Dissertations on Inflammation, Vol. 2

by John Burns

By the ancients, and many of the moderns, the pituita was considered as the cause of scrophula, producing tumefaction, by stagnating in the glands. When any of the bile became mixed with the pituita, then the inflammation was more violent, and the ulceration deeper. Some latter writers, convinced that a simple redundancy of any particular humour could not produce scrophula, had recourse to the supposition of an acrimony, which was productive of swelling and ulceration, and which might “taint the whole fluids of the body[85].”

Others attempted to explain this disease, upon the principle of debility existing in the whole body, but particularly in the lymphatic system[86]. This is an idea still more puerile than the doctrine of morbid humours, which, however unfounded, had several plausible arguments to support it, and which was incontrovertible until the laws of the animal economy were better understood. Simple debility never can give rise to the marks of the scrophulous constitution; it cannot produce ulcers of a nature and appearance so peculiar; neither can it explain why particular parts are more apt to be affected than others; because, if debility exist equally in every part of the absorbent system, then every part ought to be alike diseased; and if it exist only in particular parts, then it is necessary to point out some cause of this partial debility. We likewise frequently observe very great debility in this system, owing to general weakness, and yet no symptoms of scrophula appear in consequence.

Scrophulous people possess a peculiar constitution, and may therefore be said to constitute, in one respect, a distinct variety of the human race. This state is produced by a peculiar condition of the semen (owing to the peculiarity of the system which forms it), or of the female organs of generation, which possess the same general nature with the body, of which they form a part. When the organs of generation in both sexes are healthy, that is to say, similar in nature to what may be considered as the proper nature of the human race, taken as a distinct class of animals, then the semen stimulates the ovarium to the formation of a healthy child, or one which possesses a constitution, or susceptibility of performing, and having actions induced in it, similar to that of the majority of mankind. In this process, the ovarium is to be considered as a gland, and the semen as its peculiar stimulus. If, however, either the nature of the gland, or of its stimulus be changed, it is evident that the action induced must be more or less modified, and the secretion or product changed to a greater or less degree in its nature and properties. Were it possible for a progeny to be produced by an intercourse betwixt the human and the brute creation, they would possess a nature different from both, or perform actions of a mixed kind. This may be observed with regard to mules amongst brutes. In the same way, a healthy and scrophulous person must produce a child which differs from a healthy one, in having a certain peculiarity of constitution.

Agents produce different effects in different animals; thus the matter of cow-pox applied to the cow and to man produce very different appearances. Agents likewise, in the same genus of animals, produce different effects, according to the peculiar constitution of the individual. Thus, the matter of small-pox in some men produces only a slight local sore, whilst in the generality it produces a general disease, and eruption. The same disease affords an instance of changes taking place in the constitution after birth, by the establishment of certain actions; for it is rendered unsusceptible of the same action being induced afterwards; and, in this respect, is brought to resemble the constitution of a different genus of animals, with regard to that disease. There are some constitutions, such as those called irritable, in which certain symptoms of febrile, and other actions, are much more violent than in people of a different description. In them, for instance, typhus fever is attended with a very frequent pulse, and yet the other effects of this action are not violent in the same proportion.

Peculiarity of constitution is often manifested by no evident sign, and the modifications of actions induced are often marked by no perceptible diseased phenomena, which may be considered as belonging exclusively to that constitution. But, in the scrophulous constitution, there are, in almost every instance, perceptible modifications of the formative action[87], producing a peculiar appearance of the eye, countenance, &c. as has already been mentioned; and although some diseased actions, which receive modifications from this peculiarity of constitution, may not be attended with obvious alterations, yet others, especially such as are attended with an inflammatory condition, are distinctly changed. It is these changes which constitute what in common language has been called scrophula, which is merely a peculiarity of a common action (namely, inflammation), which is dependent, not upon any particular nature of the agent or exciting cause, but upon the peculiarity of constitution, which is susceptible, by these agents, of such an action.

From what has been said, it will appear, that I consider the scrophulous inflammation, or what has in common language been called scrophula, merely as an accidental circumstance, occurring in a scrophulous constitution; but it is by much the most dangerous and troublesome effect of the peculiarity of constitution. It has likewise a very evident effect in increasing this condition of the system; for we find, that the probability of scrophula appearing in a child is, cæteris paribus, correspondent to the presence or absence of scrophulous inflammation in the parent; or, in other words, that those who have either at the time of marriage, or before it, had scrophulous inflammation, are more likely to have their children strongly scrophulous, than others of the same family, who have not had inflammation. It is likewise certain, that if, by any cure, we can, for one or two generations, prevent the appearance of scrophulous inflammation, the children will become less and less diseased, or have less peculiarity of constitution; but if, by any accident, scrophulous inflammation be in one of the descendents excited, even in a slight degree, his immediate progeny will be more diseased than he himself before the induction of the inflammation[88].

With regard to the exciting causes of scrophulous inflammation, I may remark, that they are similar in kind to those capable of inducing simple inflammation; but they frequently operate more powerfully; that is to say, causes which would scarcely induce inflammation in a healthy person, may induce a local disease, and inflammation, in a scrophulous habit; because the different parts of the body perform their functions less healthily in a strongly scrophulous person, and are more easily deranged. In every system, those parts which are most delicate, or require the greatest perfection of action in order to keep them right, are most easily deranged. Now, in scrophulous people, the natural action being modified, the body becomes more delicate, and is more susceptible of derangement, especially those parts which naturally are delicate[89], or require a perfection of action. The glands seem to be amongst the most delicate organs; for they have not only to perform the formative, or nutritive function, in common with every other part, but they have also to perform a separate and distinct function, or change the nature of certain fluids which are brought to them. It is on account of the natural delicacy of the glandular system being increased by the diseased condition of the general system, and of the exposure of the lymphatic glands to the action of stimulating matter, taken up by the absorbents on the surface, as, for instance, matter from scabs on the head of children, that this species of inflammation most commonly appears in the lymphatic system; but this system does not seem to be the peculiar seat of the diseased condition, as some suppose, nor to be otherwise predisposed to scrophulous inflammation, except in so far as its natural delicacy is increased by the diseased condition which it possessed, ab initio, in common with the rest of the body; and consequently it is rendered less able to perform its functions properly, the effect of which is, the induction of a new local diseased action, or slow inflammatory action, by the slightest cause.

Besides the common exciting causes of inflammation, the particular formation of organs may induce this disease, or at least make very slight causes produce it. Thus, for instance, in people with a very small narrow chest, the circulation of the blood must be performed with greater action than in other circumstances, and thus may tend to induce an inflammatory state. When the bones are very vascular, and imperfectly formed, they are apt to have a morbid degree of action excited in them by very slight causes; and the same holds true with regard to any other part of the body which is imperfectly formed, or which is not exactly fitted for the support and performance of its requisite action[90].