The Forgotten Plague.

January 1, 2016 2:02 PM

By the dawn of the 19th century, the deadliest killer in human history, tuberculosis, had killed one in seven of all the people who had ever lived. The disease struck America with a vengeance, ravaging communities and touching the lives of almost every family. The battle against the deadly bacteria had a profound and lasting impact on the country. It shaped medical and scientific pursuits, social habits, economic development, western expansion, and government policy. Yet both the disease and its impact are poorly understood: in the words of one writer, tuberculosis is our "forgotten plague." [54:11]
posted by Blasdelb (28 comments total)

Leadbelly: The T.B. Blues
posted by wormwood23 at 2:07 PM on January 1, 2016 [2 favorites]

I watched this a few months ago when it aired on PBS, and it's a really excellent film. The increase in cases of drug-resistant TB should be getting more public attention than it seems to.
posted by briank at 2:12 PM on January 1, 2016 [4 favorites]

I'm not in a place where I can watch the documentary, but I had thought that TB's high death rate went with industrialization, and previously it was a serious disease but not at the levels of the 18th and 19th centuries.
posted by Dip Flash at 2:30 PM on January 1, 2016

TB is a pandemic and kills about 3,800 people a day and is the world's leading infectious killer.
posted by adamvasco at 2:58 PM on January 1, 2016 [14 favorites]

By the dawn of the 19th century, the deadliest killer in human history, tuberculosis, had killed one in seven of all the people who had ever lived.

Does this apply only to currently extant diseases?

Otherwise, smallpox would seem to be a contender:

During the 18th century the disease killed an estimated 400,000 Europeans each year, including five reigning monarchs, and was responsible for a third of all blindness.[3] Between 20 and 60% of all those infected—and over 80% of infected children—died from the disease.[4]
...
Most people became infected during their lifetimes, and about 30% of people infected with smallpox died from the disease, presenting a severe selection pressure on the resistant survivors.[20]

posted by jamjam at 3:25 PM on January 1, 2016 [2 favorites]

The documentary gives the Leadbelly lyrics some context I'd never had before.

I'm on my way to Denver

There were a lot of TB refugees in Colorado: "In the 1880s and 1890s, it is estimated that one-third of the people living in Colorado Springs had tuberculosis."

Friends just treat you so low down
Don't you ask 'em for no favors
They'll even stop a- comin' around

Because once it was discovered that TB is contagious, people began to panic about being near those who had it (or were suspected of having it.)

In them times ev'rybody have the TB, died.

It seems like he recorded this version right around the time streptomycin was being trialed. Either way, a lot of people lived in TB sanatoriums at the time.
posted by klanawa at 3:28 PM on January 1, 2016 [2 favorites]

Frank Snowden's Yale History Infectious Disease since 1600 has 2/26 lectures on tuberculosis

18. Tuberculosis (I): The Era of Consumption

19. Tuberculosis (II): After Robert Koch
posted by bukvich at 4:10 PM on January 1, 2016 [3 favorites]

I collect old radio show episodes. I often hear PSAs on them about getting free chest x-rays and how TB is the silent plague. The idea of a free x-ray to check for TB infection in the US boggles me. Of course, I remember getting a TB test done nearly every year in elementary school, along with other health checks.
posted by strixus at 5:47 PM on January 1, 2016 [7 favorites]

When I was living in Beijing circa 2005, I developed a nasty cough that wouldn't go away. The university I was attending gave me an X-ray, for about $.25 US.

Turned out I didn't have tuberculosis, the air was just phenomenally shitty.
posted by zjacreman at 6:15 PM on January 1, 2016 [4 favorites]

TB: Silent Killer is an excellent documentary from Nova about an epidemic of drug-resistant TB in Swaziland. It follows several patients over their treatment. It's one of the the few documentaries that has made me cry.
posted by Kutsuwamushi at 6:45 PM on January 1, 2016 [2 favorites]

In Curious George Goes To The Hospital, there is a sign in the hospital waiting room that says something like, "Get a chest X-Ray at this hospital today!" I wondered for years why a hospital would encourage chest X-rays without a doctor ordering them. Now I know!
posted by Anne Neville at 7:08 PM on January 1, 2016 [8 favorites]

When I applied for my US visa 20+ years ago, a chest X-ray to check for TB was a requirement. It still is.
posted by monospace at 8:09 PM on January 1, 2016 [4 favorites]

My father Donald's first wife died of TB, very young (before antibiotics). He always emphasised that my sister and I should be vaccinated against TB.

Donald was a veterinarian in the UK and spent a lot of time examining cattle for TB under the government's program to eliminate the disease. It entailed two visits (I often tagged along): first inject a test antigen; go back to measure the size of the response for each beast. The same program was used against brucellosis. I think the UK herds have been TB-free for a long time now, but it's still endemic in the wild, notably in badgers.

In novels I read as a kid TB patients were frequently sent to sanitaria in the Alps. In pre-antibiotic days, why was mountain air considered the best hope in alleviating TB?
posted by anadem at 8:11 PM on January 1, 2016 [4 favorites]

I used to be a librarian for the Historical Society of Washington, D.C., which owns a collection of c. 1913-1920 funeral home registers - I'd occasionally page through them when things were quiet. The number of people that are listed as having died from TB was sobering. I later found out the long-since-demolished TB hospital was about a ten minute walk from our house.
posted by ryanshepard at 8:19 PM on January 1, 2016 [3 favorites]

Things like drug resistant TB terrify me far more than ISIS.
posted by Candleman at 12:24 AM on January 2, 2016 [18 favorites]

For research I've spent a lot of time looking through death certificates for Alameda County, CA from the years 1870-1904, and yeah, tuberculosis comes up a lot. It's no wonder the Victorians got really into the "consumption chic" look - TB was everywhere.

I was recently reading about how the classic signs of someone being the victim of a vampire (pallor, weakness, etc.) are all the symptoms of TB and I smacked my head for not having realized that sooner.
posted by teponaztli at 6:28 AM on January 2, 2016 [6 favorites]

My aunt had TB as a young woman and went to a TB sanitarium to recover; I think it was before penicillin. She was lucky to be healthy and young enough to recover. Keeping antibiotics effective and avoiding resistance is so critical. Agreed that the spectre of antibiotic resistant TB is scary. There are a lot of old TB sanitariums around, converted to retirement homes or whatever. Thanks for posting this.
posted by theora55 at 7:54 AM on January 2, 2016 [1 favorite]

From the same site as my post above: Today's TB medecines are inadequate to tackle the pandemic.
Of course as these suffers are mainly poor brown and black people the civilized west can go back to watching TV.
posted by adamvasco at 10:16 AM on January 2, 2016 [1 favorite]

TB is definitely still around now. Here are links to reports from the Treatment Action Group on TB, including the pipeline for new drug development.
posted by gingerbeer at 10:17 AM on January 2, 2016

The increase in cases of drug-resistant TB should be getting more public attention than it seems to.

MDR-TB: "Five percent (5%) of all TB cases across the globe in 2013 were estimated to be MDR-TB cases, including 3.5% of newly diagnosed TB cases, and 20.5% of previously treated TB cases.[2]* While rates of MDR-TB infections are relatively low in North America and Western Europe, they are an increasingly serious problem worldwide, in particular in areas of the Russian Federation, the former Soviet Union and other parts of Asia."

is the next pandemic an 'if' or a 'when' thing?

Bill Gates, Crypto-Socialist? - "Bill Gates is right: the private sector is stifling innovation in green energy. But that's not the only place capitalism is holding us back." (via)

We know that energy is not the only sector to suffer from the blight of risk-averse investor laziness and innovation stagnation. What makes the aforementioned tuberculosis and other bacterial infections so frightening is that we are running out of drugs to treat these illnesses. Multi-drug-resistant (MDR) and extensively-drug-resistant (XDR) TB is spreading westward and there seems to be little we can do to stop it in the absence of the development of new classes of antibiotics.

We are on the cusp of a post-antibiotic era, where an infection after a scratch or arriving via an everyday hospital catheter can be a death sentence.

The rise of anti-microbial resistance is in many ways a more immediate threat to humanity than even climate change. And everyone familiar with the problem knows there is one reason for this: the refusal of pharmaceutical companies for some three decades now to invest in the necessary research because antibiotics are just not profitable enough compared to drugs for chronic illnesses.

In sector after sector, the set of all things that are profitable is much smaller than the set of all things that are useful. Capitalism fetters production, limiting what we could produce to only those things that permit capital to expand — a diminishment of the lives of everyone, even the wealthiest individuals. Drug-resistant TB doesn’t care how many billions you have stashed in the Bahamas.

---
*WHO MDR-TB Factsheet

GLOBAL BURDEN IN 2014

Globally, 5% of TB cases were estimated to have had multidrug-resistant TB (MDR-TB) in 2014.

Drug resistance surveillance data show that an estimated 480,000 people developed MDR-TB in 2014 and 190,000 people died as a result of MDR-TB.

Extensively drug-resistant TB (XDR-TB) has been reported by 105 countries in 2014. On average, an estimated 9.7% of people with MDR-TB have XDR-TB...

TREATMENT OUTCOMES

Only 50% of the MDR-TB patients in the 2012 cohort of detected cases were successfully treated. 16% died, 24% did not have their treatment outcome documented or interrupted treatment, and in 10% the treatment failed. Only 26% of XDR-TB patients in the 2012 cohort had a successful outcome of treatment...

FINANCING FOR MDR-TB

It is estimated that about US$8 billion per year is required for a full response to the TB epidemic in low- and middle-income countries, of which about 20% is for detection and treatment of MDR-TB.

Additionally about US$2 billion per year is required for research and development for new TB diagnostics, drugs and vaccines.

More funding is needed from both domestic and international donor sources. It is essential that full coverage of TB and MDR-TB patients is included in national health financing mechanisms to ensure that they can access care without incurring catastrophic costs.

posted by kliuless at 10:43 AM on January 2, 2016 [6 favorites]

This is where I came in. TB was still a thing when I was little. It was a thing when my mother was little. My mother had at least one friend who had TB and had to go back to the sanitarium once in awhile.
She was obsessive about me getting it or appendicitis.
You CAN remove all risk of appendicitis by having an appendectomy. It wasn't unheard of to get appendectomies preemptively.
There was no way to avoid TB. It's casually transmissible.
AIDS isn't casually transmissible.
The rise of the extreme drug resistant forms of this disease ought to scare people more.

It would be great if unnecessary use of antibiotics would come to an end.
posted by Katjusa Roquette at 11:12 AM on January 2, 2016 [2 favorites]

Heck, I am all of hoary, old 43 and I remember getting the TB test as a kid -- possibly several times (semi-annually, maybe?) -- as part of a physical, which necessitated a follow-up visit to look at the little round bump.
posted by wenestvedt at 6:23 PM on January 2, 2016 [1 favorite]

A Frank Herbert book called "The White Plague" [SLWiki] describes a man-made plague that has a specific target. The changes in society that result -- and the speed at which they come into force -- is sobering, for all that the book was written in 1982, when things still changed at the speed of telex machines and surface mail.
posted by wenestvedt at 6:26 PM on January 2, 2016 [1 favorite]

TB in Daru, Western Province, PNG. Only kilometres from Australia's northern and notoriously porous border.
posted by esto-again at 8:43 PM on January 2, 2016

In 1988, my Grandmother, at the age of 93, had her first chest x-ray due to a bout of pneumonia. The Dr. when reviewing her x-ray told her that at she had small scars on her lungs that were probably from TB. My Grandfather had a major case in the 1920s and went to a sanitarium. In 1982 when I got married I had to have a physical for TB and a blood test for syphilis before I could get a marriage license. Until a year ago I had to have a yearly TB test at my work.
posted by PJMoore at 7:18 AM on January 3, 2016 [1 favorite]

Heck, I am all of hoary, old 43 and I remember getting the TB test as a kid -- possibly several times (semi-annually, maybe?) -- as part of a physical, which necessitated a follow-up visit to look at the little round bump.

I'm 42 and had to have one when I started college in 1991. And one of my grandfather's half sisters died of TB in the 30s (they still called it consumption then). I remember I was an adult when my father finally found out that consumption and TB were the same thing, he'd never realized what it was before and was quite surprised.
posted by dilettante at 12:32 PM on January 3, 2016 [1 favorite]

PJMoore: In 1982 when I got married I had to have a physical for TB and a blood test for syphilis before I could get a marriage license.

1982? Hah! In 1996 I still had to do those tests, too (in Rhode Island). :7)
posted by wenestvedt at 12:43 PM on January 3, 2016

Lest you think this no longer happens, Buzzfeed had a piece last year from someone who had extremely-drug resistant TB and was ordered into quarantine and two years of treatment. She didn't get the TB in the US but she was treated here. V interesting story (opening part is a little NSFW).
posted by librarylis at 12:35 PM on January 4, 2016