39 - The White Plague

Tuberculosis has been humanity’s oldest and greatest killer. Starting at the turn of the nineteenth century, the White Plague was decimating entire generations in the crowded and unclean cities of Europe, North America, and across the globe. But as medical science learned more about the disease, doctors and reformers developed new ways to combat it, most notably specialized tuberculosis hospitals that sought to heal their patients with fresh air, rest, and a nutritious diet. This episode discusses the sanatorium movement and the gradual conquest of tuberculosis, long before effective antibiotic therapy existed. Along the way we’re going to talk about the King’s Evil, the dangers of rebreathed air, the healing powers of mountains, and the social determinants of health. Plus, a brand new #AdamAnswers about maternal placentophagy. All this and more on Episode 39 of Bedside Rounds, monthly podcast on the weird, wonderful, and intensely human stories that have shaped modern medicine, brought to you in partnership with the American College of Physicians. To claim CME and MOC credit, please go to www.acponline.org/BedsideRounds.   Sources: Adams, J. F. Alleyne. "The Segregation of Consumptives." The Boston Medical and Surgical Journal 157, no. 2 (1907): 35-40. Barberis I et al, The history of tuberculosis: from the first historical records to the isolation of Koch's bacillus, J Prev Med Hyg. 2017 Mar; 58(1): E9–E12. Bertolaccini et al, Surgical treatment of pulmonary tuberculosis: the phoenix of thoracic surgery? J Thorac Dis. 2013 Apr; 5(2): 198–199. CDC: World TB Day 2018, retrieved from: https://www.cdc.gov/tb/worldtbday/history.htm Cox GL. Sanatorium treatment contrasted with home treatment. After-histories of 4,067 cases. Br J Tuberc 1923; 17:27–30. Coyle CW et al, Placentophagy: Therapeutic Miracle or Myth? Arch Womens Ment Health. 2015 Oct; 18(5): 673–680. Daniel TM, Hermann Brehmer and the origins of tuberculosis sanatoria, Int J Tuberc Lung Dis. 2011 Feb; 15(2):161-2. Daniel TM, Jean-Antoine Villemin and the infectious nature of tuberculosis, Int J Tuberc Lung Dis 19(3):267–268 Daniel TM, “The history of tuberculosis,” Respiratory Medicine (2006) 100, 1862–1870. Daniel VS and Daniel TM,, Old Testament Biblical References to Tuberculosis, linical Infectious Diseases, Volume 29, Issue 6, 1 December 1999, Pages 1557–1558. Davies RPO, Tocque K, Bellis MA, Rimmington T, Davies PDO. Historical declines in tuberculosis in England and Wales: improving social conditions or natural selection. Int J Tuberc Lung Dis 1999;3:1051–4. Dormandy T, The White: A History of Tuberculosis, 1999. Farr et al, “Human Placentophagy: A review,” AJOG, April 2018. Frith J, History of Tuberculosis. Part 1 – Phthisis, consumption and the White Plague. J Mil Vet Health, 22,2. Gaensler EA. The surgery for pulmonary tuberculosis. Am Rev Respir Dis 1982;125:73–84. Grigg RN. (1958), The arcana of tuberculosis. Am Rev Tuberc Resp Dis; 78:151-172. Hayman J, “Mycobacterium Ulcerans: An infection from Jurassic Time?” The Lancet, Nov 3, 1984. Holloway-Kew KL et al, Lessons from history of socioeconomic improvements: A new approach to treating multi-drug-resistant tuberculosis, Journal of Biosocial Science 46(5):1-21, October 2013. Jacobaeus HC. The Cauterization of Adhesions in Artificial Pneumothorax Treatment of Pulmonary Tuberculosis under Thoracoscopic Control. Proc R Soc Med 1923;16:45-62 Morse D, Brothwell DR, Ucko PJ. Tuberculosis in ancient Egypt. Am Rev Respir Dis. 1964;90:524–541. Murray JF. Bill Dock and the location of pulmonary tuberculosis: how bed rest might have helped consumption. Am J Respir Crit Care Med 2003;168:1029–1033. Murray JF. Mycobacterium tuberculosis and the cause of consumption: from discovery to fact. Am J Respir Crit Care Med 2004;169: 1086–1088. Murray JF, Sanatoriums and climate, The Lancet Infectious Disease, Vol 16, Issue 7, P786, July 01, 2016. Murray JF. The white plague: down and out, or up and coming? J. Burns Amberson Lecture. Am Rev Respir Dis 1989;140:1788–1795. Murray JF et al, “Treatment of Tuberculosis. A Historical Perspective,” Annals of the American Thoracic Society. Vol. 12, No. 12 , Dec 01, 2015. Pomerantz M. Surgery for the management of mycobacterium tuberculosis and nontuberculous mycobacterial infections of the lung. In: Shields TW, Lo Cicero J, Ponn RB, et al. eds. General Thoracic Surgery, 6th ed. Lippincott Williams & Wilkins: Philadelphia, PA; 2005:1251-61. Tuberculosis Chemotherapy Centre, A concurrent comparison of home and sanatorium treatment of pulmonary tuberculosis in South India, Bull World Health Organ. 1959; 21(1): 51–144. Warren P, The evolution of the sanatorium: the first half-century, 1854-1904, Can Bull Med Hist. 2006;23(2):457-76.