after being some time used
it can be gradually  diminished, and at length  altogether dis-
pensed with.   Great diversity exists bolh-«*-te die usefulness
•> 
50
of iodine in scrofulous complaints and as to its mode oi action.
I am disposed to place it among the tonics,* when used in such
a manner as to be serviceable.   Hence  Lugol and some  others
declare that during its administration  the  appetite  improves
and the body increases in weight.   But  we  are assured  by
others that it produces irritation of the stomach and emacia-
tion of the body.   I  apprehend that at this  day  there   is  no
difficulty in believing that any article may  be so managed  by
different  persons as to produce dissimilar or even opposite  ef-
fects.   I  believe that much  of the discrepancy  of testimony
as  to the effects of iodine,  is due to the different modes in
which it is used.  I can well believe that,  used in the  quanti-
ty of a grain a day, it may  act as a tonic, and in the quantity
of five or six grains daily it may act as an irritant.   To set
this  matter in a proper light,  I  have   thought  it  worth  some
trouble to collate a number  of formulas  for the administra-
tion of iodine,  and  to calculate the quantity of that article
given for a dose according to  each formula.   I  shall  premise
3i. of a watery solution  dropped from a two ounce  vial gives
about sixty  drops, of an alcoholic tincture about 140 drops,
of an ethereal tincture about 1 80 drops.   Varieties  to a con-
siderable  extent will  take place, occasioned  by the purity of

  ♦Note.—Some physicians  think that the tonic effects of iodine are  ex-
erted principally or wholly on the absorbents, thus enabling them to take
up the morbid deposit.   Others say, that this effect is produced by its  ac-
tion as an alterative, the action of the absorbents being not  only increased
but altered.  Others  again consider it as a deobstruent.  I certainly think
an appropriate name a very important thing;  but  unfortunately in  medi-
cine, as in other departments of philosophy, men  will sometimes express
the same idea by different words, and sometimes different ideas by the
game words. It is very important,  then, that we understand correctly the
idea intended to be conveyed.   My  idea then is, that administered in suit-
able doses and under appropriate  circumstances,  iodine increases the ap-
petite and promotes digestion, furnishing a more  healthy chyle; that, in
consequence, the various  organs of the body are enabled to take on a more
healthy action;  that the nutrient vessels being furnished with a better ma-
terial for assimilation, are also enabled better to select the most appropriate
molecules.   As a consequence of the restoration  of  healthy  action, any
effete or deleterious corpuscles, deposited in the texture, are taken up and
removed.   In this way it  may be held to act both as an alterative and a de-
obstruent; but I conceive that its whole action may be referred to its tonie
powers. 
51
the alcohol and ether, also by the size of  the rim around the
mouth of the vial, and especially by the fluid running back so
as to touch the neck of the vial before it drops.
  No. 1.  Pills of iodine.  # iodini,  J to  1 gr. twice a  day.
(Appendix to  Lugol on Scrofula.)
   No. 2.  R- iodini, gr. ss.   (Pereira.)
   No. 3.  Tincture  of Iodine.   R- iodini  f i.,  rectified spirit
fSjxvi., m. v.  to f3ss.,  gr.  i to If.  (E. and U. S. P.)
   No. 4. R- iodini 9ii., S. V. R. ^i., gtt.iv. x. xx. ter. die, gr.*,
 |, *.  (D. P. and Magendie.)
   No. 5. ft iodini 3ii., S. V. R.,  § i. spt. lavend. 3n., gtt.  10,
 20, 40 thrice  a day, gr. §, f, 1*.  (Ellis' Formulary.)
   No. 6. Ethereal  Tincture. R- iodini, gr. vi., ether, sulph. 3i.,
 dose, gtt.x. bis die, gr. %.   Ellis says  30  drops of this  tinc-
 ture contain gr. i. iodine.   Appendix to Lugol says, 10 drops
 contain gr. i. iodine.  Ellis is right, whilst the appendix has mis-
 taken drops for minims.
   No. 7.  Compound Tincture Iodine.  R- iodini, §i., iod. potass.
 |ii. S. V. R., Oij., mfx.to f3i., gr. * to 2.  (L. and U. S. P.)
 Ellis directs gtt.v. xv.,  pro re nata, equal to gr. Jg to |.
    No. 8.  Solutions  of Iodine.   R- iodini, gr. v., iod. potass, gr.
 x.,  aq. destill.,  Oi., f3h.  to f3vi., gr.  ^,  i., (L. P.)   To this
 formula, appendix to Lugol adds: l Doses x. xx.  bis  terve in
 die.'  If this x. xx. refers to drops, as  I presume it does,  the
 dose will be j|3, ^ gr.
    No. 9.  R- iodini,  3vi. iod. potass, ^iss., aq. destill. Oi.  gtt.
 xx., gr.ft.  U.S. P.
    No. 10.  rjt  iodini, gr. hi., potass, iod. gr. vi., aq. destill.  §i.,
 gtt.vi.  x.  ten die, gr. ^,  ^.  Ellis' Formulary.—gtt.iii. v. gr.
 £, Jj.  Morton.
    No. 11.  R-  tincture  iodine f3i., mucil  g. acaciae ffii.,  aq.
 destil. f§vi.,  ^ss.  2d q.  hora,  gr.i.   Ellis.
   No. 12.  Rr  iodini 3i., iod. potass. 3ii., aq. destill. f vii., gK.
                               5 
52
 vii.  bis die, gr.i.   Ellis.   I presume  this is a mistake, and in-
 tended as a transcript of the following.
   No. 13. R- iodini, 3i., potass, iod. 3ii., aq. destill. |viii.,gtt.
 vi. bis die, gr.i.   (Lugol.)  Each week the dose is to be in-
 creased 2 drops until it reaches 30 or 36, maximum gr. H.
   No. 14. R- iodini gr.ss.,  potass, iod. 3ss., syr. papav. fss..
 aq.  destill. Ibss.,  § ii. ter die, gr. h   Dunglison,  N. R.
   No. 15. R- iodini gr.ii.,  iod. potass. 3iv., aq. menth. destill.
 §vi.,  ^ss. ter die, gr.i.  (Magendie.)
   No. 16. R- iod. potass.  3ss.,  aq. destill.  3i. solve,  et adde
 iodini gr.x.,  gtt.v. xv. daily, gr.| 2i.  (Append. Lugol.)
   Preparations of Iodide of Potassium.   No.  1. R- iod. potass.
 gr.ii. sulph. magnes.  |ss., tart, emetic gr.ss.,  aq. destill. |vi.,
 3i.  3 4 ve. die, gr. |5 iod. pot.   Ellis.
   No. 2. R-  iod. potass, gr.xxxvi., aq. destill.  %\. gtt.v. xx. ter.
 die,  gr.i \\ iodide.  Magendie.
   No. 3. R- hydriod. potass. 3ss., aq. destill. |i., gtt.xx. xxx.,
 to §i. daily, gr.ii, It,  3ss.
   No. 4. R- iod. potass. 3 iiss.,  aq. destill.  3iii., micae panisq.
 s. pill no. cl. divid. no. ii. ter. die., gr.ii.   (Appendix Lugol.)
   It will be observed that in the  foregoing estimate of the pre-
 parations of iodine, I have not taken  into consideration that
 which is present as an ingredient of the iodide of potassium.
 It appears that iodine is very much modified  by combination
 with other articles, as it can be  used  in  much greater quanti-
 ties  when thus combined  than  in its pure state.   Thus it is
 verv irritating when used in the form of a pill or tincture, be-
 cause of its local action.  Indeed, I do not think it ought ever
 to be used in either form.   By being  dissolved, by the  aid of
iodide of potassium, it is much  more  manageable;  by  being
combined with potassium, iron, &c,  it can be taken in much
larger quantities, so much so, that Lugol considers the iodide
of potassium simply as a solvent for iodine, although there is
half  as  much  more iodine in the solvent as is dissolved in it. 
53
Not being qualified to state the relative  value of the two,  I
have gone upon the supposition that Lugol is right in consid-
ering the iodine as of little activity.
  It may be remarked that although the 10th formula  directs
only from ^ to ^ or i, ^ of a grain of iodine thrice a day, yet
Drs.  Morton* and Ellis direct us to  diminish  the quantity if
it 'produce dizziness,  pain in the bowels, or other unpleasant
symptoms.'  If caution is necessary in using that preparation,
it would  seem much more called for in a large  majority  of
them.  No directions are appended to some of the  formulae,
so that we cannot say what  amount is intended to  be  taken
daily; but we may presume,  when not  otherwise  directed,
thrice daily.  By this calculation (leaving out of the account
the latter  directions appended to the 8th formula  as ambigu-
ous,) we have the daily quantity from li (10th formula)  to 6
grains (7th formula).   I believe, as indeed  is  believed  by
others, that Lugol has been more successful in  the employ-
ment of this article than others, because he  has used  it  in
moderate  doses, and has paid great attention to other means
of  improving  the  health,  as exercise, clothing,  diet, &c.
Many physicians, both of Europe and America, declare most
unequivocally that  they have never seen it do good.  As to
the mode  in which they used it, as well as the suitableness  of
the cases  for its  use, we know little.  One  thing, however, I
do know,  viz: that men eminent in  the profession have  their
prejudices and caprices as well as their more humble brethren.
And  when they have been foiled,  in consequence  of having
used an article in a case not adapted to  its employment, they
are  no less  apt to denounce the remedy.   In the  successful
employment  of  any  remedy,  much depends  upon its being
properly  prepared,  and many medicines have fallen into un-
merited neglect  from a want of attention to this circumstance.
I apprehend that this  is as emphatically true of iodine as of any
remedy under the sun.   I have seen a gentleman  occupying
an exalted station in the profession who used the tincture  of
iodine freely, and kept it as an officinal  preparation.  Now I
""Illustrations pul. consumption, p. 130. 
54
apprehend that this is the most objectionable mode of adminis-
tering the article.  At least I have never given it without pro-
ducing irritation of the stomach  and  vomiting,  occasioned,
doubtless, by the decomposition of the tincture by coming in
contact with water.  I presume the gentleman above mention-
ed escaped producing much  irritation,  by having his tincture
pretty well decomposed  by age before it was administered.
But  what reliance is to be placed upon  experience of this
character?  If we employ it, let it be in some  form  in  which
it is not liable to be set free, and thus produce disorder of the
stomach, as a solution with hydriodate  of potash.
  A combination  of these last two articles, namely,  iodide of
iron, would seem  to promise much in a disease in which each
is so valuable.   I  apprehend, however,  that the proportion of
iron is too small for us to expect much from that.  "When we
wish to employ the two articles in the  same case, I  think we
had better use a solution of iodine, and give Vallet's ferruginous
pill in addition.  We can thus give just as much of each arti-
cle as we please.   I have employed the article, and apparent-
ly with benefit, though I do not know that any better result
attended the administration than would have attended the use
of iodine.   No article in the materia medica requires to be pre-
scribed more carefully than this; and no physician  ought  to
administer  it without knowing its  purity.  He cannot send to
an apothecary for it  with any assurance of getting what he
wants, at least such has been my experience.  I  have  never
seen the article that did not contain sesqui-oxide  and sesqui-
iodide.  The sesqui-iodide is greatly more active, and when
given under the impression that we are giving the iodide, nev-
er fails to irritate  the stomach.  The  syrup of iodide  of iron
is said to keep well, yet would I be afraid of that  if not fresh.
Perhaps the least  objectionable  formula for this article is that
of pills  as recommended by Christison, to-wit: R. iodine 127
grains, clean soft  iron wire  fss.,  distilled water  75 minims;
agitate briskly in  a strong vial with a glass stopper  until the
froth becomes white;  pour the liquid upon  two  drachms  of
finely powdered loaf sugar in a mortar; triturate briskly for a 
55
few minutes; add gradually a  powder  composed of liquorice
powder ^ss.,  pulv. gum arabic  3iss.,  flour 3i. mix.,  divide
into  154 pills.   Each pill  contains  one grain of the  iodide.
During agitation this preparation evolves a very considerable
amount of heat, so that it is necessary  to envelope the  vial  in
a cloth.  So much gas is evolved also as to require great care
that  the stopper be not displaced and a portion of the ingre-
dients lost.
   Whilst we thus attend to improving the general health, we
should also have an eye to the local  affection.   To remove it,
volatile liniment will frequently be sufficient.  If somewhat
obstinate, some of preparations of iodine may be used topical-
ly.  Hydriodate of potash in the proportion of 3i. to §i. of
nice lard.   If  a more stimulating article is needed, from  3 to
 10 grains of iodine may  be added.
   It will be seen that it will not do to  rely upon emetics, ca-
 thartics or tonics exclusively; neither can  we  depend  upon
 them  altogether,  however judiciously combined.  We  must
 call  to our aid means more properly hygienic  than medicinal.
 In the first place, I will mention bathing.  Cleanliness  must
 of course be insisted on, but bathing, properly used, is a very
 important means of improving and preserving health.   Scarce-
 ly any circumstances preclude the occasional  use of the warm
 bath.  It removes  slight irritations, and  produces a  train of
 pleasurable sensations highly  conducive to health.  A moder-
 ate  quantity of  salt added to the bath  will make it more effec-
 tual in stimulating the skin; or the surface may be rubbed dry
 with a towel  which  had  previously  been wrung out of salt
 water and dried.   If we wish to make the  bath  medicinal,
 we  may use a solution of iodine as  recommended  by Lugol.
 Cold bathing  is  less universally applicable, and should  always
 be commenced  with caution.   Rules by which we may judge
 of its usefulness and safety have been already mentioned.  If
 it can be used safely, it will   almost certainly  be beneficial.
 What has been said as to  the means of preserving health un-
 der  the head  of predisposition, applies with  much increased
 force  here.
                            5  * 
56
  Having gone so fully into the mode proper in the treatment
of enlarged lymphatic glands, which applies very generally to
what is usually denominated the different forms of sciofula, I
will dismiss this branch of the subject with some general ob-
servations.  1st. All affections, whether considered scrofulous
or not, occurring in persons of a strumous diathesis,  bear de-
pletion worse and tonics better than the same  affections oc-
curring in healthy constitutions.   2d. Parts  affected  with in-
flammation bear exercise better; thus in scrofulous ophthalmia
it is not so necessary to exclude the light as in  common oph-
thalmia, nay, a certain amount of light is beneficial.  Again,
scrofulous  white swelling,  after the  acute stage is over, is
benefitted  by  exercising the limb moderately.   I have seen a
case in  which  the  tibia was denuded for  10 or 12 inches in
length, and over full  four-fifths of its  circumference  improve
with great rapidity  whilst the patient was permitted,  after
some constitutional treatment suited to the  first stage, to walk
upon it daily.   3d.  That during  our treatment inflammation
of some part may be set up.  Whilst this continues,  we must
intermit our tonic course  until,  by  appropriate means, we
shall have subdued  this  inflammation,  and then resume  it.
4th.  That whilst we attend  to  constitutional  treatment,  we
must not fail to make such  topical   applications as  may  be
suited  to  each particular case.   5th.  That much time is ne-
cessary to manage these cases successfully.   We cannot, if
we would, make a great  revolution  in  the  constitution  in a
short time; and if we could, we should probably produce an
evil equal to the one we cure.  A neglect  of this  considera-
tion  has been  the means of  much  injury to patients, and of
much  discredit  to remedies.  We try to do too much  in a
short time.  As a friend of mine thought, for whom Fowler's
solution of arsenic had been prescribed for intermittent fever.
As the next paroxysm was very much mitigated, he said, '■it a
little is good, a good deal is better,' so took half an ounce.
bth.  It is confessedly very difficult to appreciate correctly the
effects of  remedies in this disease.  There is not so much dan-
ger in misconceiving the immediate effects  of  our remedies. 
57
when given in decided doses, but  when  they are given in
small doses for a long time, the case is very different.   I think
I have seen the effects of such treatment appear weeks after
it had been discontinued; at least, if the amendment was  not
occasioned by that treatment, it was the effect of the powers
of nature,  for no  other remedies had been employed.  It is
easy to conceive how the employment of  another medicine,
about this time, might give rise to very erroneous opinions as
to the effects  of each.  7th.  To all of  the exclusive modes of
treatment, I would apply one remark.   That so far as  they
are  exclusive, they are wrong;  yet when used with discrimi-
 nation, and  under proper  circumstances,  each one may be
 made very useful.  Even the  cura famis, when used to  a
 certain degree and continued for a short  time, may be  the
 means of  strengthening the digestive powers, and therefore
 beneficial.  But if carried too far, it proves hurtful.  And I
 think it quite probable that much of the  credit which this
 mode enjoyed was acquired by the inability of the patient to
 pursue the treatment to the degree  prescribed, and his  un-
 willingness to inform his physician of the fact.  A case direct-
 ly in point  came  to my knowledge a short time since.   An
 eminent member of  the  profession thought  himself entitled
 to  some credit in consequence of  a cure effected  in  this
 way.  The   patient, however, put a  different  construction
 upon the affair.  He said he stood the low diet as long as he
 could, but gave it up.  'Tis true he took the soup and gruel as
 prescribed, but he took the beef and potatoes,  bread and milk
 likewise.

    Treatment of Scrofula.—Although   we  cannot  expect  to
  cure scrofula often, yet we shall occasionally meet with cases
  in which the diathesis is  weak,  and  the  accumulation of tu-
  bercular matter circumscribed, in which we may hope to wit-
  ness a restoration  to health.  Whether that restoration be a
  cure or a recovery  is perhaps doubtful.  Even in  cases where
  no restoration is to be hoped for,  still we may mitigate  the
  sufferino-s  and prolong  the life of the patient.   Besides, al- 
58
 though we may be satisfied that in the present  state of  our
 knowledge we cannot cure a given disease, we should not con-
 clude that we shall never be able to cure it.  Every physician
 should have for his  motto, '•Nil despcrandum?  The general
 constitutional plan of treatment, before and after the develop-
 ment of tubercles, will not vary much.  The same observance
 of hygienic rules will be  necessary.  Cold bathing will be less
 likely to be borne with benefit.  More care in diet will be ne-
 cessary.   Medicine, though more necessary, will be less effec-
 tual.
   The accumulation of tuberculous matter may be in any tex-
 ture or in any organ of the body;  but wherever situated, it
 constitutes scrofula,  and  is a fearful disease.  Perhaps  the
 most frequent seats are on the surface of the  mucous mem-
 branes, in the parenchyma of the lungs, the lymphatic glands,
 the spleen, peritoneum and bones.  Whilst we  continue  the
 treatment heretofore laid down, we must also be diligent in
 applications intended to benefit the local affection,  especially
 if it should not appear that there are deposits in  various parts.
 If the lymphatic glands should be most prominently  affected,
 rubbing the surface over  them with some  of the ointments of
 iodine may be tried; or blisters over the gland, to be kept dis-
 charging and removed as often  as  may  be  necessary, will
 sometimes discuss  the  swelling.  It will  frequently be very
 difficult to say whether such swollen glands  are  truly  tuber-
 cular, especially before fluctuation is evident.   We must judge
 from the doughy feel of the tumor and  the evidences  of tu-
 bercular matter  in  other situations.  When such deposit is
 found the means used to  discuss  the tumor will  be less likely
 to succeed, because we have  the  presence of a foreign  body
 to contend with.   If such body is removed by  the absorbents,
 it will require considerable time.  If suppuration take  place,
 after the matter is discharged we may still rub  the adjacent
 parts with some  of the preparations of iodine.  We  shall pre-
sently find a considerable portion of the surface  of the tumor
converted into an ulcer.   This should be bathed with salt water
a solution of iodine, or one of creasote.   If it should not im- 
59
prove under this treatment, it should have a blister laid on its
surface for half an hour, or as long as the patient can  con-
veniently bear it.   This application should be  repeated as
may appear necessary.  Dressing daily with an ointment of sul-
phate of copper, two scruples to the ounce, for a week, to be
suspended for the same period and then  repeated,  will  like-
wise be a proper dressing.
   If  the deposit should be  in the lungs, in addition to the gen-
eral treatment, we should institute counter  irritation some-
where about the chest.  This may be effected  by blisters re-
peatedly applied, by pustulations with tartaremeticointment, or
by setons. Patients are very apt to get tired of blisters and pus-
tulations.  For that reason, perhaps, it would be better to rely
on setons.  Just here I may mention the use of cod liver oil,
which has been highly extolled by Pereyra, Physician to Hos-
pital St. Andrew, Bourdeaux,  as  a remedy  in  tubercular
phthisis.  It has also been considered very serviceable in other
forms of scrofula.  I do not doubt but it is a remedy suitable for
scrofula, the more especially as  it  contains iodine in its com-
position.  Whether all its  virtues are  dependent upon  the
iodine,  or whether the iodine  exists in a  combination more
adapted to benefit scrofulous disease, I am not prepared to say.
We should  observe, however, that the only case given by him,
which I have seen, (Med. Chir.  Rev., vol. 39, p. 503,)  is one
in which tubercular matter appears to have been confined to a
small  space in the lungs.   He  examined the  patient  three
years after, when pectoriloquy  still existed.  Now allowing
him full credit for  the  accuracy of his observations, (and  to
which indeed I think him fully entitled,) we should remember
that such cases occasionally do well  without any  treatment.
I know a young man who,  some ten  years ago, expectorated
a considerable quantity of  what, from description,  I suppose
to have been tubercular matter,  in whom pectoriloquy of the
right  side is very  evident,  and who is in good health  now.
Whilst therefore we are disposed to allow due weight to each
remedy, we should still be on the watch to see that we do not
allow more than is due to some of them. 
60
  Wherever the deposits  of tubercular matter may be, I hold
it important that some mode of counter irritation  be  used  at
the same time, that we pursue the remedial and hygienic rules
already noticed.
  I will add a few words concerning  that  form of scrofula
most common in this vicinity, I mean  Cachexia Africana.
During the prevalence of cholera, many negroes who appear-
ed strongly predisposed to  this disease  were  restored to a
state of good health.  This was effected, as I suppose,  by the
free use of calomel, which was then resorted to as a remedy for
cholera.  Now 1 believe that mercury  must be used with cau-
tion in scrofulous diseases; and it certainly was not used with
a sparing hand in those days.   How is this to  be accounted
for?   Thus:  The beneficial action of a remedy does not  de-
pend upon the amount taken, but upon the effect produced.
At that time our diseases  required,  at  least  tolerated, the  use
of ealomel to an extent which would now do incalculable mis-
chief.   The quantity then used did not generally  go beyond
the remedial bounds; I say generally,  for it is  certainly true
that even then great mischief was sometimes done.   I think I
have cured, at least that I have seen get well,  divers cases of
this disease, by pursuing the treatment advised, not by emetics,
not by purgatives, not by tonics, but by what I thought a ra-
tional employment of each in its proper  place,  aided  in  no
small  degree by an enforcement of the hygienic  regulations.
I have always remembered  that it  was a  work of time, and
believed that the old adage  lthe more  haste, the less speed,'
was peculiarly applicable.
  A friend informed me that he had seen two cases cured, as
he believed, by diuresis, in one case occasioned by taraxacum,
in the other by a large quantity (two ounces)  of vinegar  of
squills taken by mistake.   Although diuresis frequently attends
the employment of iodine, yet I am disposed to  believe  that
the amendment in these  cases was due to the previous judi-
cious  treatment which  my  friend  had instituted;  but  the
amendment becoming evident soon after an event so marked,
there  was an apparent fitness in ascribing it to  that. 
61
  A long time ago, I was attending a case of this disease with
very little satisfaction to myself, and no  apparent advantage
to my patient,  when from  some cause I ceased to attend.
The mistress, thereupon, commenced giving a tincture of poke
berries.  {Phytolacca Decandra.)   Soon after this course was
adopted, the patient commenced improving.  Whether such
improvement  was  the  delayed  effect of my  treatment, in
whole or in part, I cannot tell.  The remedy, however, is used
in scrofulous affections by the same lady with,  as she thinks,
marked benefit.
   A physician in one of our southern States, as lam informed,
(but I have not learned his name or seen  his book,) has  writ-
ten a book upon this disease, in which he considers walnut
leaf tea the remedy.   Negrier, of Angiers,  some  years ago,
published a 'number of  cases of  disease  of the  lymphatics,
with or without  ulceration of the integuments, of scrofulous
ophthalmia, of affections of the bones and periosteum, &c, in
which a decided and very marked benefit was obtained  from
a course of this  simply prepared tea.  A handful of the  fresh
or  slightly dried leaves may  be added to a pint of boiling
water, and of this infusion a small cupful may  be  taken twice
a day.  An extract may also be prepared by evaporation, and
this  Dr. Negrier  recommends to be given at the same time
either in the form of pills or of a thick syrup.   A  strong  de-
coction of the leaves he has used  with excellent  effect as an
application to scrofulous ulcers.'  Med. Chirurg. Rev., vol.36,
p. 192—From Archives Generales.  The reviewer 'feels  in-
clined to predict that this  remedy is  one  deserving notice,
and that it will be found useful  in some  cases of lymphatic
and cutaneous disease.'  I am not informed as to  the use  or
not of other means by Dr.  Negrier.  I cannot, therefore,  ex-
press any opinion as to the proportion of credit  due to  the
walnut leaves.   I most sincerely wish that a remedy, an infal-
lible remedy, may be found for this frightful disease; but I must
confess that I expect the day to come at no great  distance of
time, when walnut leaf  tea (at least when exclusively trusted
to) will take its place by the side  of acorn coffee. 
62
   Having spoken of poke berries and walnut  leaves, I  may
 perhaps as well name another remedy, which has been found
 successful in the cure of scrofula.  I  mean the prickly ash,
 (Xanthoxylum Fraxineum.)  In West. Jour. Med. and Surg.,
 vol. 4, p. 361, we have the report of three cases  cured by
 this article.  In each case a long course of treatment to no ef-
 fect had preceded.  It is directed to be prepared thus: boil a
 handful of the  bark of the stem or root in a new iron vessel;
 let it stand until the iron has blackened  the tea; give thrice
 daily as much as the stomach will bear without nausea.  This
 shrub resembles little scrubby black locust when divested of
 leaves, and has a very pungent taste,  which speedily imparts
 a tingling sensation through the  nervous  system,  something
 like gum guiacum.  I am very much  disposed to believe  that
 these cases were such  as had been treated too long, and were
 in fact cases  of mercurial disease  instead of scrofula.  Until
 better informed upon the subject, I shall place them on a foot-
 ing with  a very obstinate case of  syphilis, which  a medical
 friend of mine informed me had been effectually  cured by May
 apple root  (Podophyllum Peltatum).   As a consequence, he
 had resolved  to cure all cases of syphilis  in the  same way.
 It was suggested to him that, probably under  the  use of  the
 May apple his friend  had got well of the mercurial  disease
 which had  been substituted for the venereal.   But he was so
firmly persuaded of the virtues of the May-apple, that he put
his  next syphilitic patient upon it.  But his good  sense  soon
taught him the difference between  May-apple and mercury.

  Conclusions.—After such reflections as I have been able to
make, I arrive at the following conclusions:
  1st. That in a vast majority of instances scrofula  owes its
existence to inheritance; yet
  2d. That there  is no absolute necessity that a child  having
a scrofulous parent shall be scrofulous; on the contrary'
  3d. That when one parent is scrofulous and  the other  not
a child which resembles the scrofulous  parent   will be much 
63
more apt to have scrofula than one which resembles the other
parent; in  fact,  that the latter may have  a well-grounded
hope of escape.
  4th.  That the liability by inheritance  depends upon a gen-
eral, not upon a specific law,  which is applicable to other dis-
eases besides scrofula.
  5th.  That whilst a child born of scrofulous parents may es-
cape, one born of parents not at all scrofulous, may have the
disease.
  6th.  That scrofula depends upon an  undue preponderance
of the white parts of the blood, and the white tissues in the
body.
  7th.  That in our treatment we should endeavor  to  restore
a due proportion of the red particles to the blood,  and of  the
red tissues  to the body.
  8th.  That to effect this there is no specific;  but we must
be  guided  by  general  principles  and  rational views, pre-
cisely  as is  necessary to treat successfully any  other  dis-
ease.
  9th.  That how  important  soever medicine may be in  the
management  of the  disease,  hygienic rules are by no moaii3
less  so.

  Note.—In all our quotations from the  Medico-Chirurgical
Review we have had reference to the American reprint of that
work.
                             6 
 
 
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