The characteristic feature of this disease, in all the multifarious forms that it assumes, is the formation of tubercle, which, when the malady is fully developed, is an ever-present and distinguishing element.
Tuberculous is therefore almost synonymous with scrofulous, and to facilitate an acquaintance with a large list of very prevalent maladies, we may generalize, and classify them all under this generic term. As tubercle is frequently spoken of in works treating on medicine and surgery, playing, as it does, a conspicuous part in an important list of diseases, the reader may very naturally be led to inquire:
What is Tubercle? As employed in pathology, the term is usually applied to a species of degeneration, or morbid development of a pale yellow color, having, in its crude condition, a consistence analogous to that of pretty firm cheese. The physical properties of tubercle are not uniform, however. They vary with age and other circumstances. Some are hard and calcareous, while others are soft and pus-like. The color varies from a light yellow, or almost white, to a dark gray.
It is almost wholly composed of albumen united with a small amount of earthy salts, as phosphate and carbonate of lime, with a trace of the soluble salts of soda.
The existence of tubercular deposits in the tissues of the body, which characterizes scrofula, when fully developed, must not, however, be regarded as the primary affection. Its formation is the result of disordered nutrition. The products of digestion are not fully elaborated, and pass into the blood imperfected, in which condition they are unable to fulfill their normal destiny—the repair of the bodily tissues. Imperfectly formed albuminous matter oozes out from the blood, and infiltrates the tissues, but it has little tendency to take on cell-forms or undergo the vital transformation essential to becoming a part of the tissues. Instead of nutritive energy, which by assimilation produces perfect bodily textures, this function, in the scrofulous diathesis, is deranged by debility, and there is left in the tissues an imperfectly organized particle, incapable of undergoing a complete vital change, around which cluster other particles of tubercular matter, forming little grains, like millet seed, or growing, by new accretions of like particles, to masses of more extensive size. As tubercle is but a semi-organized substance, of deficient vitality, it is very prone to disintegration and suppuration. Being foreign to the tissues in which it is embedded, like a thorn in the flesh, it excites a passive form of inflammation, and from lack of inherent vital energy it is apt to decompose and cause the formation of pus. Hence, infiltration of the muscles, glands, or other soft parts with tuberculous matter, when inflammation is aroused by its presence, and by an exciting cause, give rise to abscesses, as in lumbar or psoas abscesses. When occurring in the joints, tubercles may give rise to chronic suppurative inflammation, as in white swellings and hip-joint disease. Various skin diseases are regarded as local expressions of, or as being materially modified by, the scrofulous diathesis, as eczema, impetigo, and lupus. The disease popularly known as "fever-sore" is another form of scrofulous manifestation, affecting the shafts of the bones, and causing disorganization and decay of their structure. Discharges from the ear, bronchitis, chronic inflammation of the intestinal mucous membrane, and chronic diarrhea are frequently due to scrofula, while pulmonary consumption is unanimously regarded as a purely scrofulous affectation. Scrofula shows a strong disposition to manifest itself in the lymphatic glands, particularly in the superficial ones of the neck. The most distinguishing feature of this form of the disease is the appearance of little kernels or tumors about the neck. These often remain about the same size, neither increasing nor diminishing, until finally, without having caused much inconvenience, they disappear. After a time these glands may again enlarge, with more or less pain accompanying the process. As the disease progresses, the pain increases, and the parts become hot and swollen. At length the "matter" which has been forming beneath, finds its way to the surface and is discharged in the form of thin pus, frequently containing little particles or flakes of tubercular matter. During the inflammatory process there may be more or less febrile movement, paleness of the surface, languor, impaired appetite, night sweats, and general feebleness of the system. The resulting open ulcers show little disposition to heal.
Symptoms. There is a train of symptoms characteristic of all scrofulous disease. The appetite may be altogether lost or feeble, or in extreme cases, voracious. In some instances there is an unusual disposition to eat fatty substances. The general derangement of the alimentary functions is indicated by a red, glazed or furrowed appearance of the tongue, flatulent condition of the stomach, and bloated state of the bowels, followed by diarrhea or manifesting obstinate constipation. Thirst and frequent acid eructations accompany the imperfect digestion. The foul breath, early decay of the teeth, the slimy, glairy stools, having the appearance of the white of eggs, and an intolerable fetor, all are indicative of the scrofulous tendencies of the system.
Causes. Scrofula may be attributed to various causes. Observation has shown that ill-assorted marriages are a prolific source of scrofula. Both parents may be not only healthy and free from hereditary taints, but robust, well-formed physically, perfectly developed, and yet not one of their children be free from this dire disease. It may present itself in the form of hip disease, white swelling, "fever-sore" suppurating glands, curvature of the spine, rickets, ulcers, pulmonary consumption, or some skin disease, in every case showing the original perversion of the constitution and functions. Scrofula is hereditary when the disease, or the diathesis which predisposes to its development, is transmitted from one or both parents who are affected by it, or who are deficient in constitutional energy, showing feeble nutrition, lack of circulatory force, and a diminished vitality. All these conditions indicate that a few exposures and severe colds are often sufficient to produce a train of symptoms, which terminate in pulmonary or other strumous affections. Whatever deranges the function of nutrition is favorable to the development of scrofula, therefore, irregularities and various excesses tend to inaugurate it. Depletion of the blood by drastic and poisonous medicines, such as antimony and mercurials, hemorrhages and blood-letting, syphilis, excessive mental or physical labor, as well as a too early use and abuse of the sexual organs, all tend to waste the blood, reduce the tone of the system, and develop scrofula.
Scrofula may be the consequence of insufficient nourishment, resulting from subsisting upon poor food, or a too exclusively vegetable diet, with little or no animal food.
Want of exercise and uncleanliness contribute to its production. It is much more prevalent in temperate latitudes, where the climate is variable, than in tropical or frigid regions. The season of the year also greatly influences this disease, for it frequently commences in the winter and spring, and disappears again in the summer and autumn months.