By Soncirey Mitchell
Reader Staff
Editor’s note: Regular “Mad About Science” columnist Brenden Bobby is on a well-deserved vacation. He’ll be back next week.
Tuberculosis is a disease that, to most, feels historic. It was (likely) known in ancient Greece as “phthisis,” in 19th-century Europe as “consumption” and in more modern times as the “white plague.” Though we imagine TB as a disease of the past, it remains the most deadly infectious disease in the world, killing approximately 1 million people a year — more than HIV/AIDS and malaria combined.
Part of the reason TB is associated with the past is that most modern cases occur in poorer countries in Southeast Asia, Africa and the western Pacific Oceanic region, while Europe and the U.S. have severely limited outbreaks through testing, vaccinations and plenty of antibiotics. In the Western mind, cases of TB are relics of a distant past: Doc Holliday, John Keats, Henry David Thoreau, George Orwell, the Brontë sisters and every other famous person to succumb to TB all lived a lifetime ago or more.
From the 1600s on, increased urbanization and resulting unsanitary conditions led to a marked increase in TB cases, with an estimated one in four of all European deaths in the 1800s attributable to the disease, according to Tuberculosis: Pathogenesis, Protection and Control. Its overwhelming presence inspired (and killed) so many artists, authors, poets and other creatives that it was nicknamed the “romantic disease” and said to inspire the infected before overtaking them.
TB is generally caused by Mycobacterium tuberculosis, identified in 1882 by Robert Koch, who won the Nobel Prize in Physiology or Medicine for the discovery, though he was building on research stemming back more than a century. There are other variations on the bacteria, including strains that infect animals or are resistant to treatment. Tuberculosis spreads from person to person — or animal to person — via fluids, which can be aerosolized via coughing, sneezing or even speaking.
Until Louis Pasteur’s discoveries in the 1860s led to widespread pasteurization, many people were infected with a variation, Mycobacterium bovis, through contaminated dairy. (Yet another reason to avoid raw milk.)
The name “consumption” stems from the disease’s symptoms, which leave victims pale, weak and emaciated, as TB seemingly eats away at them. The most common form, pulmonary tuberculosis, begins in the lungs, but TB can attack almost any organ. An infected person may experience loss of appetite and weight loss, fever, fatigue, chest pain and a chronic cough that can famously produce bloody mucus. The disease’s symptoms and prevalence throughout history have led some anthropologists to draw a connection between TB and folklore surrounding vampires.
Hysteria about vampire attacks peaked in Eastern Europe during the 18th century, and most documented “cases” of vampirism went something like this: Someone would die of an undocumented ailment, then, later, their close family and friends would begin wasting away until they, too, died.
Superstition held that the first to die came back as a vampire, feeding on the life energy of those it was close to. Anthropologists have argued that, in some cases, the so-called “vampire” was likely someone infected with TB who passed it on to the people they interacted with most. The fact that victims became corpse-like and coughed up blood — almost like they’d been feeding on the living — would have only spurred superstition.
Today, the majority of people infected with TB will likely never know it. Virologists estimate that approximately one-quarter of the population has latent or inactive TB, which is combatted by the immune system and so never becomes symptomatic. People with suppressed immune systems are more likely to develop active infections, and even successful treatment doesn’t guarantee a full recovery. Pulmonary TB can scar the lungs, leading to lifelong respiratory issues.
Because TB is so often associated with the lungs, historic treatments have emphasized clean air and warm, consistent temperatures to promote recovery. TB sanatoriums were all the rage in the 19th century, ranging from expensive medical spas to veritable prisons for the sick and poor. Many people seeking a speedy recovery moved to Southern California, leading, in part, to the foundations of what is now Pasadena and the surrounding Los Angeles area. In addition to fresh air, doctors would sometimes prescribe the therapeutic artificial pneumothorax technique, which involved purposefully collapsing a damaged lung. This would deprive the bacteria of oxygen and let the lung rest to allow time for lesions to heal properly.
Few people survived the disease for long.
Researchers Albert Calmette and Camille Guérin successfully created the first TB vaccine in 1906 using bovine TB and testing it on cows. It wasn’t until 1921 that doctors began administering bacille Calmette-Guérin to humans, and it became widely accepted only after World War II. The BCG vaccine remains the only approved TB immunization to this day.
Stay healthy, 7B.