Mercury is another remedy, which at one time was much employed in this disease; but few expect any benefit from it now. Gentle, or what has been called alterative courses, are, however, still recommended by many, with a view to satisfy the patient. Various preparations have been used. Some exhibited the corrosive sublimate, others the calomel, whilst the acetite of mercury, mixed with the powder of vipers and earthworm, with the rust of iron, was much employed on the continent[97]. Antimony has frequently been conjoined with this, but without much benefit.
Nitrous acid has, I believe, in some cases, a considerable power over scrophulous ulcers. From the trials which I have made with it, I am inclined to attribute some effect to it in promoting the suppuration of scrophulous glands, or tumors, and in disposing ulcers to heal. Two or three drachms may be given daily, and continued for a fortnight, provided no bad effect be produced by it, such as pulmonic affections, &c. If, within this time, no melioration appear, we may give up this medicine.
The hepatised ammonia, in the dose of eight or ten drops, three times a-day, is sometimes useful in abating the pain, and changing the fiery appearance of the irritable ulcer, or struma maligna.
The breathing of oxygene has been proposed as a cure for this species of inflammation; but it will be extremely difficult for the advocates of pneumatic medicine to point out any authentic case in which it was really of benefit.
Much has been written concerning the local treatment of scrophulous tumors and ulcers; but we are still very much in the dark with respect to any efficacious method. Formerly, the extirpation of the gland, or tumor, was advised by all; but, more lately, doubts have been started concerning the propriety of the practice; and, by most practitioners, it is now deemed unnecessary, if not dangerous.
In the writings of the ancients, as well as many of the older writers on surgery in our own country, particularly in the works of Mr. Wiseman, this practice is freely inculcated; and many cases are detailed in which the tumor was extirpated with success. Even in the present day, no surgeon dreads the consequence of removing scrophulous joints, which, with regard to the present question, are to be considered in the same light with the glands.
It is supposed, that, by extirpating superficial tumors, the disease may be transferred to some of the more noble parts, and produce a more fatal complaint. But, if it be admitted that these tumors do not appear as necessary parts of scrophula, as the eruption of measles does of the rubeolous fever, but only as accidental circumstances, or fortuitous inflammations, rendered tedious and specific by the peculiarity of the constitution, this supposition will appear to be groundless. Even granting that scrophulous tumors did appear without any local exciting cause, and were, in every respect, similar to the eruption of exanthematous fevers, it will not thence follow, that removing the local disease, after it has appeared, will make another part become diseased; unless it be said that scrophula depends upon a particular morbid humour, which, if denied an outlet in one place, must accumulate in another, which is a supposition I will not trouble myself to refute.
The arguments, then, against the excision, are not to be drawn from its danger, but from the pain which it produces, and from the number of glands which must frequently be removed, and which might perhaps be resolved without coming to suppuration. It is likewise at times dangerous to extirpate these tumors, on account of their situation.
On the other hand, when only one gland is affected, when it is superficial, and has continued so long, in spite of our remedies, that there is little probability of resolving it, then, by extirpation, we procure a speedy cure, and avoid a tedious disagreeable ulcer, and unseemly cicatrix. The existence of the scrophulous inflammation, and particularly the ulceration, has a tendency to increase the scrophulous diathesis, or peculiar mode of action of the system. By cutting this short, therefore, we prevent that evil, and render the system less susceptible of the scrophulous inflammation, and the chance of communicating the disease to the progeny less.