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Chapter 13

Chapter 13 Tuberculosis


Department
Health Studies
Course Code
HLTB21H3
Professor
Caroline Barakat
Chapter
13

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Aqdas Qasem
Plagues and Peoples
Tuberculosis (Text. Chpt.13, C.R. 1059-1065, 270-278)
2010-10-24
Textbook:
Chapter 13 The Peoples Plague: Tuberculosis (275)
- Consumption (what Tuberculosis was called) was characterized in an 1853 medical text as having
the following features: nostalgia, depression, and excessive sexual indulgence.
- Tuberculosis (TB) was given another name by the afflicted ones:The White Plague.
- TB caused incessant coughing (made it almost impossible to eat and talk) and pain when breathing
which caused weight loss and prevented walking, the pain that required opium and whisky to
ameliorate.
- By the time of death, individuals resembled a cadaver.
- Consumptive decline was thought to be due to a hereditary predisposition or specific living habits
(i.e. poverty, or sexual promiscuity).
A Look Back (276)
- Tuberculosis of the lungs (called pulmonary TB) is the form of the disease we are most familiar
with, giving rise to the slang wordlunger”; in the United States the lung is the primary site of
infection in 80-85% cases.
- When localized to the lungs, TB can run an acute course, causing extensive destruction in a few
months so-called galloping consumption.
- TB can also wax and ane with period of remission (mistaken in some cases for chronic bronchitis
with spitting of blood).
- TB can affect organs other than the lungs as well, including the intestine and larynx; sometimes
the lymph nodes in the neck, producing of swelling called scrofula.
- TB can also produce fusion of vertebrae and deformation of the spine, called Potts disease 
hunchback, and may also affect skin and kidneys.
-Microbes causing TB are called mycobacteria free living relatives inhabit the soil and water.
- Mycobacteria have a protective cell wall.
- Three types of mycobacteria: Mycobacterium tuberculosis, M. leprae, and M. avium, which are
human pathodgen that respectively, cause TB leprosy, and a pulmonary disease with swollen glands
in the neck.
- M. avium is an opportunistic infection found in some AIDS people. M. tuberculosis is a parasite of
cattle, M. bovis can affect people with difficulty, and is not associated with the lungs. M.
tuberculosis grows best in high oxygen levels and is associated with pulmonary TB because lungs
have high oxygen levels.
- M. bovis is associated with TB of the spine, and results from a blood infection that spreads to the
spine via lymph vessels. M. bovis first affected humans through milk. M. tuberculosis is specific to
humans and spreads through droplets of saliva and mucus.
- M. bovis and M. tuberculosis are more than 99.5% alike.
- Evidence of TB is found in bony remains that predate human writing and Pott`s diseas had
described in Egyptian mummies dating from 3700 B.C.
- TB of the lungs is more recent than of the bones.
- By this info, it is thought that M. tuberculosis evolved from M. bovis after cattle was domesticated.
- Greek physician Hippocrates called the disease phthisis.
- Hippocrates thought the disease was due to evil air and did not consider it contagious.
- Aristotle suggested that it might be contagious and due to bad and heavy breath.
- By them time of Galen, the theory of contagion of phthisis was accepted in Roman Empire, but the
contagious agent could not be found.
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Aqdas Qasem
Plagues and Peoples
Tuberculosis (Text. Chpt.13, C.R. 1059-1065, 270-278)
- During the Middle Ages, in Europe, Royalty claimed that they have special powers and can heal
diseases, especially scrofula by simply just touching them and making the sing of the cross an
accurate description of ceremony is given in Macbeth and in England was known as the Kings Evil or
Royal Touching.
- Most pathologists at the time, believed that the disease was due to tumours or abnormal glands
instead of infection.
- First credible speculation of infectious nature of TB was of Benjamin Marten, who in 1772 proposed
that the cause was an animalcule or their seed transmitted by Breath from the lungs that another
person can catch.
- In 1780 were TB was at its peak in England, it was estimated that 20% of deaths were from TB.
- Reach North America in 1900. This spread may have been because of creation of “town dairies.
- TB was spread by overcrowding, textile industry being mechanized, and in England the number of
windows in buildings became minimized which enhanced the rebreathing of exhaled air of people
working in crowded, airless rooms.
- TB is seen as a plague in disguise and is the plague of all plagues.
- There is little scientific evidence to show that TB had a real effect on the brain or on creativity.
- Miliary TB is called so because the small tubercles in the lungs look like millet seeds and spread
throughout the body via the bloodstream.
- In urban centers of New York and Boston, consumption came to be seen asa Jewish diseaseor the
tailors disease”.
- Even today, there is a higher incidence of TB in U.S. prisons because: prevalence is higher among
new prisoners than in the general population, because there is a preponderance of prisoners from the
lower end of socioeconomic scale, close living arrangements make transmission more likely, and more
HIV infected people.
- In 1900s, poorer people had higher mortality from TB, and the greatest number of deaths occurred
between the ages of 15 and 45, but there was also a minor peak between 5 and 10 years of age.
- American Indians were highly vulnerable to TB, were virtually killed off by being herded together
on reservations.
- In 19th century, some believed that TB was an act of God against which there was no defence.
- Others were convinced that it was because of bad air present in crowded and dirty cities.
Finding the Germ of TB (286)
- In 1865, a French military physician, Jean-Antoine Villeman (1827-1892) succeeded in transmitting
TB to rabbits.
- He did this by recovering pus from the lung cavity of a TB patient. Some months later, TB was
found in the lungs and the lymph nodes of the rabbits that were injected with pus.
- Robert Koch (German physician) announced in front of a sceptical audience that he had found the
microbe of TB (M. tuberculosis).
- Robert Koch wrote that under the microscope, all animal tissues (i.e. nuclei) were brown, and
tubercle bacilli were beautifully blue when methylene blue was added.
- Koch then announced that he had discovered a protective substance made from extract of bacillus
tuberculin (known as PPD, purified protein derivative, today).
- Tuberculin produced fever, malaise and signs of illness tuberculin was dangerous and sometimes
lethal.
- Tubercle bacilli sensitize the body to tuberculin so that, when injected in sufficient quantities to a
TB patient, tuberculin can kill the patient via a delayed hypersensitivity reaction.
- Tuberculin serves as a diagnostic test.
- Cows with positive tuberculin skin test were killed because of infectious milk.
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