XXI. Scrofula (Struma).
SYMPTOMS. These may be divided into two classes, latent and active. The characteristics of the scrofulous constitution are chiefly the following: The face is round, the skin thick, rough, hairy or downy, and the complexion dull and pasty looking; the features are large, the nose looks broad from the expansion of the nostrils, and the lips thick, particularly the upper one; the bones are thick, and the joints large; the fingers are unshapely and thick; the eyelids are often inflamed and look weak; there is a constant secretion from the nose, and the tongue is often large and flabby; the abdomen also is large and prominent and the hair and nails grow remarkably fast.
Scrofulous children are liable to the following forms of active disease: Enlargement and suppuration of the glands of the neck and below the jaws (popularly called King’s Evil); also in the groins, armpits, and occasionally in other parts of the body; Scrofulous Ophthalmia; Otorrhoea; Ozaena; swelling and caries of bone; Abscesses; White-swellings or Hip-joint disease; Infantile Convulsions; Acute Hydrocephalus; Tabes Mesenterica; Consumption; Scald-head; scabby eruptions and cracks on the lips, face, and ears; wounds fester and heal slowly; scars remain long and are thick and fleshy.
CAUSES. Hereditary taint; want of pure air in living and sleeping rooms; new, damp dwellings; want of sunlight; deficient or poor food; insufficient clothing; want of cleanliness; or unhealthy discharge in the mother. Measles, Scarlatina, Whooping cough, Catarrh, etc., are exciting causes.
EPITOME OF TREATMENT.
1. Constitutional Scrofula. Calcarea- C., Sulphur, Iodium, Mercurius- Iodium, Silicea
2. Glandular Swellings and sores. Mercurius-Iodium, Hepar sulph., Belladonna, Silicea, Spongia, Calcarea -C.
3. Abscesses. Mercurius, Silicea, Calcarea carb., Hepar sulph., Calcarea-Iodium, China
4. Eruptions. Iris., Mercurius-Bin., Viol Tric., Hepar sulph., Croton Tig., Sulphur (See “Skin Diseases.”)
5. Ophthalmia. Mercurius-C., Belladonna, Calcarea carb., Conium, hepar sulph., Sulphur (See Section XXIX.)
6. Running from the Ear. Mercurius, Pulsatilla, Silicea, Aurum (See Section XXXI).
7. Convulsions. Belladonna, Opi., Cuprum, Gelsemium, Stramonium (See Section XXIII).
8. Consumption of the Bowels. Calcarea carb., Iodium, Phosphorus-Ac.
9. Consumption. Phosphorus, Lycopodium, Arsenicum-Iodium, Calcarea-Iodium, Calcarea carb., Stann.
10. Water on the Brain. Belladonna, Verbascum-V., Hyoscyamus, Helleborus, Stramonium
11. Bone Diseases. Aurum, Silicea, Calcarea-Phosphorus, Calcarea carb., Asafoet., Phosphorus-Ac.
LEADING INDICATIONS. Calcarea Carbonica. Scrofulous tendency; enlarged abdomen; weakness of the bones; slow dentition; swellings; susceptibility to cold and damp; frequent discharge from the nose.
Mercurius Bin. Enlarged glands; hard abdomen; various eruptions on the head, face, and ears.
Sulphur. Strumous Ophthalmia; Unhealthy skin; humid eruptions; discharge from the ears; swelling of the glands, tonsils, nose, lip, knee, hip, etc.; defective nutrition; colicky pains, mucous discharges, etc.
Arsenicum. When debility is very marked, and the patient has frequent and exhausting discharge from the bowels, sallow complexion, and emaciation.
Ferrum Iodium Anaemic, impoverished, and unhealthy conditions, common in Scrofula form imperfect assimilation of food.
Belladonna. Heat, redness, and pain in the eye, and great intolerance of light; neuralgic pains; sore throat; painful swelling of the glands.
Silicea. Scrofulous ulcers with callous edges, fistulous ulcers, Scald-head, Otorrhoea; scrofulous affections of the bones. It may follow Calcarea especially in the diseases of the bones.
Mercurius. Glandular inflammations, particularly when the glands of the neck are swollen and painful, and there are strumous affections of the eyes, pains worse at night in bed; copious saliva; disagreeable taste, and frequent unhealthy, foetid- looking stools.
Iris. Scabby eruptions; frequent bilious diarrhoea.
Aurum. When the nose is specially affected.
ACCESSORY MEANS. Three points are of prime importance nourishing food, fresh air, and regular exercise. Medicines are not alone sufficient.
Food. The food should always be sufficient, nutritious, and digestive, but not excessive. Beef, mutton, venison, fowls and game; preparations of eggs and milk, bread, mealy potatoes, rice, and other farinaceous principles.
Cod-liver-oil may be given in the absence of febrile symptoms, two or three times a day, whenever a patient is losing flesh. A teaspoonful is generally sufficient for a dose, and it is disagrees, half a tea-spoonful will suffice at the commencement. Or Maltine may be used instead.
Exercise. Moderate exercise in the open air is most essential. A bracing mountain or sea air, if it can be borne, is the best. A cold climate, if the child is warmly clothed, is generally favourable, but damp is injurious. The patient’s room should also be uninterruptedly supplied with pure air. Bathing in fresh or salt water is invaluable.
Clothing should be warm without being oppressive. The extremities especially should be kept warm. As a general rule, flannel should be worn, but only during the day. The linen should be frequently changed, always observing that it is put on perfectly dry.
XXII. Rickets (Rachitis)
SYMPTOMS. Late teething; inability to walk when eighteen months old; perspiration on the head immediately on falling asleep; curving of the bones (bow-legs). The patient kicks off the bedclothes. The spaces in the skull are late in closing and depressed; the head becomes flat and more square than natural; and the little patient desires to lie, undisturbed by playthings or company. The appetite is often voracious, and the food passes away rapidly, and almost unchanged. The flesh wastes, and there is weakness; the child is drowsy in the daytime, but restless and uneasy in the night.
In severe cases, the spine and pelvis also lose their proper shape; the chin is small, out of all proportion with the forehead, the teeth project and fall out, and are generally decayed.
The chest also becomes narrow and prominent (Pigeon-breast), and the abdomen large and distended.
CAUSES. Bad hygienic conditions; Leucorrhoea or other illness in the mother during pregnancy; too long nursing, etc.
REMEDIES. Calcarea is the principal remedy. Late dentition, diarrhoea, and tumid abdomen.
Silicea. Perspiration on the head of feet; sensitiveness to cold; enlargement of the joints.
Phosphoric Acid. Neglected cases, with pain in the limbs, and hectic symptoms.
Phosphorus, Pulsatilla, Asafoet., and Sulph. are sometimes required.
ACCESSORY MEANS. Country air, sunlight and out-of-door exercises. Patients not able to walk should sit or recline in the open air, warmly clad, during portions of the day.
Tepid or cold bathing, every morning, especially in salt water, followed by rubbing the back well with a towel for five or ten minutes, is very beneficial. In the evening the rubbing should be repeated.
DIET. Nourishing food is essential. Milk, Neave’s Food, broth, meat, beef-tea, and Cod-liver-oil. Malt or Barley food is especially suitable. If finely ground, the sediment need not be removed, as it is very nourishing and rich in bone forming materials.
DIRECTIONS. Four tablespoonfuls of ground malt boiled in a pint of water for ten minutes, with an equal quantity of new milk.
SURGICAL MEASURES. If mechanical support be necessary for crookedness of the lower limbs, simple straight wooden splints, kept in place by a good bandage, are the best.
In very obstinate cases use oil, rubbed into the whole cutaneous surface, in front of a fire at bedtime.