(b)  Scrofula  without  Tubercle  is  usually  manifested  by  various
local  lesions,  the  most  common  of  which  is  induration  and  enlarge-
ment of  the  sub-cutaneous  glands  of  the  neck,  below  the  jaws,  in
the  axiUse,  or  groins,  and  less  frequently  in  other  parts  of  the
body.  These  swellings  are  at  first  soft,  painless,  movable;  after-
wards they  may  enlarge,  become  painful,  inflame,  and  eventually
suppurate,  forming  scrofulous  Ulcers.  They  occur  very  frequently
daring  childhood,  and  are  excited  into  activity  by  Cold,  Measles,
•Scarlatina,  Whooping-cough,  etc.,  and  either  remain  for  a  long


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134  THE   FAMILY   DOCTOR.
time  inoperative,  or  proceed  to  inflammation  and  sappnration.
Not  that  all  enlargements  of  the  lymphatic  vessels  and  glands  are^
due  to  Scrofula;  they  may  arise  from  temporary  causes,  and  their
character  as  such  is  readily  determined  by  the  history  and
symptoms  they  present

Other  symptoms  of  Stroma  are — scrofnlons  Ophthalmia;  Otor-
rhoea;  Ozsena;  a  large  and  tumid  abdomen;  swellings  and  Carifis
bones,  White-swellings,  and  Hip- joint  disease;  diseases  of  the
testicle  and  mammary  gland;  various  cutaneous  diseases;  dis-
ordered dentition,  infantile  Ck>nvulsions,  and  acute  Hydrooephalu&

Ganses. — The  most  important  predisposing  cause  is  hereditary
tendency.  But  the  following  may  be  both  predisposing  and
exciting  causes,  and  their  power  in  the  production  of  Struma  can
hardly  be  overstated: —

Want  of  pure  air,  consequent  on  the  imperfect  ventilaticm  of
sitting  and  sleeping  rooms,  is  a  frequent  and  potent  exciting
cause  of  tubercular  disease,  as  indeed  might  be  inferred  from  the
physiological  evidence  of  the  extreme  importance  of  a  proper
aeration  of  the  blood.  Persons  breathing,  for  a  considerable
period,  air  which  has  been  rendered  impure  by  respiration,  soon
become  pale,  partially  lose  their  appetite,  and  gradually  decline  in
strength  and  spirits.
