86 



also in tuberculosis, both are the results of inflammatory 

 action in predisposed individuals. 1 



Beyond a few differences there is nothing in the physical 

 conformation of the scrofulous which does not represent that 

 of the tuberculous. The scrofulous, the rheumatic, and the 

 catarrhal, Mr. Hutchinson regards as the three great universal 

 diatheses to which every individual is more or less subject 

 the degree of susceptibility varying extremely in different 

 individuals ; and in many cases so great is the susceptibility 

 that in itself it constitutes a very grave and critical disease. 

 The scrofulous diathesis is almost invariably inherited, but 

 is sometimes developed by all those external circum- 

 stances which tend to reduce the natural powers of the con- 

 stitution. This diathesis, whilst it is the parent of many 

 evils, is not in itself so well-defined as others, and is 

 frequently associated with abnormal states of the circulation, 

 which have probably no connection whatever with tuberculosis 

 viz., the liability to chilblains, swollen lips, etc. The ten- 

 dency of modern thought is, however, to regard both scrofula 

 and tuberculosis as modifications of the same inflammatory 

 process, and the two diatheses generally associated with 

 them are now regarded as modifications of the same diathesis. 



The scrofulous diathesis, whilst ill-defined in itself, is very 

 frequently associated with others, as those of gout, rickets, 

 and goitrous cretins, and, in fact, with all those diathetic 

 predispositions which tend to degeneration of nutrition in 

 general. Although commonly associated with the lymphatic 

 temperament, the latter does not, therefore, necessarily imply 

 scrofula : indeed, scrofula may be well marked in those of 

 the sanguine, or of the melancholic temperament. However 

 little may be known of the real intimate nature of scrofula, 

 x Mr. Jonathan Hutchinson. 



