happiness. But such persons cannot be strictly said to be cured of their disease: upon close investigation, the most fortunate of them will be found to be more or less invalids, and, sooner or later, they will fall the victims of phthisis;-their pulmonary cavities, although perhaps considerably contracted and quiescent, have not healed, but are liable at any time to become the seat of renewed disease; whilst some neighbouring tubercle is almost certainly present, ready to develope, under any exciting cause, its fatal properties.

The phthisis of children, although in many cases severe and rapidly fatal, is, upon the whole, more frequently recovered from than that of the adult; and this from two causes:-first, from the greater power of resisting disease so conspicuous in early life; and secondly, because very often, in children, the chief portion of the diseased matter is accumulated in the bronchial glands. In these structures, although in some few cases it produces formidable symptoms, it commonly does less injury than in the lungs, and should it not be absorbed, is more disposed either to undergo calcareous transformation, or to become hardened and innocuous; and even when softening actually occurs, the resulting scrofulous abscess may, in favourable cases, be completely discharged through an opening into one of the adjacent bronchial tubes. In one or other of these ways the diseased glands are sometimes contracted, or even obliterated, and recovery gradually ensues.

IDENTITY OF CONSUMPTION AND SCROFULA. 33

CHAPTER VI.

THE IDENTITY OF CONSUMPTION AND SCROFULA.

MUCH ingenuity has been exercised by various authors, in attempting either to prove or to disprove the identity of phthisis and scrofula; and so long as the subject is viewed in any other light than a purely practical one, differences of opinion are likely to prevail.

The chemical and microscopical analyses of the tuberculous and scrofulous secretions are alike,—a circumstance of itself sufficient to render the identity of the processes under which the two are produced, something more than probable; but one upon which I shall not insist, believing that the same conclusion is made irresistible by evidence of a more simple kind, and less open to dispute.

First.-The two affections are so frequently intermixed in the history of families, and an acquaintance with the one so often implies a more or less practical knowledge of the other, that their dependence upon the same hereditary cause becomes almost self-evident. Many consumptive persons are descended from scrofulous ancestors, and scrofula

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quite as often shows itself in the offspring of those who are phthisical; whilst in the same generation the two exhibit every possible variety in their developement, some members of a family being, perhaps, scrofulous, whilst others are destined to become victims of phthisis.

Secondly.-The two are very often coexistent in the same individual;-a circumstance of no little weight in determining their identity, since one of the most striking characters of phthisis consists in its rare association with other diseases.

Thirdly. The one is convertible into the other; many consumptive persons having been scrofulous during their childhood; and many scrofulous persons having at some earlier period shown decided symptoms of phthisis. Indeed, it would often seem to be left to the operation of some accidental circumstance, to decide which of the two is ultimately to prevail.

Fourthly. The two affections are interchangeable, and scrofulous and phthisical symptoms may alternate with each other.

Examples variously illustrative of these points. must be familiar enough to every medical practitioner. The children of a family, for instance, are sometimes observed to fall, one after another, the prey to consumption, although the parents may exhibit nothing more than some obscure traces of long-forgotten scrofulous disease. I have seen several cases, where, perhaps, a few scars upon a

mother's neck-the old cicatrices of former strumous abscesses, have been left, as it were, to explain, at some future period, the phthisical condition of her offspring. At the Consumption Hospital, it is only too common to witness the decidedly scrofulous parent seeking relief for the phthisical child; whilst it is even more common to observe the mother, herself slowly fading under the ravages of consumption, bearing in her arms the little sufferer from some form of scrofulous disease. Everyone must have noticed the capriciousness of the two affections in their developement in the same generation. I am acquainted with a family-once a large and happy one, but now reduced to the father and a daughter,-in which this has been most painfully exemplified: the mother had not long died of phthisis, before the same disease exhibited itself amongst the children, in all of whom, with one exception, it ultimately proved fatal; scrofula is now manifest in the survivor, and seems, indeed, to be the sole condition to her reprieve.

The coexistence of the two, although occasionally seen in adult life, is more frequent amongst children, numbers of whom, when suffering under scrofula, will be found, upon minute examination, to be also the subjects of latent phthisis; whilst instances are not wanting, even amongst adults, of the aggravation of phthisis by some distressing scrofulous complication. There is invariably a tendency, in cases of this nature, for the one form of disease

to keep the other in abeyance; and it is this circumstance which makes the union of the two to be less frequent than it really is.

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The conversion of one into the other, is an occurrence which is constantly taking place during infancy and childhood; and I cannot recall to mind a single case of consumption happening before the age of ten years, which had not been preceded either by strumous glands, or some symptoms of marasmus, hydrocephalus, or other scrofulous affection.

The alternation of the two is less common in early than in more advanced life; and, although not very frequent, it shows more plainly than any other circumstance, that the two conditions are dependent upon one and the same cause, and are merely external and internal manifestations of the same disease. A remarkable example of its occurrence was lately under my notice at the Consumption Hospital, in a patient who had been under treatment for nearly three years. The softening process was going on in the lungs at the time of his admission, and the case bore a most unpromising appearance; the cervical glands, however, soon began to discharge scrofulous matter, and an abscess formed in the tibia. From this time, the pulmonary symptoms abated, the patient improved in health, and returned to his employment, which was that of a town-traveller. A few months afterwards he again applied at the hospital, without the