NATURE OF SCROFULA. 255 



through the divergence of opinion as to the identity of varia- 

 tions of the diseases spoken of as scrofulous and tuberculous, 

 some regarding them as identical, others as separate and 

 distinct. A very common cause of confusion, it will be found, 

 is that of using the term tiibevde to express the meaning now 

 understood to be conveyed by that of scrofula — the indwelling 

 disposition to the production of the lesion. 



Scrofula may in our present nomenclature be taken to 

 express the indwelling predisposition which precedes the 

 development of tubercle ; that this latter is but the local 

 expression of the constitutional taint known as scrofula. This 

 bad habit of body, it is probable, is intimately related to faulty 

 conditions of the assimilatory process in either or both the 

 primary and secondary digestion. 



h. Nature of Tiiherde. — At one time tubercle was believed to 

 be an exudation from the blood which, at first fluid, ultimately 

 developed cellular characters; this is now proved to be incorrect, 

 although it is yet, in a somewhat modified form — in which 

 certain of its cell-elements are regarded as wandering leuco- 

 cytes — the view held by a few. Others regard this adventitious 

 material as the result of degenerative changes of normal or 

 morbid elements, in which specific activities carry out definite 

 changes, succeeded by retrogression and death. Some — the 

 more modern investigators — maintain that the masses are 

 merely hyperplasia of normal lymphoid or adenoid tissue, a 

 structure extensively distributed in animal bodies, and parti- 

 cularly abundant in those situations where tubercle is chiefly 

 found. Changes in the minute lymph-vessels themselves, 

 particularly their endothehum and tissue-elements surrounding 

 these, have also been stated as being the true source of 

 tubercle ; while quite recently attention has been directed to 

 its parasitic or bacterial origin. 



c. Causation. 1. Scrofula. — In whatever way explained, 

 there is nearly a general consensus of opinion in regarding 

 heredity as the first great factor in the production of the 

 scrofulous diathesis — transmission of a something, either 

 textural peculiarity or dynamic or formative power from parent 

 to progeny, whereby in certain conditions this tendency or 

 scrofulous condition may develop in tuberculosis or specific in- 

 flammatory action. By some, common inflammation is regarded 



