When I was a medical student, long ago in the mid-1930s, the disease to worry about the most was tuberculosis. It was all around. Anyone could catch it, at any time, from infancy to old age, and there was really nothing much to be done about it. You might survive if you were lucky, and that was that. Your chances were somewhat better when you were lucky enough to have it spotted early and took to your bed, preferably in one of the great number of state hospitals or private sanitaria built for the exclusive care of TB. Rest was the only marginally useful treatment: rest for the whole body in bed, and technologically induced rest for the affected tissue by injecting air into the pleural space to collapse the lung temporarily, or cutting away the ribs to cause permanent collapse. There were no drugs of any value.
The great effort was to keep the disease confined to the lungs, and to hope against its spreading. This was also a matter of luck. If the bacilli spread from the lungs into the blood-stream or lymphatics, and reached the central nervous system, that was the end. Tuberculous meningitis was always fatal, and the only function for the doctor was to see to it that the end came as peacefully as possible for the patient, and to provide information and support for the patient’s family.
Everyone lived in fear of tuberculosis but it was not much talked about. Families preferred not having it known that one of the children had died of consumption; it meant something wrong with the family.
The hardest part of the disease, for both the patient and the family, was that it took so long to die. Even in its most malignant form, called galloping consumption, it went on for weeks, even months. The only relief was a curious phenomenon near the end, known as spes phthisica, when the patient suddenly became optimistic and hopeful, even mildly elated. This was the worst of signs; spes phthisica meant that death was coming soon.
There were specialists in tuberculosis, internists and surgeons who did nothing else but look after patients with this one disease. They were extremely useful and important people and were kept very busy, but their principal contribution was information; they knew, from long, concentrated experience, the natural history of the disease, and were highly skilled in making a prognosis. Also, they knew a lot about the art of making patients more comfortable.
The basic research on tuberculosis began in the 1890s with Koch, who discovered the bacillus, and the effort expanded with increasing energy over the next forty years, consuming the scientific lives of hundreds of investigators in laboratories all around the world. Gradually, they gained a fairly clear understanding of the ways in which tuberculosis became disseminated through communities, and public health techniques for early detection and isolation were developed. The underlying mechanisms enabling the tubercle bacillus to destroy living tissue were explored in depth…
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