Thursday, September 05, 2013

1689-1970: The slow death of a killer called Consumption

By 1880 a few physicians suspected tuberculosis to be contagious, but the idea was not rock solid in the medical community.  In fact, the idea had been brought up many times, perhaps the first time as bar back as the ancient Greeks (1, page 16), and once again in 1020 by Avicenna.

Avicenna discovered the disease could spread through soil and water, and created quarantines to prevent the spread of the disease.  Yet despite this early success, progress as far as the disease tuberculosis was concerned was slow.  The disease continued to scare people until well into the 20th century.

The following are some of the major advancements that helped end the tuberculosis scare:
  1. 1689 Dr. Richard Morton determined the pulmonary form was associated with tubercles in the lungs
  2. 1696 Giorgio Baglivi observed the tuberculosis patients got better after a sword wound to the chest.  This was the first observation that a pneumothorax (collapsed lung) might benefit the progress of the disease and induce healing.
  3. 1834:  F.H. Ramadge performed the first successful surgery where the lungs of a patient with TB were intentionally collapsed.  Ramadge did extensive research on TB, and even invented an inhaling pipe to treat the disease.
  4. 1839 J.L. Schonlein, noting the tubercle, identified tuberculosis as a single disease
  5. 1854 the first tuberculosis sanatorium was opened in Gorbersdorf, Germany (now in Poland) by Hermann Brehmer.
  6. 1882 Robert Koch identified Mycobacterium tuberculosis.  He thought his glycerinie extract of the tubercle bacilli would be a remedy, but it wasn't.  However, it was later adapted as a test for TB.
  7. In 1895 William Rontgen discovered the x-ray, and this allowed physicians to detect the disease early and monitor its progression
  8. 1906 lbert Calmette and Camille Guérin in 1906 had success immunizing against a strain of tuberculosis.  They invented what they called the BCG vaccination and used it first in France.
  9. 1930s Plombage Technique was trialed to remove infected part of lung.  The part of lung was forced to collapse, and was thought to heal quicker.  Some of these patients had their chest stuffed with ping pong balls or similar objects to prevent their chest from caving in.  There actually was success between the 30s and 50s until the antibiotic was proven to be more successful
  10. 1944 Streptomycin discovered as an effective treatment for tuberculosis
  11. 1952 Isoniazid invented as the first effective oral drug to treat TB
  12. 1967 Rifampin was another antibiotic discovered to treat the disease, it was introduced to the market in the 1970s
All of these discoveries and inventions helped with the treatment of the disease, although it was studies of tuberculosis patients at sanatoriums like National Jewish Health in Denver, Colorado, that truly helped prove the disease was spread most by places associated with poor hygiene.  

Initial studies showed a high incidence of TB among sweat shops in New York and Chicago and similar occupations where there were crowds of people in places associated with poor hygiene.  Efforts were made to educate people of important positions, and laws were passed by cities, especially the New York legislature, forcing improved hygienic practices in public work places.

Major campaigns were begun to discourage people from spitting in public places.  Hand washing was encouraged.  People were encouraged wash and bathe often.  People were educated about the disease, and this, perhaps even more so than the TB test and the vaccine that was later invented, lead to the demise of the disease.

Another significant improvement was the sanatoriums that opened up all over the United States and Europe.  These allowed for the patients to get state of the art treatment, yet it also provided an opportunity to educate them that their disease is communicable, and easily spread to others.  They were educated to not spit in handkerchiefs that sat around.  Plus these sanatoriums kept the TB patients isolated from society, and this also helped prevent the spread of the disease.

All of this helped decrease the number of tuberculosis patients, and tuberculosis deaths, yet what was the true triumph was the discovery in 1946 of the antibiotic streptomycin.  Now there was an effective cure, or at least treatment, for the disease.  Yet still, to prevent the spread, a focus must remain on good hygiene.  This effort continues to this day. 

No comments:

Post a Comment