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History of Diseases

Explore library resources related to the history of various diseases.

Pulmonary Tuberculosis: a brief history of the disease

 

Other Names: Consumption, Phthisis, White Death

Tuberculosis is an infectious disease which attacks humans of all ages and can infect nearly every part of the human body. Pulmonary tuberculosis, that is tuberculosis of the lungs, makes up the vast majority of the cases. It is an ancient disease. Neolithic skeletons (4500 B.C.), and Egyptian Mummies (1000 B.C.) have been found with tubercular lesions on their bones. Consumption is a translation of a Sanskit word (1000 B.C.) for a wasting disease. Phthis is the word the ancient Greeks used for the disease. As far as historians know it only became epidemic in the 17th century. A hundred years ago it caused the deaths of Canadians than any other single cause. Few families escaped some visitation.

What it's Caused By and How it is Spread

The bacteria is called mycobacterium tuberculosis. It was isolated by Robert Koch in 1882. Tuberculosis can infect animals as well and bovine tuberculosis can be passed to humans through infected milk. Pasteurization has eliminated this as a cause of infection.

Tuberculosis is most commonly spread the same way a cold is by breathing in the infected droplets put into the air when someone sneezes, coughs or spits. From the lungs, the bacteria can spread to other parts of the body to cause tuberculosis of the lymph nodes, bones, brain, throat for example. The spread of the bacteria is slow, indeed it can lie dormant for years or forever after first coming into contact with host tissue. A lowering of the immune system by stress or another illness will activate it. Therefore the poor subsisting in overcrowded housing, poor food and stressful conditions are particularly susceptible to this disease.

Symptoms and Diagnosis

Breathing becomes laboured, a persistent cough accompanied by bloody sputum and night fevers develop. As the blood and therefore the body becomes starved of oxygen, the person starts loosing weight, loosing colour, loosing energy. Before the etiology of the disease was understood, people saw their family members slowly 'consumed' by the disease, hence the name 'consumption' for pulmonary tuberculosis. Of course many types of lung diseases were lumped under the term ‘consumption', lung cancer and bronchitis for example.

Koch attempted to create a vaccine against tuberculosis which he called tuberculin. While was unsuccessful as a vaccine, it proved to be a very useful diagnostic tool because it generated an allergic reaction to anyone with the tuberculosis bacilli. The tuberculin formula has changed somewhat over the years but the tuberculin skin test remains a standard of tuberculosis control programs.

Wilhelm Roentgen discovered x-rays in 1895. The chest x-ray became another standard diagnostic tool. It revealed the tubercular lesions on the lungs before any symptoms were presenting. However because the pictures did not distinguish between healing, healed and dormant lesions, a bacterial test was used to confirm the infection. X-rays were used in induction examinations in both World War I and World War II and they were used in periodic public health blitzes in order to identify cases out of the general population.

Therapy

Until the 1950's the only known cure for tuberculosis required rest, good food , gentle exercise and time in vast amounts, years worth.. The first sanatoriums were established in places like Switzerland in the 1850's to cater to those people. The first sanatorium in North America was set up at Saranac Lake in the Adirondacks of Upper New York State in 1876 and up here Muskoka had the first two sans in Canada. The Mountain San (Chedoke Division) was fourth after Weston in Toronto.

Like most sanatoriums the Mountain Sanatorium was started as an act of philanthropy. Resting at home or travelling and eating well was impossible for working people. Not surprisingly therefore, tuberculosis raged through the parts of Hamilton where working people lived with a terrible death toll. Before the discovery of the antibiotic streptomycin, the average length of stay was 562 days. A year and a half, for the most part spent in bed. This was just an average among 753 beds. Three years was very common and a few people spent 10 and 15 years there.

The cornerstone of the sanatorium treatment was self control. Patients learned how to control their coughing and spitting. They were taught to be vigilant against depression and morbid thoughts. Long lists of rules controlled every aspect of a patients day. When patients were allowed to talk or move about, read, listen to the radio, do crafts or school work. Strict schedules for eating, sleeping, bathing and using the bathroom were enforced. In the words of one medical superintendent writing about running a san, "Everything which is not expressly allowed is forbidden." It was their job and duty to get well as soon as possible and return to productive employment.

A number of other therapies were tried. Surgical procedures like pneumothorax, where the diseased lung was collapsed and immobilized so that the lesions would have a chance to heal. Although it was used extensively between 1920 and 1940 there was little evidence it was useful. It was not used after 1949.

Heliotherapy, the healing value of the sun, was also used. Patients lay under lamps or out in the sunshine.

Chemotherapy proved finally to be the successful cure. Streptomycin was isolated by Selman A. Waksman, at Rutgers University in 1944. Once this became widely used, patients no longer required the years of bedrest that the sanatoriums provided. Sanatoriums began to close or find other uses for their facilities.

Cultural Significance of Tuberculosis

Tuberculosis was considered as a disease of the poor because they were the most effected population in society. It was a disease with a definite social stigma attached to it. Suffers and their families were considered dirty and diseased.

Curiously however during the 19th century there was another view held right along side this one, that it was a disease of sensitive, artistic people. The ‘consumptive look' was the standard for white, middle class beauty. Ralph Waldo Emerson, the American essayist called his consumptive fiance; "too lovely to live long." Robust health was considered vulgar in a lady. The paintings of Dante Gabriel Rossetti paintings from this time are filled with pale, thin girls with their hair cascading over their shoulders as though they'd just gotten out of bed. Only venereal disease was as associated with the literati as tuberculosis. To name just a handful of the famous people who died during their most productive years of pulmonary tuberculosis, Honore de Balzac, (1799-1850), French writer;Anne Bronte, (1816-1849) English writer; Emily Bronte, (1818-1848), English writer;Elizabeth Barrett Browning, (1806-1861), English writer;Anton Chekhov, (1860-1904) Russian writer;Frederic Chopin, (1810-1849), French composer; Stephen Crane, (1871-1900), American writer;Franz Kafka (1883-1924), German writer; John Keats, (1795-1821), English poet; Vivian Leigh, (1913-1967), English actress; Edward Lincoln, (1846-1850) ,son of Abraham and Mary Lincoln; Thomas Lincoln, (1853-1871), son of Abraham and Mary Lincoln;Louis XIII, (1601-1643), King of France; Louis XVII, (1785-1795), King of France;Katherine Mansfield, (1888-1923), New Zealand writer; George Orwell, (1903-1950),English writer;Robert Louis Stevenson (1850-1894) Scottish writer;Henry David Thoreau, (1817-1862) American writer.

The impact on history of this disease is enormous and incalculable. Until recently it was the most important cause of death in Europe and North America. It killed and incapacitated millions of people, many of them during their most productive years. It orphaned and widowed and ruined millions more.

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