28 GENERAL DISORDERS OF NUTRITION. 



burst spontaneously, or have been lanced, and if no new centre of in 

 flammation have formed meantime, the fever gradually abates, the 

 patient's strength returns, the emaciation ceases, often long before the 

 ulcers have begun to heal, and while they still secrete large quantities 

 of pus. 



Glandular tumors depending upon cellular hyperplasia are not 

 attended either by pain or fever ; but, when very voluminous, particu- 

 larly when seated upon the neck, they not only produce great deform- 

 ity but hinder the mobility of the head. Hitherto it has not been 

 ascertained whether scrofulous enlargement of the lymphatic glanda 

 exerts any detrimental influence upon the composition of the blood, 

 whether the cellular elements destined for the blood are retained in 

 the gland, or whether scrofulous glands affect the quality of the blood 

 as the glands of leucaemia do, but in a far slighter degree. 



The progress of scrofula is tedious and treacherous, and nearly 

 always is marked by periodical alternations of improvement and aggra- 

 vation. Either the same series of symptoms recurs again and again 

 with renewed severity, or else, the former set having abated, or sub- 

 sided, new ones arise. Complete recovery from scrofula is a very com- 

 mon occurrence, especially if we include the cases in which no trace of 

 the disease remains excepting a peripheral speck upon the cornea, an 

 unsightly cicatrix, or other mark, which does not disturb the general 

 health and comfort. Death rarely results from the lesions to which 

 the epithet of scrofulous is usually given. Of these, tedious disease 

 of the bones and joints, and suppuration of the bronchial glands, are 

 the only ones which endanger life. On the other hand, a large num- 

 ber of scrofulous children die of croup, hydrocephalus, and other acute 

 maladies, for which such subjects have a predisposition quite as decided 

 as for the affections to which the term scrofulous usually is applied. 

 Finally, it should be mentioned that lardaceous disease of the liver 

 (Bud&s scrofulous tumor of the liver), spleen, and kidneys, often de- 

 velops during scrofulous disorders, particularly in tedious cases of 

 suppuration and disease of the bones. 



Regarding the relationship of scrofula to tubercle, we have already 

 stated that no doubt many scrofulous children afterward become 

 tuberculous ; but also that a large number of them escape tuberculosis, 

 especially those in whom the constitutional delicacy, upon which the 

 former affection depends, subsides in after-life, and in whom no caseous 

 deposits remain as residua of scrofulous disease. 



TREATMENT. The prophylaxis against congenital scrofula lies 

 almost beyond the sphere of the physician. It is devoutly to be de- 

 sired that scrofulous, tuberculous, sickly, and superannuated persons 

 should not marry at all, *nd that healthy and vigorous individuals 



