TUBERCULOSIS

I know very little about past outbreaks and pandemics (other than a few half-anecdotes about some notable events like the 1854 Broad Street cholera outbreak or the 1918 flu pandemic). So I decided to do some reading. One of the more interesting bits I stumbled across was about how bad tuberculosis was here in Canada. The near total absence of information isn't surprising but the little information we do have is pretty wild.

In 1867, tuberculosis was the leading cause of death in Canada. As you might assume, what caused tuberculosis (a bacteria, Mycobacterium tuberculosis) or how it was spread (via the air) was unknown. In Québec alone tuberculosis was killing around 3,000 annually at this time. The first sanatorium for caring for those with TB opened there only in 1907, with others springing up across the country over the next twenty years or so. In 1911 the Saskatchewan Anti-Tuberculosis League was formed and a decade later Canada's first official TB survey was conducted in that province. The survey was ordered to determine the rate of tuberculosis infection among school children. The findings were astonishing: more than half of all children were found infected. In 1926, Esther Paulson (someone who would later become Canada's leading authority on nursing tuberculosis patients) reported that 5 of her 17 nursing school classmates themselves became TB patients during their term. So, nearly three decades into the 20th century this thing was still a real plague, even in the health care setting.

Therapies for tuberculosis at this time were just as you'd expect and the same as for most other ailments: combinations of happy thoughts, peasant surrounds, and fresh air (or in many cases standing patients outside in all weather for 10-12 hours a day). As late as 1916, Charlotte Aiken's nursing text offered as much as the going treatment for TB patients. However, if things got serious, of course, those trusted curatives bloodletting and homeopathics could be called upon.

The first real treatment for tuberculosis, the antibiotic streptomycin, was discovered in a soil sample by PhD student Albert Schatz in 1943 and entered the medical literature in ‘44. From there, though neither placebo-controlled nor double-blind, the first randomized trial of streptomycin against pulmonary tuberculosis was undertaken between ‘46 and ’48, where it showed some promise.

(As an aside: In 1952 Dr. Selman Waksman, whose lab Schatz worked in, received the Nobel Prize in Medicine "for his discovery of streptomycin, the first antibiotic active against tuberculosis." Schatz had to sue Waksman and the Rutgers Research and Endowment Foundation for recognition. He received virtually no money from the discovery or later recognition, and despite his antibiotic going on to become invaluable globally and placed on the World Health Organization’s list of essential medicines.)

Most surprising to me was that, despite how far we’ve come in nearly a century and all of the better treatments we now have available, the 2016 World TB Report estimated more than 10 million people still contract tuberculosis each year and almost 2 million continue to die from it. Gah!