1846.]

ARE PHTHISIS AND SCROFULA IDENTICAL?

135

trusted to statistical calculations, that he has actually been led to believe, that "where there is a large mortality from consumption, there is a small mortality from scrofula, and vice versa. To bear him out in this somewhat unexpected conclusion, he adduces, among other circumstances, the testimony of Mr. R. Martin to prove that phthisis is much less frequent in India than in our own country, while scrofulous disease is alleged, on the authority of another East India practitioner, Dr. Stewart, to be very frequent there. As we shall revert to the opinions of these gentlemen, when we come to allude to the influence of Climate on Scrofula, we shall not say more at present than that they are strikingly opposed to each other on one very material point.

If we required any other argument to prove the intimate connexion and relationship of scrofulous disease and tubercular phthisis, we should point to Dr. Baly's letter addressed to Mr. Phillips, in reply to certain interrogatories on the subject. The entire letter, indeed, proceeds on the assumption of this very point; and the numerous and very interesting facts, which the writer brings forward from his experience during the last five years at the Millbank Penitentiary, abundantly show that the very same circumstances and conditions tend either to check or to promote the development and progress of Consumption and of Scrofula-the two diseases uniformly increasing or diminishing pari (or, at all events, simili) passu.

"The frequency of Scrofula and internal tubercular disease amongst the prisoners in the Millbank Penitentiary, was one of the first and most important facts which offered themselves to my observation when I commenced my attendance at the Institution in the spring of 1840. I found that the prevalence of the disease had already engaged the attention of the Medical Officers, and that a considerable number of prisoners who were most severely affected with it, had been separated from the rest, and placed in a distinct Ward, and that the system of discipline as it regarded them, had by medical suggestion been much relaxed. The experience of the four subsequent years, and the examination of the Medical Records of the Penitentiary, only strengthened the impression which I had at first received.

"The great amount of tubercular disease engendered by imprisonment in the Penitentiary is proved by the following facts. During eighteen years, 205 deaths occurred amongst the prisoners in that Establishment. Of this number, however, 31 deaths arose from the Asiatic Cholera, which was epidemic during the years 1832-4, and only 174 from ordinary causes. Now of the 174 deaths, 75 were caused by Consumption, and eight by other forms of tubercular disease. Again, during the same period of eighteen years, 355 prisoners were pardoned on the ground of illness, and of these, 90 laboured under Consumption, and 78 under external Scrofula. So that very nearly half the deaths, and the same proportion of the pardons on medical grounds, were due to external or internal Scrofula, or tubercular disease." P. 362.

Mr. Phillips lays a good deal of stress, in the working out of his posi tion that Scrofula and Phthisis are in many respects different forms of morbid action, on the circumstance that the subcutaneous lymphatic glands are diseased in only a very small proportion of those who die from phthisis. But what does this prove?-nothing more, as far as we can perceive, than that when, from a certain cachectic state of the system, one organ is more particularly the seat of disease, another is generally less seriously affected with it at the same time. Dr. Renton of Madeira puts the question

thus:-"May not your views of Phthisis being rare, when enlarged glands are common, arise from the same identical constitution wreaking its vengeance on the more external parts." Although few of our readers, we should suppose, will be inclined to adopt Mr. Phillips's views, it may be but fair to him, and not uninteresting to them, to present, in his own words, the following summary of his views:

66

I apprehend," says he, "it has now been shown, by abundant evidence, that with the exception of the deposit itself, which, whether found in the lungs, or in a cervical gland, whether examined by the naked eye, by the microscope, or by chemical analysis, is very similar, the circumstances attendant upon the development of Scrofula and Phthisis are widely different. In Scrofula the gland undergoes considerable change, inflammatory in its nature, before the matter is deposited in it; in the lung we commonly find the tissue around a recent simple tubercular deposit unchanged by inflammation. We find, further, that in districts where the causes of Phthisis act with most intensity, those of Scrofula fall lightest; that the age when the ravages of Scrofula are most keenly felt is precisely that when the visitation of Phthisis is least to be apprehended; that the sex which suffers most severely from one of those diseases is least affected by the other. And beyond all this, there is the fact that, among the numerous victims of Phthisis, at least eighteen out of every twenty exhibit no marks of having suffered from Scrofula. It seems to me, therefore, that these facts constitute so clearly marked a difference between the two affections, that it will be most convenient, most conducive to scientific correctness, to consider them as affections possessing a certain general similarity of character, but no identity. It may be that they belong to the same family, so do Pleurisy and Pneumonia; but every one deems it desirable to make as clear a demarcation as possible between those diseases. I say the same of tubercular disease generally and Scrofula, between which the points of resemblance are strong, in so far as concerns the deposit ; but in all else they are weak." P. 78.

Despite this attempt at distinction, Mr. Phillips himself, in many subsequent parts of his volume, seems to regard Scrofula and Phthisis as members of the same family; for, at page 203, he actually uses the former as the generic term, and includes the latter, and Tabes Mesenterica, as different species.*

In Chapter VII., Mr. Phillips endeavours to show that Scrofula is by no means so common or prevalent a disease in England, as in most other countries of the world. After giving a variety of statistical particulars, he says:

"It is thus seen, that though derived from so many and such different sources, there is a striking concurrence in the results of the evidence I have collected, and that agreement constitutes a strong reason for believing that my data do, very nearly, represent the actual prevalence of the disease. We see that the Returns

*It may be worthy of notice that M. Lugol, in his lately published volume,— of which we gave a copious review in the Number of this Journal for January, 1845-has devoted a Chapter expressly to prove the identity of Scrofulous and Tubercular diseases. The same opinion is held by MM. Rilliet and Barthez, whose admirable work on the Diseases of Children we still more recently brought under our reader's notice. Let us, however, not forget to mention that the subject named, last year, by the French Royal Academy of Medicine for the Portal prize was, "The Analogies and the Differences between Tubercles and Scrofula."

1846.]

THE DISEASE LESS PREVALENT IN ENGLAND.

137

of cases of Scrofula, found among our ordinary population, are singularly confirmed, not only by the Returns of Hospitals and Dispensaries, but also by the examination of Recruits and Convicts; and I think we are thus justified in regarding as near the truth our estimate of the prevalence of Scrofula, such as we have defined the disease. That is to say, that scars are apparent in about 1 per cent.; that the subcutaneous glands are enlarged, so as to be perceptible on simple inspection in less than 3 per cent.; and that the glands may be detected by the finger in 241 per cent. of those of the children of the poor who are under sixteen, and in 8 per cent. of those above; or taking the whole population, in 10 per cent.; and that something less than 3 per cent. of the people are under treatment for the disease in its various forms." P. 84.

He then adduces numerous details respecting the prevalence of the disease in other countries of Europe and of America, and alludes particularly to the numbers of recruits in the French army that are yearly rejected for having marks of Scrofula. He closes his remarks with these encouraging (would that they were proved to be true) words :

:

"It appears, then, that comparing Paris with London, the deaths from Scrofula, when compared with the population, are six times as many in the former as in the latter capital; and that for the whole of France, the marks of Scrofula presented by recruits are twice as many as among our own recruiting population.

“Is it not, then, abundantly proved, that the notion that Scrofula is eminently an English disease, is incorrect; and am I not warranted in stating that there is no country, so far at least as our information extends, in which the people are more free from the disease than in England and Wales?" P. 91.

Is Scrofula on the increase in this country? Without adducing the data which our author has collected together on this point, we shall merely give the conclusion to which he has arrived :—

"Tried, then, by such tests as I have been enabled to apply, which though not strictly accurate, are the best we possess, and which, when used with caution, constitute a fair body of evidence on the point, the conclusion seems a fair one that Scrofula is much less prevalent in the present day than it was in the seventeenth and eighteenth centuries." P. 98.

The subject of the Etiology of Scrofula is treated at great length in Chapter IX. Nearly 150 pages are devoted to its consideration. With respect to the hereditariness or transmissibility of the disease from parent to child, Mr. Phillips, after exposing the extravagant absurdity of many of M. Lugol's hobby-horsical views on this subject, as we had previously done in our review of his work, propounds some peculiar notions of his own. He will not, for example, admit that "a scrofulous mother does ordinarily produce a scrofulous child."

"Nay," he says, "it is not apparent that the influence of a scrofulous parent is more efficient to induce Scrofula in the child than the influence of equal constitutional debility in a parent, originating in other causes than Scrofula. In other words, an ailing parent is less likely than a healthy one to give birth to a vigorous child, and a weakly child is more susceptible than a vigorous one of Scrofula, as well as of other diseases. But in the sense of a direct specific tendency in a scrofulous parent to reproduce in the child the same disease from which the parent suffers, in virtue of an agency of a different nature to that which would be exercised by simple constitutional debility in the parent, it seems to me we have no satisfactory proof." P. 238.

According to his researches, the influence of hereditary transmission does

not appear to be quite 4 per cent.-a very low ratio, it will be admitted. As bearing him out in his views, he appeals to the testimony of M. Louis in reference to tubercular phthisis; for this gentleman remarks that "in reality I have observed nothing decisive in favour of the hereditary character of phthisis." After examining the opinions of various other writers on the general question of hereditary influence and predisposition,* Mr. P. comes to this conclusion respecting Scrofula :

The result of the facts now offered is, that a feeble constitution is a favourable, though not a necessary, or indispensable, condition for the development of the tuberculous cachexia; that a feeble constitution is more likely to be the offspring of diseased than healthy parents; but that we are not in a condition to point out the causes in the parent which tend most to entail feebleness upon the child, nor what kind of disease or feebleness in the parent tends most to induce the development of Scrofula in the child.” P. 127.

We need not extend our remarks on the various alleged causes of scrofulous predisposition in the child, as derived from the age or affinity of the parents, from being suckled by a scrofulous nurse, and so forth,† as our attention was so recently occupied with all these matters in the review of Lugol's work; and there are no new facts adduced by the present author to throw light upon these somewhat obscure topics. There is, however, one opinion that may deserve to be noticed en passant, as it is decidedly at variance with common belief."

"I doubt whether we have any clear evidence of the bad consequences, either on the mind or the body, of frequent intermarriages. I know that, in the management of stock, a notion adverse to breeding in and in prevails, but I know also that it is most extensively practised, especially with the best bloods and breeds, and therefore I conclude that the apprehended evils are not realized.

"In so far as concerns the human race, this point is not easily elucidated, and even with reference to brute animals the evidence is very inconclusive. The only mode of satisfactorily examining the question in the human species, is to observe people who are more or less isolated, and are therefore obliged to intermarry within a narrow circle. For if the principle be operative, it should be found under these circumstances. The classes most favourably situated for the inquiry are the inhabitants of small islands, having little intercourse with other islands and main lands; and on our own coasts, the people of the Isles of Portland, Man, and of the Channel Islands best realize those conditions, but I do not find that Scrofula is more prevalent among those Islanders, than in places where the

*The following truly characteristic and instructive anecdote of John Hunter well deserves to be generally known:

"On the trial of Donellan for the murder of Sir Theodosius Boughton, he was asked: 'Is not apoplexy sometimes apt to run in a family? To which he replied: There is no disease whatever that becomes constitutional, but what can be given to a child; there is no disease that is acquired, and becomes constitutional in the father but can be given to a child. The father has a power of giving that to the child by which means it becomes hereditary. There is no such thing as hereditary diseases, but such a thing as hereditary disposition." P. 122.

"Dupuy asserts that 'the milk of a tuberculous cow may contain a greater quantity of phosphate of lime than that of a healthy cow. Labillardière has proved that there may be seven times more phosphate of lime in the milk of a cow affected with pulmonary tubercle than in that of a healthy animal." P. 141. What should cause this inordinate amount of the earth of bones in the milk of a diseased animal?

1846.]

INFLUENCE OF FOOD IN ITS PRODUCTION.

139

circle is much larger. The Quakers, again, have for years married within a comparatively narrow circle, certainly much narrower than other classes of people in Britain; and I do not find more Scrofula among them than among other people of a similar social condition. The Jews, again, marry within a narrow circle, and in their early history near intermarriages seemed to be sought for; and we have no authority for saying that Scrofula is more than usually prevalent among that isolated race. And with respect to noble and royal families, I know of no evidence which favours the belief that frequent intermarriages tend to the production of Scrofula." P. 138.

From this debatable point, we pass on to notice some of the remarks of our author on the influence of Alimentation in the production of Scrofula.

It is almost unnecessary to say that those infants, who are deprived of their mother's milk and are brought up by hand, not only have a much more slender chance of life than those that are suckled as Nature intended, but also, if they should survive, are generally more feeble, ailing, and more frequently affected with Scrofulous maladies. No one is likely to dispute either the fact for it has been proved over and over again-" that Scrofula is least prevalent where children and others are best fed," or the position "that food exercises a more important influence than any other agent in the production of the disease." In reference to these points, Dr. Baly mentions a very conclusive fact, derived from his experience of the prisoners in the Millbank Penitentiary, which in itself speaks volumes: "A marked difference in respect of their general health and the number of them affected with scrofulous disease, is presented by the convicts sent to the central prison of Millbank, from different parts of Great Britain, preparatory to their transportation. By far the thinnest convicts, and those having the largest proportion of unhealthy and scrofulous individuals amongst their number, come from the Scotch prisons, in which the diet consists of a sparing allowance of vegetable and farinaceous food."

As showing the paramount influence of diet on the production of scrofula, we have only to attend to the state of things among the poorer classes in Ireland. The disease is more than twice as common among the Irish as it is among the same classes in England; we need not say that the food of the former is vastly less nutritious. The following communication from Dr. Martin of Waterford to our author, attests the distressing amount of scrofulous disease among the children in the Portlaw district :

“In 100 children under thirteen years of age, of people of the poorest class, not employed in factory labour, 17 had fair hair and blue eyes; enlarged glands were to be felt in the necks of 83, and two had suffered from necrosis of the tibia. In 50 children under 13, in the class of small farmers and petty shopkeepers, 28 were of fair complexion and gray eyes; enlarged glands were detected in 18 of the 50; 1 suffered from morbus coxæ. In 60 children under 13, belonging to the parents of the poorest class of factory operatives, 8 had decidedly fair complexion and blue eyes, the majority had light brown hair and gray eyes; enlarged glands were to be detected in the necks of 37; 1 had a scrofulous cicatrix, and 1 was suffering from white-swelling. In 60 children, under thirteen years, of the more comfortable class of factory operatives, 8 had decidedly fair complexion and blue eyes; enlarged glands were to be detected in the necks of 26. În 100 girls, be tween fourteen and eighteen, employed for more than a year at factory labour, 9 were of decidedly fair complexion and blue eyes; enlarged glands were to be de