Scrofula: The King's Evil

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Scrofula: The King's Evil


Disease History, Characteristics, and Transmission

Disease History, Characteristics, and Transmission

Scope and Distribution

Treatment and Prevention

Impacts and Issues



Scrofula is a form of extrapulmonary (outside the lungs) tuberculosis, a bacterial infection of Mycobacterium tuberculosis.

Disease History, Characteristics, and Transmission

The disease has a long and interesting history, first mentioned by Herodotus in 400 BC who recommended that sufferers be quarantined. Scrofula has also had a long association with royalty. It became known as the King's Evil as early as 491 A.D, and was thought to be cured by the “king's touch.” French monarchs claimed the ability to heal the disease from the time of Clovis in 481 AD through Louis XVI, who was beheaded in1793, as did English kings beginning with Edward the Confessor (1042-66), ending with the Hanoverian dynasty in the eighteenth century.

Since antiquity, monarchs claimed a quasi-divine status, often asserting that the royal family had a divine right to rule. Various ceremonies of royal courts may have lead to the association of royalty with magical powers of healing. Perhaps because the lesions appeared and reappeared, people who were “touched” may have experienced an illusion of cure.

Politics also played a role in kings claiming they could heal scrofula. When the legitimacy of royal power was threatened, for instance among early Norman kings who ruled England by conquest, “healing ceremonies” became predominant. Usually in these rituals, the physician would hold the head of the patient as the king would pronounce, “The king touches you, and God cures you,” making the sign of the cross touching forehead to chin and cheek to cheek. After the ceremony, French kings would distribute alms, and in England, the king would cross the sore of the sick person with a stamp of gold called an angel, worth ten shillings. The angel had a hole bored through it for a ribbon to be drawn, so the sufferer could wear it around his neck.


ANTIBIOTIC RESISTANCE: The ability of bacteria to resist the actions of antibiotic drugs.

BROAD-SPECTRUM ANTIBIOTICS: Broad-spectrum antibiotics are drugs that kill a wide range of bacteria rather than just those from a specific family. For, example, Amoxicillin is a broadspectrum antibiotic that is used against many common illnesses such as ear infections.

ENDEMIC: Present in a particular area or among a particular group of people.

LESIONS: The tissue disruption or the loss of function caused by a particular disease process.

QUARANTINE: Quarantine is the practice of separating people who have been exposed to an infectious agent but have not yet developed symptoms from the general population. This can be done voluntarily or involuntarily by the authority of states and the federal Centers for Disease Control and Prevention.


Samuel Johnson, an eighteenth-century author who wrote the first comprehensive English dictionary, suffered from scrofula as a child, and proudly wore his angel around his neck his entire life.

The true reason why scrofula was contracted was not known until the late nineteenth century. Because scrofula seemed to affect whole families, it was assumed that it was a hereditary, rather than an infectious disease. One of the common ways it spreads is though infected milk—either from an infected mother's or wet nurse's breast milk, or through contaminated cow's milk fed to infants or children. Before Koch's postulates of disease or pasteurization of milk in the 1880s, there was little understanding of the connection between bacteria and illness. During the mid-to-late nineteenth century in the United States, clean and inexpensive milk was also difficult to get; milk was often watered down, chalk or dye could be added to whiten dirty milk, and “swill milk,” produced by cows fed distillery waste was common. These cows often carried bovine tuberculosis, and milk bottles were not sterilized. It was also not until regulations about food safety were standardized, milk was regularly pasteurized, and dairy cleanliness maintained that scrofula ceased to be a health threat in industrialized nations.

Disease History, Characteristics, and Transmission

The term “scrofula” comes from the Latin “scrofulae” or a breeding sow, as pigs were thought to be susceptible to the disease, and the glandular swellings on the neck were compared to little pigs.

Scrofula results in an inflammation of the lymph glands and an enlargement of the lymph nodes in the neck. The nodes often ulcerate causing draining sores, and the sufferer also has fevers, chills, sweats, and sometimes weight loss. Lesions often subside, and then reappear as the disease takes its course and spreads through the skin, mucous membranes, bones and joints.

The disease can be contracted either through person-to-person contact, or via contaminated milk, or even via household objects that come into contact with the mouth.

Scope and Distribution

Though in developed countries, scrofula is now quite rare, lowered immune function resulting from HIV infection increases the risk of contracting the disease. As antibiotic resistance to tuberculosis has increased, scrofula has been making its reappearance, particularly in underdeveloped countries.

Treatment and Prevention

Though the king's touch is no longer considered effective, new challenges have arisen in the treatment of scrofula.

Treatment is largely through broad-spectrum antibiotics in a nine-to-twelve month course, and recovery is usually complete though there can be scarring around the lymph nodes.

Other treatments include short-course chemotherapy for tuberculosis patients, and increased detection protocols. In severe cases, surgery is done to remove the infected lymph nodes, but surgery alone tends to have disappointing results as it does not remove the underlying infection and it can cause scarring.

Impacts and Issues

Since 1985, scrofula has made a comeback in the United States largely due to immigration from endemic countries, rising rates of HIV infection, antibiotic resistance, and the abandonment of aggressive tuberculosis screening and control programs.

In sub-Saharan Africa, and increasingly in Asia and South American, scrofula is also posing a threat, particularly as a form of HIV-related tuberculosis. In its TB/IV Clinical Manual, the World Health Organization reports that growing rates of HIV-infections increase demands on programs to control tuberculosis, and there is more tuberculosis recurrence in AIDS patients.


'tis call'd the Evil: A most miraculous work in this good King; Which often, since my here-remain in England, I have seen him do. How he solicits heaven, Himself best knows: but strangely-visited people, All swoln and ulcerous, pitiful to the eye, The mere despair of surgery he cures

Shakespeare, Macbeth, Act IV, scene 3

See AlsoTuberculosis.



Bloch, Marc The Royal Touch. Sacred Monarchy and Scrofula in England and France. London: Routledge and Kegan Paul; Monteal: McGill-Queen's University Press, 1973.


Barlow, Frank. “The King's Evil,” The English Historical Review, 95, 374 (January 1980), pp. 3-27.

Harries, Anthony and Dermot Maher. “Introduction,” TB/HIV: A Clinical Manual World Health Organization, 1996.

Lomax, Elisabeth. “Hereditary of Acquired Disease? Early Nineteenth Century Debates on the Cause of Infantile Scrofula and Tuberculosis,” Journal of the History of Medicine and Allied Sciences October 1977, pp. 356-374.

Wheeler, Susan. “Henry IV of France Touching for Scrofula by Pierre Firens.” Journal of the History of Medicine and Allied Sciences 58 (2003), pp. 79-81.

Jacqueline Wolf, Don't Kill Your Baby: Public Health and the Decline of Breastfeeding in the 19th and 20th Centuries Columbus: Ohio University Press, 2001.

Web Sites

McClay, John E. “Scrofula,” E-medicine from WebMD <> (accessed March 2, 2006.

Anna Marie Roos