Before beginning this project, my ideas about tuberculosis had mostly been informed by period dramas; a character looks a little ill, starts coughing up blood, and inevitably dies soon after. The reality, of course, is very different.
Tuberculosis is not just confined to the lungs, and while it is fatal in approximately 50% of cases if left untreated, it wasn’t the instant death sentence I had assumed it to be. It is also not a disease of the past; tuberculosis is still a major problem in developing countries, and has been declared a global health emergency by the World Health Organisation. According to a recent report from the WHO, in 2013, an estimated 9 million people developed TB and 1.5 million died from the disease.So what is tuberculosis? Historically known as consumption or phthisis, TB is a widespread infectious disease, spread through coughs, sneezes, and sputum, and connected with overcrowding and malnutrition. While it most commonly affects the lungs (referred to as pulmonary tuberculosis), it can affect other areas of the body. Most infections are latent, meaning the disease cannot be spread from infected patients, though one in ten of these cases will progress to the active disease. It affects the body by causing the formation of granulomas, in which the central cells die, causing lesions, fibrosis and cavities.
The cause of tuberculosis was unknown for much of the nineteenth century, though there was much speculation over what might be responsible (culprits such as ‘bad air’, ‘damp soil’, and ‘moral culpability’ were suspected); and doctors across Europe disagreed about whether the disease was infectious or hereditary until the 1880s, when Robert Koch identified the responsible bacterium.
Even after the cause was identified, until effective antibiotics were discovered, treatment of tuberculosis in the United Kingdom was difficult. Hospitals in the nineteenth century were seen as places of restoration, run as charitable organizations. The expense of treating a chronic disease, and the low hopes of a favourable outcome, meant that they were reluctant to take on consumptive patients. In London, five specialist consumption and chest hospitals existed, one of which was the Hospital for Consumption and Diseases of the Chest, Brompton, founded in 1841, but these hospitals struggled due to lack of funds to treat as many patients as they had hoped.
The twentieth century saw the development of the sanatorium, which provided a structured regime of rest and good nutrition allowing patients to recuperate and fight off the disease. Despite their popularity, these institutions are not thought to have had much effect on recovery rates, especially since they tended to only treat the patients with the best prognosis. Dispensaries were also established, which could provide outpatient care so that sufferers didn’t have to leave their homes and work for extended periods of time.From the 1920s, surgical treatments such as artificial pneumothorax became popular with British doctors. These procedures would collapse the lung, filling the cavity with gas, to ‘rest’ the lung and allow lesions to heal. These, and other unpleasant-sounding treatments, were never really subject to any evidence-based scrutiny, but don’t appear to have been effective as cures. They were finally replaced by medical solutions, with the discovery of antibiotics effective against tuberculosis in 1944 (streptomycin), 1957 (isoniazid), and 1972 (rifampin). BCG inoculation programmes were slow to develop in the UK, but have further helped to reduce the incidence of the disease. The disease had been in slow decline throughout the UK throughout the twentieth century (beginning as early as 1840 in England) due to improvements in living standards and better nutrition; effective chemotherapy dramatically accelerated the decrease of tuberculosis, and raised hopes that the disease may finally be eradicated. This optimism has proven to be short-lived. While TB is now rare in the UK, the rise of drug-resistant strains of the disease, poor living conditions in developing countries, and high rates of HIV, have led to a global resurgence in infection rates. The quest to eradicate the disease continues.
Thomas Dormandy, The White Death: A History of Tuberculosis (London, 1999)
F B Smith, The Retreat of Tuberculosis: 1850-1950 (London, 1988)
Wikipedia, ‘Tuberculosis’, http://en.wikipedia.org/wiki/Tuberculosis
Wikipedia, ‘History of Tuberculosis’, http://en.wikipedia.org/wiki/History_of_tuberculosis
WHO Global Tuberculosis Report 2014 http://www.who.int/tb/publications/global_report/en/