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Chapter 13

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University of Toronto Scarborough
Health Studies
Rhan- Ju Song

October 4 , 2012 Chapter 13: The People’s Plague- Tuberculosis  Today consumption is more commonly known as tuberculosis “the white plague”  Having Tb meant having powers of seduction A Look Back  Tuberculosis is an ancient disease that has plagued humans throughout recorded history and even before  It has been present since antiquity, and Egyptian mummies showed signs of tuberculosis  When restricted to the lungs, tuberculosis can run an severe course, causing extensive destruction in a few months—so called- galloping consumption  The microbes that cause TB are called mycobacteria  Three mycobacteria, Mycobacterium tuberculosis, M.leprae, and M. avium are human pathogens that respectively cause TB, leprosy, and a pulmonary disease with swollen glands in the neck  M. tuberculosis grows best when oxygen is plentiful, and it is associated with pulmonary TB, probably because the lung has high levels of oxygen  M. tuberculosis is specific to humans and spreads from person to person through droplets of saliva and mucus o This airborne mode of transmission was clearly favoured when humans settled down and established towns and cities  TB, it is believed to spread to the Middle East, Greece, and India via nomadic tribes  Tablet that describes the disease: patient coughs, sputum is thick and sometimes contains blood, breathing like a flute skin is cold  Hippocrates called the disease “phthisis” meaning “to waste” o Hippocrates believed that the disease was due to evil air, he did not think it was contagious o Aristotle suggested that it was contagious, due to “bad and heavy breath” o By the time of Galen the theory of contagion phthisis came to be accepted in the Roman Empire, however the contagious agent could not be found  Royalty believed that they had supernatural powers to heal disease o Kings and queens were able to heal those afflicted with scrofula by simple touch  Royal Touching: king/queen touched the sufferer, made the sign of the cross, and provided the afflicted with a gold coin  The word tuberculosis is of recent vintage and refers to the fact that in the lung there are characteristic small knots or modules called “tubercles”  The cause of the rise in TB may have been the demographic shift from rural to urban living Finding the Germ of TB  In 1865, a French military physician succeeded in transmitting tuberculosis to rabbits  Bacillus Anthrac- rod shaped bacterium, germ of anthrax  Koch’s identification of M. tuberculosis was not so simple: the microscopic bacillus is colourless and unusually difficult to stain because of its waxy cell wall, and therefore it cannot be easily seen with the light microscope  Koch announced that he had discovered a protective substance made from an extract of the bacillus called tuberculin (today known as PPD)  When injected into animals, tuberculin produced fever, malaise, and signs of illness 1 October 4 , 2012 o Koch believed that tuberculin sensitized the animal and effected cure ( but it did not)  Koch’s tuberculosis did serve a practical purpose as a diagnostic test  Even today, it remains one of the most useful methods for determining previous exposure to TB The Disease of Tuberculosis  The way of contracting the disease was through breathing  Persons with pulmonary TB may infect others through airborne transmission: coughing, sneezing, and speaking  Tubercle bacilli are rather healthy and can survive in moist sputum for 6 to 8 months  Agent- that causes tuberculosis is the Mycobacterium tuberculosis, an acid fast bacillus  Three main types of the human bacillus: o Type 1- found in India, least virulent o Type A- Africa, China, Japan, Europe North America o Type B- Exclusively in Europe and North America  When Tb enters the body it can be viable throughout the hosts life time  Someone can have TB however they will not know because there is no signs of infection  Infection can remain dormant or active, and then they can start to see symptoms o It is an indefinite and invariable incubation period o People who have it, don’t look or feel sick o They have a 10% risk of developing active TB in their lifetime  People who have active TB are infectious, if they are not treated they can spread it to 10-15 people each year  There is no resistance to tuberculosis, if you had it once you can get it again  Coughing, pallor, spitting of blood, night sweats, and painful breathing all signify the spread of the disease o Each droplet nuclei can contain between 1 and 3 bacilli o Spread through the air by coughing or sneezing  Chest x rays show tubercles and fluid in the lung, and sounds of gurgling and slush can be heard though a stethoscope placed on the chest  In tuberculosis, it is important to
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