Two different books I've been reading this week mention scrofula, a disease that was endemic in England and France from medieval times well into the 19th century. Known as "the king's evil," scrofula was supposedly curable by the touch of a king, or even the application of a ring or coin the king had touched.
Scrofula is a skin disease caused by the tuberculosis bacterium, in adults. The medical term is cervical tuberculous lymphadenopathy, which means "tuberculosis of the neck that makes your lymph glands swell in an unnatural way." The major symptom of scrofula is a big lump on the neck, which over time can swell, rupture and fester. Pretty, huh?
Removing the lump with surgery is a bad idea. Surgery does not remove the infection, which just makes more lumps over a wider area. Scrofula does respond to antibiotics, just as other forms of tuberculosis do.
As with other forms of tuberculosis, scrofula made a comeback with the rise of AIDS, and when it shows up now, it's often drug-resistant; the CDC says that scrofula affects about 5% of severely immunodeficient AIDS patients.
The virtual disappearance of tuberculosis in the developed world is one of the greatest triumphs of public health. A few years ago a friend came back from China testing positive for exposure to tuberculosis, and I remember feeling an almost superstitious shock of dread at the news -- but nine months of antibiotics later, he was fine.
Still, it's one thing to treat TB; what's more amazing, and what I don't understand as well, is why people stopped getting TB and scrofula -- or for that matter, in the developed world, many visible diseases at all.
Three hundred years ago, a walk through any city in the world was a tour of innumerable visible signs of disease: the rotting noses of syphilis, the flush of erysipelas (a strep infection of the skin), the lumps of scrofula. Now, walking the streets of New York and London, we simply don't see it.
This had started to happen even before the widespread use of antibiotics, so some of the credit must go to basic hygiene practices, things like hand-washing and food safety and indoor plumbing. But I wonder, too, whether certain diseases -- like leprosy -- just burn themselves out over time.
And I'm very glad I've never had scrofula. Though I worry about this skin tag on my neck...