and indeed, the washing out, by means of these, the lymphatic system, would seem to be a measure promising success; but in very many instances of the use of these waters, I have not been well satisfied that they had shortened the duration of the disease more than had often happened, when no such remedy had been employed."* Dr. Cullen states scrofula to be an hereditary disease, and Mr. Carmichael strongly objects to this opinion; but before we go further, let us see if Dr. Cullen and Mr. Carmichael really mean one and the same disease. We shall give the author's own descrip. tion of the disease he has been so successful in treating, and his method of cure.

"In entering into a consideration of the circumstances which in children may produce disorders in the alimentary canal, it may be satisfactory to state a few cases, which prove that glandular swellings of the neck in infants are preceded and accompanied by a disordered state of the bowels; and that the removal of the former depends upon relieving the latter. Infants on the breast and in the second year are frequently affected with swellings of the glands at the upper and lower parts of the neck, and in the axilla, which make their appearance suddenly, and increase rapidly, often to a considerable size, until suppuration is established: when they break, or are punctured, they are difficult to heal, remain a long time open, and though at first they evince more of the phlegmonous than of the scrofulous inflammation, yet afterwards they often assume the characteristic appearances of scrofula. Having observed the connection between disorder of the primæ via and the symptoms of scrofula, I was induced to inquire into the state of the bowels in these cases; and I universally found that the evacuations of the child were either green, black, or slimy, for some time previous to the occurrence of the swelling. Within the last seven months I took notes of several of these cases which occurred at St. George's Dispensary, and in private practice; and I shall transcribe a few of them, as their history must convey a clearer idea of their nature than any general description.

"CASE 1.-In the beginning of July, 1809, I was called upon to see an infant, three months old, affected with large tumours of a phlegmonous appearance on each side of the neck, immediately below the under jaw. On inquiry, I was informed that the child from her birth had never been regular in her bowels, and that her evacuations were constantly either of a green or black appearance. I directed a grain of calomel with six of rhubarb to be given every second night, and ten grains of prepared carbonate of lime, with two of carbonate of soda, every morning and evening.

"This course had soon a good effect. In four or five days the evacuations became natural in appearance, the tumours were poul

ticed

First Lines, § 1753.

ticed until they broke, and in about a fortnight were perfectly healed.

"CASE 2.-Edmond Burke, 14 months old, was brought to St. George's Dispensary on the 21st of August, 1809, on account of a tumour, hard, red, and painful, extending under the lower jaw from one ear to the other, the commencement of which was only observed by the mother four days before. His dejections, during the preceding six weeks, were of a green and sometimes of a black colour. I directed emmollient poultices to the tumour, a grain of calomel, with ten of rhubarb, to be taken every second night, and fifteen grains of carbonate of lime with five of soda, orning and evening.

"Under this treatment, the evacuations soon exhibited a natural appearance, the tumour broke in a week, and after discharg ing a considerable quantity of matter, healed in a fortnight more, like any common abscess.

"I pointed out this case, as well as several others of the same description, to the attending physicians of St. George's Dispensary.

"CASE 3.-William Jackson, 5 months old, was brought to me on the 21st of September, 1809, with an inflammatory tumour on the left side of the neck, which was only observed seven days before. His mother informed me that his bowels had not been regular since his birth, but that he was attacked frequently by convulsions during the last fortnight, and that his dejections were of a green colour and sour smell. He was directed to take half a grain of calomel, with ten grains of prepared carbonate of lime, morning and evening. The frequent use of the tepid saltwater bath was also enjoined, together with warm cloathing and frequent hand rubbing.

"Under this treatment, in a fortnight, the evacuations became perfectly natural; about the same time the tumour broke, and soon afterwards healed without difficulty.

"CASE 4.-I was consulted about a child, 4 months old, on the 5th of October, 1809, who was affected with a large swelling, similar to those already mentioned, on the left side of the neck. She had been ordered poultices of sea-weed, by a physician of this city, I presume from an opinion of the scrofulous nature of the tumour.

"The mother requested advice at the same time for a disordered state of the infant's bowels, which she said had never been regular since her birth: under the plan of treatment mentioned in the last case, both complaints were removed in four weeks."

It certainly is no uncommon thing to meet with such phleg monous tumours as the author describes, in young children, accompanied with a disordered state of the primæ viæ; we have seen numerous cases of them, and have for many years treated them nearly in the same manner Mr. Carmichael recommends, but

e

never flattered ourselves that we had cured scrofula when these tumours suppurated and had healed; first, because we believed scrofula to be a disease that did not usually appear in the first months of the child's life; and next, because real scrofula is too unmanageable a disease to be cured in two or three weeks; scrofulous tumours are also much more indolent than those above described, which make their appearance suddenly, and increase rapidly, and as the author justly observes," evince more of the phlegmonous than of the scrofulous inflammation;" they also appear at all seasons of the year, and in children apparently of very different temperaments, circumstances differing materially from the characteristic appearances of scrofula; but not to rest on our own authority, let us compare this affection with the disease named scrofula by Dr. Cullen, for to the accuracy of his history and description, we presume Mr. Carmichael will not object, whatever he may think of his opinions on the nature and causes of that disease.

"The scrofula generally appears at a particular period of life. It seldom appears in the first or even in the second year of a child's life; and most commonly it occurs from the second, or as some allege, and perhaps more properly, from the third to the seventh year. The scrofula generally shows itself at a particular season of the year; and at some time between the winter and summer solstice, but commonly long before the latter period. It is to be ob served further, that the course of the disease is usually connected with the course of the seasons. Whilst the tumors and ulcerations peculiar to this disease, appear first in the spring, the ulcers are frequently healed up in the course of the succeeding summer, and do not break out again till the ensuing spring, to follow again with the season, the same course as before." The tumors are without pain, and without any change in the colour of the skin; in this state, they often continue for a long time; even for a year or two, and sometimes longer: from the time they first appeared in the spring, they often continue in this way till the return of the same season in the next, or, perhaps, the second year after. About that time, however, or perhaps in the course of the season in which they first appear, the tumor becomes larger and more fixed; the skin upon it acquires a purple, seldom a clear redness, but growing redder by degrees, the tumour becomes softer, and allows the fluctuation of a liquid within to be perceived. All this process, however, takes place with very little pain attending it.” *

We may fairly conclude, the hard red painful tumours Mr. Carmichael so easily and speedily cured, were not scrofula; this trifling circumstance, however, is no obstacle to our author, in constructing his hypothesis, which he attempts to establish by the following argument.

"But even supposing that these tumours were not in any way entitled

*First Lines, § 1740, 1742, 1744.

entitled to the name of scrofula, their connexion and dependance upon disorder of the alimentary canal; sufficiently establishes the point, that swellings of the lymphatic glunds may arise from, or be connected with, disorder of the digestive organs; and this is all that is at present necessary for our purpose in tracing the symptoms of scrofula to their source."

We do not see how the admitting the connexion and dependance of those tumours upon disorders of the digestive organs, is all that is necessary to trace the symptoms of scrofula to their source, while we suppose these tumours not in any way entitled to the name of scrofula.

Resting then upon the solidity of the above quoted argument, the author proceeds, "Having satisfied ourselves that the first symptoms of scrofula are those which denote disorder of the chylopoietic viscera, and that disorder of those parts is in early life frequently followed by swelling of the lymphatic glands of the neck, let us now proceed to consider the several circumstances, which in childhood precede and induce this effect."

We must here.observe, that we are not satisfied of the author's position; and lest our readers should be as little satisfied with it as ourselves, we will, by an extract from the volume before us, place the author's doctrine in a more connected point of view, and offer a few remarks, which naturally arise from the consideration of the proximate cause of scrofula being a disordered state of the chylopoietic organs.

"When it is considered that the first symptoms of scrofula are an enlarged belly, swelled upper lip, irritation at the nostrils, and irregularity of bowels, with green and black coloured fæces, all of which continue during the progress of the disease, and severally denote disorder of the digestive organs; and when it is also considered that disorder of those organs in children, is accompanied by the generation of an acid in the alimentary canal, we are justified in considering scrofula as a disease arising from, and generated by, disorder in the bowels, and that the treatment most likely to be successful, would be grounded on the indications of neutralizing the acid formed in the primæ viæ by alkalies and absorbent earths, of promoting a healthy secretion of the gastric juice, and of the bile, by exercise, tonics, and mercury, and of preventing, as much as possible, the further formation of acid in the bowels, by restricting the patient to a diet easy of digestion, and free from ascescency or disposition to the acetous fermentation."

So far from considering the symptoms above enumerated, as the pathognomonic ones of scrofula, we should conclude them to denote the presence of worms in the intestinal canal, or at least such a state of that canal as readily affords a nidus for those insects; while the healthy state of the digestive organs, during the existence of indurations of the glands and disease of the bones, the acknowledged symptoms of scrofula, would induce us not to think ourselves justified in considering scrofula as a disease arising from, and ge(No. 138.) M nerated

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nerated by, disorder in the bowels." At all events, the scrofula of Mr. Carmichael differs from the scrofula of other authors, especially from the disease so called by Dr. Cullen, as we have endeavoured to show; but there yet remains one point on which we must compare our author's opinion of scrofula, and Dr. Cullen's, and that is, its being, or not, an hereditary disease. The author thinks the popular notion of scrofula being hereditary, is founded in error, and he charges Dr. Cullen with propagating this error; he says, "in support of this statement, it is only necessary to recollect his opinion, that scrofula arises from a peculiar acrimony of the fluids;" that the disease rarely appears but in children whose parents had at some period of their lives been affected with it. In this quotation, opinion is confounded with fact; scrofula arising from a peculiar acrimony of the fluids was Dr. Cullen's opinion, its being hereditary was asserted as a matter of fact, and is only to be controverted by disproving that fact, by showing scrofula does not occur more generally in the children of scrofulous parents. Dr. Cullen's words are plain and unambiguous, and are capable of confirmation or refutation by an appeal to experience. With respect to the influence of parents in producing this disease, it deserves to be remarked, that in a family of many children, when one of the parents has been affected with scrofula, and the other not; as it is usual for some of the children to be in constitution pretty exactly like the one parent, and others of them like the other, it commonly happens, that those children who most resemble the scrofulous parent, become affected with scrofula, while those resembling the other parent, entirely escape."* After all, it is a mere dispute of words; the author, while he admits advanced scrofula to prevail in particular families, denies the disordered state of the digestive organs, and the generation of acidities in the primæ viæ in children to be hereditary, and Dr. Cullen never asserted them to be so. The author calls that state of those organs scrofula, and Dr. Cullen never did. The following attempt to explain the fact of scrofula prevailing in particular families, is not satisfactory, nor does it notice the disease appearing exclusively in the children resembling the scrofulous parent.

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"It must be acknowledged, however, that there are instances of the prevalence of this disease in particular families; but when this is the case, it is most probable, that instead of an hereditary taint, either a languid inert fibre predisposes to its attacks, or the same bad mode of rearing children (such as abandoning them to the negligence of hireling nurses) has been transmitted from one ther to another, and produces similar effects whenever it occurs." With respect to the exciting causes of scrofula, much needs not to be said; while the author persists in calling weak digestion and acidities in the primæ viæ scrofula, he may fairly call all circum

mo

stances

*First Lines, § 1739.