GENERAL DISORDERS OF NUTRITION. 



relapse of disease which has been dormant for years. We have already 

 stated that, under such circumstances, persons, who during childhood 

 did not suffer from the disease, are attacked by it later in life. 



It is impossible to describe scrofula briefly, and at the same time 

 comprehensively ; for its various manifestations combine in the most 

 diverse manner : in one case, this group of symptoms, in another, that 

 one assuming prominence ; and since many patients, notwithstanding 

 the tedious course of their malady, remain free from symptoms which 

 form the most important feature in other cases. And although it is 

 little to be doubted that the localization of scrofulosis (if we may use 

 the term) depends either upon the action of causes which are especially 

 hurtful to the organ attacked, or else upon the morbid susceptibility 

 of the organ to influences whose effect is universally injurious, never- 

 theless we can seldom tell why it should be marked in one case by a 

 scrofulous exanthema, in another by an ophthalmia ; why, in a third, a 

 disease of bone should prevail ; and it is equally inexplicable why the 

 inflammation and hyperplasia of the lymphatic glands should be more 

 extensive and obstinate in one case than in another. It has not been 

 determined even whether there be such a thing as primary hyperplasia 

 of the glands, or if this process, like the inflammation, be always of a 

 secondary character, proceeding from irritation transmitted to the 

 gland from some neighboring focus of inflammation. As the reality 

 of the latter fact is susceptible of proof in a great majority of instances, 

 it is not improbable, where it cannot be proved, that the irritation for- 

 merly existed at the point of origin of the lymphatic vessels involved, 

 but that it has already subsided ; for it is a rule that glandular enlarge- 

 ments long outlast the morbid process which has induced them. 



The cutaneous eruptions which are the most common, and often the 

 earliest symptoms of the diathesis, are usually situated upon the face 

 and scalp. They generally belong to the form of dermatitis, in which 

 an exudation, more or less filled with cells, is effused upon the surface 

 of the cutis, and which nowadays are known as eczema and impetigo, 

 and used formerly to be called tinea and porrigo. The more destruc- 

 tive affections of the skin such as lupus do not usually appear until 

 a later period of life. 



Scrofulous inflammation of the mucous membrane is most apt t< 

 appear in the vicinity of the natural orifices of the body, where it 

 readily implicates the neighboring skin, especially if it be moistened 

 by the superabundant secretions. Thus scrofulous coryza is usually 

 complicated with eczema of the upper lip ; inflammation of the exter- 

 nal auditory passage with eczema about the ear; catarrhal conjuncti- 

 vitis with eczema of the cheek ; conversely, the cutaneous eruptions 

 about an orifice often spread to its mucous membranes, thus inducing 



