Scrofula can be denned only historically. That is, scrofula is a term about which there was some measure of consensus in the past, but one that has now been largely superseded by terms that indicate some form of tuberculosis. It must be emphasized, however, that scrofula is not simply an old name for what we call tuberculosis. Our ontology of disease centers on the tubercle bacillus, and we would commit a grave historical error if we assume that with its aid we can know what was actually there in old discussions of scrofula. To understand these old discussions, we need to know how and why the old picture of scrofula was put together. The distribution of scrofula, as we shall see below, has much more to do with the religious and political convictions of those who saw it than with physical geography or economic conditions or other circumstances normally considered conducive to diseases. Likewise in regard to its clinical manifestations, we may note, first, that this term itself implies an underlying entity that becomes manifest. But, second, scrofula, historically, was its collection of symptoms and signs. What we need to understand is what went into that collection, and why.

History and Geography

“Scrophula,” like “scurvy” and “syphilis,” is not a term that was used by the ancients. Whereas there may be special reasons why the latter two were unknown (a distribution to the north of the ancient Mediterranean and a possible Columbian origin, respectively), there seems to be no reason to suspect that scrofula was a new disease.