The story of Old Hag Tuberculosis

Tuberculosis is an old hag. She is wise. She is unhurried. She has very strict rules. If she'd die, humanity would inherit a vast fortune. 

But, as most old crones, she refuses to succumb. 

For each century she's been around, she's gathered a new name: phthisis, consumption, the white plague, king's evil, Pott disease, scrofula. 

It was once considered that tuberculosis appeared right around the time Homo sapiens came out of Africa, some 40,000 years ago. But a fossil 500,000 years old contained a Homo erectus infected by this disease

When people learned how to write, they wrote about tuberculosis - the Egyptians created the first known tuberculosis asylum, the ancient Greeks gave its first known name, phthisis, the Old Testament describes a "consumption" epidemic, Atharvaveda offers the first description of a tuberculosis lymph node. 

Tuberculosis does not discriminate. It affects:

  • kings – at least three French kings have been affected 
  • politicians – Nelson Mandela, Eleanor Roosevelt
  • scientists – Alexander Graham Bell, Dmitri Mendeleev, Erqin Schrodinger
  • musicians– Frederic Chopin, Tina Turner
  • authors – Honore de Balzac, John Keats
  • everyone else – Immanuel Kant, John Calvin

Tuberculosis was, in her youth, an extremely romantic young woman. English kings would try to cure tuberculosis with the "royal touch". Botticelli painted it in The Birth of Venus, as the woman depicted was his muse and his great platonic love, Simonetta Vespucci, who probably had tuberculosis, depicted as an ethereal, pale woman. 

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how do i get this wonderful skin?

You breathe in deeply and for a longer period of time close to another person with tuberculosis in its contagious phase. 

In the industrial era we begin to see the true face of the white plague. This period meant a huge wave of new infections because of human crowding, poor nutrition and dubious hygiene rules. The painters depicted it in its true form - as a disease which brought an agonising, slow and inevitable death. Authors became poetic archivists of the slow and inexorable evolution. Still, it was a romanticised disease, partly because so many artists had it. Alexandre Dumas the son wrote: "It was the fashion to suffer from the lungs; everybody was consumptive, poets especially; it was good form to spit blood after any emotion that was at all sensational, and to die before reaching the age of thirty."

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Where youth grows pale, and spectre-thin, and dies;

 

Where but to think is to be full of sorrow – John Keats c.1820

  

The sister of painter Edvard Munch (The Scream) died of tuberculosis. It haunted him.

A short time after the end of the industrial era, finally, the medical world understood what tuberculosis was. It was not a curse, it was not hereditary. Antoine Villemin first described it as a contagious, infectious disease with Robert Koch later finding that it was a bacteria difficult to isolate, colour and observe.

Initially, tuberculosis was treated by...rest. Patients would be put to bed-rest in either clean mountain air or salty sea air and, eventually, procedures arose which put the lungs to rest - meaning using different, surgical maneuvers, to take one of the lungs out of function. Treatments were dramatic and tuberculosis sanatoriums quickly became sanctuaries of isolation and immobility. A patient wrote: "The rules are: 1. Absolute and utter rest of mind and body—no bath, no movement except to toilet once a day, no sitting up except propped by pillows and semi-reclining, no deep breath. Lead the life of a log, in fact. Don't try, therefore, to sew, knit, or write, except as occasional relief from reading and sleeping. 2. Eat nourishing food and have plenty of fresh air."

Sanatoriums had, in the end, major impact of that time's society. For example, his regular sanatorium visits inspired Thomas Mann to write his magnum opus, The Magic Mountain. 

We needed to go through both world worlds in order for the medical world to discover antibiotics effective against tuberculosis. The problem is that the bacteria of tuberculosis (Mycobacterium tuberculosis) is a very resistant bacteria which hides very well from the body and from antibiotics. Initially, the treatment lasted for 18 months. Nowadays, through the discovery of new drugs, it has been shortened to (only) six - this treatment has been unchanged since its conception, in the 60s. 

From the moment Robert Koch announced the discovery of the agent causing tuberculosis, its incidence decreased dramatically. With each new discovery, we chipped at the health of this venerable old woman. We began isolating patients, vaccinating, administering treatment and following patients and their contacts. 

Today, the medical world is facing a modern tuberculosis epidemic. In 2014, tuberculosis killed 1,4 million people. 

Tuberculosis is a disease which hits you when you're down. It hits you when you don't have enough money to live in a decent home, when you're not eating properly, when you're stressed or when you have other diseases which weaken your immune system. 

Because all of these reasons, and many more, killing this old hag is very difficult. It implies new treatment tools, new equipment, but also education, raising socio-economical standards and better communication. 

Strides are being made. Researchers across the globe are trying to find new, innovative and possibly crazy ways to kill this old disease. And they are getting help from governments, foundations, NGOs and advocacy groups. 

I am one of these researchers. I hope in 30 years to be out of a job.

 

Article, in Romanian, initially appeared in http://soundofscience.info Translated and edited with permission.

Ioana Margineanushow