Sometimes only the anterior part of a scrophulous tumor suppurates and ulcerates, and the deeper part of it remains swelled and hard. In this case, the bottom is generally covered with a slough, which comes slowly away piecemeal, and is renewed for some time, until the tumor subsides, partly by sloughing, partly by absorption, and partly by the subsidence of the remaining inflammatory action. In this case, sprinkling the surface lightly with precipitate, or blue vitriol, is of service; and this may be alternated with the common warm poultice. When the surface becomes cleaner, dry lint forms a very good dressing; and this may be covered with a pledget of linen spread with cerate. Afterwards pressure is useful.
The irritable overacting sore, or what has been called the struma maligna, is very difficult to manage, especially as it is frequently connected with a diseased state of the bones or tendons below.
The hepatized ammonia, diluted in the manner formerly mentioned, or simple ointment, mixed with opium, are sometimes of use.
Poultices of bitter almonds, beat up with a little olive oil into a fine pulp, and then warmed, occasionally relieve the pain, and make the ulcer more healthy.
Carrot poultices, or warm poultices made of bread and strong decoction of camomile flowers, are also sometimes of use.
Carbonic acid gas, or carbonated hydrogene, are sometimes of temporary, rarely of permanent advantage.
Anodynes, internally, are useful here, as in other painful sores.
In all cases of scrophulous inflammation or ulceration, it is useful to exhibit, alongst with the proper local treatment, such internal medicines, and to attend to the constitution, in such respects as may be deemed proper. Upon these points I have already made some observations.