SCROFULA. 825 



and intestinal catarrhs, accompanied by enlargement or caseous de- 

 generation of the bronchial or mesenteric glands. 



SYMPTOMS A:NT> COURSE. In many instances the scrofulous ca- 

 chexia betrays itself by the patient's habit of body, which will often 

 arouse suspicion of his delicacy and of his feeble power of resistance 

 against disease, long before any actual morbid tendency (diathesis) is, 

 as it were, officially announced by the occurrence of frequent and ob- 

 stinate attacks of illness induced by causes so insignificant as to have 

 escaped observation. 



The " scrofulous habit " is marked by a deficience of blood and by 

 a bad nutritive state of the more important and more highly-organized 

 tissues ; sometimes accompanied by an accumulation of fat in certain 

 regions, especially in the upper lip and nose. When the imperfect 

 nutrition is accompanied by an over-production of fat, there seems to 

 be an indolent state of the processes of constructive and destructive 

 assimilation ; but when not only the skin and the muscles, but also 

 the subcutaneous fat, is in a state of imperfect development, it is 

 probable that these processes are in a condition of unnatural activity. 

 Based upon these differences, in the patient's bodily habit, a classifica- 

 tion of scrofula into the torpid and erethitic forms has been made. 

 Canstatt very aptly describes the torpid scrofulous habit in the follow- 

 ing words : " An unusually large head, coarse features, a thick chin, 

 swollen abdomen, enlarged cervical glands, and flabby, spongy flesh ; " 

 and depicts the habit of erethitic scrofula as follows : " A skin of re- 

 markable whiteness, with a tendency to redden easily, and through 

 which the rose-pink or bluish subcutaneous veins are visible, a deep 

 redness of the cheeks and lips, blueness of the thin and transparent 

 sclerotica, which imparts a swimming and languishing look to the eyes. 

 The muscles of such persons are thin and soft, and their weight is light 

 in proportion to their stature, indicating a slightness of their bones. The 

 *eeth are handsome, and of a bluish lustre, though long and narrow ; 

 the hair is soft." There is no lack of examples of either of these forma 

 of disease, and though it may not be possible immediately to assign 

 every case to one or other category, yet in practice it will be well to 

 adhere to the classification into torpid and erethitic scrofula, since, as 

 we shall find by-and-by, we thereby obtain valuable data for the estab- 

 lishment of therapeutical indications. 



Scrofula, although principally a disease of childhood, rarely declares 

 itself in the first year of infancy, excepting through a few faint tokens. 

 At the period of puberty scrofulous diseases usually subside, and with 

 them the scrofulous habit more or less completely disappears. More 

 rarely, exposure of the body to pernicious influences at this time excites 

 the subsiding scrofulous tendency to renewed activity, or even induces a 



