The Causes of Scrofula, Or King's Evil

Among the causes of scrofula should be placed first, hereditary predisposition; not that the disease itself may be inherited, as is generally supposed, but, as is the case with nearly all hereditary affections, there is a transmission from parent to child of a susceptibility to morbid influences by which this disease is characterized. It is probable that in a large share of the cases of scrofula, the disease is simply the result of development, through favoring circumstances, of tendencies inherited from consumptive or scrofulous parents. We believe, however, that the influence of a bad hygienic condition has been clearly shown to be so active an agent in producing this disease, and in developing an inherited tendency to it, that we may be justified in charging bad hygiene with by far the greatest number of cases of scrofulous disease. Among the most important errors in diet are those appearing in early infancy. Of this sort should be mentioned the feeding of children upon food not suited to their condition, such as vegetables and farinaceous articles, and particularly the evil custom in some countries, especially Sweden and Germany, of allowing young children to imitate the example of their parents in drinking coffee and beer. It has also been shown by evidence which is entirely worthy of credence, that scrofula, as well as consumption, is very often produced in human beings, especially children, through the medium of milk. A child may imbibe a scrofulous taint through being nursed by a scrofulous or consumptive mother or wet-nurse. The testimony is equally clear that this disease is not infrequently produced by milk from scrofulous or consumptive cows. That scrofula is by no means an uncommon disease in cows, has been clearly shown by the demonstration that the affection known as pearl disease among cows and other live stock, is identical with scrofula and other tuberculous affections. Some idea of the prevalence of this disease among cows may be gained from the statement of an eminent physician who asserts that at least fifty per cent of the live stock of Hanover, Germany, is affected with pearl disease, or scrofula.

The production of scrofula has also been attributed to the use of potatoes, starchy vegetables, and other farinaceous articles of food. This error has prevailed so extensively in some countries that it has become the fashion for mothers to prohibit the use of vegetables, particularly potatoes, to their children; and as a German medical writer has said, "Many a poor child has been sent hungry to bed while its anxious mother passed a sleepless night in consequence of the discovery that it had eaten a potato." Scientific investigation has shown, however, that in this case, as well as with many popular notions of the same sort, there is no real foundation either in theory or in reliable experience. We believe, however, it can be clearly shown that the large use of animal food, especially the use, as food, of animals in which scrofulous disease has been developed by confinement in stalls or close pens for the purpose of fattening, is one of the most serious dietetic causes of scrofula. Experiments have shown that the flesh, as well as the milk, of tuberculous or consumptive animals, will give rise to scrofula or consumption when eaten, even if cooked with a moderate heat. This being the case, how can we resist the conclusion that the use, as food, of the flesh of animals which have been fattened under conditions the best calculated to produce scrofulous disease, and the carcasses of which, in a large number of cases, show the actual anatomical changes resulting from scrofula, and especially the use of the flesh of the hog, which is known to be almost universally affected more or less intensely with scrofulous infection, must be among the most active and wide-spread causes of this almost universal malady ? We are firmly convinced, not only by theoretical reasoning, but from practical observations, that of all dietetic errors, the use of swine's flesh is the most active cause of scrofulous disease.

We should not omit to mention, however, that eating between meals, the use of pastry, candy, sweetmeats, and tidbits of all sorts, is also a prolific cause, not only in producing scrofula, but in developing scrofulous tendencies which might otherwise remain latent. Bad air, arising from overcrowding, deficient ventilation of living-rooms, sleeping apartments, and school-houses, must also be mentioned as a prolific cause of scrofula. If, as has been frequently shown by careful investigations of the subject, scrofula is, in some degree at least, an infectious disease, being communicable by means of diseased particles thrown off from the lungs by respiration, it will readily be seen that the crowding together of large numbers of children, quite a large percentage of whom must in all cases be suffering more or less with scrofulous affections, must be in the highest degree dangerous.

Uncleanliness of the skin, through want of frequent bathing, must also be a very common cause of this affection, or at least of the development of pre-existing scrofulous tendencies on account of increasing the liability to diseases of the skin. Certain diseases, as measles, scarlatina, diphtheria, typhoid fever, small-pox, and other affections of a grave character, frequently occasion the development of this disease.

It has also been shown that vaccination is not infrequently the means of inducing, or at least developing, scrofulous affections. There is good reason for believing that vaccine virus may be the means of communicating the scrofulous taint to the person vaccinated when it has been obtained from either a child or a calf suffering from scrofulous disease.

It has been generally supposed that persons of a sanguine temperament, or those having light complexions, blue eyes, and light hair, are particularly liable to scrofula, and even that the peculiarities of the temperament mentioned are indications of a scrofulous tendency. It has been shown, however, by Phillips, from a careful collection of statistics, that this popular theory of disease is erroneous, and that persons of the very opposite temperament and characteristics from those named, are equally liable to the disease. Thus it will be seen that it is almost impossible to predict the occurrence of scrofula, before it has made its appearance, by any personal peculiarity. Indeed, the only basis upon which the probable occurrence of scrofula can be predicted is that of known hereditary predisposition. It is contended, however, by those who have had the most experience in the treatment of this affection, that there is a distinct " scrofulous habit," of which there are said to be two varieties. The first, or irritable form, according to Dr. Birch-Hirschfeld, the eminent author of an able article on scrofula in Ziemssen's Encyclopedia of Medicine, is characterized by a delicate frame of body, deficient muscular development, thin skin inclined to bluish tint, with transparent veins especially in the temporal region and on the eyelid, soft hair, mostly of a light color, blue, lustrous eyes with a dilated pupil, irritable temper, "and sexual and intellectual precocity." The same author describes the second, or torpid form of scrofula as characterized by a burly frame of body, bloated appearance, richly developed adipose tissue, and muscles incapable of great exertion. The head is large, the physiognomy becomes heavy and unpleasant by the thickness of the upper lip, the broad jaws, and short, thick neck. The psychological character is distinguished by a sluggish, phlegmatic disposition and deficient development. Between these two typical classes there lie, of course, all the intermediate forms of disease.