Tuberculosis is still with us, is it hiding within you?

TUBERCULOSIS IS STILL WITH US, IS IT HIDING WITHIN YOU?

 In ancient Greece, it was known as “Phthisis,” in Ancient Hebrew, “Schachepheth.”  In Rome, it was called, “Tabes.”  “Consumption” was the more modern moniker [for the accompanying weight loss] of the 18th and 19th Centuries.  But it was never known as the “Black Death” or as a “Yellow Fever.”  Three hundred years ago, it was called the “White Plague” [the dying were so pale before death].  And don’t forget to include “Scrofula” in the description.  That swelling of lymph nodes and neck was also Tuberculosis (TB), although TB initially focuses primarily on the lungs.

The oldest record we have of this pestilence?  Underwater in the Mediterranean, off the coast of the Levant.  Hard to call it a village.  But people lived there even before the invention of pottery, in a time when sea levels were lower.  And they were able to erect stone megaliths.  The site is called Atlit Yam.

The bones recovered from their watery graves are almost 9,000 years old.  And they contain genetic material from the Tuberculosis organism!  TB was written about in India 3,000 years ago, and 1,000 years later in China.  For 300 years after 1600, it was responsible for one-quarter of all deaths in Europe and in the United States.

What is Tuberculosis?  Not a virus.  This pestilence is caused by a bacterium, Mycobacterium tuberculosis[another species attacks animals like deer and cattle].  Dr. Robert Koch identified it as such in 1882.

You have previously read of Koch’s scientific exploits in regard to epidemiology.  He also studied Cholera.  But in 1905, he received the Nobel Prize in Physiology or Medicine for his work on Tuberculosis.

With the advancing of the industrial revolution came a handy historical definition of the “Long Nineteenth Century.”  Calculate it to be from 1789 to 1914, when a rapidly growing population crowded industrialized nations.  And it was a period bracketed by major international warfare.  A good time for the spread of disease carried forth by human expectorate [haven’t we just seen that happen again with Covid-19].

The majority of the people in these industrialized nations would become infected with Tuberculosis.  In the United States in 1900, TB was the third leading cause of death [even higher than heart disease and cancer].  In 2019, 10 million people contracted the disease, and 1.4 million died globally.  Did Tuberculosis kill more humans throughout history than any other microbe?

So you can see why Robert Koch’s analyses were so timely and important.  Before his discovery in 1882, we didn’t know what caused Tuberculosis.  Heredity was a hypothesis.  But when the bacterium was found, and the respiratory nature of its contagion understood, isolation in sanitariums became the chosen treatment.  And that continued to be the method of treatment until the advent of antibiotics [initially streptomycin in 1961].

There are still many abandoned places in our nation’s cities, which served to house those sick with Tuberculosis.  Some are considered to be haunted, like Louisville’s famous Waverly Hills Sanatorium, which opened in 1910.  The “White Plague” severely struck that city during the turn of the century two times ago.

And this turns our interest to another place in Kentucky, which was thought to serve a similar purpose in an earlier period.  That’s why Dr. John Croghan bought it in 1839.  Mammoth Cave.

Croghan had suffered bouts of Tuberculosis, and wanted to see if cave air would serve as a healthful retreat for TB patients.  So in 1842, 15 patients entered into buildings constructed within Mammoth Cave.  Five soon enough died inside, and the experiment was abandoned [two of these stone “tuberculin huts” still remain for you to visit today].  In 1849, Dr. Croghan himself died of his infection with Tuberculosis.

Have you recently visited your doctor, who listened to your chest sounds with a stethoscope?  There is a connection to Tuberculosis in the history of that diagnostic action.  The first stethoscope was a wooden tube carved by Dr. Rene Laennec in 1816.  He was a French physician whose mother and uncle died of Tuberculosis.

Laennec was once too embarrassed to place his ear directly on the chest of a female patient.  That’s how physicians listened, back then, to the heart and lungs of a sick person.  Laennec’s awkwardness led directly to the device that your doctor uses with you!

Laennec had studied the presence of Tuberculosis lesions [“tubercles”] in autopsies of people dying from the condition.  He discovered that lesions could spread throughout the entire body.  But he did not understand, then, how the disease was contagious.  In 1826, Laennec died, at age 45, of Tuberculosis, undoubtedly as a result of his extensive studies.

He was not alone in being infected with Tuberculosis.  Amongst the great number, three more will be noted.

The English poet John Keats died in 1821 of “galloping consumption.”  He had been caring for his sick brother in England, fleeing to Italy for the hopefully healing weather after he became infected.  Keats died of Tuberculosis one year later in Rome at the young age of 25.  His last poems were thusly inspired by disease and death coming.

In 1835 and 1840, French aristocrat and diplomat Alexis de Tocqueville published his famous books called, “Democracy in America.”  Tocqueville died of Tuberculosis at age 53 in 1859, after periodic eruptions of the disease in his body.  It is ironic that, in the next year, the greatest test of this nation’s democratic institutions was to begin.

Our final example is the great Russian playwright, Anton Chekhov [and he was a medical doctor].  It was Chekhov [as well as Ibsen of Norway and Strindberg from Sweden] that introduced us to “realism” in theater.  His first symptoms of Tuberculosis manifested in 1884.  TB would kill him twenty years after.  He wrote his greatest works under the disease’s great sanctions.   Plays like “The Three Sisters,” “The Cherry Orchard,” and “Uncle Vanya.”

Now for the obligatory quote relating the awful physical impact of the last stages in this consumptive disease [from Maurice Fishberg, “Pulmonary Tuberculosis,” 1922].

… Suddenly, like a thunderbolt out of a clear sky, after a fit of coughing … he is seized with a sharp agonizing pain in the chest, he feels as if ‘something has given way,’ or as if something cold is trickling down his side.  He at once sits up in bed holding his hand over the affected side, gasping for breath.  Acute, distressing dyspnea, cyanosis, a small rapid and feeble pulse, cold, clammy extremities and other phenomena of collapse make their appearance.  The facial expression is that of profound agony, the eyes prominent, the lips livid, and the forehead clammy.

 

So here is the surprising thing about Tuberculosis, and why this lowly bacterium is still with us and killing.  Tuberculosis is the No. 1 killer among infectious diseases.  It spreads by coughing, speaking, sneezing, or singing out tiny particulates to which the bacteria are clinging.  And they are highly infectious when floating around out there!

It is thought that 25% of the world’s population has been infected with Tuberculosis.  In most people, their native immune system is strong enough to fight it.  But, in some cases, their immune system walls off the infected region in “tubercles,” with the bacteria still inside.  And you might never know you had been attacked by the organism.  But the TB bacteria may still be alive in there.  And you might find those “tubercula” in imaging performed for another medical reason.

This asymptomatic condition is called a “latent” Tuberculosis infection.  It may never manifest the disease symptoms, and may not become contagious.  But it is possible for the bacteria to become active again, especially if one’s immunity system weakens.  Therefore, treatment is often still recommended.

This infectious monster has tracked our movement throughout our history.  It may have even run with our African hominid ancestors 3 million years ago [based on a genetic analysis]! And Tuberculosis remains a present danger to our population.

My wife’s grandfather died from the disease in 1931.  Her father lost part of his lung to Tuberculosis in the early 1960s, and her son tested positive for it in 2009, yet exhibited no symptoms.  He was immediately treated with the antibiotic Isoniazid (INH), the same one that was used to treat his grandfather, 50 years earlier.

It is an unfortunate aspect of our human society, that a disease that is preventable and treatable, still extracts such a price from our population.  We seem, at times, to gather and act in ways that facilitate the easy expansion of such creatures.

Surely we could do better with a little more science, and a willingness to help others!

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