Tuesday, August 27, 2013

1750-1850: Tuberculosis wreaks havoc

The industrial revolution swept across the modern from 1750-1850. New inventions improved agriculture, manufacturing, mining, transportation and technology, and this had a stunning effect on culture and economies.  The world was forever changed for the better, or so people suspected.

Yet while culture and economies improved, a vicious killer spread across this modern world.  No one knew what it was. No one knew where it came from.  No one knew what to do about it.  The killer was generally referred to as consumption, and if you got it you were probably doomed. 

Yet since people were ignorant about what it was, and what caused it, and how it was contacted, they didn't know that by getting together in poorly ventilated areas of mills and factories that they were breathing the contaminated air that was exhaled by people who had the disease.  They didn't know that the bacteria was transported through the air and was inhaled.  

They didn't know the disease was spread by sharing hanker chiefs, and by touching contaminated people.  They didn't know that the disease was prevalent before the industrial revolution, but the disease was more of a random disease that occurred here and there by chance.  Yet with the beginning of the revolution, people gathered in small, poorly ventilated areas.  People moved to cities, right into the grasp of the killer.  They did this because they wanted to create a better life for themselves and their children, and they did this not knowing they were living with a beast.  

There were a variety of names for it.  It was called scrofula (swollen lymph nodes), Pott's disease (TB of the bone, spine), the Great White plague (17th century Europe), consumption or phthisis (TB of the lung),  lupis vulgaris (TB of the skin), Mesenteric disease (TB from non-pasteurized milk), white swelling (TB of bone), and King's Evil (TB of of lymph glands). Or sometimes it's simplty referred to as "captain of the ship of death." (9)  We refer to it as tuberculosis.  

A plague swept through Europe in the 16th century, and during this time what Hippocrates referred to as phthsis was referred to as the Great White Plague.  Yet it was usually described by scientists and physicians as either phthsis or consumption and sometimes even scrofula.

During the next 200 years thousands would be killed.  Little was known about it other than it's symptoms.  Usually, a patient was diagnosed by a physician only after the patient noticed he was coughing up blood.  By this time the disease was near its later stages, and prognosis was grim.

  Franciscus dele Bo Sylvius published a book in 1679 called the Opera Medica in which he made the association between nodules in the lungs with phthisis.  Perhaps as a result, in the 17th and 18th centuries there were many references to the disease being contagious, and many warnings about those infected with it.  (3)  Yet for the most part physicians thought it was hereditary, as Hippocrates thought.

Giovanni Baptista Morgagni, an Italian anatomist who lived 1682-1771, wrote quite a bit about medicine in his later years.  He warned that the condition might be an infection and he warned against doing autopsies on anyone infected with it. (1, page 2)

TB was called white plague from 18th-19th centuries
Right around the turn of the 17th century a health edict in the Republic of Lucca in Italy warned: "Henceforth, human health should no longer be endangered by objects remaining after the death of a consumptive. The names of the deceased should be reported to the authorities, and measures taken for disinfection.”(2)

English Physician Benjamin Martin published a book in 1720 called "A New Theory of Consumption."  He wrote that the disease was caused by "wonderfully minute little creatures."  He believed these "creatures" enter the body and cause the symptoms.

Likewise, Martin believed that those in close proximity to the patient, particularly those talking to the person, should be careful.  He wrote:

"It may be therefore very likely that by an habitual lying in the same bed with a consumptive patient, constantly eating and drinking with him, or by very frequently conversing so nearly as to draw in part of the breath he emits from the lungs, a consumption may be caught by a sound person...I imagine that slightly conversing with consumptive patients is seldom or never sufficient to catch the disease."

In 1793 Dr. Matthew Ballie published a book "Morbid Anatomy of Some of the Most Important Parts of the Human Body." (?check year and book)  He provided a description of the lungs and many lung diseases.  He wrote about consumption, and was among the first to note nodules in other organs other than the lungs.

In 1689 Richard Morton (1637-1698) used the term "tubercle" to describe lesions he saw in organs of those who died of consumption.

Rene Laennec was born in 1787 and contacted tuberculosis as a young adult.  He became rapt in studying this disease during the course of his career as a physician.  He is best known for his invention of the stethoscope.  He was also the first to master its use.  He was also the first to see tubercles in lung tissue of those patients?

In 18? he published "A Treatise on Diseases of the Chest, and of Mediate Auscultation."  He
described how to use the stethoscope in assessing and diagnosing patients.  He also discussed the pathology of many disease processes, including what was used it to describe symptoms during various stages of the condition.

Laennec met his demise by the grips of tuberculosis in 1826 at the young age of 45.

Samuel George Morton  (1637-1698) was a pupil of Laennec.  In 1834 he published his own book titled "Pulmonary Consumption."  This would be the first book on the subject published in the United States. (4, page 10).  He recommended that the age old practice of bleeding patients who are coughing up blood was a "plan that has hurried thousands of patients to their graves by destroying the last remains of strength."

However, if the patient was of good strengh with a good pulse, he recommended "ten or twelve ounces of blood, taken rapidly from a large oriface, may divert the current of the circulation and relieve the pulmonary congestion."  (5, page 120).

This would work because the condition resulted in ulcers which dry and the blood becomes congested around these regions causing the ulcers to burst, and this is why these patients spit up blood.  He beleived bleeding prior to this happening would help prevent the congestion.

Other remedies may may also help "promote absorption of the congested blood" include:
  • Spirits of turpentine
  • Elixer of vitriole
  • Common salt
  • Opium
  • Sugar of lead
  • Rest
  • Diet of gum water and farinaceous food
He likewise agreed with a Dr. Beddoes who recommended a ride in the fresh air as treatment.  Morton quotes Beddoes:
 "In haemoptysis and pulmonary hemorrhages, I never observed any bad consequence from traveling in a carriage:  on the contrary, I have known these discharges to stop on a journey, though previously they had, for many days, occurred at least once in twenty-four hours."
Johan Lukas Schönlein (1793-1864) wrote relatively little during his life.  He wrote a doctoral thesis and two papers of 1 and 3 pages respectively, although that was it. Still, despite his lack of enthusiasm for writing, it was Schönlein who introduced the terms hemophilia and tuberculosis (1839). The word "tuberculosis" was derived from "tubercle", a word introduced by Morton in 1689 to describe the characteristic lesions of consumption.

The mid 19th century was a time when many scientists and doctors were experimenting with microbes.  In 1843 Dr. Klencke became the first to cause an animal to develop the condition by innoculating a rabit with "portions of miliary and infiltrating tubercules from a man.  Klencke, after accomplilshing this result, did not continue his investigations, and they were consequently soon forgotten."  (6)

Despite all the research that had been done prior to 1865, many physians believed that each case of tuberculosis "rose spontansously in predisposed people."  (2)  Yet it was in 1865 that a French military physician named Jean Antionne Villemin proved that tuberculosis was caused by an infecting organism.

He innoculated cattle with both human tuberculosis and bovine tuberculosis. (6)  He thus proved that two diseases were of similar origin, and he proved that the disease could be transferred form a human to cattle and from cattle to rabbits.  (2)

Regardless of Villemin's work the idea that tuberculosis was a spontaneous condition was ingrained in the minds of many, and they performed many experiments trying to prove Villemin wrong.  Yet in the end Villemin's ideas won out.  Although it took a few years.

Robert Koch (1843-1910) was the next to perform many experiments on tissue from tuberculosis victims to see if he could learn more about it and come up with a cure.  He invented a staining method that allowed him to see the tubercle bacillus.  And, through "artificial cultivation," he was able to grow the bacillus.  He then proceeded to reproduce the characteristics of tuberculosis in animals.  He also identified different forms of the disease in various animals.

Today paleopathologists (scientists who study ancient diseases) are unable to identify tuberculosis by finding the bacteria because they "disappear" shortly after the victim dies.  (8)  Yet some types of the disease effect bones and joints leaving scars that can be identified.

References:
  1. Norris, Charles Camblos, "Gynecological and Obstetrical Tuberculosis," 1921, New York, London
  2. Koehler, Christopher W., "Consumption, the great killer," http://pubs.acs.org/subscribe/archive/mdd/v05/i02/html/02timeline.html
  3. "History of TB," New Jersey Medical School, Global Tuberculosis Institute, http://www.umdnj.edu/ntbc/tbhistory.htm
  4. Klebs, Arnold Carl, "Tuberculosis," 1909, New York
  5. Morton, Samuel, "Pulmonary Consumption," 1834, Philadelphia
  6. Flenner, Simon, , "Immunity in Tuberculosis," Annual report of the Smithonian Institution, 1907, New York, page 627 
  7. "Captain of the Men of Death," Ulster Med J. 1989; 58(Suppl): 7–9.
  8. Sigeris, Henry E, "A History of Medicine," volume I, "Primitive and Archaic Medicine," Second Edition, 1955, New York, Oxford University Press, page 53
  9. Seth, Vimlesh, SK Kabra, Rachna Seth, "Essentials of Tuberculosis,"  Third ed., Jaypee Brothers Medical Publishing, 2006, page 3-4
  10. Jones, Greta, "Ca;ptain of All These Men of Death," 2001, New York
  11. Prioreschi, Plinio, "A History of Medicine," 1991, volume I, "Primitive and Ancient Medicine," Edwin Mellen Press, Chapter VII, "biblical Medicine," page 514
  12. Landau, Elaine, "Tuberculosis," 1995, New York, Chicago, London, Sydney, Franklin Watts, pages 13-32
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