What is it that removed this sickness from the public? Surely not the laying on of hands as practiced by the royal heads of England and of the Continent. Was it that all those that were susceptible, simply died (as in the case of “Black Death” or the plague? Perhaps “modern” medicine spared us of this misfortune? Or we became self inoculated by having been exposed to the disease and thus spared from its effects?)
None of the above is the answer. The most unlikely and perhaps one that is vastly overlooked is the lowly bathtub. How can this be? Consider that in the times when disease spread rapidly thru a family, the neighbors, communities, cities and whole countries; sanitation was essentially unknown. Bathing was considered an unnecessary waste of water. No one did it, so why bother and even if one wished to partake, there was no means of doing so. A dip in the cold water in the spring followed perhaps infrequently during the remainder of the year sufficed. Even within a family that decided to do so, there was an order of entry into the bath waters so that those less fouled would go first. Sensible.
So King’s Evil survived until just before the turn of the twentieth century. Then a revolution took place. The majority of which can be laid to those of P. T. Barnum’s stripe, who promoted to those less able to afford, the promise that they could be just as good as the wealthy who surely partook of such splendor. Behold, the arrival of the bath tub. (Package and Print, Alec Davis, Clarkson N. Potter, Inc. N.Y. 1967).
Even in the far reaches of our country the bathtub emerged as a necessary “evil.” Most probably introduced by those fair ladies who provided a service to men far from home. By insisting that the customer buy “extras” beyond that which he at first desired, additional revenues were generated and indirectly all benefitted. In Lubbock Texas in an antique shop back in the 1960's a fine example of a copper bathtub was discovered. This grand creation of some tinsmith was fully eight feet long and capable of containing more than one. As no places for attachment of faucets or a drain were in evidence, it appeared that the tub was just that. Something to be filled with heated water and after the bath, water removed by dipping a bucket until it was emptied. You might imagine that as the day progressed, those responsible for the filling and emptying may have become a bit lazy so that those enjoying this blessing of man, may not have had the best of the water. The old saying of “throwing the baby out with the bath” probably came from not being able to see clearly what was in the water. This is especially true when you consider that while scented soap balls were available to some, for the majority, soap was the product of cooking hog fat with ashes from the fireplace or kitchen. The resulting lye soap was (and is) a harsh caustic that could be made to dislodge dirt but the user paid a price.
So what became of King’s Evil and along the way, just exactly what is this malady. To do justice, one can’t just consult modern medical tomes or reference books. The discussion is brief, inane and worse than that, wrong! The following is from two or three basic references that were available to the public (and the medical profession) in the period 1850 -1900.
Simply put, when a person is sick and the glands of the neck swell and burst releasing an ugly, rotten mess, and the opening only with difficulty heals it is possible that this person has tuberculosis, an often-times fatal disease which was called King’s Evil or scrofula.
From Chamber’s Encyclopedia – “Scrofula or Scrophula, was until the last quarter of a century (Since Chamber’s was published in 1880 or thereabouts, the last quarter of a century, places the description in the time period of 1875 to 1850), regarded as consisting essentially of indolent glandular tumors, occurring frequently in the neck, suppurating slowly and imperfectly, and healing with difficulty”.
Here you have a disease that has been with man for ages and with the sole practice of laying on of the hands, nothing much seemed to effect a cure (and the King’s touch should be much in doubt). Along comes the microscope, Louis Pasteur, and recognition that sanitation if practiced provided a means of warding off some diseases and if not that, perhaps hastening their cure.
Some credit must be given to those who coined the name “scrofula,” the association of the disease with other animals besides man implied that hogs (swine), cows and perhaps other animals that provided food for man might be somehow related to the disease in man.
Then there was the recognition that perhaps the disease was inherited. That is, the mother seemed to sometimes pass the disease onto her infant. An alternative theory must have emerged that perhaps it might be something in the mother’s milk that might be the factor. This is evidenced by the recommendation that a wet-nurse be used. (Probably some wise medical practitioner observed that an infant suckling a wet-nurse that had the disease, became infected, and the converse that some mother’s seemed to pass on the disease if the mother was infected.)
Now if the mother’s milk was suspect, how about that from cows? This linkage held as well.
Then again suffering was not exclusively the property of those affected with scrofula, no, it appeared that a disease known as “consumption” or wasting disease was wide spread. Those affected, often adults and the aged, simply went into decline, the disease essentially consumed the victim. They coughed up blood, had difficulty breathing, lost their appetite, lost weight and wasted away. Consumption, later called phthesis, perhaps replaced scrofula as the most feared disease.
How to treat consumption, was the providence of many of the patent medicines of the period. Few if any gave lasting relief. Probably those containing alcohol, opium and codeine made resting easier but didn’t halt the progress of the disease. A change of climate was often recommended and moving to Arizona and Tennessee was recommended. In some cases living in caves was an accepted norm. The major caverns in the United States were fitted for those suffering from the disease.
If that was not enough, other diseases were noted that seemed to be like a plague on mankind. Bone diseases and loss of sight were among those seemingly unrelated events.
And then, the discovery that a single microorganism was the culprit for all these problems. The Mycobacterium tuberculosis caused disease of: adrenal glands, bones, central nervous system, gastrointestinal tract, genitourinary tract, joints, liver, lymph nodes, miliary, pericardium, peritoneum, pleural, and pulmonary. Here was a chronic, recurrent infection which affected the lungs but virtually every organ of the body could be affected. Worse yet while the disease might develop rapidly, or it might lay dormant for years or even decades before the symptoms appeared. And, it could reemerge with a vengeance with an ancient dormant infection coming to life.
With discovery came relief from this scourge. Diseased animals were disposed of. Milk was pasteurized, and a couple of chemicals in the 40's and 50's were discovered that seemed to be extremely effective in eradicating the disease.
The compound Isoniazid is a bactericide which when given as an oral dosage enters freely the body cells and the central nervous system. Its introduction in 1952 replaced sulfa drugs which were the predominant treatment for TB prior to that time. Isoniazid is an analog of nicotinic acid. It acts to prevent synthesis of a major component (mycolic acid) of the mycobacterium’s cell wall, thus preventing replication of the micro organism.
Another chemical Rifampin, is also effective in controlling the disease. Rifampin is an antibiotic. It is effective in inhibiting a bacterial enzyme (RNA polymerase) which is essential for reading the genetic code. It does not inhibit mammalian RNA polymerase.
Isoniazid and Rifampin either alone or together quickly brings the disease under control and the patient becomes noninfectious in about two weeks. It is estimated that an organism has about one chance in 100,000,000,000 of surviving and replicating when Isoniazid in combination with Rifampin is given. Unfortunately, that isn’t good enough.
The goal of chemotherapy is to rid the body of the organism and prevent relapses. As the organism is vulnerable to the chemicals only during their reproductive stage, and the organism divides in a sixteen to twenty-hour cycle, then having the chemical present at adequate levels would appear to be effective, unfortunately, the organism hides out in old lesions, and in macrophages (a cell of the immune system that cleanses the body of infective agents. Unfortunately, the mycobacterium can reside within the macrophage which is a long-lived cell, and spring to life on release from the macrophage.)
We have in this country and throughout the world a population of individuals that are quite susceptible to TB. They have AIDS. As their immune system is compromised, they are vulnerable to this disease and many others. As death would probably occur within a few months if TB were not aggressively treated, a massive program of chemical intervention is practiced. Successfully!
But, what happens if the person taking the cocktail of drugs to control TB fails to do so? The treatment is interrupted. Some mycobacterium survives the chemical onslaught and replicate. Those that survive may have mutated to a new specie that is now resistant to the medicines of choice. And they spread.
We are now faced with the possibility that king’s evil may reemerge to damn mankind with a vengeance. What should we do, simply taking a bath once a week is no longer the solution?
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