Credit: http://ocp.hul.harvard.edu/contagion/tuberculosis.html

TB in History

When I took world history diseases were presented as a minor footnote in class.  We were of course told about the Black Death and Small pox but that was only a few sentences.  The Colombian Exchange was also mentioned, but not to the point that I actually understood what my teacher was talking about.  As far as I was concerned at the time, it probably dealt with the amount of valuable goods Columbus got off the natives.  (In my teacher's defence he was really fond of teaching the wars instead.)  Anyway, a few years later I come across the term during a geography class and I find out the truth.  The Columbian Exchange was all about the diseases that spread both from the Europeans to the natives, and from the natives to the Europeans.  There were really quite a few of them, but what really caught my eye was the fact that some of these diseases weren't being introduced to North America, they were being re-introduced.

It is well known that prior to the exchange tuberculosis was a well-established disease throughout Europe with some of the earliest known cases dating back to around 4000 B.C.E. in Ancient Egypt.  However, there is evidence that TB was present at various points in American History prior to the Columbian exchange even further back in history than the documented cases in Ancient Egypt.  The earliest known instance of TB at present was discovered in North America approximately 17,000 years ago in the skeletal remains of a bison (Rothschild, et al., 2001). However, during the time of the Columbian exchange TB had long since entered into a state of extreme dormancy in the New World.   

This can be inferred due to a lack of references to the disease by Native Tribes by the writers that recorded Tribal history during these time periods, a lack of remedies, or treatments known, testimony of elder Indians as to having never previously heard or having encountered a similar illness, a lack of physical symptoms regarding the bones or the lymph nodes in members of the tribes during the 1800’s, and European records regarding the rapid spread of the pathogen among the local tribes showing a lack of resistance to the disease.

There was a disastrous outbreak among Sioux Tribe Government run reservations during the late 1800’s.  During this time it was commonly believed that the outbreak was due to the Native American’s lack of “civilized” behavior.  It wasn’t until Robert Koch discovered the bacillus bacteria, Mycobacterium tuberculosis, on the 24th of March in 1882 that it was finally understood that Tuberculosis was a pathogenic bacterial disease instead of a manifestation of the wrath of god or an inherited genetic illness, which had been the popular belief prior to this discovery. 

The Geographical Spread of Tuberculosis in the U.S.

Tuberculosis was in a long term state of dormancy on the American Continents. The only evidence suggesting that it was not completely dormant in the American Continents is an accounting at the beginning of the 1600’s of a “chest” disease by the Tarasco of the Michoacan, which was a Native American Tribe in Central America instead of the present U.S. regions (Hrdlička ,1909).  This, however, rapidly changed since  tuberculosis, according to the New Jesuit Father’s, was running rampant throughout the French controlled regions during the 1700 and 1800’s and had heavily infected the Montaigne Indian Tribes of  the Canadian Regions. 

 It is known that until 1794 there were no documented cases of consumption Southeast of what is today the Canadian Border.   This was recorded by several medical doctors during this time period such as Dr. Benjamin Rush (Rush, 1783).  TB however spread quickly, first down through the North-Eastern regions such as Boston, and New York and as far as the Mississippi Valley, and what is today the Central United States as quickly as the first quarter of the 1800’s.

 The spread of TB throughout the western regions of the United States however had a different point of origin.  The Spanish were also responsible for the introduction of the White Plague into today’s Mexico, and through the travels of the conquistadors South-Western Indian Tribes became infected, and the disease spread along the coast and the mountain ranges northward.  By the beginning of the 1900’s every Native American Tribe was infected. 

The Treatment of TB

Antibiotics for TB were first developed during the 1940’s.  Prior to this the major discoveries regarding this disease revolved around the identification of this illness, and the realization of what conditions made the spreading of the disease faster. 

It was discovered during the 1850’s, by Dr. Henry Ingersoll Bowditch, that the speed in which TB killed could be slowed, or forced into dormancy if the infected individual was moved into regions that had a specific type of climate. 

After an examination of the records it was discovered that in the few instances where an individual recovered from consumption fresh, unpolluted, freely circulating air was always present.  It was also found through trial and error, that the majority of previous medical advice was worsening the illness.  Dr. McDowell in 1843 published his notes regarding consumption patients and the things that he found worked the best with them.  Contrary to the popular opinion of his time, he had found that the common procedure of blood-letting, purging, a weak broth diet, and a warm environment actually worsened many patients’ conditions.  Instead he acted as an advocate for the exposure of brisk cold air, four meals a day, and gentle exercises. 

 Dr. Bowditch took this information a step further and included the factor of rain fall into his calculations.  It didn’t take long to realize that the sanatoriums that were used in dry climates had a higher likelihood of survival and recovery than those in wetter climates.  On average sanatoriums in climates that had frequent rain had a survival rate of about five years.  With the realization of this information, individuals that were sick with TB began to change their locations.  They moved to the Rocky Mountains (of which Colorado Springs is the most famous), Lake Tahoe, the Caribbean, the dry regions of the American South-West, and the Adirondacks (when between 800-2,500 ft).  These places quickly became havens for healing and recovery from the disease.  However, those that had contracted TB and had successfully recovered could not move away from these regions without quickly becoming sick once again.

It was during the last decade of the 1800’s that government officials residing in contact with Native American Tribes began to accurately report the cases of consumption on the reservations.  It was found that tribes that lived true to their cultural beliefs, and in dry arid regions, had the lowest amount of victims to the disease, such as the Navaho which had the fewest fatalities out of all the tribes over these two decades. 

There was a movement at this time to publicly declare consumption as a contagious disease.  In 1868 a health commissioner by the name of Dr. Stephen Smith attempted to declare it as a pathogen and failed. In 1882 the bacteria was first discovered, but the connection of contracting the disease through drinking milk did not occur in any records prior to when the pasteurization of milk became a more common practice in 1886.  When this occurred the amount of children to contract TB began to decline. Even with this knowledge it was not until 1889 when Dr. Biggs, Dr. Prudden and Dr. Loomis convinced the New York City Health Department, that TB was finally recognized as a contagious disease that any place in the world willingly recognized it as such.  This was the start of a publicity campaign to educate the masses on the measures needed to be used in order to limit the spread of the white plague.  This is believed to be the first leaflet to have ever been produced by the health department for the masses.  It was distributed to every tenement house in New York, and it was delivered to every house where a known death from TB had occurred.  For the sake of historical interest a copy of this leaflet is included below.

This unfortunately began a political panic in the legislature in 1898 and 1899.  The result was that instead of putting forth further efforts in order to work on educating the populace as to the cause and prevention of tuberculosis the health department had to fight to keep laws that would legally allow the violation of the rights of those that had contracted or had been exposed to consumption.  The bills would have given the city the right to take any and all measures to wipe out the areas infected with consumption.  Since at the time it was believed that consumption was the poor man’s disease and approximately 90% of those inhabiting the city had contracted TB it could have resulted in the mass genocide of the poor in New York City.  In 1907 it finally became legally mandatory for all doctors in the New York area to report any and all cases of consumption to the health board, finally allowing for an accurate understanding of the extent and spread of the disease in the city. 

With the new understanding of TB’s role as a contagion research institutes, sanatoriums, and medical hospitals were built all around the country.  The earliest hospitals were built in Boston during 1890’s, the Chicago Tuberculosis institute was built in 1909, and it was in 1917 that the leading research institute of TB was opened in Colorado Springs by Dr. Webb. 

With a large campaign for the education of the public in regards to the nature of tuberculosis the amount of individuals sick with the illness began a slow decline until the introduction of a combination of antibiotics that when taken over the period of a year could finally kill the disease, with further knowledge and experimentation another antibiotic (pyrazinamide) was discovered that when taken in combination with the first two (isoniazid, & rifampicin) reduced the time needed down to eight months, and later a fourth (ethambutol) was discovered so that when taken together all four needed to be taken for 2 months, and the original two antibiotics for a total of four months. The patient is considered cured at the end of 6 months if no symptoms arise after treatment.  Unfortunately, since 1999 TB has since mutated in areas such as Haiti, Lima, and Russia, into strands in which isoniazid and rifampicin are no longer able to cure the disease due to a lack of available medication for the necessary time periods in order to properly cure the disease. Currently the US suffers from very low numbers of TB victims due to the prevalence of the necessary antibiotics.    

An Interesting Lecture On Tuberculosis