into manhood; whilst with phthisis, the very opposite is observable, this form of the disease being comparatively rare during the early stages of life, and becoming more conspicuous in proportion as the tendency to scrofula diminishes. Sex also contributes its influence, consumption being more frequent in female than in male children,* whilst scrofula certainly shows itself oftener in the latter ;† -and this may serve, in some measure, to explain the fact to which I shall presently allude, of phthisis being more common in adult males than females; it being probable that the former have, in many instances, escaped its attack during childhood, in consequence of the early presence of some one of the common forms of scrofula having postponed the really phthisical symptoms to a more advanced age. There are doubtless many conditions of life which exert an influence in the developement of one in preference to the other; but these are too obscure either to be defined or explained. * See Chapter VIII. †This remark is not founded upon statistical evidence, but upon general observation of scrofulous cases brought to the Consumption Hospital. CHAP. VI. THE RELATION OF CONSUMPTION TO OTHER TUBERCULAR DISEASES. HAVING shewn that phthisis and scrofula are but modifications of the same disease, it remains that I should briefly allude to their connexion with a number of other affections, known, it is true, by distinct names, and characterized by a very dissimilar train of symptoms to that of phthisis, yet differing in nothing, pathologically, either from it or the common forms of scrofula, except in the position of the tubercular secretion. In all tuberculous diseases the morbid deposit is liable to be more or less scattered through the whole of the internal organs, but there is always a tendency to its greater accumulation in one particular part; and, hence arise differences in the character of the malady according to the relative importance of the affected organ to the functions of life. Properly speaking, phthisis is only a generic term, admitting of as many species as there are internal organs liable to become tubercular; but it has been so long employed to designate exclusively that form of the disease in which the pulmonary organs are the most implicated, and we are so accustomed to regard it as expressive only of the common every-day variety of tubercular affection popularly termed consumption, that it seems quite as undesirable to extend its meaning, as it is at present unnecessary to use the prefix pulmonary in order to explain it. It is, however, of the greatest importance to bear in mind the common origin of all tuberculous affections, since, however dissimilar they may appear, one is often converted into another; and what may ultimately end in ordinary consumption may have a very different beginning. One of the most common of these diseases is that termed tabes mesenterica, from the tubercular deposit being chiefly collected in the glands of the mesentery. In many phthisical cases these glands are found enlarged and more or less occupied with tubercle, but they are then generally, although perhaps not always, secondarily affected, in consequence of some tuberculous ulceration upon the mucous membrane of the intestines. The true tabes mesenterica is principally seen in infancy and childhood, and is, perhaps, the most common form under which the scrofulous diathesis at this period of life is exhibited; it does not appear to be necessarily connected with a previous tubercular condition of any portion of the alimentary canal, but more generally arises from primary tuberculosis of the chyliferous glands. It is seldom accompanied by any urgent thoracic symptom, although nearly every other evidence of consumption sooner or later manifests itself: upon careful examination, however, the lungs are frequently found in a more or less degree tubercular; and, very often, there are other indications of scrofulous disease. The affection is chiefly seen amongst the members of consumptive families, frequently appearing in infants, the offspring of phthisical parents, although, like ordinary consumption, it may be acquired. Its tendency to become converted into phthisis is often very marked; a vast number of who may persons, who overcome its attack in early life, falling, at some future period, a prey to consumption. The acute, and sometimes also the chronic, hydrocephalus of children, is a disease of the same nature, its pathological anatomy often displaying a tubercular condition of the membranes of the brain-usually the pia-mater. It is true that its general characters bear but a slight resemblance to consumption, but this is solely attributable to the peculiar functions and importance of the parts implicated, and the necessary predominance of cerebral symptoms. In many cases, however, there is something which leads to a suspicion that other internal organs— especially the lungs and bronchial glands are likewise diseased; and where recovery from hydrocephalus takes place, it is not unusual to see it followed, in after life, either by some other form of scrofula, or by actual consumption. There is a scrofulous disease of the cerebral membranes occurring at a later period of life, of a more acute form, and known as tubercular meningitis; but as this is to be regarded rather as a complication of phthisis, than an original disease, it will come before us, more properly, in a subsequent chapter. Most of the cases of chronic peritonitis have a scrofulous origin, and ultimately assume many of the general characters of consumption: now and then they are secondary to some malignant or other disease; but in the majority of instances, they are dependent upon an accumulation of tubercular matter about the peritoneum and intestines. This affection is more rare than either of the preceding, and differs from them in being less frequent in infancy and childhood, than in middle and more advanced life. It is invariably associated with a tubercular condition of the lungs (a valuable help to its diagnosis), and the two often advance simultaneously; but it sometimes runs a solitary course, checking, as it were, the pulmonary disease. It would be too great a digression to enter further into a description of these particular forms of tubercular affections; and it is unnecessary that I should do more than briefly enumerate a few other morbid conditions included under the general term-scrofula. Certain local inflammations, particularly of the eye and ear;-strumous enlargement of the secreting and absorbent glands ;—many diseases of the osseous system, such as caries of the vertebræ, disease of the hip-joint, etc., and the disorder popularly called rickets,—are all intimately related |