Scrophulous inflammation is in general dangerous and tedious, in a degree proportioned to the effects and duration of simple inflammation upon the same parts. Thus, simple inflammation of one of the conglobate glands of the neck, is tedious, but not dangerous; and the same holds true of scrophulous inflammation; but the duration of this is much longer. Simple inflammation of the lungs, again, is dangerous; and scrophulous inflammation is infinitely more so. Such parts as heal easiest, when affected with simple inflammation, or ulceration, recover soonest from scrophulous inflammation; and the same causes which retard the one will retard the other also. Thus, the same cause which renders a superficial simple ulcer unhealthy and chronic, will prevent a superficial scrophulous ulcer from healing: But, if none of these causes operate, then scrophulous inflammation, or ulceration, will heal pretty readily, provided that simple inflammation, or ulceration of the same parts, would do so; but, for this purpose, it must be quickly induced; for all inflammation, or ulceration, which is slowly induced, is slowly removed. As a confirmation of these positions, we find, that a blister on a scrophulous person will heal readily, because the inflammation is induced acutely, or with a certain degree of quickness, and has, when the affection is simple, a promptitude to heal, which manifests itself also in scrophulous people. In this instance, the difference in the time required to heal the inflammation in a sound and a scrophulous person is not perceptible; because the affection, if simple, has a tendency to heal immediately. But, in a deep wound, especially if contused, we find the difference more marked; because here, although the constitution be healthy, the duration of the disease is considerable; and, in a scrophulous person, the cure is protracted still longer, and the sore assumes a specific appearance. In diseases of the glands, the difference is still more perceptible; because the disease, although simple, is longer in duration. In affections of the bones and cartilages, the same is observed. When a bone is fractured in a healthy person, it unites without inflaming; and, in a scrophulous person, unless the diathesis be exceedingly strong, it likewise does so, but the union is longer of taking place; but, if a bone inflames in a sound person, the disease is very tedious; and, in a scrophulous habit, it is infinitely more so. The same holds true with regard to tendons and cartilages; and hence the greater danger of a sprain in a scrophulous than a healthy person. From these, and other facts, which it is altogether unnecessary to mention, it fully appears, that scrophulous inflammation is tedious and dangerous, in proportion to the progress and effects of simple inflammation and its consequences, when it attacks the same parts; but this proportion is not regular and uniform; but the duration increases, in a higher ratio, in proportion as the simple inflammation and ulceration of the same parts, and in the same circumstances, is tedious. Thus, a deep wound in a healthy person is pretty long of healing; but, in a scrophulous person, it is much more so. Simple inflammation of a gland is still more tedious than the same extent of inflammation in cellular substance; and scrophulous inflammation is still longer of running its progress; but the proportion betwixt the duration of the scrophulous inflammation, in these two cases, is not exactly as the duration of the simple inflammation of the two, compared with each other, but is in an increased ratio.
When scrophulous inflammation is excited in the vicinity of a part already possessing this action, it occasionally removes the action from that part, in the same way as inducing simple inflammation by a blister in one part cures the same disease in another part in the vicinity. It was an observation of this fact which made it be considered as part of the description of scrophulous tumors and ulcers, that they not unfrequently disappear in one place, whilst they show themselves in another; but, in every instance, this disappearance is an effect, and not a cause; for we uniformly observe, that, before it takes place, the new part has begun to inflame or swell.
With regard to the diagnosis of scrophula, it is impossible to say any thing satisfactory; because, as long as the inflammation remains trifling, and the skin sound, it is very difficult, if not impossible, to distinguish a scrophulous swelling from any other of a different kind. Much assistance has been supposed to be derived from the situation of the tumors, most of those which appear in the neck being considered as scrophulous; but this is certainly a false principle. From the same method of reasoning, most swellings in the groin have been considered as venereal, whilst many are of a very different nature, and not a few scrophulous. The best plan is to attend to the appearance of the body in general, and to the presence or absence of the sign of a scrophulous system; next, whether any ulceration be present, by the absorption of matter, from which these swellings may have been produced. If these be present in a system not possessing the marks of scrophula, the probability of the tumor being scrophulous is less; but, if the system be evidently scrophulous, then we must consider, whether the glands, originally swelled by the absorption of matter, have assumed the slow inflammation of a scrophulous nature, or have assumed a different species of inflammation, dependent upon the peculiarity of the matter; for they can scarcely be supposed to be simply inflamed. Scrophulous swellings of the lymphatic glands are generally soft and doughy, and frequently give the feel of containing a fluid long before suppuration has taken place. They are at first free from pain, and, in mild cases, even toward the end, the pain is inconsiderable. When matter is formed, the skin generally becomes purple, and then gives way in a small spot. Swellings of the secreting glands are to be distinguished from schiro-cancer, by the hardness being less, the pain very inconsiderable, the presence of a scrophulous habit, and by the feel of fluctuation much earlier than takes place in cancer. Upon the whole, the presumption of any affection being scrophulous, is to be formed by the presence of the marks of a scrophulous diathesis, and the absence of such symptoms and appearances, whether antecedent or present, which characterise inflammation of a different species, or make us suppose it to have taken place, whether this be simple or specific. Scrophulous ulceration is distinguished by its peculiar aspect, joined with the marks of a scrophulous habit.
Of the Treatment of the Scrophulous Inflammation.
If the foregoing reasoning be just, it will appear, that, in scrophulous habits, our great attention ought to be directed to the prevention of the scrophulous inflammation, which is to be done by avoiding, as far as lies in our power, the operation of any agent tending to excite inflammation. It has been observed, that, in scrophulous systems, very slight causes were sufficient to produce disease; because the parts on which they act possess a peculiar constitution, and are less capable of performing their natural and healthy functions properly, and therefore are sooner rendered diseased. Inflammation may also be induced by the structure of the part being such as to prevent it from carrying on its functions properly, and therefore the same effect is produced as in the former case, where the constitution, or mode of action, and not the evident structure or mechanism of the part, was affected.
The lungs are to be prevented from assuming the scrophulous inflammation, by avoiding, in the first place, all the common exciting causes of pneumonia, such as cold, damp, &c. It is, in the next place, to be prevented, by avoiding such causes as tend to increase the circulation in the chest, or affect the function of respiration. Hence, violent exercise, climbing ascents, intoxication, thick hazy atmosphere, are to be guarded against.
The lymphatic glands are to be prevented from inflaming, by avoiding exposure to cold, and to the other common causes of inflammation, but especially by preventing the absorption of irritating matter, such as matter from sores, and the like. A neglect of this is perhaps one of the most frequent causes of scrophulous inflammation; for swellings of the glands of the neck can very often be distinctly traced to scald head, to ulcerations about the ears, little sores in the mouth, caries of the teeth, or to the absorption of particles of food allowed to remain and undergo fermentation in the mouth. The greatest attention ought therefore to be paid to cleanliness. The head ought, in scrophulous children, to be washed daily, and the sweat removed from behind the ears; vermin ought to be diligently removed; but mercurial, and acrid preparations, frequently used with that intention, ought to be avoided.