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HLTB21H3 (177)
Chapter 13

Chapter 13 - Tuberculosis

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Department
Health Studies
Course
HLTB21H3
Professor
Caroline Barakat
Semester
Fall

Description
Tuberculosis – ‘The White Plague’ • Symptoms – nostalgia, depression, extensive sexual indulgence • Tubercles – small knots/nodules in lungs History • TB present since antiquity • TB limited to animals (8000 – 4000BC) • Egyptian mummies (2400 BC) o Pott’s Disease in mummies (3700BC – 1000BC) • 800BC ‘Phthisis’ or ‘consumption’ – Homer • 668BC – 626BC Spread in Greece, Middle East, India via Nomadic tribes o Found in Assyrian King Ashubanipal • 460 BC – Hippocrates - disease due to evil air but not contagious; called it phthisis • Aristotle (384 – 322BC) – due to ‘bad and heavy breath’; contagious • Egypt, India, and China as early as 5,000, 3,300, and 2,300 years ago respectively (Daniel 2006) o Typical skeletal abnormalities • Middle ages - Claims of royal supernatural powers (AD 500 – 1500) o In England, practice of ‘Kings Evil’ or the ‘Royal Touching’ o Cure occurred in some cases due to natural remission of disease • (1546) Fracastorius - Modern Theory of Contagion • (1629) Consumption - leading cause of death in London • (1679) Franciscus D Sylvius: lung nodules - "tubercles” – though to be tumors or abnormal glands rather than infection • 1720 - Benjamin Marten – 1 person to call it an infection • 1780 – peak or TB in England • 1800s – another peak, when plays were written • 1875-1880 – peak in eastern Europe • 1900 – peak in North America • 19 century –spread to rest of Europe and N America o Linked to artistic talents since many writers and artist had consumption o Western Europe considered it beautiful and erotic: extra thinness, long neck and hands, pale face, shining eyes and red cheeks • (1839) "tuberculosis" first used • Mid 19 century – TB was romanticized o Opera productions ‘La Traviata (1853), ‘La Boheme’ (1895) o Classical movie ‘Camille’ (1936) – based on Alexandre Dumas’ novel ‘The Woman of the Camellias’ • Possible causes of rise in TB o Demographic shift, urbathzation o Rise in scrofula in 17 century o Rise in textile industry o Increase in population = increase in crowding o Minimization of windows = rebreathing exhaled air • Possibility it would bring down industry and civilization o Black plague – 1 year – 50000 killed o TB – 2 centauries – 1 million/ year killed • Victorian Era (1837-1901) • North America o Ancient NA – 8 year old boy had Pott’s Disease o 1804 – ¼ death in NY were cause of TB o 1812 – 1821 – London o 1850 – African American had higher death rates than whites  Baltimore had 2X o Occurred in young Jews, prisoners and Native people • TB caused by behavioral patterns o Sealing winds in the winter o Sleeping in same beads as patients o Inadequate ventilation • Cures at the time o Moving to place with fresh air and sunlight o Example Cecil Rhodes moved to Africa and had a big part in there diamond mines in and establishment of British empire in Africa Decline in TB in 1940s • Higher standards of hygiene • Destruction of TB in cows + pasteurized milk • Land washing + cleaner cities • Better nutrition + higher standards of living Finding the cure • 1854 – Dr. Brehmer - Doctoral Dissertation- “Tuberculosis is a Curable Disease” • 1854 - Jean-Antoine Villemin -specific microorganism as cause o Succeeded in infecting rabbits with TB…but infectious natire of TB wasn’t accepted • 1882 – Dr. Robert Koch –Mycobacterium tuberculosis o Developed ‘tuberculin’ test • 1895 - Wilhelm Konrad von Rontgen – use of radiation Etiology • Agent - Mycobacterium tuberculosis, an acid-fast bacillus • Has free living relatives that fix nitrogen and degrade organic material in soil • Have protective cell wall made of unusual waxy lipids (mycolic acid) and polysaccharides (lipoabomanan and aribinogalacton) • 3 types of mycobacteria o M. Tuberculosis – causes TB  M. bovis found in cattle is 99.5% identical; need less O2; can infect by drinking milk; linked to TB in the spine o M. Leprae – causes leprosy o M. Avium – pulmonaru disease • 3 main types of the human bacillus o Type 1 – found in India; least virulent o Type A – Africa, China, Japan, Europe, N America o Type B – Exclusively in Europe and North America Forms of Tuberculosis • Forms o Pulmonary TB – lungs o Scrofula – lymph nodes in neck o Pott’s disease – fusion of vertebrae and deformation of spine o Lupus vulgaris – affects skin o Addison’s diease – adrenal cortex • Several animal forms of the bacillus • Bovine type may lead to pulmonary TB (most common form) or Miliary tuberculosis • Commonly
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