MB. B. PHILLIPS ON .SCROPIILA.

THE subject of scrofula has inspired an interest less for its own effects, 'though they are bad enough in ruined health, diseased glands, and yet more painful affections, than for its supposed connexion with consump- lien. The tubercular deposit in the lungs has been held by the highest authority, as well as by popular opinion, to be merely a varied mode of that deposit in the glands of the neck, which, first swelling and then sup- purating, not only injures beauty by its scar but leaves in legible hand- writing the warning of a tainted blood. This identity Mr. Phillips de- nies. After a minute examination of the anatomical characteristics and the statistics of consumption and scrofula, be says- " I apprehend it has now been shown, by abundant evidence, that, with the ex- ception 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 con- siderable change, inflammatory in its nature, before the matter is deposited in it; in the lung we commonly find the tissue around a recent tubercular deposit un- changed 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 plithisis, 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 is probable that there is more of distinction than of difference here. According to actual constitution, influencing circumstances, and the in- tensity of the cachexia, (bad habit of body,) the strumous blood may sometimes end in one form of disease, sometimes in another. If all cir- cumstances tend to produce scrofula in the direct form, the patient pos- sibly dies before the age of consumption : if the virus, or whatever it be, remain latent longer, the lungs alone may become the seat of the deposit, and the morbid anatomy be differently modified. This is not the only occasion in which Mr. Phillips runs apparently counter to received opinion. He denies hereditary disease, (except in two disorders, where the affection is present at the birth,) though he admits that parents may transmit a weakly constitution, in which scrofula or any other disorder may be more readily set up. Unless he is also prepared to deny in individuals a constitutional tendency to one disease more than another, we cannot admit the cogency of his view. Likeness and character we all know are transmissible, though not always transmitted, and sometimes so strongly that we recognize a son by some trifling act of deportment; but it would scarcely be philosophical to deny the transmission of pa- rental manner because an infant does not bow at its birth.

The fact is, we know no more of physics than we do of metaphysics; it is mere observation or reflection upon results, causes being altogether hidden. Why do the same circumstances induce one disease in one man, and in another some different disorder ? We may say it is a constitu. tional disposition or predisposition : which is a truth in one sense ; but, beyond such obvious considerations as stature, muscular development, and vigour, we cannot tell what this constitution is, still less what causes it, unless we take refuge in " organization " ; when the same puzzle will remain if we seek for a further resolution. We do not even know what disease is, other than by reference to its results, still less what produces it. Mr. Phillips admits that he cannot tell the modus operandi of the medicine he administers. It savours of pedantry to deny the existence of a thing because the nature of the case does not admit of its being directly proved by positive evidence. Upon these two points Mr. Phillips resembles those philosophers who class a constitution with a law-deed, and require it to be produced for inspection.

In all other matters Mr. Phillips is remarkably free from narrowness or prejudice ; and his treatise on Scrofula is entitled to great praise, as con- taining the results of elaborate research, extensive inquiries, and consi- derable observation. Perhaps his resuscitation of ancient opinions and practices, as well as his notices of former superstitions on the "evil," may be pushed too far, as encumbering the reader with dead matter. But it renders the treatise more complete, and collects together a good deal of curious re. ing, neatly and briefly compiled. The statistics are voluminous, and sometimes rather collateral than direct; but they bring together from many quarters—British, Continental, American, and Colo- nial—a large amount of well-selected matter, bearing upon health, parent- age, diet, and so forth, as relating to scrofula; leading to the conclusion that our island is not preminently obnoxious to the complaint ; and that the percentage ratio of deaths from consumption is reduced, according to our only evidence, the bills of mortality. Thus, In 1750, the deaths from consumption were

1 in 144 1801, 1 .

. 154

1811, 1 ..

196 1821, 1 .

. 288

1833, 1 . . 258

The statistical research also throws up some information respecting the past and present condition of the people • which Mr. Phillips thinks, with Dr. Twiss, has advanced ; but he doubts whether the improvements in towns, recommended by the Poor-law Commissioners, will prevent death at anything like the rate which Mr. Chadwick asserts, (however excellent and proper they may be in themselves) ; destitution, and not dirt or foul air, being the real cause of the low expectation of life among the poor. The more strictly medical view of Mr. Phillips on scrofula may be stated thus. He considers the deposition of scrofulous matter (a cheesy sort of substance found in various glands) as the only sure test af scrofulous disease : till then it is rather a constitutional disposition or taint than actual scrofula, at least such as we have proof of. " In a constitution favourable for the deposit of scrofulous matter, I believe there are no features, in the absence of the tumor, so constant and so conclusive as to justify a reliance upon them in pronouncing an opinion whether a constitu- tion be scrofulous or not. It is certain that the ordinary tests are fallacious: I know that the major part of them may be observed, again and again, without any other evidence that the constitution is tainted with scrofula. We may even have enlarged glands, while no product such as that which I have alluded to is de- posited; although, in the absence of any source of irritation, enlarged subcutaneous lands constitute grounds for grave suspicion that the constitution is scrofulous. Thos, whatever may be the constitutional peculiarity, however marked may be the general physiognomy by what is called the scrofulous diathesis, we have no certain sign of the existence of the disease until sufficient evidence can be obtained that the deposit has taken place. The constitution may suffer long before such a deposit is made, and the glands themselves may be swelled without presenting in their substance a scrofulous deposit: indeed, the deterioration of the system pro- ceeds so slowly, that although the tendency be directly onwards from the yeriod when the gland is simply enlarged to that when the deposit would ordinal* occur, in that interval favourable or unfavourable circumstances may be expe- rienced, and no deposit may take place: on the one hand, the constitution may improve and the glandular swelling may subside; on the other, the.ailingchild, life may be cut short by other diseases before the proof of scrofula is complete. " In childhood, the time necessary for the perfect development of the disease is, I believe, very long; so long as to build up the whole body with bad materials. In adult life, the time is still more considerable; so that, although in each case the causes of the disease may be efficient, their influence .may not be-continued long enough to bring about such a change in the constitution as fits it for the _development of scrofula; and if they be not so continued, the swelled glands may subside, and the person may escape the deposit, or, the causes of ill health be- coming more intense, he may die of some more acute disease."

The cause of the scrofulous deposit, Mr. Phillips thinks, is to be found in a depraved state of the blood ; this much is certain, that the blood of a scrofulous person undergoes a change. Whether this change "does really stand to scrofula in the relation of cause," he says, "I cannot con- clusively prove, though I believe that it does." Could it be proved, how- -ever, there would still be the further questions—Do circumstances cause -the change ? or do they induce changes in the body, that act upon the blood ? does the depraved blood act directly by depositing the particles -.with which it is charged, or previously let down the constitution, and in- directly prepare the glands for the reception of the foreign matter. The primary if not the sole cause of scrofula, in the opinion of Mr. Phillips, is insufficient nutrition—deficient or improper food ; and to food alone he looks for a cure. Change of air and change of scene are useful as aids ; treatment may correct deranged health, or assist the digestion, weakened or impaired; certain medicines, during the fine season (from May till October) may improve the scrofula, though the patient would probably have im- proved as much without them ; but as soon as use has blunted or ex- izausted the effects of these things, the patient will fall back to his former condition, unless he can be efficiently nourished. Hence, with the poor the case is almost hopeless.

This, of course, is only to be received as the merest outline of the wri-

,ter's views : the filling up involves many questions on the nature of the -disease, and its preventive management and treatment, which somewhat qualify the general proposition laid down so broadly as we have laid it : good air and exercise, for example, enablinga person to struggle against the taint better than one whose concomitants as well as his food are deleteri- ous. Many curious conclusions and useful hints are also thrown out in the course of the discussion ; of which we quote a sample.

INFANT SCHOOLS.

A great social experiment is now in progress, from which most important con- sequences must follow. The truth seems deeply fixed in the minds of thinking men, that the character of our people is to be determined by the education or mental training they receive in childhood; and as the conviction is strong that :the work cannot be begun too early, children are collected into infant schools al- , most as soon as ,they can walk. And as I have had large opportunities (by which I have endeavoured to profit) of estimating the effect of such training upon the bodily health of the child, will now express the conviction at which I have arrived.

I believe, then, the effect is prejudicial. I know that the health of those infants -who are suffered to amuse themselves as they please during the day, is better, .cceteris paribus, than that of those children who have been for many months regular attendants at infant schools. And the reason of the difference I appre- - bend to be this, that in children the blood is vigorously circulated through the entire frame by means of the exertion of the muscular system; and this exertion of the muscular system can only be maintained by providing such amusement as 'will keep the body in motion. The listless walk around the school-rooms,. though repeated many times a day, will not quicken the heart's action, and will not warm 'the hands and feet. And so long as the hands and feet and the imrfiiee of the body remain cold for many hours of every day, so long the child will have con- gestion of some internal organs; and a state of permanent disease is readily in- duced, digestion is ill-performed, nutrition is defective; and if this state of things be long-continued, scrofula may be the consequence.

THE STET:MODS IN THE FIELD.

• There is commonly a general want of-tone and energy in the solids which in- capacitates the sufferer for proper exercise; the muscular system is quickly ex- hausted, and incapable of sustained exertion,—this is a consequence of impaired nutrition. The splendid-looking corps of Dutch Grenadiers, which constituted, when on parade, so distinguished an ornament of Napoleon's army, and which was said to be greatly tainted with scrofula, suffered more from fatigue, cold, and hunger, during the disastrous retreat from Moscow, than any other portion of the French army; few of them, indeed, survived the retreat. It is matter of remark in the army, that fair, lymphatic-looking men, apparently enjoying brilliant health, frequently present a dragged, broken-down appearance, after two or three days' severe marching.