Part 19

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.

The mesenteric glands are to be prevented from inflaming, by supporting the action of the bowels, and preventing the formation of irritating matter, which, when absorbed, may swell these glands. Nourishing digestible diet, conjoined with rhubarb, and such remedies as act as tonics, at the same time that they keep the belly easy, are of use in this view; for the whole process of digestion is thus supported, and neither the feculent part of the food, nor the mucus of the intestines, become morbidly irritating.

The other parts of the body are to be prevented from inflaming, by avoiding the usual causes of inflammation, and the action of whatever may injure the healthy condition of the part, or impede the natural action. Thus, the knee and ankle joint occasionally become affected with scrophulous inflammation after fatigue, which injures the healthy condition of the parts.

Besides these precautions, which are necessary in those of an evidently scrophulous constitution, with regard to particular parts, it is likewise useful to preserve as vigorous and perfect a performance of the natural actions of the system, considered in the aggregate, as possible, by which we lessen the risk of any one part becoming diseased; for, whatever impedes or diminishes the performance of the natural and healthy action of a part (and, in this case, the whole body is to be considered as made up of parts), renders that part more susceptible of disease, or derangement of its actions. Cleanliness, pure air, warm and sufficient clothing, nourishing and digestible diet, invigorating exercise, and a due proportion of sleep, are therefore very powerful preventatives of this species of inflammation, insomuch, that Dionis remarks, that seventy-five out of the hundred, who came to be touched by the king, were children of the poor peasants.

When scrophulous inflammation does take place, then this invigorating plan is had recourse to as a cure, whilst, in truth, it is most useful as a prophylactic. The invigorating plan, which consists in the use of good diet, moderate exercise, sea bathing, &c. is indeed useful at this period, both because it tends to make the disease more easily overcome, and prevents other parts from being injured; but its utility is still greater as a prophylactic; and it does not appear to have any certain efficacy in promoting the resolution of scrophulous tumors, because these have naturally a strong disposition to advance slowly to suppuration, and therefore are not readily affected by such means as tend simply to strengthen the system, or support its actions, because these do not change its peculiarity, or morbid modification, which existed, ab origine. But, when the tumors have proceeded the length of ulceration, then they have gone a step farther to a natural termination; and, although the means which strengthen the system cannot remove the scrophulous diathesis of the system, they may nevertheless accelerate the cure of a chronic tedious ulcer, which is slowly tending of itself to a termination.

The remedies called agentes similes operate more directly on the scrophulous mode of action than those means which tend simply to strengthen the system, and may be usefully conjoined with them, because these agents tend to induce an action different from the scrophulous one, at the same time that it possesses a certain coincidence with, or general resemblance to the natural or healthy action. Hence, the bark has been frequently found to be useful in the cure of scrophulous inflammation, but oftener of ulceration than tumefaction of the glands, for the reason mentioned above. It does not appear, however, to possess, by any means, that certain power of curing scrophulous affections which is attributed to it by Dr. Fothergill, and several other authors; nor are we to suppose that it shall infallibly cure scrophulous inflammation, or ulceration of parts, which, even when affected with simple inflammation, are very difficult to be cured. If we find it difficult to cure a simple inflammation, or ulceration of a tendon, cartilage, or bone, we must not be disappointed if even a specific remedy for scrophula (granting such a one ever to be discovered) were to prove ineffectual in procuring a speedy restoration to health. The bark is likewise often ineffectual, because it is improperly administered. Given in small quantities, once or twice a-day, as is frequently done, it may prove a stomachic, and increase, like other tonic bitters, the power of the stomach, or the functions dependent on it; but we never can thus obtain the benefits of the specific action of the bark on the system. For this purpose, it must be given liberally, in as great doses, and as frequently repeated as can be done without producing continued sickness, or vomiting; and this must be continued regularly, late and early, not for days, but perhaps for weeks, at the same time that we prevent the action of such causes as would counteract the effects of the bark, such as poor diet, bad air, confinement, &c. Administered in this way, the bark may be rendered really useful, not only in the cure of scrophulous ulceration, but perhaps of many other diseases, whilst, in the common way of prescribing it, little or no benefit is derived from it.

See what has been said on this subject when treating of the cure of mortification.

The muriated barytes has been recommended by Dr. Crawford, and has of late been tried in France by M. Pinel and others. It does not appear to have any influence on tumid glands, or scrophulous tumors; but occasionally it is serviceable in scrophulous ulceration. It is, however, a medicine on which very little dependence can be placed, and which fails in a great majority of instances.

See the second volume of Medical Communications.

Nosographie Philosophique, Vol. II. p. 238.

When it is wished to prescribe it, the following is a very good formula:

R. Terræ Ponder. Salit. Chryst. gr. x. Aq. Font. Aq. Cassiæ utriusque uncias iii Syrupi Aurent. uncias ii.

Half an ounce of this may be given at first, twice or three times a-day, and gradually increased to such quantity as the stomach can bear without sickness.

The muriat of lime has been proposed by M. de Fourcroy; it is given more liberally than the muriated barytes, but it is not more efficacious.

Iron by itself, or mixed with the fixed or volatile alkalis, has also been frequently employed, but with very little benefit.

This metal was one of the principal ingredients in a remedy used by the Marischal de Rougeres, which consisted of filings of iron, sal ammoniac, salt of tartar, &c. Journal de Med. Tom. XL. p. 219.

Burnt sponge, millipedes, vitriolated tartar, and many other trifling remedies, which were at one time in repute, are now deservedly neglected.

Cicuta has been greatly recommended by Dr. Fothergill and others. It has very little effect on scrophulous tumors, or mild ulcers; but, when administered freely, it is sometimes of service in the irritable fiery ulcer, which was by the older writers called struma maligna.

This is highly recommended by M. Martcau. Journ. de Med. Tom. IV. p. 121.

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. Antimony has frequently been conjoined with this, but without much benefit.

Practique Moderne de Chirurger, par Ravaton, Tom. II. p. 3.

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.