SCROFULA or Struma (formerly known in England as “king’s evil,” from the belief that the touch of the sovereign could effect a cure), a constitutional morbid condition generally exhibiting itself in early life, and characterized mainly by defective nutrition of the tissues and by a tendency to inflammatory affections of a low type with degenerative changes in their products. The subject has been considered in most of its features under Pathology (vol. xviii. p. 405), and only a further brief reference is here necessary. Scrofula may be either inherited or acquired. Heredity is of all causes the most potent, and naturally operates with greater certainty where both parents possess the taint. As in all hereditary diseases, however, the liability may be scarcely perceptible for one or two generations, but may then reappear. Other causes referable to parentage may readily produce this constitutional state in children, as weakness or ill health in one or both parents, and, as seems probable, marriages of consanguinity. But, apart altogether from hereditary or congenital influences, the scrofulous habit is frequently developed, especially in the young, by such unfavourable hygienic conditions as result from overcrowded, cold, and dark dwellings, insufficient and improper food, exposure, and debauchery. Even among the old in such circumstances the evidences of scrofula may be seen to present themselves where before they had been absent....
There are two well-marked types of the scrofulous constitution to be often observed, especially among the young. In the one the chief features are a fair complexion with delicate thin skin, blue eyes, dilated pupils, long eyelashes, soft muscles, and activity of the circulatory and nervous system; while in the other the skin is dark, the features heavy, the figure stunted, and all the functions, physical and mental, inactive. In many instances, however, it will be found that both types are more or less mixed together in one individual. The manifestations of scrofula generally appear in early life, and are often exhibited in young children during the first dentition by inflammatory skin eruptions of obstinate character on the face and other parts; later on in youth there appear glandular swellings either externally, as on the neck, or affecting the gland structures of the chest or abdomen, while at the same time mucous membranes and bones may become implicated. The distinctive features of the scrofulous inflammatory affections are their tendency to chronicity and to suppurative and degenerative changes, the affected parts either healing slowly with resulting disfigurement, as on the neck, or continuing to retain traces of the products of the diseased action, which may set up serious disturbance of the health at some future time. Further, the scrofulous constitution always influences the duration and progress of any disease from which the individual may suffer, as well as its results. Thus in pneumonia, to which the scrofulous would seem to be specially liable, the products of the inflammation are not readily absorbed as in previously healthy persons, but, remaining in the lung-tissues, are apt to undergo caseous degenerative changes, which may issue in phthisis (see Pneumonia and Phthisis). The connexion of scrofula with tubercle is pointed out in the article Pathology (loc. cit.).
Scrofula may under favourable circumstances tend to improvement as age advances, and it occasionally happens that persons who in early life showed unmistakable evidences of this condition appear ultimately to outgrow it, and become in all respects healthy and vigorous. The treatment is essentially similar to that described for rickets or phthisis, and is partly preventive and partly curative. It consists mainly in hygienic measures to promote the health and nutrition of the young, and of suitable diet, tonics, &c., where evidences of the disease have declared themselves. See Rickets, Phthisis.
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