290 P A T H O 
nefs, the other of a more firm confiftence. Soft fcrofu- 
lous tumours are always formed by the effufion of a fluid j 
and it may be remarked that they are fomewhat variable 
in their fize, being one day more prominent and tenfe, 
the next more funk and flaccid. When they are opened 
in the early ftate, they are found to contain nothing but 
a ferous fluid, which lies in the cells of the cellular mem¬ 
brane. As the fluid is not contained in one common 
cavity, the tumour has a foft flabby feel, and imparts to 
the fingers of a furgical examiner no diftindt fenfation, 
either of elafticity or fluctuation. But, when the fluid 
has been for home time eft'ufed, a finking difference oc- 
curs, a fluid lodged in a particular cavity now being 
evidently perceptible. This change feems to proceed 
from the deftrudtion of the partitions which are between 
the ceils of the cellular fubftance. As thefe collec¬ 
tions, however, are not accompanied with any fen Able 
degree of inflammation, they are not furrounded with a 
firm, folid, circumfcribed bafe; and they do not betray 
any great tendency to ulcerate the flcin, and burft of their 
own accord. Hence they fometitr.es become very promi¬ 
nent, and the flcin is gradually diftended to a furprifing 
degree. 
The matter contained in fuch tumours alfo undergoes 
a change. After a time, the more folid parts are depo- 
fited in the form of little maffes, refembling coagulated 
milk. The remaining portion of the fluid is rendered 
thinner, and refembles whey. A quantity of purulent 
matter is alfo formed on the internal furface of the cavity, 
which feems to he attacked with a flow kind of inflam¬ 
mation. The admixture of this purulent matter greatly 
changes the appearance of the contents of the tumour, 
and they now bear more refemblance to thofe of a com¬ 
mon abfcefs. They never acquire, however, exadtly 
the properties of healthy purulent matter, being always 
thinner, more tranfparent, and more of a greenilh co¬ 
lour. 
Although the tendency to ulceration is not confidera- 
ble, the lkin at length gives way, and allows the matter 
to efcape through a narrow opening. After the contents 
are evacuated, the tumour fubfides; but, there being in 
general little difpofition in the parts to heal, a fcrofulous 
lore is ufually formed, which difcharges unhealthy mat¬ 
ter, and continues open for an indefinite length of time. 
The other more firm kind of fcrofulous fwelling al¬ 
ways increafes flowly, and mofl commonly attacks the 
neighbourhood of joints. The affedted part enlarges, 
without acquiring any circumfcribed determinate form. 
By degrees the tumour becomes fofter; and at laft parti¬ 
cular portions near the furface become more prominent, 
inflame, fuppurate, burft, and difcharge matter. But, 
as the fuppuration is only partial, and the difcharge in- 
confiderable, they have little effect in diminUhing the fize 
of the fwelling, or in producing any other change of 
importance. The only difference occafioned is the addi¬ 
tion of little ulcerations, which lead to iinufes, and emit 
matter. 
A common abfcefs, in a perfcn of a fcrofulous condi¬ 
tion, often exhibits appearances which betray the dif- 
eafed ftate of the fyftem. The matter firft fecreted is 
formed with extraordinary rapidity; the fwelling is fome¬ 
what more tranfparent, the furface more (hining, and the 
colour of the tumour more blue, than is obfervable in a 
cafe of healthy abfcefs. Scrofulous abfceffes alfo con¬ 
tain, before they burft, a larger quantity of purulent 
matter, in relation to their fize, than common phlegmo¬ 
nic abfceffes. When abfceffes in fcrofulous patients burft, 
an empty cavity is not left; but there is feen a mafs of 
cellular membrane apparently deprived of life. It refem¬ 
bles wet cotton, and often feparates in the form of a fo¬ 
lid mafs. The reparation is effected without pain. This 
ftate of the cellular membrane bears fome remote analogy 
to the death of the central parts in a carbuncle ; but it 
differs from the latter difeafe by there being no malignity, 
pain, nor danger. 
LOGY. 
The bones of fcrofulous people partake of the general 
difeafe in the conftitution ; they feem to contain a fmall- 
er proportion of the phofphate of lime, and a larger one 
of gelatinous matter, than what exifts in the compofition 
of a healthy bone. They are alfo exceedingly fuicepti- 
ble of morbid adtion. The particular changes, however, 
induced in the bones by fcrofula, are not to be treated of 
in this place. 
With regard to fcrofulous juicers, their margin is com¬ 
monly of a pale red or purplifti call, with a (hining fur¬ 
face; the edges in general thin ; and the furface of the 
fore funk fomewhat below the level of the furrounding 
parts. Thefe fores are moftly attended hut with a fmali 
degree of inflammation, and little pain ; they are not very 
fenfible, and have no great difpofition to fpread. The 
matter difcharged from them is vifcid, having very little 
colour, and often an offenfive fmell. In confequence of 
its vifcidity it adheres to the furface of the fore, and co¬ 
vers the granulations. It is to be obferved, however, 
that fcrofulous ulcers fometimes affume a more malignant 
afpedt, having elevated indurated edges, and fungous 
central granulations, accompanied with pain and an icho¬ 
rous difcharge. In thefe cafes, they may counterfeit the 
appearance of cancerous ulcers; but, though the refem¬ 
blance may be very impofing, we are in general able to 
afcertain the real nature of the cafe, by tracing its hif- 
tory from the commencement, and by infpecting the reft 
of the patient’s body with accuracy ; when the veftiges 
of former fcrofulous fores, or other proofs of a fcrofu¬ 
lous conftitution, often manifeft themfelves. 
Scrofulous fores often continue to difcharge for a long 
while, with very little change of appearance. In time, 
however, they begin to heal, and, for the moil part, 
dry up altogether at laft, leaving a very ugly red irre¬ 
gular cicatrix, upon which the flcin feldbm recovers its 
natural look. In general, fcrofulous complaints are moft 
troublefome in the fpring, and get better towards the 
end of the fummer. 
Scrofula is an hereditary difeafe. It is doubtful whe¬ 
ther it can be communicated by contadt, or even inocu¬ 
lation. Kortum tried to transfer fcrofula from one per- 
fon to another by inoculation ; but, although he took 
great pains to infert the matter completely, and repeated 
the experiment frequently, yet all his attempts failed, as 
no difeafe was communicated to the perfon inoculated, 
nor even any very evident irritation excited at the pk.e 
where the matter was inferred. Yet it is unqueftionably 
propagable by transfufion of blood from the difeafed 
horfe, not only to other horfes, but to affes, as has been 
lately proved by profeffor Coleman at the Veterinary In- 
ftitution. 
The remote caufes of fcrofula are Well eftabliftied. 
Every circumftance capable of prolonging for a certain 
fpace of time irritation of the bowels; an alteration in 
the quality of the blood from injuries of the nervous fyf¬ 
tem ; and, above all, a cold and humid atmofphere; will 
produce fcrofula. The laft caufe is perhaps the moft 
frequent of all. The means of cure are therefore ob¬ 
vious. The fame regulations that we haveadvifed under 
phthilis, for exciting and ftrengthening the flcin, are to 
be put in force. The diet fhould be regulated ; the fe- 
cretions of the mucous membranes gently excited. In 
performing the firft indication, much ft refs has been laid 
by Mr. Lloyd upon the necefiity of warm clothing. This 
is a very important matter. Flannel fliould be worn next 
the flcin ; and the patient fhould ufe every means in his 
power to keep up a regular temperature of the body. 
For this purpofe, rhe drefs fhould be as heavy at one pe¬ 
riod of the day as another; and the pradtice of fleeping 
under too many bed-clothes avoided; there being good 
reafon to believe that a great majority of perl'ons err in 
this latter refpedl. Cold bathing, whenfoUozved by re-aCtion, 
fhould alfo be enjoined; and the patient fhould remove 
toa lefs humid air than that in which he has been accuf- 
tomed to live. The regulation of the digeftive organs 
embraces 
