Scrofula
Encyclopedia
Tuberculous cervical lymphadenitis refers to a lymphadenitis of the cervical lymph nodes
associated with tuberculosis
. It was previously known as "scrofula".
, but only 8% of cases in children. The rest are caused by atypical mycobacterium (Mycobacterium scrofulaceum
) or nontuberculous mycobacterium (NTM). With the stark decrease of tuberculosis in the second half of the 20th century, scrofula became a very rare disease. With the appearance of AIDS
, however, it has shown a resurgence, and presently affects about 5% of severely immunocompromised patients.
s are the appearance of a chronic, painless mass in the neck
, which is persistent and usually grows with time. The mass is referred to as a "cold abscess", because there is no accompanying local color or warmth and the overlying skin acquires a violaceous (bluish-purple) color. NTM infections do not show other notable constitutional symptoms, but scrofula caused by tuberculosis is usually accompanied by other symptoms of the disease, such as fever
, chill
s, malaise
and weight loss
in about 43% of the patients. As the lesion progresses, skin becomes adhered to the mass and may rupture, forming a sinus
and an open wound
.
is usually performed by needle aspiration biopsy
or excisional biopsy
of the mass and the histological demonstration of stainable acid-fast
bacteria in the case of infection by M. tuberculosis (Ziehl-Neelsen stain
), or the culture of NTM using specific growth and staining techniques.
and formation of fistula
e. Furthermore, surgery may spread the disease to other organs. The best approach is to use conventional treatment of tuberculosis
with antibiotics. Scrofula caused by NTM, on the other hand, responds well to surgery
, but is usually resistant to antibiotics. The affected nodes can be removed either by repeated aspiration, curettage
or total excision (with the risk in the latter procedure, however, of causing unsightly scarring or damage to the facial nerve
, or both).
, affecting the lymph node
s of the neck. It is informally or historically known as the King's Evil, referring to the belief that sufferers would be cured by the touch of the Monarch, a practice which continued in England
until the early 18th century. In adults it is caused by Mycobacterium tuberculosis
and in children by nontuberculous mycobacteria
. The word comes from the Latin
scrofula, meaning brood sow
.
In the Middle Age
s it was believed that "royal touch", the touch of the sovereign
of England
or France
, could cure diseases due to the divine right of sovereigns
. Scrofula was therefore also known as the King's Evil. The kings were thought to have received this power due to their succession from Edward the Confessor
, who, according to some legends, received it from Saint Remigius
. From 1633, the Book of Common Prayer
of the Anglican Church contained a ceremony for this, and it was traditional for the monarch
(king or queen) to present to the touched person a coin
— usually an Angel
, a gold
coin the value of which varied from about 6 shilling
s to about 10 shillings. King Henry IV of France
is reported as often touching and healing as many as 1,500 individuals at a time.
Queen Anne
touched the infant (later Doctor) Samuel Johnson
in 1712, but King George I
put an end to the practice as being "too Catholic
". The kings of France continued the custom until Louis XV
stopped it in the 18th century, though it was briefly revived to universal derision in 1825.
In the 18th Century, Mrs Elizabeth Pearson, an Irish herbalist, proposed a treatment for scrofula involving herbs and a poultice and extract of vegetable; and in 1815, Sir Gerard Noel presented a petition to the House of Commons advocating her treatment.
In 1768 the Englishman John Morley produced a handbook Essay on the Nature and Cure of Scrophulous Disorders, Commonly Called the King's Evil. The book starts by listing the typical symptoms and indications of how far the disease had progressed. It then goes into detail with a number of case studies, describing the specific case of the patient, the various treatments used and their effectiveness. The forty-second edition was printed in 1824.
In 1924, French historian Marc Bloch
wrote a book on the history of the royal touch: The Royal Touch: Sacred Monarchy and Scrofula in England and France (original in French).
Cervical lymph nodes
Cervical lymph nodes are lymph nodes found in the neck.-Classification:There are approximately 300 lymph nodes in the neck, and they can be classified in many different ways.Henri Rouvière produced an influential classification in 1938...
associated with tuberculosis
Tuberculosis
Tuberculosis, MTB, or TB is a common, and in many cases lethal, infectious disease caused by various strains of mycobacteria, usually Mycobacterium tuberculosis. Tuberculosis usually attacks the lungs but can also affect other parts of the body...
. It was previously known as "scrofula".
The disease
Scrofula is the term used for tuberculosis of the neck, or, more precisely, a cervical tuberculous lymphadenopathy. Scrofula is usually a result of an infection in the lymph nodes, known as lymphadenitis and is most often observed in immunocompromised patients (about 50% of cervical tuberculous lymphadenopathy). About 95% of the scrofula cases in adults are caused by Mycobacterium tuberculosisMycobacterium tuberculosis
Mycobacterium tuberculosis is a pathogenic bacterial species in the genus Mycobacterium and the causative agent of most cases of tuberculosis . First discovered in 1882 by Robert Koch, M...
, but only 8% of cases in children. The rest are caused by atypical mycobacterium (Mycobacterium scrofulaceum
Mycobacterium scrofulaceum
Mycobacterium scrofulaceum is a species of Mycobacterium.It is the most common cause of cervical lymphadenitis in children.It is sometimes included in the "MAIS group" with Mycobacterium avium and Mycobacterium intracellulare....
) or nontuberculous mycobacterium (NTM). With the stark decrease of tuberculosis in the second half of the 20th century, scrofula became a very rare disease. With the appearance of AIDS
AIDS
Acquired immune deficiency syndrome or acquired immunodeficiency syndrome is a disease of the human immune system caused by the human immunodeficiency virus...
, however, it has shown a resurgence, and presently affects about 5% of severely immunocompromised patients.
Signs and symptoms
The most usual signs and symptomSymptom
A symptom is a departure from normal function or feeling which is noticed by a patient, indicating the presence of disease or abnormality...
s are the appearance of a chronic, painless mass in the neck
Neck
The neck is the part of the body, on many terrestrial or secondarily aquatic vertebrates, that distinguishes the head from the torso or trunk. The adjective signifying "of the neck" is cervical .-Boner anatomy: The cervical spine:The cervical portion of the human spine comprises seven boney...
, which is persistent and usually grows with time. The mass is referred to as a "cold abscess", because there is no accompanying local color or warmth and the overlying skin acquires a violaceous (bluish-purple) color. NTM infections do not show other notable constitutional symptoms, but scrofula caused by tuberculosis is usually accompanied by other symptoms of the disease, such as fever
Fever
Fever is a common medical sign characterized by an elevation of temperature above the normal range of due to an increase in the body temperature regulatory set-point. This increase in set-point triggers increased muscle tone and shivering.As a person's temperature increases, there is, in...
, chill
Chill
Chill may refer to:* Chills that occur during high fevers as a result of immune response to disease* Shivering, a bodily function in response to early hypothermia in warm-blooded animals...
s, malaise
Malaise
Malaise is a feeling of general discomfort or uneasiness, of being "out of sorts", often the first indication of an infection or other disease. Malaise is often defined in medicinal research as a "general feeling of being unwell"...
and weight loss
Weight loss
Weight loss, in the context of medicine, health or physical fitness, is a reduction of the total body mass, due to a mean loss of fluid, body fat or adipose tissue and/or lean mass, namely bone mineral deposits, muscle, tendon and other connective tissue...
in about 43% of the patients. As the lesion progresses, skin becomes adhered to the mass and may rupture, forming a sinus
Sinus (anatomy)
Sinus is Latin for "bay", "pocket", "curve", or "bosom". In anatomy, the term is used in various contexts.A sinus is a sack or cavity in any organ or tissue, or an abnormal cavity or passage caused by the destruction of tissue...
and an open wound
Wound
A wound is a type of injury in which skin is torn, cut or punctured , or where blunt force trauma causes a contusion . In pathology, it specifically refers to a sharp injury which damages the dermis of the skin.-Open:...
.
Diagnosis
DiagnosisMedical diagnosis
Medical diagnosis refers both to the process of attempting to determine or identify a possible disease or disorder , and to the opinion reached by this process...
is usually performed by needle aspiration biopsy
Needle aspiration biopsy
Needle aspiration biopsy , may refer to fine needle aspiration cytology , fine needle aspiration biopsy and fine needle aspiration , is a diagnostic procedure sometimes used to investigate superficial lumps or masses...
or excisional biopsy
Biopsy
A biopsy is a medical test involving sampling of cells or tissues for examination. It is the medical removal of tissue from a living subject to determine the presence or extent of a disease. The tissue is generally examined under a microscope by a pathologist, and can also be analyzed chemically...
of the mass and the histological demonstration of stainable acid-fast
Acid-fast
Acid-fastness is a physical property of certain bacteria, specifically their resistance to decolorization by acids during staining procedures.Acid-fast organisms are difficult to characterize using standard microbiological techniques Acid-fastness is a physical property of certain bacteria,...
bacteria in the case of infection by M. tuberculosis (Ziehl-Neelsen stain
Ziehl-Neelsen stain
The Ziehl–Neelsen stain, also known as the acid-fast stain, was first described by two German doctors; Franz Ziehl , a bacteriologist and Friedrich Neelsen , a pathologist. It is a special bacteriological stain used to identify acid-fast organisms, mainly Mycobacteria...
), or the culture of NTM using specific growth and staining techniques.
Therapy
Treatments are highly dependent on the kind of infection. Surgical excision of the scrofula does not work well for M. tuberculosis infections, and has a high rate of recurrenceRecurrence
Recurrence and recurrent may refer to:*Recurrence relation, an equation which defines a sequence recursively*Poincaré recurrence theorem, Henri Poincaré's theorem on dynamical systems...
and formation of fistula
Fistula
In medicine, a fistula is an abnormal connection or passageway between two epithelium-lined organs or vessels that normally do not connect. It is generally a disease condition, but a fistula may be surgically created for therapeutic reasons.-Locations:Fistulas can develop in various parts of the...
e. Furthermore, surgery may spread the disease to other organs. The best approach is to use conventional treatment of tuberculosis
Tuberculosis treatment
Tuberculosis treatment refers to the medical treatment of the infectious disease tuberculosis .The standard "short" course treatment for TB is isoniazid, rifampicin , pyrazinamide, and ethambutol for two months, then isoniazid and rifampicin alone for a further four months...
with antibiotics. Scrofula caused by NTM, on the other hand, responds well to surgery
Surgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
, but is usually resistant to antibiotics. The affected nodes can be removed either by repeated aspiration, curettage
Curettage
Curettage, in medical procedures, is the use of a curette to remove tissue by scraping or scooping.Curettages are also a declining method of abortion. It has been replaced by vacuum aspiration over the last decade....
or total excision (with the risk in the latter procedure, however, of causing unsightly scarring or damage to the facial nerve
Facial nerve
The facial nerve is the seventh of twelve paired cranial nerves. It emerges from the brainstem between the pons and the medulla, and controls the muscles of facial expression, and functions in the conveyance of taste sensations from the anterior two-thirds of the tongue and oral cavity...
, or both).
Prognosis
With adequate treatment, clinical remission is practically 100%. In NTM infections, with adequate surgical treatment, clinical remission is greater than 95%. It is recommended that persons in close contact with the diseased person, such as family members, be tested for tuberculosis.History
Scrofula (scrophula or struma) is any of a variety of skin diseases; in particular, a form of tuberculosisTuberculosis
Tuberculosis, MTB, or TB is a common, and in many cases lethal, infectious disease caused by various strains of mycobacteria, usually Mycobacterium tuberculosis. Tuberculosis usually attacks the lungs but can also affect other parts of the body...
, affecting the lymph node
Lymph node
A lymph node is a small ball or an oval-shaped organ of the immune system, distributed widely throughout the body including the armpit and stomach/gut and linked by lymphatic vessels. Lymph nodes are garrisons of B, T, and other immune cells. Lymph nodes are found all through the body, and act as...
s of the neck. It is informally or historically known as the King's Evil, referring to the belief that sufferers would be cured by the touch of the Monarch, a practice which continued in England
England
England is a country that is part of the United Kingdom. It shares land borders with Scotland to the north and Wales to the west; the Irish Sea is to the north west, the Celtic Sea to the south west, with the North Sea to the east and the English Channel to the south separating it from continental...
until the early 18th century. In adults it is caused by Mycobacterium tuberculosis
Mycobacterium tuberculosis
Mycobacterium tuberculosis is a pathogenic bacterial species in the genus Mycobacterium and the causative agent of most cases of tuberculosis . First discovered in 1882 by Robert Koch, M...
and in children by nontuberculous mycobacteria
Nontuberculous mycobacteria
Nontuberculous mycobacteria , also known as environmental mycobacteria, atypical mycobacteria and mycobacteria other than tuberculosis , are mycobacteria which do not cause tuberculosis or Hansen's disease ....
. The word comes from the Latin
Latin
Latin is an Italic language originally spoken in Latium and Ancient Rome. It, along with most European languages, is a descendant of the ancient Proto-Indo-European language. Although it is considered a dead language, a number of scholars and members of the Christian clergy speak it fluently, and...
scrofula, meaning brood sow
Sow
Sow may refer to:* Sowing seed* Female animals: badger, bear, pig family* Shape in which metal is cast* Type of siege engine* River Sow, England* "Sow", a poem by Sylvia Plath* Sow , the band/spoken word project comprising Anna Wildsmith-People:...
.
In the Middle Age
Middle age
Middle age is the period of age beyond young adulthood but before the onset of old age. Various attempts have been made to define this age, which is around the third quarter of the average life span of human beings....
s it was believed that "royal touch", the touch of the sovereign
Sovereign
A sovereign is the supreme lawmaking authority within its jurisdiction.Sovereign may also refer to:*Monarch, the sovereign of a monarchy*Sovereign Bank, banking institution in the United States*Sovereign...
of England
England
England is a country that is part of the United Kingdom. It shares land borders with Scotland to the north and Wales to the west; the Irish Sea is to the north west, the Celtic Sea to the south west, with the North Sea to the east and the English Channel to the south separating it from continental...
or France
France
The French Republic , The French Republic , The French Republic , (commonly known as France , is a unitary semi-presidential republic in Western Europe with several overseas territories and islands located on other continents and in the Indian, Pacific, and Atlantic oceans. Metropolitan France...
, could cure diseases due to the divine right of sovereigns
Divine Right of Kings
The divine right of kings or divine-right theory of kingship is a political and religious doctrine of royal and political legitimacy. It asserts that a monarch is subject to no earthly authority, deriving his right to rule directly from the will of God...
. Scrofula was therefore also known as the King's Evil. The kings were thought to have received this power due to their succession from Edward the Confessor
Edward the Confessor
Edward the Confessor also known as St. Edward the Confessor , son of Æthelred the Unready and Emma of Normandy, was one of the last Anglo-Saxon kings of England and is usually regarded as the last king of the House of Wessex, ruling from 1042 to 1066....
, who, according to some legends, received it from Saint Remigius
Saint Remigius
Saint Remigius, Remy or Remi, , was Bishop of Reims and Apostle of the Franks, . On 24 December 496 he baptised Clovis I, King of the Franks...
. From 1633, the Book of Common Prayer
Book of Common Prayer
The Book of Common Prayer is the short title of a number of related prayer books used in the Anglican Communion, as well as by the Continuing Anglican, "Anglican realignment" and other Anglican churches. The original book, published in 1549 , in the reign of Edward VI, was a product of the English...
of the Anglican Church contained a ceremony for this, and it was traditional for the monarch
Monarch
A monarch is the person who heads a monarchy. This is a form of government in which a state or polity is ruled or controlled by an individual who typically inherits the throne by birth and occasionally rules for life or until abdication...
(king or queen) to present to the touched person a coin
Coin
A coin is a piece of hard material that is standardized in weight, is produced in large quantities in order to facilitate trade, and primarily can be used as a legal tender token for commerce in the designated country, region, or territory....
— usually an Angel
Angel (coin)
The Angel is a gold coin introduced into England by Edward IV in 1465 as a new issue of the Noble, thus is was first called the "angel-noble". It is based off the French coin known as the Angelot or Ange, which had been issued since 1340. It varied in value between that period and the time of...
, a gold
Gold
Gold is a chemical element with the symbol Au and an atomic number of 79. Gold is a dense, soft, shiny, malleable and ductile metal. Pure gold has a bright yellow color and luster traditionally considered attractive, which it maintains without oxidizing in air or water. Chemically, gold is a...
coin the value of which varied from about 6 shilling
Shilling
The shilling is a unit of currency used in some current and former British Commonwealth countries. The word shilling comes from scilling, an accounting term that dates back to Anglo-Saxon times where it was deemed to be the value of a cow in Kent or a sheep elsewhere. The word is thought to derive...
s to about 10 shillings. King Henry IV of France
Henry IV of France
Henry IV , Henri-Quatre, was King of France from 1589 to 1610 and King of Navarre from 1572 to 1610. He was the first monarch of the Bourbon branch of the Capetian dynasty in France....
is reported as often touching and healing as many as 1,500 individuals at a time.
Queen Anne
Anne of Great Britain
Anne ascended the thrones of England, Scotland and Ireland on 8 March 1702. On 1 May 1707, under the Act of Union, two of her realms, England and Scotland, were united as a single sovereign state, the Kingdom of Great Britain.Anne's Catholic father, James II and VII, was deposed during the...
touched the infant (later Doctor) Samuel Johnson
Samuel Johnson
Samuel Johnson , often referred to as Dr. Johnson, was an English author who made lasting contributions to English literature as a poet, essayist, moralist, literary critic, biographer, editor and lexicographer...
in 1712, but King George I
George I of Great Britain
George I was King of Great Britain and Ireland from 1 August 1714 until his death, and ruler of the Duchy and Electorate of Brunswick-Lüneburg in the Holy Roman Empire from 1698....
put an end to the practice as being "too Catholic
Catholic
The word catholic comes from the Greek phrase , meaning "on the whole," "according to the whole" or "in general", and is a combination of the Greek words meaning "about" and meaning "whole"...
". The kings of France continued the custom until Louis XV
Louis XV of France
Louis XV was a Bourbon monarch who ruled as King of France and of Navarre from 1 September 1715 until his death. He succeeded his great-grandfather at the age of five, his first cousin Philippe II, Duke of Orléans, served as Regent of the kingdom until Louis's majority in 1723...
stopped it in the 18th century, though it was briefly revived to universal derision in 1825.
In the 18th Century, Mrs Elizabeth Pearson, an Irish herbalist, proposed a treatment for scrofula involving herbs and a poultice and extract of vegetable; and in 1815, Sir Gerard Noel presented a petition to the House of Commons advocating her treatment.
In 1768 the Englishman John Morley produced a handbook Essay on the Nature and Cure of Scrophulous Disorders, Commonly Called the King's Evil. The book starts by listing the typical symptoms and indications of how far the disease had progressed. It then goes into detail with a number of case studies, describing the specific case of the patient, the various treatments used and their effectiveness. The forty-second edition was printed in 1824.
In 1924, French historian Marc Bloch
Marc Bloch
Marc Léopold Benjamin Bloch was a French historian who cofounded the highly influential Annales School of French social history. Bloch was a quintessential modernist. An assimilated Alsatian Jew from an academic family in Paris, he was deeply affected in his youth by the Dreyfus Affair...
wrote a book on the history of the royal touch: The Royal Touch: Sacred Monarchy and Scrofula in England and France (original in French).
See also
- ScrofulodermaScrofulodermaScrofuloderma is a skin condition caused by tuberculous involvement of the skin by direct extension, usually from underlying tuberculous lymphadenitis....
- Tuberculosis diagnosisTuberculosis diagnosisTuberculosis is diagnosed by finding Mycobacterium tuberculosis bacteria in a clinical specimen taken from the patient. While other investigations may strongly suggest tuberculosis as the diagnosis, they cannot confirm it.-Diagnosis:...
- Tuberculosis treatmentTuberculosis treatmentTuberculosis treatment refers to the medical treatment of the infectious disease tuberculosis .The standard "short" course treatment for TB is isoniazid, rifampicin , pyrazinamide, and ethambutol for two months, then isoniazid and rifampicin alone for a further four months...
- Touch PiecesTouch piecesA touch piece is a coin or medal attached to attracted superstitious beliefs, such as those with "holes" in them or those with particular designs...
External links
- Werrett, Simon. "Healing the Nation’s Wounds: Royal Ritual and Experimental Philosophy in Restoration England." History of Science 38 (2000): 377-99.
- Scrofula from eMedicine medical article
- Scrofula MedPix(r) Images