In collections of matter not far removed from the surface, the most
superficial, and generally the most dependent, portion of the parietes
appears inflamed; its inner surface is gradually absorbed; and, when
it has thus become attenuated, a portion of the integument sloughs or
ulcerates. A communication is established with the diseased parts,
through the external surface, thus providing an aperture for the
evacuation of the matter—of extraneous substances—or of parts of the
body which have either mortified, or otherwise become useless to the
system. In such collections, more especially if deeply seated, the
matter generally seeks the surface, or extends in the course of the
bloodvessels.
Cold abscesses, as they are called, often contain as much flaky
fibrinous matter as true pus: hence one of the signs of inflammation,
swelling, is absent; the fibrin being discharged instead of having been
added to the neighbouring parts.
As formerly remarked, suppuration occurs much more readily in some
constitutions than in others; and patients peculiarly liable to the
formation of abscesses, without any great degree of previous excited
action of the bloodvessels, are said to labour under _Struma_ or
_Scrofula_. These terms are by some used to denote a distinct or
specific disease, while others consider them merely as a peculiar state
of the constitution.
The strumous diathesis is said to be marked by hair and irides of a
very light colour, and by the skin being of a peculiar white hue; but,
in some instances, the complexion is unusually dark and sallow. The
upper lip generally presents a swollen appearance, as also the columna
and alæ of the nose. The organization throughout is delicate, and the
patient is frequently of a handsome, though infirm, structure.
Constitutions, in every respects strong and originally vigorous, may,
from various causes, become weak, and present many of the symptoms
usually termed scrofulous. I recollect a young patient, born of healthy
parents, who had enjoyed excellent health, becoming covered with ulcers
and chronic abscesses, in consequence of exposure to cold during
menstruation.
To the continued irregular and imprudent exhibition of mercurial
_alteratives_, as they are called, may be attributed the cachectic and
scrofulous constitutions of many thousands of patients of all ages.
The strumous diathesis is said to depend upon a want of balance, or
proportion, between the solids and circulating fluids. Want of action
and power in the organs forming and circulating the blood, disordered
digestion, and various other circumstances which it is unnecessary
to detail, have also been considered as causes of this state of the
constitution.
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