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HLTA01- Chapter 13


Department
Health Studies
Course Code
HLTB21H3
Professor
Caroline Barakat

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HLTA01
Plagues and People
Chapter 13: Tuberculosis
The People’s Plague: Tuberculosis
- Consumption having the following features: nostalgia, depression, and excessive
sexual indulgences
o More commonly known today as tuberculosis (TB)
o ‘White Plague’
- TB thought to produce spells of euphoria, increased appetite, exacerbated sexual
desire
o Imagined to be an aphrodisiac, and to confer extraordinary powers of seduction
- People who suffered for Tb in Western Europe were thought to be beautiful and erotic
o Extreme thinness, long neck and hands, shining eyes, pale skin and red skins
- Painful death drowning in one’s in own blood
- Never understood that it was a chronic disease, so it was highly romanticized
- Operas: La Traviata & La Boheme based on novel The Woman of the Camellias and
turned into a movie Camille
o Heroine in movie coughs blood on a white handkerchief that resembles the red
and white slower colors of camellia and symbolically represents her sexual
availability during her menstrual cycles
- Description of consumption: incessant coughing (made talking and eating almost
impossible and breathing painful), weight loss that prevented walking, and pain that
required opium and whisky to ameliorate
A Look Back
- Pulmonary TB tuberculosis of the lungs
o Most familiar with this type
o ‘Lunger’
o Can run an acute source, causing extensive destruction within a few months
o Can wax and wane with periods of remission
- Tb can affect lungs, intestine and larynx, sometimes the lymph nodes in neck (producing
scrofula)
- Can produce fusion of vertebrae and deformation of spine (Pott’s disease)
o Can lead to hunchback and can affect the skin and kidneys
- TB of adrenal cortex destroys adrenal function and results in Addison’s disease
- Microbes causing TB (and leprosy) mycobacteria

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o Inhabit soil and water
o 3 mycobacteria causing TB, leprosy, and pulmonary disease with swollen glands
in neck all human pathogens
Mycobacterium tuberculosis
M. leprae
M. avium
- M. avium opportunistic infection found in some immunocompromised people
o Symptoms: weight loss, fevers, chills, night sweats, abdominal pains, diarrhea,
overall weakness
- M. bovis closely related to M. tuberculosis
o Grows in low oxygen levels and not associated with lung disease
o Associated with TB of the spine and results from a blood infection that spreads
to the spine via the lymph vessels
- M. tuberculosis associated with pulmonary TB
o Grows where oxygen is plentiful
o Specific to humans
o Spreads from person to person through droplets of saliva and mucous
o Airborne transmission
- TB evidence found in bony remains that predate human writing
o Pott’s disease has been described in Egyptian mummies from 3700 BC to 1000
BC
o One mummy died with extensive destruction of the bones of the spine
o However, there is no evidence of TB in any of the mummies
o Small boy in the tomb of Ramses II had lungs showing signs of pulmonary TB
(1000 BC to 400 BC)
TB in lung is more recent than TB of bones
- M. tuberculosis is suggested to have evolved from M. bovis after domestication of cattle
before 8000-4000 BC
- TB spread to Middle East, Greece, and India by nomadic tribes who were milk drinking
herdsmen
o From central and eastern Europe
- Hippocrates called disease phthisis ‘to waste’
o Person was emaciated and debilitated, red cheeks, great suffering and death
o Didn’t consider it contagious
- Aristotle thought it was contagious due to ‘bad and heavy breath’
- Middle Ages ‘royal touching’
o Kings and queens were able to heal those suffering from scrofula by touching
them
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o Clovis of France and Edward the Confessor of England were the first ones with
this gift
- Tuberculosis refers to the fact that in the lung there are characteristic small knots or
nodules called ‘tubercles’
- Benjamin Marten cause was animalcule or their seed transmitted by breath from ones
lungs and transmitted to another person
- Cause for rise in epidemic of 16th century possibly the ‘town dairies’ when there was a
shift from rural to urban living
o Held cows that were formerly pastured
o Animal-to-animal transmission as well as animal-to-human transmission
(zoonotic)
o Resulted in the rise of scrofula in the 17 century
- Cities became more crowded when peasants started moving there
- Buildings had less windows which circulated the same breath around a room
- Plague of all plagues
- Romantic and attractive in Victorian era because it produced no obvious repulsive
lesions
- Vivien Leigh was affected by TB and was recommended to go to a sanitarium but
refused
- TB was actually brought by an 8 year old boy in AD 700 (before Columbus arrived)
o Evidence of Potts disease, lesions in the spine containing M. bovis and the
domestic herds of cattle served as the source of the infection
- More female deaths in Baltimore than males
- More African American deaths that whites in Baltimore and New York
- Behavioral patterns also contributed to spread
o Caretakers of the sick frequently slept in the same bed as their patients
- Inadequate ventilation
- Urban centers of New York and Baltimore called TB the ‘Jewish disease’ or ‘tailor’s
disease’
- TB did flourish among Jews, however they were not the cause of the spread
o Used as a tool of anti-Semitism
- Higher incidence in U.S. prisons
Finding the Germ of TB
- Jean-Antoine Villemin successfully transmitted TB to rabbits from a man who died
from TB 33 hours earlier
o TB was found in the lungs of the rabbits and the lymph nodes of only those who
had received the pus
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