This text was copied from Wikipedia on 9 July 2024 at 4:10AM.

Mycobacterial cervical lymphadenitis
Other namesScrofula, scrophula, struma, the king's evil
Scrofula of the neck, showing characteristic bumps on the skin
SpecialtyInfectious disease

The disease mycobacterial cervical lymphadenitis, also known as scrofula and historically as king's evil, involves a lymphadenitis of the cervical lymph nodes associated with tuberculosis as well as nontuberculous (atypical) mycobacteria.


Scrofula is the term used for lymphadenopathy of the neck, usually as a result of an infection in the lymph nodes known as lymphadenitis. It can be caused by tuberculous or nontuberculous mycobacteria. About 95% of the scrofula cases in adults are caused by Mycobacterium tuberculosis, most often in immunocompromised patients (about 50% of cervical tuberculous lymphadenopathy). In immunocompetent children, scrofula is often caused by atypical mycobacteria (Mycobacterium scrofulaceum) and other nontuberculous mycobacteria (NTM). Unlike the adult cases, only 8% of cases in children are tuberculous. With the stark decrease of tuberculosis in the second half of the 20th century, scrofula became a less common disease in adults, but remained common in children. With the appearance of HIV/AIDS, however, it has shown a resurgence, and can affect patients at all stages of the disease.[1][2]

Signs and symptoms

The most usual signs and symptoms 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, chills, 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. The fatal outcome some patients experienced in earlier times was due to a cheese-like presentation of the lungs and the King's Evil lesions. It was also associated with pulmonary tuberculosis.[3]

Cervical lymphadenitis is commonly caused by an infection of mycobacteria in the head region. This disease is very inconsistent; cases can have different laboratory findings. Sometimes the disease can occur due to tuberculosis disease. However it is vital that, on a case-by-case basis, it is determined whether the cause is tuberculous or nontuberculous mycobacteria, as treatment often differs between the two forms.[4]


Diagnosis 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.


The classical histologic pattern of scrofula features caseating granulomas with central acellular necrosis (caseous necrosis) surrounded by granulomatous inflammation with multinucleated giant cells. Although tuberculous and non tuberculosis lymphadenitis are morphologically identical, the pattern is somewhat distinct from other causes of bacterial lymphadenitis.[5]


17th century

King's Evil was known as a frequent disorder in the 17th century, and was believed to be caused by bad blood coagulating in spongy organs such as the thyroid and the lymph nodes. Physicians also believed the disease could be inherited and could result from parents' untreated venereal infections. [6]

The treatment for mycobacterial cervical lymphadenitis consisted primarily of small incisions to remove the surrounding soft tissue and/or the abnormal mass. Until the 18th century, many doctors thought the only way to cure the disease was to be touched by a member of a royal family. In both France and England, the kings who were thought to have an inherited miraculous power to cure the illness, touched crowds of infected people. The 'touchings' began in France during the reign of King Philip I (1060–1108) and in England during the reign of King Henry I (1100–1135). This act of public healing by powerful kings and royal family members encouraged the nickname "King's Evil".[7] After the touching, the sovereign presented the affected person with an angel on a gold-plated coin that was to be hung around the infected person by a ribbon. This was used as a way of warding off the disease. This coin could have weighed as much as 5 grams and was considered a touch piece of great value.[8] At age three the English lexicographer Samuel Johnson, for example, was treated for scrofula in this way, touched by Queen Anne and presented with a piece of gold, unfortunately, to no effect.[9]

The royal touch and surgical removal were not the only methods of healing employed: Scrophularia nodosa (common name: Figwort), which has nodular roots that resemble the swollen lymph nodes of the affected, was thought to be useful in treating the disease, according to the doctrine of signatures – the plant being hung around the neck of the affected. Figwort does, in fact, contain compounds that can help decrease inflammation, irritation and discomfort.[10]

20th century to present

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 recurrence and formation of fistulae. Furthermore, surgery may spread the disease to other organs. The best approach is to use conventional treatment of tuberculosis with antibiotics. The cocktail-drug treatment of tuberculosis (and inactive meningitis) includes rifampicin along with pyrazinamide, isoniazid, ethambutol, and streptomycin ("PIERS"). Scrofula caused by NTM, however, 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, often causing unsightly scarring, damage to the facial nerve, or both).

Many different therapeutic options exist, particularly regarding non tuberculosis mycobacterial infections, such as incision and drainage, aspiration biopsy and chemotherapy. All of these methods have proved to result in a cure of the disease. However different treatments can cause different side effects along the way to recovery. Some of these side effects include facial nerve injury and scarring. Therefore, the course of treatment is tailored to each patient, taking into account their history as well as the severity of infection.[11]


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 and etymology

The term 'cervical' refers to the cervical lymph nodes in the neck; it is unrelated to the cervix. The alternative name scrofula comes from the medieval Latin scrōfula, diminutive of scrōfa, meaning brood sow, because swine were supposed to be subject to the complaint., or because the line of elevated lymph nodes was thought to resemble the belly of a breastfeeding sow.

In the beginning of the Modern Age some Western Europeans believed that royal touch, the touch of the sovereign of England or France, could cure diseases owing to the divine right of sovereigns. Henry VI of England is alleged to have cured a girl with it. Scrofula was therefore also known as the King's evil. 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 shillings to about 10 shillings. In England this practice continued until the early 18th century, and was continued by the Jacobite pretenders until the extinction of the House of Stuart with the death of the pretender Henry IX. 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 Samuel Johnson in 1712,[12] 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 by Charles X in 1825.

Physicians, healers, and patent medicine sellers offered a wide range of cures for scrofula or the King's Evil. Since ancient times, the highly toxic heavy metal mercury, referred to as cinnabar, quicksilver or calomel, was administered as an ointment or pill or inhaled as a vapor to treat skin diseases. Mercury taken internally induced vomiting and sweating, reactions believed to cure the disease. In 1830, the New-York Medical and Physical Journal continued to recommend mercury as the best cure for scrofula, stating it caused an irritation that would counteract the disease and increased the working of the glands.[13] Alternative treatments were also offered. Many rejected the harsh side effects of mercury, claiming their cures were made of "natural" or "vegetable" ingredients. Patent medicines labeled as sarsaparilla were recommended for scrofula.[14]

Examples of treatments recommended between the 17th and 19th century include the following:

  • Herbalist Nicholas Culpepper (1616–1654) claimed to have treated his daughter for scrofula with lesser celandine, and cured her within a week.[15] Ironically, Culpepper would himself later die of tuberculosis.
  • In the 18th century, 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.[16]
  • In 1768, the Englishman John Morley produced a handbook entitled 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.
  • Richard Carter, a frontier healer in Kentucky, recommended several treatments for the King's Evil, or scrofula, in his 1815 home medical guide Valuable Vegetable Medical Prescriptions for the cure of all Nervous and Putrid Disorders.[17]
  • In the 19th century in the United States, the patent medicine Swaim's Panacea was advertised to cure scrofula. Swaim's Panacea contained mercury.[18]

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).[19]

Case studies

A three-year-old healthy young female presented with a bilateral cervical lymph node enlarged. The patient was admitted to the hospital after tuberculosis skin test became positive and further examination showed several other enlarged lymph nodes near her neck. At the hospital, she underwent an exploration surgery where they excised part of her presented lymph node and drained her retropharynx. The drained retropharynx grew methicillin-resistant Staphylococcus epidermidis and Streptococcus mitis. After these findings, the patient received oral linezolid for ten days and had antimicrobial drug therapy for 14 days. Once the patient returned for a follow-up appointment, the lymph node had only slightly decreased in size. Due to this, it had to be completely removed from her neck. Bacterial cultivation of tissue from the excised lymph node resulted in the growth of "atypical Mycobacteria", which were identified by 16S gene sequencing as Mycobacterium florentinum. After she recovered and went home, there were no repeat signs that the infection was back for over a year.[20]

See also


  1. ^ Moazzez AH, Alvi A (April 1998). "Head and neck manifestations of AIDS in adults". American Family Physician. 57 (8): 1813–22. PMID 9575321.
  2. ^ Sun L, Zhang L, Yang K, Chen XM, Chen JM, Xiao J, et al. (March 2020). "Analysis of the causes of cervical lymphadenopathy using fine-needle aspiration cytology combining cell block in Chinese patients with and without HIV infection". BMC Infectious Diseases. 20 (1): 224. doi:10.1186/s12879-020-4951-x. PMC 7071630. PMID 32171271.
  3. ^ Duarte GI, Chuaqui FC (April 2016). "[History of scrofula: from humoral dyscrasia to consumption]". Revista Médica de Chile. 144 (4): 503–7. doi:10.4067/S0034-98872016000400012. PMID 27401383.
  4. ^ Bayazit YA, Bayazit N, Namiduru M (2004). "Mycobacterial cervical lymphadenitis". ORL; Journal for Oto-Rhino-Laryngology and Its Related Specialties. 66 (5): 275–80. doi:10.1159/000081125. PMID 15583442.
  5. ^ Rosado FG, Stratton CW, Mosse CA (November 2011). "Clinicopathologic correlation of epidemiologic and histopathologic features of pediatric bacterial lymphadenitis". Arch Pathol Lab Med. 135(11):1490–93. doi:10.5858/arpa.2010-0581-OA. PMID 22032579.
  6. ^ Gallagher, N (April 2024). "A Sad Inheritance of Misery: The Cultural Life of Hereditary Scrofula in Eighteenth-Century England". Medical History. 68 (1): 1–21. doi:10.1017/mdh.2023.37. PMC 11046006.
  7. ^ Sturdy DJ (1992). "The Royal Touch in England". European Monarchy: Its Evolution and Practice from Roman Antiquity to Modern Times. Franz Steiner Verlag. p. 190. ISBN 3515062335.
  8. ^ "Gold coin used in the ceremony of touching for the king's evil". The British Library. Retrieved 2020-12-15.
  9. ^ Encyclopædia Britannica, ed. (1964). Encyclopædia Britannica, Vol. 13. William Benton. p. 108.
  10. ^ Furdell EL (2001). The royal doctors, 1485-1714 : medical personnel at the Tudor and Stuart courts. Rochester, New York: University of Rochester Press. p. 190. ISBN 978-1-58046-051-4.
  11. ^ Mandell DL, Wald ER, Michaels MG, Dohar JE (March 2003). "Management of nontuberculous mycobacterial cervical lymphadenitis". Archives of Otolaryngology–Head & Neck Surgery. 129 (3): 341–344. doi:10.1001/archotol.129.3.341. PMID 12622546.
  12. ^ Henry Hitchings (2005). Dr Johnson's Dictionary: The Extraordinary Story of the Book that Defined the World. John Murray. p. 11.
  13. ^ "The New York Medical and Physical Journal". 1830.
  14. ^ Resor C (March 18, 2020). "What is scrofula? Can it be cured?".
  15. ^ Reader's Digest Field Guide to the Wild Flowers of Britain. Reader's Digest. 1981. p. 26. ISBN 9780276002175.
  16. ^ "Petition of Mrs. Pearson Respecting Her Discovery For the Cure of Scrofula, or King's Evil". Hansard. 31: 1086–87. 3 July 1815.
  17. ^
  18. ^ Young JH (1961). "Chapter 5: The Toadstool Millionaires".
  19. ^ Bloch M (1973). The Royal Touch: Sacred Monarchy and Scrofula in England and France (Les Rois thaumaturges). London: Routledge & Kegan Paul.
  20. ^ Syed SS, Aderinboye O, Hanson KE, Spitzer ED (September 2010). "Acute cervical lymphadenitis caused by Mycobacterium florentinum". Emerging Infectious Diseases. 16 (9): 1486–7. doi:10.3201/eid1609.100433. PMC 3294984. PMID 20735941.

External links

6 Annotations

Second Reading

Third Reading

San Diego Sarah  •  Link

This ceremony is usually traced to Edward the Confessor, but there is no direct evidence of the early Norman kings having touched for the evil. Sir John Fortescue, in his defense of the House of Lancaster against that of York, argued that the crown could not descend to a female, because the Queen is not qualified by the form of anointing her, used at the coronation, to cure the disease called the King’s evil.

Burn asserts, “History of Parish Registers,” 1862, p. 179, that “between 1660 and 1682, 92,107 persons were touched for the evil.” Everyone coming to the court for that purpose, brought a certificate signed by the minister and churchwardens, that he had not at any time been touched by His Majesty. The practice was supposed to have expired with the Stuarts, but the point being disputed, reference was made to the library of the Duke of Sussex, and 4 several Oxford editions of the Book of Common Prayer were found, all printed after the accession of the house of Hanover, and all containing, as an integral part of the service, “The Office for the Healing.”

The stamp of gold with which the King crossed the sore of the sick person was called an angel, and of the value of 10 shillings. It had a hole bored through it, through which a ribbon was drawn, and the angel was hanged about the patient’s neck till the cure was perfected. The stamp has the impression of St. Michael the Archangel on one side, and a ship in full sail on the other.

“My Lord Anglesey had a daughter cured of the King’s evil with three others on Tuesday.” — MS. Letter of William Greenhill to Lady Bacon, dated December 31, 1629, preserved at Audley End.

Charles II “touched” before he came to the throne. “It is certain that the King hath very often touched the sick, as well at Breda, where he touched 260 from Saturday, 17 April to Sunday, 23 May, as at Bruges and Bruxels, during the residence he made there; and the English assure … it was not without success, since it was the experience that drew thither every day, a great number of those diseased even from the most remote provinces of Germany.” — Sir William Lower’s Relation of the Voiage and Residence which Charles the II. hath made in Holland, Hague, 1660, p. 78. Sir William Lower gives a long account of the touching for the evil by Charles before the Restoration.…

San Diego Sarah  •  Link

L&M: “Scrofula, a tubercular infection of the soft tissues, generally the glands; allegedly healed by the touch of a consecrated King. … In England ceremonies had been held frequently since the reign of Edward III. Under Henry VII an office was added to the service book; it appears (modified and in English) in some prayer books during the reign of King Charles and up to 1719. … There was a great revival of the practice at the Restoration. … At this period the sufferers attended a service at which prayers were offered, and were given a gold coin (‘touchpiece’), touched by the ruler which they hung around their necks. On this occasion over 600 are said to have attended at Whitehall palace. The King thereafter appointed Fridays for the ceremony and limited the number to 200. … The ceremony went out of use under the Hanoverians; Dr. Johnson, as a little boy in Anne’s reign, is said to have been among the last to have been ‘touched’.”

As transcribed by Paul Brewster on 23 Jun 2003

San Diego Sarah  •  Link

Background to Charles II Touching for scrofula:

Kings, Bastards, and Enthusiasts Touching for the Evil in Restoration England -- By Christopher Andrews
An honors thesis submitted to the History Department of Rutgers University
Written under the supervision of Prof, Alastair Bellany, April 2012…

His research says in part -- and I have omitted a lot:
"Charles II alone touched nearly 7,000 of his subjects in 1660, and by the end of his 24 year reign, he had stroked around 100,000 people.
However, despite this popularity, within 30 years of Charles’ death the royal rite of healing was abandoned by the English monarchy."

"Immediately upon his return in 1660, he enthusiastically, even frantically, resumed the full rite, and he touched almost every month for the remainder of his reign."

"Valentine Greatrakes, the ‘Irish Stroker’, was a veritable 17th century celebrity, a faith healer whose apparently miraculous cures rivaled those of the king. By all accounts, Greatrakes healed thousands of sick petitioners, and was wondrously successful in his cures.
"'The great discourse now at the CoffeeHouses, and every where' in 1666 was Valentine Greatrakes, and all manner of men and women traveled across the British Isles for a chance to receive his touch.
"Even Charles II, clearly fascinated by this rival stroker, could not resist the spectacle and had Greatrakes summoned to Whitehall to perform his cures before the entire royal court."

"... reports that Greatrakes was in England had reached the royal court, and he was shortly summoned by Lord Arlington to report to Whitehall and present himself before Charles II. No account survives that describes the meeting between the two greatest healers of the day. Whatever transpired, Charles was content to leave Greatrakes unmolested, a notable contrast with his father who imprisoned numerous pretenders to his touch.
"While in London, Greatrakes cultivated friendships with prominent people, such as the Virtuosi Robert Boyle, Ralph Cudworth, Benjamin Whichcott, the magistrate Sir Edmund Berry Godfrey, and the poet Andrew Marvell, all of who bore witness to his extraordinary healing abilities. ...
By the summer of 1666, Greatrakes had tired of the excitement of London, and returned to his estates in Affane [IRELAND].
"By all accounts he continued to heal throughout his life, and kept in contact with members of the elite he had met in England, exchanging correspondences with Edmund Berry Godfrey, and sending details of the continuing cures he wrought in a letter to Robert Boyle in 1668."

It is important for us to know about Greatrakes because it was possible for his "miracles" to be examined, while any questioning of The King's powers to heal were off limits, since Anglicans still believed he was a representative of God on earth.

San Diego Sarah  •  Link


"Clerical hierarchy were forced to confront a miracle worker of the Protestant faith. ... Although a minor event in an era of turmoil, Greatrakes forced society to confront the relationship between religion, science, and politics. The fractures between these beliefs, and conclusions drawn from them, influenced thinking towards the most famous miracle healer of the age, Charles II."

"Charles began his healing career almost from the time of his father’s execution, touching 11 people in Jersey in Dec,, 1649, aged 19, without throne or kingdom.
"From this humble beginning, Charles II became the most prolific healer of the age, possibly of all England rulers before or since. By his death in 1685, Charles had touched over 100,000 people; 2 percent of the English population."

"Charles was always careful to cultivate his image as a healing monarch, and encouraged public viewings of the rite. He invited dignitaries to the ceremony, such as ... Cosimo III of Tuscany, and the Ambassador of Morocco, who remarked after the ceremony that he now found Charles 'to be the greatest monarch in Europe.'"

"... a member of the royal household, Nathaniel Crewe, Lord Bishop of Durham, and as Clerk of the Closet to Charles II, acted as the king’s personal chaplain and head of the private gallery at the Chapel Royal. He was responsible for the healing ceremony, where he presided at the king’s right hand, holding the gold angels the king would present to the sick."
Pepys knew Crewe:…

"... the kings defenders sought to have things both ways: they denied current Catholic miracles, while promoting their own wonder-working king."
Chancellor "Edward Hyde ... proclaimed in his book *Animadversions* that Charles II had healed more than any other figure in history -- while attacking the 'Fanaticism fanatically imputed to the Catholick Church.'
"Simultaneously denying contemporary miracles and defending the cures of the king was an intellectual challenge; by saying the royal touch was not quite a miracle, they walked a fine line between their theology and their royalism."

"An undercurrent of belief, ... was that the gift of healing was given to those who were personally holy. Charles II was notorious for his decadence, and many decried his personal life. His moral laxity must have made it difficult for the deeply religious to accept his healing gift."

"Charles II strived to strengthen his rule ... consequently sought to portray himself as a divinely sanctioned ruler who both answered only to God, and followed common law and was dedicated to protecting the rights of the English people and the existing establishment.
"The royal rite of healing was the perfect expression of those 2 images of the monarchy. The gift of healing was God given, making the king a quasi-divine person. But Charles used the gift to heal and protect his subjects ... not to rule arbitrarily."

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Chart showing the number of references in each month of the diary’s entries.