SCROPHULA.

King's Evil.

Scrophula, Sauv. gen. 285. Vog. 397. Sag. 121. Struma, Lin. 284.

Description. This disease shows itself by hard, scirrhouss, and often indolent tumors, which arise by degrees in the glands of the neck; under the chin, armpits, and different parts of the body, but most commonly in the neck, and behind the ears. In process of time, the cellular substance, ligaments of the joints, and even the bones themselves, are affected. In scrofula the swellings are much more moveable than those of the scirrhouss kind; they are generally softer, and seldom attended with much pain; they are tedious in coming to suppuration; are very apt to disappear suddenly, and again to rise in some other part of the body. We may likewise mention as characteristic circumstances of this disease, a remarkable softness of the skin, a kind of fulness of the face, generally with large eyes, and a very delicate complexion.

Causes. A variety of causes have been mentioned as tending to produce scrofula, viz. a crude indigestible food; bad water; living in damp, low situations; its being an hereditary disease, and in some countries endemic, &c. But whatever may in different circumstances be the exciting or predisposing causes of the scrofula, the disease itself either depends upon, or is at least much connected with, a debility of the constitution in general, and probably of the lymphatic system in particular, the complaint always showing itself by some affections of the latter. And that debility has at least a considerable influence in its production is probable, not only from the manifest nature of some of the causes said to be productive of scrofula, but likewise from such remedies as are found most serviceable in the cure, which are all of a tonic invigorating nature.

Prognosis. The scrofula is a distemper which often eludes the most powerful medicines, and therefore physicians cannot with any certainty promise a cure. It is seldom, however, that it proves mortal in a short time, unless it attacks the internal parts, such as the lungs, where it frequently produces tubercles that bring on a fatal consumption. When it attacks the joints, it frequently produces ulcers, which continue for a long time, and gradually waste the patient; while in the meantime the bones become foul and corroded, and death ensues after a long scene of misery. The prognosis in this respect must be regulated entirely by the nature of the symptoms.

Cure. It was long supposed that scrofula depended upon an acid acrimony of the fluids; and this, it is probable, gave rise to the use of burnt sponge, different kinds of soap, and other alkaline substances, as the best remedies for acidity. But although a sourness of the stomach and prime vice does no doubt frequently occur in these complaints, yet this symptom seems to be entirely the consequence of that general relaxation which in scrofula so universally prevails, and which does not render it in the least necessary to suppose a general aëscency of the fluids to take place; as the one very frequently, it is well known, even in other complaints, occurs without the least suspicion of any acid acrimony existing in the other. This is also rendered very probable from the indolent nature of scrophulous tumors, which have been known to subsist for years without giving any uneasiness; which could not have been the case, if an acid, or any other acrimony, had prevailed in them.

In the treatment of scrofula, different morbid conditions, existing in different parts, require, according to circumstances, various means of cure: but, upon the whole, the remedies directed may be considered as used with a view either to the tumours, to the ulcerations, or to the general state of the system. Gentle mercurials are sometimes of use as resolvents in scrophulous swellings; but nothing has such considerable influence as a frequent and copious use of cinchona. Cold bathing too, especially in the sea, together with frequent moderate exercise, is often of singular service here; as is likewise change of air, especially to a warm climate.

In the scrophulous inflammation of the eyes, or ophthalmia irrumola, the cinchona has also been given with extraordinary advantage: and we meet with an instance of its having cured the gutta roacea in the face; a complaint which it is often difficult to remove, and which is extremely disagreeable to the fair sex.

From the various cases related of tumefied glands it appears, that when the habit is relaxed and the circulation weak, either from constitution or accident, cinchona is a most efficacious medicine, and that it acts as a resolvent and diuretic. It will not, however, succeed in all cases; but there are few in which a trial can be attended with much detriment. Dr Fothergill observes, that he has never known it avail much where the bones were affected, nor where the scrophulous tumor was so situated as to be accompanied with much pain, as in the joints, or under the membranous coverings of the muscles; for when the disease attacks those parts, the periosteum seldom escapes without some injury, by which the bone will of course be likewise affected. Here cinchona is of no effect: instead of lessening, it rather increases the fever that accompanies those circumstances: and, if it do not really aggravate the complaint, it seems at least to accelerate the progress of the disease.

Various are the modes in which cinchona is administered: Dr Fothergill makes use of a decoction, with the addition of some aromatic ingredients and a small quantity of liquorice root, as a form in which a sufficient quantity may be given without exciting disgust. But where it is easily retained in the stomach in substance, perhaps the best form of exhibiting it is that of powder; and in this state it is often advantageously conjoined with powder of cicuta, an article possessing very great deobstruent powers.

The powder, however, soon becomes disagreeable to very young patients; and the extract seems not so much to be depended upon as may have been imagined. In making the extract, it is exposed to so much heat, as must have some effect upon its virtues, perhaps to their detriment. In administering it, likewise, if great care be not taken to mix it intimately with a proper vehicle, or some very soluble substance, in weak bowels it very often purges, and thereby not only disappoints the physician, but injures the patient. A small quantity of the cortex Winteranus added gives the medicine a grateful warmth; and a little liquorice, a few raisins, gum arabic or the like, added to the decoction before it be taken from the fire, by making the liquor viscid enables it to suspend more of the fine particles of the bark; by which process the medicine is not only improved in efficacy, but at the same time rendered less disagreeable.

In indolent swellings of the glands from viscid humours, sea water has been strongly recommended by Dr Rutte.

Dr Fothergill also acquaints us, that the cicuta even by itself is not without a considerable share of efficacy in removing scrophulous disorders. He mentions the Scrofula case of a gentlewoman, about 28 years of age, afflicted from her infancy with scrophulous complaints, feverish ophthalmies, glandular swellings, &c., cured by the extractum cicute taken constantly for the space of a year. He observes, however, that when given to children, even in very small doses, it is apt to produce spasmodic affections; for which reason he rarely exhibits it to them when very young, or even to adults of very irritable habits.

Dr Fothergill gives several other instances of the success of cicuta in scrophulous cases, and even in one which seemed to be not far removed from a confirmed phthisis; but owns that it seldom had such good effects afterwards: yet he is of opinion, that where there are symptoms of tubercles forming, a strumous habit, and a tendency to phthisis, the cicuta will often be serviceable. It is anodyne, corrects acrimony, and promotes the formation of good matter. With regard to the quality of the medicine, he observes, that the extract prepared from hemlock before the plant arrives at maturity, is much inferior to that which is made when the hemlock has acquired its full vigour, and is rather on the verge of decline: just when the flowers fade, the rudiments of the seeds become observable, and the habit of the plant inclines to yellow; this, he thinks, is the proper time to collect the hemlock. It has then had the full benefit of the summer heat; and the plants that grow in exposed places will generally be found more active than those that grow in the shade. The less heat it undergoes during the preparation, the better. Therefore, if a considerable quantity of the dry powder of the plant gathered at a proper season be added, less boiling will be necessary, and the medicine will be the more efficacious. But let the extract be prepared in what manner forever it may, provided it be made from the genuine plant, at a proper season, and be not destroyed by boiling, the chief difference observable in using it is, that a larger quantity of one kind is required to produce a certain effect than of another. Twenty grains of one sort of extract have been found equal in point of efficacy to thirty, nay near forty, of another; yet both of them made from the genuine plant, and most probably prepared with equal fidelity. To prevent the inconveniences arising from this uncertainty, it seems always expedient to begin with small doses, and proceed step by step till the extract produces certain effects, which seldom fail to arise from a full dose. These effects are different in different constitutions. But, for the most part, a giddiness affecting the head, and motions of the eyes, as if something pushed them outwards, are first felt; a slight sickness, and trembling agitation of the body; a laxative stool or two. One or all of these symptoms are the marks of a full dose, let the quantity in weight be what it will. Here we must stop till none of these effects be felt; and in three or four days advance a few grains more. For it has been supposed by most of those who have used this medicine to any good purpose, that the cicuta seldom procures any benefit, though given for a long time, unless in as large a dose as the patient can bear without suffering any of the inconveniences above mentioned. There is however reason to believe, that its effects, as a diuretic, are in no degree dependent on its narcotic powers: and we are inclined to think, that recourse is often had to larger doses than are necessary; or at least that the same benefit might be derived from smaller ones continued for an equal length of time.

Patients commonly bear a greater quantity of the extract at night than at noon, and at noon than in the morning. Two drams may be divided into thirty pills. Adults begin with two in the morning, two at noon, and three or four at night, with directions to increase each dose, by the addition of a pill to each, as they can bear it.

But, after all, the best form under which the cicuta can, we think, be exhibited, is that of powder from the leaves. This, either under the form of powder or made into pills, may be given at first to the extent of four or five grains, and the dose gradually rising till it amount to 15 or 20 grains twice or thrice a day. Given to this extent, particularly when conjoined with cinchona, it has often been found of great service in scrophulous cases. At the same time it must be allowed, that such patients, after resisting every mode of cure, will have in some instances a spontaneous recovery in the progress of life, probably from the system acquiring additional vigour.

Different mineral waters, particularly the sulphureous ones, as those of Harrowgate, Moffat, and Gillsland, have been much recommended in scrophula, and sometimes productive of benefit. Recourse has sometimes also been had with advantage to zinc, iron, and barytes, particularly muriate of barytes. But as well as in rachitis, no remedy has been found more efficacious in scrophula than cold bathing, especially sea-bathing.