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Chapter 13

Week #4 - Sherman Ch. 13; Kiple P. 1059-1065.docx

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University of Toronto Scarborough
Health Studies
Caroline Barakat

(Reading) Week #5 | Sherman Ch. 13; Kiple P. 1059-1065 Chapter 13 The People’s Plague: Tuberculosis Egypt, India, and China as early as 5,000, 3,300, and 2,300 years ago respectively - consumption was characterized in an 1853 medical text as having the following features: nostalgia, depression, and excessive sexual indulgence - another name: ―the White Plague‖ - in the 1800s, when epidemic TB reached its peak in Western Europe, persons with tuberculosis were considered both beautiful and erotic: extreme thinness, long neck and hands, shining eyes, pale skin, and red cheeks - a more accurate and less romantic description of the consumptive includes incessant coughing, which 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 - tuberculosis of the lungs (called pulmonary TB) is the form of the disease we are most familiar with - when localized to the lungs, tuberculosis can run an acute course, causing extensive destruction in a few months— galloping consumption - tuberculosis can affect organs other than the lungs, including the intestine and larynx; sometimes the lymph nodes in the neck are affected, producing a swelling called scrofula - tuberculosis can also produce the fusion of the vertebrae and deformation of the spine, called Pott’s disease after Sir Percival Pott - this may lead to a hunchback, and it may also affect the skin (lupus vulgaris), and the kidneys - TB of the adrenal cortex destroys adrenal function and results in Addison’s disease - microbes that cause TB (also leprosy) are called mycobacteria - their free-living relatives inhabit soil and water, where they fix nitrogen and degrade organic materials - mycobacteria have a protective cell wall that is rich in unusual waxy lipids - three mycobacteria, Mycobacterium tuberculosis, M. leprae, and M. avium, are human pathogens that cause TB, leprosy, and a pulmonary disease with swollen glands in the neck - M. avium is an opportunistic infection found in some immunocompromised people; its symptoms can include weight loss, fevers, chills, night sweats, abdominal pains, diarrhea, and overall weakness - parasite of cattle, M. bovis - although M. bovis can infect people, it does so infrequently and with great difficulty - M. bovis grows under conditions where the oxygen levels are low; when it does infect people, it is not associated with lung disease - M. tuberculosis grows best when oxygen is plentiful, and it is associated with pulmonary TB, probably because the lung has high levels of oxygen - but TB of the spine is associated with M. bovis and results from a blood infection that spreads to the spine via the lymph vessels - it has been hypothesized that M. bovis arose from soil bacteria, and humans first became infected with M. bovis by drinking milk - M. tuberculosis is specific to humans and spreads from person to person through droplets of saliva and mucus - genetically, M. bovis and M. tuberculosis have been shown to be >99.5% identical - Pott’s disease has been described in Egyptian mummies dating from 3700 BC to 1000 BC - it has been suggested that M. tuberculosis evolved from M. bovis after cattle were domesticated between 8000 and 4000 BC - TB, it is believed, then spread to the Middle East, Greece, and India via nomadic tribes (Indo-Europeans) who were milk-drinking herdsmen who had migrated from the forests of central and eastern Europe ~1500 BC - Greek physician Hippocrates called the disease phthisis, meaning ―to waste,‖ and noted that the individual was emaciated and debilitated, and had red cheeks and that it was a cause of great suffering and death - he did not consider it contagious - Aristotle suggested that it might be contagious and due to ―bad and heavy breath‖ - during the Middle Ages, a feudal system developed in Europe by which a small elite (nobility) ruled the rest of society, their subjects - royalty claimed that their right to rule and their talents were of divine origin, and they publicized this through claims of royal supernatural powers to heal scrofula - kings and queens were able to heal those afflicted with scrofula by simple touching - during the ritual ceremony, the king or queen touched the sufferer, made the sign of the cross, and provided the afflicted with a gold coin th - in England this practice was known as the Kings Evil or the Royal Touching, and it persisted until the early 18 century - the word ―tuberculosis‖ refers to the fact that in the lung there are characteristic small knots or nodules called ―tubercles‖ - these were first described by Franciscus Sylvius in 1679; he also described their evolution into what he called lung ulcers - first credible speculation on the infectious nature of TB was Benjamin Marten, who in 1772 proposed that the cause was an ―animalcule or their seed‖ transmitted by the ―Breath emits from his Lungs that may be caught by a Person‖ th - 19 century –spread to rest of Europe and N America - cause of this rise in TB may have been the demographic shift from rural to urban living as well as the creation of ―town diaries‖ - these diaries were wooden buildings in the town center that housed dairy cows that had formerly been pastured; now the tubercular cows were within the town, which provided ideal circumstances for animal-to-animal transmission as well as animal-to-human (zoonotic) transmission of TB - with a resurgence of trade, the walled towns of England continued to provide the means for human-to-human transmission - this was especially so when the textile industry became mechanized; this development led to a shift from a rural cottage industry to the more urban riverside cities where waterpower was available - towns grew in population size to become cities; as peasants streamed into these urban centers, people were more and more crowded together - practice in England of taxing a building partly based on his number of windows tended to affect building design to minimize the number of windows - this enhanced the rebreathing of exhaled air of those living and working in the crowded, airless rooms - increased density of people provided ideal conditions for the aerial transmission of M. tuberculosis and pulmonary TB - to those living during the Victorian Age, TB was not only romantic, but was also attractive because the disease produced no obvious repulsive lesions - to the Victorians, the blood in the sputum blended with menstrual blood—and so sickness and death were blended with eroticism and procreation - military TB (small tubercles in the lungs look like millet seeds and spread throughout the body via the bloodstream) - domestic herds of cattle as well as wild herbivores probably served as the source of infection - with urbanization, immigration of infected individuals, higher population densities, and poor hygiene, the conditions for the spread of TB in the New World was favored th - its first peak was in the early 19 century - TB was especially prevalent in cities along the Atlantic coast - TB was not strictly an urban disease—it was also present in rural areas - the critical element was found to be not the total population but the size of the household - crowding facilitated household transmission - inefficient heating of the home usually led to a sealing of the windows and doors in winter to keep out the cold, so transmission was enhanced - behavioral patterns also contributed to the spread of the pulmonary TB: caretakers of the sick frequently slept in the same bed as their patients, and physicians advised against the opening of windows in rooms where there were those sick with consumption - filthy conditions and lack of ventilation characteristic of tenement housing played a key role in the rise of the incidence of pulmonary TB in the United States - in the urban centers of New York and Boston, consumption came to be regarded as ―a Jewish disease‖ or the ―tailors’ disease,‖ because so many young immigrant Jews who were consumptives earned their living in the garment industry, cutting, sewing, and stitching - because Jews were highly susceptible to TB, these sickly Jews were not only racially inferior, but they would soon become public charges - TB was used as a tool of anti-Semitism that justified the ostracism and persecution of Jews - today, there is a higher incidence of TB in U.S. prisons - the increased incidence is due to several factors: prevalence is higher among new prisoners than in the general population, because there is a preponderance of prisoners from the lower end of the socioeconomic scale; close living arrangements make transmission more likely; and prisoners are at a higher risk for TB owing to their higher incidence of HIV infections - 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 - during the 19 th century, some believed that TB was an act of God against which there was no defense - others were convinced that the disease was a result of bad air present in the crowded and dirty cities - many consumptives sought refuge in warmer or milder climates - ocean voyages were also recommended for those with TB because of the slow tempo and the clean air, especially on cruise ships - living at high altitudes where the air was unpolluted and crisp was considered beneficial - change in scene did not cure one of TB - critical factor in establishing the political map of Africa Finding the Germ of TB - Robert Koch was able to isolate and characterize the germ of anthrax, a rod-shaped bacterium he named Bacillus anthracis - Koch’s identification of M. tuberculosis was not simple: the microscopic bacillus is colorless and unusually difficult to stain because of its waxy cell wall, and therefore it cannot be easily seen with a light microscope - to make it visible required heating and a special aniline dye (methylene blue) - staining technique was improved by Paul Ehrlich, who found that the bacilli would retain the dye color if they were first stained with a red fuchsin followe
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