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mining the integrity of the organ. That the recognition of the recent or remote period of the application of local remedies is of great value in estimating their seriousness when situated on the trunk and over organs important to life is easily understood, since they may have been used at a distant period in acute disease from which the individual has completely recovered. When existing in these situations, great caution should be exercised; but if a medical officer be perfectly satisfied that the appearance was not recent, and that the man was clearly in rude health, his constitution untainted, the proportions of the figure symmetrical, and organs sound, it would be too dogmatical to assume that all marks of treatment upon the trunk are to be an unqualified cause of rejection. Nevertheless, though this ought not exclusively to apply, these marks, when they exist in some regions, should be viewed with still greater gravity than in others; thus under the clavicles, along the spine, or over the right hypochondrium, the observance of marks of medical treatment manifest the possible tendency to most disqualifying diseases, which duties or exposure may arouse. When such traces are found over the cardiac region, the man should be always rejected; they point out that disease once existed there, and it is more than likely that some sequelæ resulted and are persistent, although possibly not plainly detectable unless exertion or other circumstances favoured their observance, or time, by
increase, should have developed them. The argument usually adopted against the admission of men into the service, who bear any traces of medical treatment, is the power at any time of declaring themselves unfit for duty by alleging disease to exist ; yet, assuredly, this is too definite. By such arrangement the loss of good recruits would often accrue; malingering is much less frequent in the army than formerly ; and how little does a man so circumstanced differ from a soldier who, having been in hospital, has there undergone treatment that has left permanent marks.
Setons and issues are almost invariably to be deemed disqualifying; they are generally used in severe chronic disease; usually the traces are found on the extremities, on the nape of the neck, back, or loins, but they may be detected in almost any situation.
situation. The marks of cross-cupping are a recognized invariable cause of rejection ; it has been so determined for many reasons; especially it is supposed, that diseases sufficiently serious to require treatment by cross-cupping may be liable to recur. Although sound men may hereby be occasionally lost to the service, this estimation of these evidences of treatment is universally admitted. Marks of single cupping need not always cause rejection; the observations relative to the evidences of leech-bites and blisters are in a great measure applicable here. Attention to the locality, the probable period of application, and the other different associations, is of the greatest importance in these cases. A man may bear traces of bleeding in the arm for injury or acute disease which has left no lesion behind; if unaccompanied by other extensive marks of treatment, and the medical officer is satisfied of the man's perfect fitness, it does not appear that this is alone deserving of any serious consideration. If in any instance, as has been before implied, the least indication of local or constitutional disturbance were associated with traces of treatment, I hardly think any circumstances warrant the man's approval.
From the time of Celsus to the present day the consideration of scrofula has occupied the attention of some of the brightest intellects that have pursued the study of medicine. Statistics have been collected and examined, experience has been promulgated, experiments have been instituted with untiring energy, chemical analysis has lent its aid, pathology has largely contributed from its great truths, the master minds and sagacious understanding of Thompson, Carswell, Sir A. Cooper, Lugol, and Glover, with numerous others, have been zealously applied to the investigation of this subject, which must be considered of the greatest importance, from its frequent occurrence, from its frightful mutilations, from the horror with which all classes regard its appearance in their families, and the care they take to attribute the effects to other causes; and from the great fatality, many rela
when affecting organs important to life. Volumes have been written, yet the results of all this labour, experience, and talent, are far from determinate, and are still open to future investigation in tions; not only as to the nature of the disease itself, but as to preventive or remedial measures. The greatest diversity prevails as to the most feasible explanation of the proximate cause; the humoral and absorbent theorists have made no advance. The identity of scrofula and tubercle is denied by many; others, again, trace almost every chronic and many acute diseases to a strumous habit. The management and treatment are most unsatisfactory, whether considered in reference to the depleting system, or the more rational one, of good air, diet, and medicines, justly admitted to exercise a beneficial influence.
Most writers agree that scrofula presents itself in every tissue in the body, in every gland conglomerate and conglobate, from the liver to the smallest lymphatic, in cellular, mucous, and serous membranes, free surfaces or subtissues, in osseous structure or individual organs. No age or sex, no position in life is an exemption. A child may come into the world to pass its life a cripple, or live a mere existence unaccountable for its acts, cut off alike from social ties and participation in other happiness of thinking man,-a drivelling idiot. A child may be born healthy, and grow to man's estate, athletic, active, and intelligent; the insidious cough sets in, attributable to some irregularity, which in
a few months may blast the happy prospects that have dawned with childhood and risen with youthful hope. Or the man who has passed a healthy life, may
find towards the termination, a bronchitic affection lapse into tubercular deposition. Different forms of the disease preponderate in childhood, adult, and old age, but almost each variety is met at every time of life. Much has been said of the appearance of scrofulous individuals, these appearances are sometimes laid down as definite as if they were invariable; the fallacy of this is quite evident, as individuals of almost any previous apparent character of constitution, are occasionally from the exciting cause of disease, especially venereal and its specific, mercury, rendered the subjects of struma.* We have all seen instances of men under the influence of a course of mercury for syphilis, develope enlarged glands in the neck or groins, tubercles in the lungs, or scrofulous disease in the extremities: happily prejudice has yielded to the advance of progressive knowledge, and from a wholesome dread of the effects of an unlimited use of this drug, these results are possibly less frequent than a few years back. Still such is often the sequela of debilitating disease.
In persons who are, by hereditary tendency or constitutionally, predisposed to scrofula, certain peculiarities in the face and figure, as protuberant upper lip, alæ of the nose enlarged and thickened, large flat feet, and various irregularities in the
* Manifesting more than likely an hereditary predisposition.