IMPETIGINES. 631 



following the inoculated, more frequently than the natural, 

 smallpox. This last position, however, we can confidently af- 

 firm to be a mistake ; although it must be allowed, that in fact 

 the scrofula does often come on immediately after the smallpox. 

 It is, however, difficult to find any connexion between the two 

 diseases. According to my observation, the accident only hap- 

 pens in children who have pretty manifestly the scrofulous dis- 

 position ; and I have had several instances of the natural small- 

 pox coming upon children affected at the same time with scro- 

 fula, not only without this disease being anyways aggravated 

 by the smallpox, but even of its being for some time after much 

 relieved. 



MDCCXLII. The scrofula generally shows itself first at a 

 particular season of the year ; and at some time between the 

 winter and summer solstice ; but commonly long before the lat- 

 ter period. It is to be observed further, that the course of the 

 disease is usually connected with the course of the seasons. 

 Whilst the tumours and ulcerations, peculiar to this disease, ap- 

 pear first in the spring, the ulcers are frequently healed up in 

 the course of the succeeding summer, and do not break out 

 again till the ensuing spring, to follow again with the season the 

 same course as before, 



MDCCXLIII. Frequently the first appearance of the dis- 

 ease is the tumid and chopped lip above mentioned. Upon 

 other occasions, the first appearance is that of small spherical 

 or oval tumours, moveable under the skin. They are soft, but 

 with some elasticity. They are without pain ; and without any 

 change in the colour of the skin. In this state they often con- 

 tinue for a long time ; even for a year or two, and sometimes 

 longer. Most commonly they first appear upon the sides of 

 the neck below the ears ; but sometimes also under the chin. 

 In either case, they are supposed to affect in these places the 

 conglobate or lymphatic glands only; and not at all the salivary 

 glands, till the disease is very greatly advanced. The disease 

 frequently affects, and even at first appears in, other parts of 

 the body. In particular, it affects the joints of the elbows and 

 ankles, or those of the fingers and toes. The appearances about 

 the joints are not commonly, as elsewhere, small moveable 



