tapped, upon the very morning when the operation of tapping was to have been performed. Very few cases are recorded of a cure of this disease, either by the efforts of art or nature. It would appear as if the absorbents of the ovarium were hardly capable of being excited to the degree of action necessary for the removal of the fluid. In one instance only have I ever known such absorption to occur, and the relief prove permanent. In most instances the ovarium again fills, and the patient ultimately dies. Death takes place sometimes from exhaustion, and sometimes from inflammation supervening on the sac in consequence of tapping.

Morbid anatomy.-On dissection, the ovarium is found converted into a capsule, often of enormous size, and of variable thickness, adhering in most cases, but not universally, to the peritoneum lining the abdominal parietes. It is sometimes so large as to occupy almost the whole cavity of the abdomen. In other cases, instead of a single bag, the ovary is converted into a congeries of cysts, either separate, or communicating with each other by considerable openings, and containing at times fluids of different kinds. Occasionally

tumours of a firm texture are found attached to the inner surface of the capsule.

The fluid of a dropsical ovary is almost always mucilaginous, and of a bluish or sometimes chocolate colour. Without experience in the disease, it is difficult to give credit to the statements which have been published of the quantities of fluid observed in different cases. In the Philosophical Transactions for the year 1784, a case is related of a woman who, in the course of twenty-five years, was tapped eighty times; and from whom six thousand six hundred and thirty-one pints of fluid were abstracted. On the 9th January, 1822, I drew off, after death, from a single thin membranous cyst, eighty-two pints. I have heard of a hundred and twenty pints having been drawn off at once during life. The rapidity with which the fluid accumulates varies in different cases. In the Medical Communications* will be found an interesting case of dropsy of the ovarium, in which nine hundred and sixty-four pints were discharged in the course of one year, at fourteen tappings, making, on an average, a daily secretion of nearly two pints

Vol. ii. page 123.

and a half. The disease lasted five years, during which time the patient was tapped forty-one times, and two thousand seven hundred and eighty-six pints of fluid were taken from her. In general it will be found, that when twenty-five or thirty pints are accumulated in the sac, the uneasiness from distension becomes so great that paracentesis abdominis is rendered necessary.

Causes. Of the causes of dropsical ovary very little is known. It does not appear that impregnation gives any peculiar disposition to it. Among the recorded cases many occurred among unmarried women. It has commenced as early as the twentieth year of life; but it is most frequent after thirty. Some cases may possibly have their origin in chronic inflammation of the ovarium. This opinion is supported by the fact, that in several instances the disease has been attributed by the patient to a contusion or fall.

Treatment.-Little need be said on the subject of treatment. Mercury has been tried and found to be useless. The operation of tapping affords the only effectual relief which it is in our power to hold out. A radical cure of the disease has been attempted by making a large opening in the cyst, with the view of inducing inflammation and adhesion, as in the case of hydrocele. Very powerful reasons, however, have been urged against this operation by Dr. W. Hunter,* and it appears in every respect unadvisable.

See Medical Observations and Inquiries, vol. ii. page 41.

CLASS IX.

CHRONIC CONSTITUTIONAL DISEASES.

CHAP. I.

SCROPHULA.

General outline of the Pathology of Scrophula. Marks of Scrophula in the healthy conditions of the body. Characters of Scrophulous disease. Structures affected by Scrophula. Causes of Scrophula. Hereditary predisposition. Acquired Scrophulous Diathesis. Causes leading to the development of Scrophulous disease. Principles of treatment. Importance of pure air. Sea bathing. Nourishing diet. Influence of tonic, alkaline, and other medicines. Treatment of Scrophulous inflammation of the Lymphatic Glands.

THE pathology of scrophula is altogether sui generis, not assimilating with that of any other known disease. It is moreover a subject of very great difficulty. A full investigation of it presupposes an acquaintance with almost all forms of disease, and of the modifications of which they are susceptible. Its extent is unbounded. To the physician and the surgeon it is equally an object of attention. Whether we regard symptoms, causes, or treatment,-whether we view diseases as external or internal, acute or chronic, a knowledge of the several doctrines connected with scrophula is indispensable to their complete elucidation. It may be considered, in fact, as the most important of those great links which bind together the infinitely varied ramifications of medical inquiry.

Interesting as scrophula is to the general pathologist, it cannot be denied that it is more especially essential in the inquiries of the surgeon. The principal forms of scrophulous disease being external, fall under his cognizance, and from them the chief characters of the affection are necessarily derived. These considerations will point out how little calcu

lated is this investigation for a work so brief in its plan, and so confined in its design, as the present. We may even go further, and say, that a subject of such extent and difficulty is ill suited for elementary works generally, and that the student should at first content himself with a superficial examination of it. Such at least is all that will here be attempted.

Marks of the scrophulous habit. -Scrophula is usually designated by nosologists as a morbid state of the lymphatic glandular system; but our notions of the affection would be very imperfect were we to view it only in this light. On the other hand, some have altogether denied to scrophula the name of a disease, and have considered it only as a peculiar habit of body giving a predisposition to morbid action. Without waiting to discuss a point which resolves itself into a mere dispute about words, I proceed to state, that independent of the unequivocal characters of scrophulous disease, there are marks by which, in the very healthiest conditions of the body, the scrophulous disposition may (not indeed with certainty, but with a reasonable share of probability) be distinguished. Of this kind are, a fair, thin, and smooth skin, in which the bloodvessels are particularly apparent; light and soft hair; large blue eyes and a blooming complexion; the upper lip, columna nasi, and lower part of the nostril, more tumid than natural; fulness and turgescence of the veins; long and slender fingers; and lastly, a narrow chest, and prominent shoulders. The scrophulous habit is thus characterized by a general laxity of muscular fibre, and delicacy of organization throughout the body. The mental faculties are usually developed early. The intellect is acute and lively.

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Characters of scrophulous disease. The scrophulous diathesis, however, can never be decisively proved by the concurrence even of all these appearances. There must be superadded to them certain morbid phenomena, before its presence in the system can confidently be pronounced; and these will seldom fail to exhibit themselves, for scrophula is marked by a peculiar disposition to morbid action in the body. Among the earliest, the most frequent, and most characteristic symptoms of the disease, are swellings of the absorbent glands, particularly those of the neck. This, too, is the mildest form under which scrophula ever appears. Such tumours sometimes continue for a long time, neither advancing nor receding, unattended by

pain or any constitutional disturbance. Sometimes they subside spontaneously, but more frequently suppuration of an imperfect kind gradually takes place in them, followed by open ulceration. The ulcers heal slowly, leaving ragged and unsightly scars, and are succeeded by other tumours, which run a similar course. In this manner the disease is often kept up for a series of years, until at length the constitution strengthening, either throws it off, or it appears under some of its more severe and dangerous forms.

An opinion has been entertained, that in scrophula a morbid matter is generated which has a specific influence on the lymphatic system; but there are no sufficient grounds for this notion. What the circumstances, however, are, which in a scrophulous habit render the lymphatic system so peculiarly liable to inflammation we know not. Scrophula affects equally many other structures, and in all cases the inflammation which is excited has the same general character. It is of a chronic, languid kind. The scrophulous abscess is distinguished by its jagged and uneven sides The pus which it contains, instead of having a bland, uniform, cream-like appearance, is thin, or ichorous, and mixed with curdy flakes. The ulcer by which it is succeeded has a smooth, obtuse, and overlapping margin. The surface of the sore is of a light red colour, and the granulations are flabby and indistinct. For a great length of time, in spite of every care, it remains indolent, neither increasing nor diminishing in size.

Structures affected by Scrophula.-There is hardly an organ or tissue of the body which can be considered free from the occasional ravages of scrophula. It appears sometimes in the head, in the form of small tumours, attached to the membranes, or imbedded in the substance of the brain or cerebellum, and laying the foundation of hydrocephalus. In the lungs scrophula exhibits itself in the form of tubercles, scattered through their substance, modifying the character of inflammation in that organ, and producing genuine consumption. Scrophula, in like manner, attacks in their turn all the viscera of the abdomen, the liver, the peritonæum, the kidney, the ovaria, and above all the mesenteric glands.

The gradual expansion of the opinions of pathologists regarding the nature of scrophula, will be found ably detailed in an article in the Edinburgh Medical and Surgical Journal, vol. xviii. p. 121.