Can nose-picking give you lupus?

by Mike

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As stereotype would predict (34% of the city’s residents were German as of the 1900 census), the Milwaukee Medical Journal had regular reports on what physicians were up to in the German and Austrian empires.

In addition to the dispatch from Marosvasarkely (a Hungarian city now part of Romania and called Târgu Mureș), Julius Bruess summarizes two German articles about “lupus”. There were two types of lupus at the time. He doesn’t need to specify which one, because only one is contagious.

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Here we see “lupus” grouped with “scropholoderma” and “tuberculosis verrucosa cutis” as skin conditions that can be treated with a paste containing resorcin, also known as resorcinol or 1,3-dihydrobenezene. “This paste destroys all lupus tissue, but does not affect the healthy tissues. After 3 days a scab is formed. After this, for several days, application of Kaolin compound.”

The pros and cons of resorcin were covered in a review by Augustus Ravogli in the September 5, 1891 Cincinnati Lancet-Clinic. Ravogli says it often causes as much dermatitis as it cures, but is useful for contagious diseases like impetigo. Wikipedia calls it a “disinfectant” and “antiseptic”, but says it’s now given for eczema, psoriasis, dandruff and even allergies, none of which are caused by infections.

But back to lupus. As suggested above, this form of lupus is one of the many cutaneous manifestations of tuberculosis. Even today, there are several important types of cutaneous TB, with “lupus vulgaris” the most common. It’s generally found in people who have already suffered from TB in the lungs. And from the 19th century to today it’s been described as starting out as a soft “apple jelly” nodule, eventually turning into ulcers or dry lesions similar to “scropholoderma” (scrofuloderma).

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The apple jelly nodule, in F.J. Gant’s Science and Practice of Surgery (1886) and Narasimhalu et al., Infectious Diseases in Clinical Practice 21(3):183-184 (2013).

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Tuberculosis, also known as “consumption,” “phthisis,” or the “white plague,” was the cause of more deaths in industrialized countries than any other disease during the 19th and early 20th centuries. By the late 19th century, 70 to 90% of the urban populations of Europe and North America were infected with the TB bacillus, and about 80% of those individuals who developed active tuberculosis died of it.

For most of the 19th century, tuberculosis was thought to be a hereditary, constitutional disease rather than a contagious one. By the end of the 19th century, when infection rates in some cities were thought by public health officials to be nearly 100%, tuberculosis was also considered to be a sign of poverty or an inevitable outcome of the process of industrial civilization. About 40% of working-class deaths in cities were from tuberculosis.

(from Harvard University Library’s CONTAGION: Historical Views of Diseases and Epidemics)

In the 1880s it became accepted that TB was a contagious disease, thanks to the work of Robert Koch. Both his discovery of the “tubercle bacillus” and his preparation of sterilized extracts that can be used to test people for immune reactions against the bacillus. Thus the disease could be more objectively diagnosed… but not really treated, except by rest and fresh air in the sanatoria that quickly cropped up throughout the Western world.

Knowledge may not provide power, or freedom. In the absence of any effective treatment, it wasn’t necessarily helpful to find out that TB was unquestionably contagious. People tend to become more and more paranoid about ways we “know” the disease can be transmitted, whether AIDS via toilet seats and pay phones during the 1980s, or via dry sputum particles stirred up by street sweepers in the 1890s.

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People also become fixated on ways we “know” the disease can be controlled. We rationalize draconian measures, ranging from segregating infected people in the Carville Leprosarium to pursuing siege campaigns against badgers. And just like the Wassermann test for syphilis, covered in our very first post, the Mantoux test for tuberculosis often provided unwelcome and unhelpful information, no matter how accurate. If someone has recovered from their symptoms, but tests positive, what does that mean? What are their chances of manifesting more symptoms? Will they ever test negative?

* * *

Another indication that the tubercle bacillus remains within the body, even after lung infection clears up, is when it reemerges as lupus vulgaris. Today in countries where TB is rare, we use “lupus” as shorthand for “systemic lupus erythermatosus”, but lupus vulgaris still exists. And though many investigations, from Dr. Henry G. Anthony in 1903 to Dr. Harry Keil in 1933, failed to find a conclusive link between TB and lupus erythematosus, there has never been a doubt about TB’s role in lupus vulgaris.

The last excerpt from the Milwaukee Medical Journal’s German dispatches:

A contribution to the hygiene of schools with reference to the jurisdiction of school physicians is furnished by Prof. Lassar in reporting a case in point on the etiology of tuberculosis of the skin. It is a known fact that teachers will with preference, in order to inflict a mild punishment, pull the ears of their scholars. This proportionately considered harmless encouragement may be followed by severe consequences. If the teacher is tubercular he cannot prevent impregnating his finger nails with sputum containing tubercular bacilli.

For any number of diseases, you could say “Hey, if you treat someone roughly and your fingers are contaminated, you might infect that person.” Right? Even in 1902 there was scarlet fever, tetanus, ringworm, the aforementioned impetigo, and so on. But to get people’s attention, you warned them about tuberculosis.

Prof. Lassar’s main case study, a woman who traced her longstanding case of lupus vulgaris back to a teacher’s habitual ear-related punishments, was picked up by some other journals. And he made one other point — which the Hahnemannian Monthly, for example, ignored, but the Milwaukee Medical Journal passed along to its subscribers.

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Really, you COULD transmit any number of diseases by abusing the mucous membrane of the nose with the finger nails. But how often does it happen?

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