Chapter 13: The People’s Plague- Tuberculosis
Tuberculosis has been thought to produce spells of euphoria, increased appetite and exacerbated sexual
desire. When epidemic TB reached Western Europe, people with TB were considered beautiful and erotic.
TB was romanticized without knowing that it was actually an chronic infectious disease.
Tuberculosis includes: coughing making eating and breathing very difficult, weight loss that prevented
walking, and severe pain.
A Look Back
Tuberculosis is an ancient disease. Tuberculosis of the lungs (pulmonary TB) is the most common form of
disease. In the U.S., the lung is the primary site of infection. When the lungs are the primary site, TB can
run an acute course causing extensive destruction in a few months—so called galloping consumption.
TB can be mistaken with chronic bronchitis with the spitting up of blood.. TB can affect organs such as
the intestine and larynx, and the lymph nodes in the neck producing a swelling called scrofula.
Tuberculosis can also produce the fusion of the vertebrae and deformation of the spine, called Pott’s
disease. This may lead to a hunchback and also affect the skin (when it is called lupus vulgaris) and the
kidneys. TB of the adrenal cortex destroys adrenal function and leads to Addison’s disease.
The microbes that cause TB (and leprosy) are called mycobacteria. Mycobacteria inhabit the soil and
water, where they fix nitrogen and degrade organic materials. Mycobacteria have a protective cell wall
composed of unusual waxy lipids and polysaccharides.
-TB of the spine is
closely related to
M.bovis and results
from a blood
infection that spreads
to the spine via the
-grows best when
oxygen is plentiful
-found in some
-weight loss, fevers,
chills, night sweats,
disease with swollen
glands in the neck
-grows where the oxygen levels are low
-not associated with lung disease
-parasite of cattle
-arose from soil bacteria
-humans were first infected by drinking
-spreads from person to person via
droplets of salvia and mucus
-M.bovis and M.tuberculosis have been
shown to be >99.5% identical
Pott’s disease has been found in Egyptian mummies and one of the mummies dies with extensive
destruction of the bones and the spine. TB disease of the lung is more recent than that of the bones found
in tombs. It is suggested that M.tuberculosis evolved fro M.bovis after cattle were domesticated. It is
believed that TB spread to the Middle East, Greece, and India via nonmadic tribes who were milk-
Hippocrates called this disease phthisis meaning “to waste”. He believed this disease was due to evil air
and not contagious. Aristotle believed it was contagious and due to “bad and heavy breath”. However, the
contagious agent could not be found.
It was believed that the kings and queens of Europe were able to heal those affected with scrofula by
simple touching. Cure occurred in some cases due to natural remission of the disease.
The word tuberculosis refers to the fact that in the lungs, there are small knots called tubercles. Sylvius
also described their evolution into what he called lung ulcers. Marten believed that the cause was an
“animalcule of their seed” transmitted by breathe. Almost every pathologist believed that the disease was
due to tumors or abnormal glands rather than an infection back then.
Peaks of TB occurred in England, Western Europe, Eastern Europe, and North America. The cause for the
rise in TB may have been the demographic shift from rural to urban living and the creation of “town
dairies”. Dairies were wooden buildings in the town center that houses dairy cows that had formerly been
pastured. Animal-to-animal transmission and animal-to-human (zoonotic) transmission of TB resulted in
the ruse of scrofula in the 17th century.
Due to urbanization and the increase in textile industries, people were more and more crowded together.
This enhanced the re-breathing of exhaled air if those living and working in crowded, airless rooms. The
increased density of people provided ideal conditions for the aerial transmission of M.tuberculosis and
pulmonary TB. It was feared that TB might bring about the collapse of industrialized Europe.
Tuberculosis is a plague in disguise. The Black Plague in London existed for an year and killed 50
thousand. During the Victorian Age, TB was romantic and also attractive because the disease produced no
obvious repulsive lesions. There is little scientific evidence to show that TB had any real effect on the
brain or on creativity.
In the 1940s and 1950s, streptomycin and isoniazid became available to treat TB. Military TB is a form of
TB where small tubercles in the lungs look like millet seeds and spread throughout the body via the
bloodstream. It is not true that TB was brought to the Americas by European explorers and settlers.
However, TB was already present in prehistoric America waiting for new human hosts. TB’s first peak
was in the 19th century. TB was especially prevalent in the cities along the Atlantic Coast.
TB did not affect all segments of the U.S population equally. TB was present in both urban and rural
areas. The critical elements was not the total population but the size of the household. Transmission was
enhanced when the homes had inefficient heating, sealing of windows and locked doors. Behavioral
patterns such as sleeping on the same bed as the victims contributed to the spread of pulmonary TB.
Filthy conditions and inadequate ventilation played a huge role in the rise of pulmonary TB in the U.S In
the urban centers of New York and Boston, consumption came to be regarded as a “Jewish disease” or the
“tailor’s disease”. TB did flourish among Jews who lived in crowned, unhealthy conditions in the poorest
parts of the city.
There is a higher incidence of TB in U.S prisons today. In the 1900s, poorer people tended to have higher
morality from TB.
TB was a disease of Europe and North America and was absent from those countries in Africa where
there had been little or no European immigration. Some believed that TB was an act of God against where
there was no defense. Some believed that the disease resulted from bad air present in the crowded cities.