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CHAP. V.

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, the same 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 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 stru

mous 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 circum

stance which makes the union of the two appear to be less frequent than it really is.

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 better 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 is, at the present time, under my notice at the Consumption Hospital, in a patient who has 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 scrofulous symptoms, but apparently in the last

stage of phthisis. After a short rest and proper care, his health again improved; he increased in weight, the scrofulous abscesses reappeared, and he resumed his occupation. This curious alternation of symptoms has again been partially repeated, and will probably continue to be so, until the health finally gives way, and the pulmonary disease gains the mastery. Cases very similar to this, but less distinctly marked, have several times presented themselves.

Such illustrations of the connexion between phthisis and scrofula, appear to me to afford more practical and convincing proofs of their identity than any reasoning whatever; because (as we shall presently have occasion to notice), not only has consumption no such relationship with any other form of disease, but it is amongst the best examples of the so-called antagonism of one disease to another.

When we seek to ascertain why scrofula should be developed in one generation, or in one individual, and phthisis in another, we become at once involved in difficulties which beset all such inquiries; and until we have discovered more accurately in what the tubercular diathesis essentially consists, it will be as well to avoid any attempt at explanation. Age, however, seems to have an important influence in this particular; the liability to scrofula being greatest during infancy, and decreasing gradually as childhood passes into youth, and youth

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