BRIEF HISTORY OF TUBERCULOSIS

Recognition of and research on tuberculosis

Other names for tuberculosis include:

• consumption
• miasma
• scrofula
• wasting disease
• pthisis
• swollen glands
• Pott's disease
• bone/joint infection
• Lupus vulgaris
• cutaneous infection

Index to Historical References to Tuberculosis

The Bronze Age

1500 B.C.

460 BC- 400 AD

1500's

1600's

1700's

1800's

1900's

For other sites, see:

• History of Western Biomedicine
• The History of the Mycobacterium tuberculosis/Homo sapiens relationship

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The Bronze Age

Disease and mortality in the Early Bronze Age people of Bab edh-Dhra, Jordan. During the 1977 field season at the Early Bronze Age site of Bab edh-Dhra 92 individuals were recovered from underground shaft tomb chambers. Morbid conditions found in these skeletons include trauma, possibly two cases of tuberculosis, osteomyelitis, post-menopausal osteoporosis and congenital anomalies. Of the 92 skeletons recovered 56 (61%) were 18 years of age or older, 28 (30%) were between 1 and18 years of age and 8 (9%) were less than one year of age.
[Source#13]

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1500 B.C.

1500 BC-Tuberculosis bones and the remnants of old tuberculosis adhesions in the chest have been found in Egyptian mummies (source#19)

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460 BC-400AD

460-370 BC.-The disease was well recorded in the age of Pericles in Greece. Hippocrates, the father of medicine, described pulmonary tuberculosis occurring in day-to-day clinical experience. (source#19)

130 B.C.- Caelius Aurelius-early Roman physician

The symptoms of the disease are as follows: there is a latent fever, which generally begins toward the end of the day and is relieved by the coming of the new day; this is accompanied by much coughing at the beginning and the end of the night, with the discharge of sanious sputa...The voice is either hoarse or high pitched, breathing is difficult, cheeks fluched, and the rest of the body ashen colored. The eyes have a worn appearance and the patient is emaciated, a fact more obvious from the appearance of his naked body than from his countenance...There is a loss of appetite for food...Many subject the purulent sputa to diagnostic tests. Thus they place the phlegm over hot coals and note its odor when it has burned; for a foul odor always characterizes the product of physical decomposition.

The symptoms described above closely parallel those described by physicians in the 1930s. It is also interesting that the Romans performed tests on the sputum, for in the 1930s it seemed that analysis of the sputum played a major diagnostic role. (source#24)

131-200 A.D. Galen

Galen saw consumption as uncurable and urged people to avoid it altogether. The disease was common in the Roman Empire. Abundant reference in the medical texts of Celsius and Galen are found. A regimen of rest, fresh air and good food was recommended. (source#22)

400 AD

From the time of the Mosaic Laws there has been a prohibition that the flesh of animals suffering from consumption ("wen" or "scurvy") should not be used as food (Leviticus xxii, 22). The Talmud, especially the Mishnah, codified at the close of the second century, and the Gemarra of the fifth century contained numerous enactments against the eating of such flesh. (source#22)

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1500's

1546-Girolamo Tracastoro wrote the book "De Morbis Contagiosis"--This was the first book to explain that TB was contagious. Tracastoro wrote that ìthe seeds of contagion remain in such bodies as articles of clothing and bedsheets used by the infected.(source#24)

Evidence from the New World.- The purpose of this study has been first, to critically review the evidence for the presence of human treponematosis and tuberculosis in the skeletal remains of prehistoric natives in the New World, and second, to report on nine new cases dated to before contact and suggesting the presence of these two disease conditions. A review of the medical history and findings by human paleopathologists leaves little doubt that both diseases originated in the Old World. The findings of this study lend further support to the fact that, although rare, human treponematosis and tuberculosis were indeed endemic in the pre-Columbia New World before contact. There is no evidence that these two diseases could have arisen independently and de novo, especially during the relatively short time since man's arrival in the New World. Where a disease has been endemic for quite some time as appears to be the case with human treponematosis and tuberculosis, milder forms of the disease and improved host response could have developed in which only the most severe cases would be observable. This explains the rarity of skeletal lesions suggestive of these two human disease conditions in prehistoric human populations.

SO - Am J Phys Anthropol 1979 Nov;51(4):599-618(source#13)

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1600's

1614-1672 - Holland- Sylvius de la Boe in Holland furnished clear descriptions of tubercles, tuberculous cavities and tuberculous lymph nodes. (source#19)

1672- Thomas Willis-Clinician

Willis described TB as the most difficult ailment to cure, and strongly believed that all other diseases of the chest inevitably led to consumption. Waksman (source#24)

1689-Richard Morton

-wrote a bood on consumption entitled Phthisiologia---TB was also formerly known as phthisis.

-symptoms he noted included inflammation of the lungs, fever, coughing, difficulty breathing

-He also noted that TB recurred in many men. (source#24)

1624-1689 (birth, death) Sydenham was commonly referred to as the British Hippocrates. He felt that consumptions were due to the fumes and pollution that were present in London (source#24)

1600's -(later part of century)- tuberculosis in animals was supposed to have some relation or even be identical with venereal disease found in humans. People's fear was so great that official prohibition was demanded to prevent the sale of meat of tuberculoid cattle. A couple of nodules found on the wall of the chest or diaphragm of a carcass were enough to condemn the animal. People feared even to touch the blood or entrails, and the butcher's knife was thrown away with the carcass, in many cases with the axe with which the animal was felled (source#22).

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1700's

1716- A French butcher furnished meat from diseased cattle. He was fined 5,000 pounds, condemned to nine years of exile, and prohibited permanently from engaging in the same trade. (source#22)

1720-Marten wrote a book entitled "A New Theory of Consumption". He described how in the past Hippocrates and other prominent physicians held that certain people were more susceptible to being affected by consumptions. These people had "shrill voices, long necks, protruding shoulder blades...". Marten questioned these views and wrote that "This must not be taken as a general rule because we often find robust and strong men fall into this distemper and such weakly tender persons as above described many times exempted from it." Marten also believed that "minute, living creatures" might be causing TB. It seemed that Marten was an early physician who realized that TB did not only attack certain people. He understood that TB was a much more widespread problem. Marten was a physician who appeared to be on the right track in his beliefs concerning TB. (source#19)

1732- Corporal punishment was meted out in Germany for anyone who sold the meat of tuberculoid animals or evaded inspection. (source#22)

1761- Austria- Leopold Avensbrugger, the father of percussion, published a book on tuberculosis about the relation of pathological changes and clinical signs of tuberculosis. (source#19)

1782- Graumann, a physicist presented a treatise on tuberculosis where he proved tuberculosis and syphilis were not identical. Subsequently, the prohibition against the use of flesh of tuberculoid animals was rescinded in Prussia (1785, August) Austria (July 1788) so that by the close of the eighteenth century its use was not restricted.(source#22)

1782-It is obvious that in 17th and 18th century Italy the necessity for proper handling of TB patients and properly cleaned facilities were of prime importance. The Department of Public Health in Naples passed a law which included the following components: a) The physician shall report a consumption patient when ulceration of the lungs has been established under penalty of 300 ducats for the first offense and banishment for ten years for repitition of it. b) That the authorities make an inventory of the clothing in the patient's room th be identified after his death; and if any opposition shall be made the person doing so, if he belongs to the lower class shall have 3 years in the gallows or inprison, and if of the nobility, 3 years in the castle and a penalty of 300 ducats.

c)That household goods not susceptible of contamination shall immediately be cleansed and that which is susceptible shall at once be burned and destroyed. d) That the aythorities themselves shall tear out and replaster the house from cellar to garret, carry away and burn the wooden doors and windows, and put in new ones. e) That newly built houses shall not be inhabited within one year after their completion and 6 months after the plastering has been done and everything about the building operation has been finished. f) That superintendants of hospitals must keep clothing and linens for the use of consumptives in separate places. (source#24)

1788- Leipzig- a record is said to show the deaths of twelve students were traced to eating the flesh of a tuberculous animal. (source#22)

In 18th century Italy physicians were required to report all cases of consumption and all belongings of victims were to be destroyed. Autopsies were done on victims. When working with patients physicians made sure to allow for proper ventillation and all sputum of patients was to be expelled into jars. All utensils used by physicians were to be boiled in lye. (source#24)

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1800's

1810-Carmichael, a London physician, published a treatise insisting that the tuberculosis of cattle is transmissible to man through the use of tuberculoid meat or milk. (source#22)

1815-Thomas Young wrote the book "A Practical and Historical Treatise on Consumptive Diseases". In his book he stated that only 1 in 1000 successfully recovered from consumption and the best medical care could save a mere 1 in 100 lives of those afflicted. Whether or not Young had actual data to support these statistics is not important. Young's claims show the reader how hopeless physicians felt in the face of consumption/TB.

(source#24)

1865- A French army surgeon, Villemin, described results of an elaborate series of experiemtns on the inoculation of animals with tuberculosis tissue and the transmission of disease from animal to animal. Prior to this, few physician thought tuberculosis was communicable, most considered it a hereditary condition. (source#19)

1875-The German veterinary council imposed the most rigid system of meat inspection the world had ever seen. France abolished private slaughterhouses. (source#22)

1882-Robert Koch, a German bacteriologist discovered the tuberculosis bacillus. (source#19)

The centenary of Robert Koch's discovery of the tubercle bacillus is an appropriate occasion for a reconsideration of the American reception of Koch's bacteriologic investigations. At the time of the U.S. centennial in 1876 American views on infectious disease were disparate and ill-formed. The news of Koch's initial tuberculosis investigations stirred controversy in the inchoate American medical community. By the late 1880s, however, his ideas and techniques achieved widespread acceptance and by the time an aging Koch travelled to the United States in 1908 the American medical community had been transformed. New and divisive theoretical issues had become prominent. Koch was now in conflict with a medical establishment resistant to ideas incongruent with its native ideas.

SO - Ann Intern Med 1982 Nov;97(5):761-6 (source#13)

1840-1910 Causes of death in colonial doctors. The causes of death in 910 New Zealand doctors, 1840-1910, are given. Natural causes were the most frequent reason for death with pulmonary tuberculosis being important. Other leading causes of death were accident or violence, alcoholism, drug taking and suicide.

SO - N Z Med J 1978 Jul 26;88(616):49-51 (source#13)

1816-1912 A historical basis for modern concepts of the pathogenesis of tuberculosis. Theories of the pathogenesis of tuberculosis accepted by clinicians in this field, receive no mention or little emphasis in textbooks of pathology. These are: the systemic character of the disease from the initial infection; the role of tissue allergy; the subclinical, benign and lifelong character of most tuberculosis infections, yet liable to an endogenous activation by the influence of stress. These concepts go far back in history, and reference is made to Bayle (1816), Koch (1891), Calmette and Guerin (1906), Von Pirquet (1907) and Ghon (1912). The origin of the pulmonary apical lesion was controversial in the 1920s. Assmann formulated a theory of reinfection, which is opposed to Simon's theory of primary origin, which is gaining acceptance today. Histological studies of early lesions by Vorwald show their haematogenous origin and Sweany's work on late lesions emphasises the instability of tubercle at any age of the lesion. Krauses's survey of the pathogenesis anticipates the modern concept of tuberculosis as being mainly a condition of stress.

SO - S Afr Med J 1975 Jun 28;49(27):1105-10 (source#13)

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1900's

1900's- Tuberculosis has long been prevalent among elderly people. When tubercle bacilli first enter human bodies they usually remain through the rest of their hosts' lives and are capable of causing clinical disease any time, even in old age. In 1900, a large percentage of people of all ages were harboring tubercle bacilli and high mortality and case rates obtained among elderly people. The only way to solve the problem among future old people was to protect infants, children, and youths from becoming infected and remain so throughout life. As far as possible that was accomplished by isolating and treating tuberculosis patients in sanatoriums and hospitals, with anti-tuberculosis drugs after 1946, and controlling the disease among cattle. In due time, large numbers of children entered adulthood uninfected. From year to year, they replaced those heavily infected as they advanced in years. By 1973 the mortality rate was only a fraction of 1.0 per 100,000 among people under 34 years but of those of 65 to 84 years it was 9.7. The case rate was 28.1 for those older than 45 years. Although tuberculosis among the elderly has tapered off phenomenally, much time and work are necessary to accomplish eradication.

SO - Am J Public Health 1976 Nov;66(11):1101-6 (source#13)

1932- Griffith reports that in 1,040 cases of pulmonary tuberculosis, 2.3 percent are due to bovine tuberculosis. 163 such cases were found in Great Britain alone. (source#22)

1937-Scientist Mohler in Germany found tuberculosis bacilli still alive and virulent in butter kept in cold storage for six months. (source#22)

1942-World War II- increases in tuberculosis evident in all great cities. Greatest in countries most ravaged. Poland (Warsaw and Lodz) rate of tuberculosis triples. The death rate in Warsaw 1944 was 500/100,000 people. Several hundred thousand deaths due to tuberculosis in Europe (Poland, Austria, Germany, Italy, France, Netherlands, Belgium and England) while five to ten million people suffered from the disease. (source#19)

1964- Selman Waksman, in his book, described the progression of Tuberculosis through five distinct historical periods:

1. The Classical Period which includes the days of Hippocrates
2. Post-Renaissance Period during which several 16th and 17th century British physicians (mentioned above) were prominent
3. The late 18th and early 19th centuries can be denoted ìThe Period of Clinical Diagnosisî. During this time the stethoscope was developed.
4. One might refer to the fourth period as ìThe Infectious Periodî, for it was during this time that TB was realized to be infectious. During this period Koch determined the causative agent of TB
5. Waksman called the last stage `The Period of Accurate Diagnosis and Treatment'. This stage saw the widespread use of chest X-rays (still used today), the pneumothorax, and the increased use of sanitoria.

(source#24)

For information on research regarding treatments such as antibiotics, x-ray therapy and pneumothorax, please see the history of treatment page.

King/Queen's touch (500-1700) underline

Phlebotomy (1800)

Sanatoriums (1859-1900's) underline

X-Rays used for chest (1895-present) underline

Bed rest, fresh air, diet and strange concoctions (early 1900's) underline

Pneumothorax/collapse therapy (1890's) underline

Gold therapy (1900's) underline

Antiobiotics (1944-present) underline

Chemotherapy (1900's) underline

The decline of mortality in the more developed nations has been related to two major influences, economic development and the introduction of medical measures. The contribution of medical measures has been a source of continuing controversy. Most previous studies employ either a birth cohort or calendar year arrangement of mortality data to address this controversy. The present study applies an age-period-cohort model to mortality from respiratory tuberculosis in England and Wales, Italy, and New Zealand in an attempt to separate economic influences from that of medical measures. The results of the analysis indicate that while the overall contribution of medical measures is small when examined by calendar year, specific birth cohorts both in Italy and in England and Wales benefited substantially from these measures. The environmental conditions in New Zealand, however, were such that the introduction of medical measures barely affected declining mortality levels from respiratory tuberculosis.

SO - Demography 1982 Aug;19(3):409-27 (source#13)

The Prevention of Tuberculosis included:

Avoiding garbage form which `miasmas' emanated

No spitting, covering mouth when coughing

Isolation of diseased

Burning possessions of deceased patients

Pasteurization of cow's milk

Legislation designed to prevent spread

(12 pt reg)

In the Middle Ages, kings were considered sacred, and in some countries they were held

to possess miraculous powers of healing.

For many centuries the kings of France and England used to `touch for `scrofula'-that is, they claimed to be able, simply by their touch, to cure people suffering from this disease, and their subjects shared a common belief in their powers. (source#14)

(10 pt reg)

note announcing that Louix XIV will touch for scrofula on Easter Sunday

Charles II of England touching for scrofula

Henri IV of France touching for scrofula

(source#14)

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Pneumothorax/

Collapse Therapy (14 pt bold)

(12 pt regular)

1890 -Collapse therapy invented by the Italian physician Forliana, who subsequently began treatment by pneumothorax. (source#19)

Excerpts from a sanatorium manual on compression and pneumothorax:

Artificial pneumothorax- compression of the affected lung by the introduction of gas or filtered air into the pleural cavity. Refills of air were first given every other day, then twice a week, once a week, once every two weeks, once a month, finally every four to six weeks. Pneumothorax

was to be continued for a period of from two to four or more years...

Bilateral Pneumothorax- compression of both lungs by pneumothorax. Actually only a portion of both lungs was collapsed and patients taking bilateral thorax, though short of breath, could lead moderately active lives.

Thoracoplastly- removal of the ribs on one side of the thorax to accomplish a permanent collapse of the affected (diseased) part of that lung.

....as the Medical Director explained, collapsing a lung was like putting a splint on a broken leg. (source#21)

James Carson, a Scot, graduated from Edinburgh in 1799. He settled in Liverpool where he became a successful and respected physician and where he also found time to pursue a longstanding interest in physiology and to conduct certain important experiments. He read a series of papers on these experiments and their import before the Literary and Philosophical Society of Liverpool of which the two most important were On the elasticity of the lungs and On lesions of the lungs. In the first he clarified the mechanics of respiration while in the second he suggested that this knowledge might be employed to produce temporary collapse of the lung as a therapeutic measure. Two attempts at a clinical trial were defeated by widespread pleural adhesions but the first recorded attempts at artificial pneumothorax had been made. George Bodington, a Warwickshire man, after serving a surgical apprenticeship studied at St Bartholomew's Hospital and obtained the licence of the Society of Apothecaries in 1825. He later practised near Sutton Coldfield where he was known as an acute observer and a thoughtful and fluent speaker. In 1840 he published an essay on the treatment and cure of pulmonary consumption in which he roundly condemned the current therapy and advocated instead fresh air in abundance, gentle exercise in the open, an adequate and varied diet, and a minimum of medicaments. Violently attacked by the reviewers he became discouraged about tuberculosis and devoted the remainder of his professional life to the care of the mentally ill.

SO - Thorax 1980 Jul;35(7):483-9 (source#13)

Patient receiveing pneumothorax treatment at the Trudeau Sanatorium, 1937- Photograph by Alfred Eisenstadt, courtesy of Life Magazine/Time Inc.

source#15

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X-Rays (14 pt bold)

(12 pt regular)

Chest X-ray--A chest X-ray is a pemanent record of the condition of the patientís lungs. X-rays can discriminate fine shadows, and this is a quality not possible with a fluoroscope. X-rays can reveal infected areas as well as areas which are possibly healing. (source#24)

1895-X-ray photographs invented and used to identify tuberculosis areas in the lungs, tuberculin tests started.

(source#19)

1940's-Waksman called the last stage `The Period of Accurate Diagnosis and Treatment'. This stage saw the widespread use of chest X-rays (still used today), the pneumothorax, and the increased use of sanitoria. (source#24)

New Page

Bed Rest, Fresh Air, Diet and Strange Concoctions (14 pt Bold)

(12 pt regular)

Many early physicians felt that southern climates and sunshine were key elements in the treatment of a TB patient.

In the 17th century Sydenham, the British physician mentioned above, believed that TB could sometimes be cured by exercise. He suggested daily horseback riding and instructed people to abandon any special diets prescribed by other physicians.

Petrus Forestus (1522-1595) instructed his patients to drink the milk of a young woman or warm milk from a cow, ass, or goat.

Others promoted the benefits of `marine air'.

Some touted the benefits of sun radiation.

In the 1880's in the United States hundreds of people moved to Arizona with the belief that this climate might cure their TB.

In 1821 the `Nantucket Inquirer' encouraged drinking strange concoctions and inhaling the smoke from burning rosin or the steam of boiling tar to strengthen one's lungs.

Some physicians instructed patieints to eat only `animal foods'.

(source#24)

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Gold Therapy(14 pt bold)

(12 pt regular)

Although from the time of Koch onwards there had been desultory experiments with a variety of gold preparations in the management of pulmonary tuberculosis, gold as a recognised and accepted treatment did not emerge until 1925. In that year Holger Mollgaard of Copenhagen introduced sanocrysin, a double thiosulphate of gold and sodium, with which he had conducted an extensive series of animal experiments. The results of these were considered to justify its use in clinical practice and two physicians, Secher and Faber, undeterred by its toxicity, reported enthusiastically in its favour. Other Danish physicians followed but, alarmed by violent reactions, modified the dosage, an example followed by British workers. Encouraging results continued to be reported although each series contained a significant proportion of failures, and toxicity remained high. The first properly planned and fully controlled clinical trial took place in the United States and produced a report which was wholly adverse and which sounded the death knell of gold therapy throughout America. Until 1934-35 gold was used extensively in Europe but thereafter there was a sudden and largely universal cessation of interest and within a few years gold, introduced with such eclat and carrying so many high hopes, had vanished from the therapy of tuberculosis even though, at that point, no better alternative was available.

SO - Thorax 1980 Dec;35(12):884-9 (source#13)

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Antibiotics(14 pt bold)

Robert Koch,

pioneer bacteriologist in 1910.

Courtesy of the New York Academy of Medicine Library

source#115

(12 pt regular)

1885-The Italian bacteriologist Cantani had TB patients inhale cultures of nonpathogenic bacteria. This actually decreased the quantity of tubercle bacilli in the patients' sputum. (source#21)

1888-The Rumanian scientist Babes found that products of certain gram + and gram - bacteria could inhibit the growth of M. tuberculosis. (source#24)

1940's-Selman Waksman did a good deal of work with Actinomycetes. In Waksman's lab the antibiotics actinomycin and streptothricin were isolated. Streptothricin effective agent to prevent the proliferation of M. tuberculosis but has toxic effects in animals. (source#24)

1940-The Italian bacteriologist Zorzoli demonstrated the antituberculoidal activities of the products of certain bacterial species including Aspergillus and Mycotorula. (source#24)

1943-Sulfa drugs available but literally no effect on TB-Penicillin also no effect on TB. In September of 1943 streptomycin was isolated. This antibiotic was found to be effective against M. tuberculosis and much less toxic to animals than streptothricin. (source#24)

1944- November 20, 1944 marks the first day that streptomycin was tested in a human subject. This initial administration of streptomycin proved to be successful in improving the condition of the patient and appeared to eventually cure this patient of TB. (source#24)

1944-Waksman discovered streptomycin and used it against tuberculosis. Large frequent doses were given, but tolerance and resistance quickly developed. (source#24)

1946-Para-aminosalisylic acid (PAS) found to slightly potent against tuberculosis. (source#19)

1947-Tuberculosis responsible for 1/25 of all deaths in the United States. (source#19)

1947- by May it was realized that certain strains of M. tuberculosis had developed resistance to streptomycin. Thus, the search continued to find chemotherapeutic agents that could be used alone or in conjunction with steptomycin. The search for drugs to battle TB continues to this day. (source#24)

1948 -A combination of streptomycin and PAS was found to be very effective against tuberculosis. (source#19)

1951-Isoniazid (INAH) was first used and shown when used with PAS to be better than streptomycin.

(source#19)

New Page

Chemotherapy(14 pt bold)

(12 pt regular)

The last 25 years have seen many important developments in tuberculosis chemotherapy in Singapore. Beginning in the 1950s, chemotherapy consisting of streptomycin (S), isoniazid (H) and p-aminosalicylic acid (PAS) was introduced at first with 2-drug and later 3-drug combinations (i.e., SPH/PH for a total of 18 to 24 months). In the 1960s, 2 early studies showed that thiacetazone (T) could not be substituted for PAS in standard chemotherapy as it was a more toxic and less potent drug. Routine tuberculosis treatment achieved good results for patients followed up for 5 years after completing treatment. A fully supervised regimen of streptomycin and isoniazid (S2H2) given twice weekly proved to be as effective as a largely self administered regimen of PAS/INH. Ethambutol (EMB) was shown to be effective in the initial treatment of pulmonary tuberculosis when combined with isoniazid. In the 1970s, rifampicin (R) was first investigated starting with an intermittent regimen of isoniazid and rifampicin given once or twice weekly. The success of this regimen led to 2 short course studies of 6-month regimens. Rifampicin was given daily for the full duration of 6 months (2SHRZ/HR; 2SHRZ/HRZ; Z = pyrazinamide) or intermittently 3 times a week in the continuation phase (2SHRZ/H3R3; 2HRZ/H3R3; 1SHRZ/H3R3). All the 6 months regimens were highly effective.

SO - Ann Acad Med Singapore 1982 Jul;11(3):366-9 (source#13)

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TImeline (14 pt bold)

(12 pt regular) http://www.brown.edu/Research/TB-HIV_Lab/About_TB/TB_Timeline.html

New Page

Sanatoriums(14 pt bold)

(12 pt underline)

*General history of Sanatoriums

*Paimio Sanatorium, Finland

*Adirondack Cottage/The Trudeau Institute

*Lake Saranac Sanatorium

*Chedoke Hospital (http://www.cmh.on.ca/documents/history/html)

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Lake Saranac Sanatorium (14 pt bold)

(12 pt regular)

Lake Saranac Sanatorium started as Adirondack Cottage; pioneered by Edward Livingston Trudeau, a young doctor who fell ill with tuberculosis in the spring of 1872. Upon his diagnosis, Trudeau spent a season at a resort hotel at Saranac Lake, New York and returned home much improved. In 1879 he published a paper in the Medical Record about the health benefits of the Adirondacks for the consumptive patient. The village or Saranac lake flourished and expanded with the arrival of afflicted people hopeful for a cure. In 1885 the Saranac Lake Sanatorium was opened. Trudeau prescribed rest, fresh air, good food, and a wholesome state of mind.

"This spot always has had a wonderful influence on me, and it is not to be wondered that I decided almost at once to place the first little wooden building of my proposed Sanitarium on it."

-Trudeau

The hospital grew, becoming more like a town than a medical facility.

"The Sanitarium has grown to be a picturesque little village, It comprises thirty-six buildings scattered over the entire hillside between the north and south gates...the patients'' cottages are grouped about a large administration Building, and other cottages for the heads of departments are clustered together at the south entrance, near which are the stable, barns and the big fire-proof laundry. In addition to the patient's cottages, there are many other buildings which represent various activities: a nurses' home for the Training School, an infirmary for bed-ridden patients, a post office, a colonial brick and marble library building, a reception and medical building with offices, laboratory and x-ray department,a recreation pavilion for amusements and entertainments, a workshop building were the patients are taught fancy leather-work, book-binding, brass work and framemaking as a recreation and a graded excercise, and a beautiful stone chapel."

Like other Sanatariums, Lake Saranac had rules and maxims for patients to follow as well as strict schedules. Surgical treatments such as pneumothorax were routine. Saranac Lake's busiest year was in the 1930's. With the dropoff of patients, the Great Depression, and the advent of antibiotics, the number of patients decreased. Renamed the Trudeau Institute after Trudeau's death, the facility today is an immunological research laboratory.

(source#15, also Caldwell@Murray.Fordham.edu)

Edward Livingston Trudeau

Source:p245 Courtesy of the Trudeau Institute4e Biomedical Research Laboratory, Saranac Lake,

New York Source#115

Edward Livingston Trudeau

Source:p245 Courtesy of the Trudeau Institute4e Biomedical Research Laboratory, Saranac Lake,

New York Source#15

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Adirondack Cottage and the Trudeau Institute (14 pt Bold)

(12 pt regular)

Adirondack Cottage was pioneered by Edward Livingston Trudeau, a young doctor who fell ill with tuberculosis in the spring of 1872. Upon his diagnosis, Trudeau spent a season at a resort hotel at Saranac Lake, New York and returned home much improved. In 1879 he published a paper in the Medical Record about the health benefits of the Adirondacks for the consumptive patient. The village or Saranac lake flourished and expanded with the arrival of afflicted people hopeful for a cure. In 1884, Trudeau's first cottage called the Little Red, was built in Trudeau's first attempt to build a sanatorium. The rest cure was adopted, and Trudeau charged only what his patients could afford to pay. He prescribed rest, fresh air, good food and a wholesome state of mind. The Adirondack Cottage was later renamed the Saranac Lake Sanatorium and then the Trudeau Sanatorium after the death Edward Trudeau.

(source #15)

The Trudeau Institute's research principally supported the treatment goals of the Adirondack Cottage Sanitarium at a time when tuberculosis caused more than one in every ten deaths in the United States. Now the Institute focuses on immunology. source (source#1)

Edward Livingston Trudeau

Source:p245 Courtesy of the Trudeau Institute

Biomedical Research Laboratory, Saranac Lake,

New York Source #15

Patient Isabel Smith, asleep in her room at the Trudeau Sanatorium's Ludington Infirmary, 1937 Photograph by Alfred Eisenstaedt, courtesy of Life Magazine and Time Inc.

Source #15

Patients curing in winter at the Adirondack Cottage Sanatorium, Saranac Lake, New York. (Courtesy of the Adirondack Collection, Saranac Lake Free Library)

Source#15

New Page

Paimio Sanatorium, Finland (14 pt bold) 1929-1932, Alvar Aalto

(12 pt reg)

In the design of the Paimio Sanatorium (1929-32), Aalto gave body to his "humanist" aspirations in a work which must be counted one of the masterpieces of the

modern movement.

The building stands on high ground twenty miles

from Helsinki, overlooking forests and lakes. At the time it was built, the best cure for tuberculosis (the Sanatorium was to specialize in the cure of this disease) was felt to be exposure to sun, fresh air, and greenery. This was one of these cases where the aims of the client and the "sanitary" philosophical and visual aspects of the new style were in accord from the beginning. The patients' rooms were placed in a long six-story slab facing south, served by corridors running along the north side, and with an open roof terrace, part covered by a canopy, on the top floor; the beds could be wheeled here on particularly warm days. The structure of this part of the building was a tapered concrete "trunk" from which the floors were cantilevered, thus allowing the openness of façades and freedom of circulation. The mono-material character of this wing was accentuated by curved details and a sculptural sense of volume, which belied the more cardboard qualities of certain other buildings in the International Style.

Behind the slab grouped the "serving" elements of the hallway, the doctors' wing and lounge, and the nurses' wing. Each function was expressed in a slightly different form, and angled to the topography of the site. The effect on approaching the building was that the slab and the lounge block funneled one towards the entrance. Variations in fenestration and detail ensured that the main divisions in the form were articulated throughout. Rising like a well-proportioned ship above the Finnish landscape, the Sanatorium announced its healing function through clean forms, tidy proportions, and well-lit volumes. At the same time, its horizontal balconies and garden terracing supplied links to the surrounding landmasses....[in the tuberculosis sanatorium], forms were found which extended the vocabulary of earlier modern architecture into new, and more

complex, formal territory. (Source#17)

Paimio Sanatorium, Finland 1929-1932(10 pt no photo yet)

Alvar Aalto

source #17

(10 pt no photo yet)

plan of ensemble, Paimio Sanatorium,

Finland 1929-1932

Alvar Aalto

source #17

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General history of Sanatoriums (14 pt bold)

(12 pt regular)

Sanatoriums originated in Europe in the middle of the nineteenth century. The first sanatoriums were typically retreats, luxury resorts or spas for the middle and upper classes. Later, many more sanitoria were constructed and appeared to almost compete for patients. In the early part of the 1900s, only a small fraction of thousands of people with tuberculosis could get into sanatoriums. However, with the advent of the Trudeau institute and the conversion of hospitals, by 1950 over one hundred thousand beds were available in the United States alone. The newer sanatoriums typically charges people what they could afford to pay and served a range of afflicted patients and prescribed rest, pure air, good food, and a `wholesome state of mind'. Physicians at the various sanitoria claimed that the climate and surroundings exclusive to their particular sanitorium were the most beneficial for healing the sick.

By the 1930's, most sanatoriums printed magazines and distributed them to their patients emphasizing the sanatoriums as a popular alternative to the confinement of the industrial city. Patients flocked to the sanatoriums, often there were waiting lists of two years or more to get in. Once in a sanatorium, a patient's stay could range from two to twenty years. During this time, patients underwent a variety of treatments, from baths to surgical procedures such as pneumothorax. Lesson books were often distributed, and daily planners for the patient's activities were not uncommon.

"Sanitoria is often the best option for a TB patient because this environment is designed specifically to treat the sick, and at home it may be more difficult for family members to cater to the sick as the disease progresses. Being at home also puts more people at risk of contracting the disease. The medical attention in sanatorium is at times more adequate, and in other instances is not enough individualized."

Patients were not always fond of the treatments. Betty MacDonald, a patient at the Pines wrote, "There's one thing to be said in favor of The Pines," I thought, "it's going to make dying seem like a lot of fun." However, sanatoriums, among health regulations, better living conditions, and perhaps natural selection were instrumental in the decline of tuberculosis. In 1900-1904, tuberculosis was causing roughly 184.8 deaths per year, by 1944 the death rate was down to 43.4 per 100,00.

The advent of treatments such as streptomycin and isoniazid in the 1940s resulted in the closing of the sanatoriums. People afflicted with the disease preferred to take antibiotics for a year or two rather than spend a prolonged stay in the sanatoriums. Some of the sanatoriums were turned into hospitals, others convalescent homes or religious institutions. Some acquired a reputation for being `haunted hospitals', left abandoned for several years due to the fear of catching `germs that had been there for years and would remain there for years'.

sources#15,21,24

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Famous People Afflicted with Tuberculosis (14 pt bold)

(12 pt regular underline checkov, chopin, kafka, keats, emily, anne, charlotte)

Anton Checkov died 1904 writer

Frederick Chopin died 1849 composer

Laennec died 1826 TB researcher: recognized various forms of TB as a single disease

Franz Kafka died 1924 writer http://www.cowland.com/josephk/timeln.html

John Keats died 1821 poet

John Harvard ? founded Harvard

Robert Louis Stevenson died 1894 writer

Max Lurie died 1920 TB researcher who developed immune and susceptible inbred rabbits

The Bronte Family

Mother Bronte died 1821

Reverend Bronte chronic infection

Maria died 1825

Elizabeth died 1825

Branwell died 1848 writer, opium addict

Emily died 1848 author of Wuthering Heights

Anne died 1849 author of Agnes Grey

Charlotte died 1855 author of Jane Eyre

(source#7)

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Anton Chekhov, Writer (14 pt Bold)

(12 pt regular)

Anton Chekhov (1860-1904). Writer, physician and tuberculosis patient.

Chekhov chose writing as a career after a childhood of hardship and poverty. Tuberculosis manifested soon after medical graduation and caused his death at the age of 44. Essentially a short story writer, he used simplicity and impressionism to portray sympathetically the psychology of the common man. Similarly his plays, popular today, written in a light and ethereal style, while static, have an inner psychological evolution. The best example is The Cherry Orchard.

SO - S Afr Med J 1979 Apr 21;55(17):682-6 (Source#13)

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Frederick Chopin, Composer (14 pt Bold)

(12 pt regular)

Frederick Chopin was not strong from childhood. He was spoken of as a little, frail, delicate elf of a boy, and it was said that the attention of his family was concentrated upon his health. In 1826, the same year that Laennec died of tuberculosis, Chopin, then only sixteen years old, began to show signs of breaking. His sister, Emilia, was at Reinerz suffering from far advanced tuberculosis. Chopin was sent to stay with her but she died at the age of fourteen while Chopin apparently recovered his usual health.

Chopin later went to the isle of Mallorca, where he hoped to recuperate from his disease. George Sand wrote of him in 1839, "Poor Chopin, who has had a cough since he left Paris, became worse: we sent for a doctor-two doctors-three doctors- each more stupid than the other, who started to spread the news in the island that the sick man was consumptive in the last stage. As a result there was great alarm. Phthsis is rare in these climate, and is looked upon as contagious. We were regarded as plague-infested; and, furthermore, as heathen, as we did not go to the mass. The owner of the little house in which we had rented turned us out brutally, and wished to being an action against us to compel us to limewash his house, which he said we had infected. The law of the island plucked us like chickens."

"I have been sick as a dog the last two weeks; I caught cold in spite of 18 degrees C. of heat, roses, oranges, palms, figs and three most famous doctors on the island. One sniffed at what I spat up, the second tapped where I spat it from, the third poked about and listened how I spat it. One said I had died, the second that I am dying, the third that I shall die...All this has affected the "Preludes" and God knows when you will get them." -Frédéric Chopin: Mallorca

At Barcelona, as they were leaving the inn, the landlord demanded to be paid for the bed on which Chopin had slept, on the pretext that it was infested, and that the police regulations required that it should be burned.

Chopin died in 1849.

source#24,13

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John Keats, Poet, Physician and Tuberculosis Patient (14 pt Bold)

(12 pt regulra)

John Keats (1795-1821) trained as a physician at Guy's Hospital, but abandoned medicine for poetry. Progressive tuberculosis, a family disease, led him to Italy in the hope of a cure and to join Shelley and Byron at Pisa. He died in Rome in an apartment overlooking the Spanish Steps. Since 1909 this has been a Keats-Shelley literary memorial. During World War II its most valuable manuscripts narrowly escaped destruction during the bombardment of the Cassino monastery, where they had been sent for safekeeping. Able to devote but 4 years of his short life solely to poetry, Keats achieved distinction as a major English poet known for his sensitivity and sensuous imagery.

source: S Afr Med J 1981 Jun 6;59(24):875-8(Source#13)

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Emily Bronte(14 pt Bold)

(12 pt regular)

Daughters Emily, Anne and Charlotte Bronte are famous for their novels: Wuthering Heights, Agnes Grey and Jane Eyre, respectively.

The following are several excerpts from The Brontes, Their Lives, Friendships, and Correspondence in Four Volumes Vol II Chapters XIII-XX 1844-1849 Wise, Thomas James Shakespeare Head Press Oxford, MCMXXXII. These are letters from the Brontes that reveal their affliction with tuberculosis.

November 23rd, 1948

"Dear Ellen- Whatever my inclination may be to let all correspondence alone for the present, I feel that to you at least I ought to write a line. I told you Emily was ill, in my last letter. She has not rallied yet. She is very ill. I believe, if you were to see her, your impression would be that there is no hope. A more hollow, wasted, pallid aspect I have not beheld. The deep, tight cough continues; the breathing after the least exertion is a rapid pant; and these symptoms are accompanied by pains in the chest and side. Her pulse, the only time she allowed it to be felt, was found to beat 115 per minute. In this state she absolutely refuses to see a doctor; she will not give and explanation of her feelings, she will scarcely allow her illness to be alluded to. Our position is, and has been for some weeks, exquisitely painful. God only knows how all this is to terminate. More than once, I have been forced boldly to regard the terrible event of her loss as possible and even probable. But the nature shrinks from such thoughts, I think Emily seems the nearest thing to my heart in this world...."

-C. Bronte

December 9th, 1948

"I know it would be useless to consult Drs Elliotson or Forbes: my sister would not see the most skillful physician in England if he were brought to her just now, nor would she follow his prescription. With regard to Homeopathy, she has at least admitted that it cannot do much harm, perhaps if I get the medicines she may consent to try them; at any rate, the experiment shall be made..." -C. Bronte

December 19th, 1948

"Dear Ellen- I should have written to you before, if I had one word of hope to say; but I had not. She grows daily weaker. The physician's opinion was expressed too obscurely to be of use. He sent some medicine which she would not take. Moments so dark as these I have never known. I pray for God's support to us all. Hitherto He has granted it..." -C. Bronte

December 23, 1848

"My Dear Ellen- Emily suffers no more from pain or weakness now. She will never suffer more in this world. She is gone, after a hard, short conflict. She died on Tuesday, the very day I wrote to you. I thought it very possible she might be with us still for weeks, and a few hours afterwards she was in eternity..." -C. Bronte

December 25, 1948

"....My father and my sister Anne are far from well, as to me, God has hitherto most graciously sustained me- so far I have felt adequate to bear my own burden and even to offer a little help to others-I am not ill- I can get through daily duties- and do so ething towards keeping hope and energy alive in our mourning household. My father says to me almost hourly, "Charlotte, you must bear up- I shall sink if you fail me"....-C. Bronte

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Anne Bronte(14 pt Bold)

(12 pt regular)

The following are several excerpts from The Brontes, Their Lives, Friendships, and Correspondence in Four Volumes Vol II Chapters XIII-XX 1844-1849 Wise, Thomas James Shakespeare Head Press Oxford, MCMXXXII. These are letters from the Brontes that reveal their affliction with tuberculosis.

Anne Bronte had never been very strong. During her schooldays at Roe Head, and later in her situations as a governess, Charlotte was always anxious about her, and on one occasion Miss Wooler's apparent disregard of Anne's weakness caused Charlotte to have a bitter quarrel with her. After the death of Emily, Anne began to be seriously ill, and her father, with a premonition of what was to follow, made haste to get the best possible medical attention and advice...Anne became gradually worse and their only hope was to get her away to the seaside, but the doctors forbade such a course during the cold early months of the year. As the months dragged by, Anne became increasingly anxious to go; she was afraid of delaying too long. She did not wish to die, she was full of plans for the future, and, as she wrote to Ellen Nussey, she longed to do some good in the world before she left it...It was not until the end of May that the sisters were able to make definite arrangements for their long-desired visit to the seaside. Scarborough was the place chosen, minly because Anne knew it quite well...May 23 was the date fixed for the journey...but when the day cam round Anne was too ill to move, and the journey had to be postponed until the following day. By that time Anne was almost too weak to walk. She survived the journey , but only for three days, she died on Monday, My 28, 1849.

January 22, 1849

"...I would state Mr. Teale's opinion of my sister's case...Mr Teale said it was a case of tubercular consumption, with congestion of the lungs-yet he intimated that the malady had not yet reached so advanced a stage as to cut off all hope; he held out a prospect that a truce and even an arrest of the disease might yet be procured; till such truce or arrest could be brought about he forbade the excitement of travelling, enjoined strict care, and prescribed the use of cod-liver oil and carbonate of iron..." -C. Bronte

January 30, 1849

"...During the mild weather Anne really seemed something better. I began to flatter myself she was gathering strength. But the change to frost has told upon her, she suffers more of late. Still her illness has none of the fearful, rapid symptoms which appalled in Emily's case. Could she only get over the spring, I hope summer may do much for her..." -C. Bronte

May 30th, 1849

"My dear sir- My poor sister is taken quietly home at last. SHe died on Monday. With almost her last breath she said she was happy, and thanked God that Death was come, and come so gently. I did not think it would be so soon..."- C. Bronte

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Charlotte Bronte(14 pt Bold)

(12 pt regular)

The following are several excerpts from The Brontes, Their Lives, Friendships, and Correspondence in Four Volumes Vol II Chapters XIII-XX 1844-1849 Wise, Thomas James Shakespeare Head Press Oxford, MCMXXXII. These are letters from the Brontes that reveal their affliction with tuberculosis.

January 15, 1849

"Dear Ellen...as to your queries about myself, I can only say, that if I continue as I am I shall do very well. I have not yet got rid of the pains in my chest and back. They oddly return with every change of weather; and are still sometimes accompanied with a little soreness and hoarseness, but I combat them steadily with pitch plasters and bran tea. I should think it silly and wrong indeed not to be regardful of my own health at present; it would not do to be ill now." - C. Bronte

January 30, 1849

"Dear Ellen...I have felt much less of the disagreeable pains in my chest lately, and much less also of the soreness and hoarseness. I tried an application of hot vinegar, which seemed to do good..." - C. Bronte

June 4, 1849

"My Dear Sir...They are both gone, and so is poor Branwell, and Papa has now me only-the weakest, puniest, least promising of his children. Consumption has take the whole five...I am ordered to remain at the sea-side awhile..." - C. Bronte

June 13, 1849

"My Dear Sir...An immediate change of scene has done me good...Had I never believed in a future life before, my sister's fate would assure me of it. There must be Heaven or we must despair- for life seems bitter, brief-blank...A year ago-had a prophet told me how I should stand in June, 1849-how stripped and bereaved-had he foretold the autumn, the winter, the spring of sickness and suffering to be gone through- I should have thought-this can never be endured. It is over. Branwell-Emily-Anne are gone like dreams-gone as Maria and Elizabeth went twenty years ago. One by one I have watched them fall asleep on my arm-and closed their glazed eyes-I have seen them buried one by one-and-thus far-God has upheld me. From my heart I thank Him....I intend to go home to Papa. May I retain strength and cheerfulness enough to be a comfort to him and to bear up against the weight of the solitary life to come...I cannot help dreading the first experience of it-the first aspect of the empty rooms which once were tenanted by those dearest to my heart-and where the shadow of their last days must now- I think-linger for ever..." - C. Bronte

Charlotte died in 1855. The common belief is that the Brontes' drinking water killed them- it ran through a cemetery near their house.

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Personal Accounts of Tuberculosis(14 pt Bold)

( 12 pt underline)

*Katherine Mansfield

*Betty MacDonald

*Various Quotes through the Years

*Voices: Past and Present

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Katherine Mansfield from Journal on Her Illness(14 pt Bold)

A personal account of TB in the early 20th-century (12 pt italic)

(12 pt regular)

(Excerpt from Medicine: A Treasury of Art and Literature, eds. Ann G. Carmichael and Richard M. Ratzan, New York: Hugh Lauter Levin Associates, 1991. Pages 227-229)

Born in New Zealand in 1888, Mansfield seems to have been destined to become a writer, getting her first short story published at the age of 9. She moved to England as a young woman, spending the remainder of her life in England and France, most of it with the critic John Middleton Murry. Mansfield was only beginning to establish a reputation as a short story writer when her pulmonary tuberculosis worsened in the early 1920s. Like a throwback to the Romantic age and the great poets, she spent her life seeking a sunny Mediterranean post of recovery. She died of a pulmonary hemorrhage in 1923.

Pulmonary Tuberculosis (12 pt italic)

(12 pt regular)

[1918]. The man in the room next to mine has the same complaint as I. When I wake in the night I hear him turning. And then he coughs. And I cough. And after a silence I cough. And he coughs again. This goes on for a long time. Until I feel we are like two roosters calling to each other at false dawn. From far-away hidden farms.

August [1920]. I cough and cough, and at each breath a dragging, boiling, bubbling sound is heard. I feel that my whole chest is boiling. I sip water, spit, sip, spit. I feel I must break my heart. And I can't expand my chest; it's as though the chest had collapsed....Life is--getting a new breath. Nothing else counts.

Suffering(12 pt italic)

(12 pt regular)

[19 December 1920]. I should like this to be accepted as my confession.

There is no limit to human suffering. When one thinks: "Now I have touched the bottom of the sea--now I can go no deeper," one goes deeper. And so it is for ever. I thought last year in Italy, Any shadow more would be death. But this year has been so much more terrible that I think with affection of the Casetta! Suffering is boundless, it is eternity. One pang is eternal torment. Physical suffering is--child's play. To have one's breast crushed by a great stone--one could laugh!

I do not want to die without leaving a record of my belief that suffering can be overcome. For I do believe it. What must one do? There is no question of what is called "passing beyond it." This false.

One must submit. Do not resist. Take it. Be overwhelmed. Accept it fully. Make it part of life.

Everything in life that we really accept undergoes a change. So suffering must become Love. This is the mystery. This is what I must do. I must pass from personal love to greater love. I must give to the whole of life what I gave to one. The present agony will pass--if it doesn't kill. It won't last. Now I am like a man who has had his heart torn out--but--bear it--bear it! As in the physical world, so in the spiritual world, pain does not last for ever. It is only so terribly acute now. It is as though a ghastly accident had happened. If I can cease reliving all the shock and horror of it, cease going over it, I will get stronger.

Here, for a strange reason, rises the figure of Doctor Sorapure. He was a good man. He helped me not only to bear pain, but he suggested that perhaps bodily ill-health is necessary, is a repairing process, and he was always telling me to consider how man plays but a part in the history of the world. My simple kindly doctor was pure of heart as Tchehov was pure of heart. But for these ills one is one's own doctor. If "suffering" is not a repairing process, I will make it so. I will learn the lesson it teaches. These are not idle words. These are not the consolations of the sick.

Life is a mystery. The fearful pain will fade. I must turn to work. I must put my agony into something, change it. "Sorrow shall be changed into joy."

It is to lose oneself more utterly, to love more deeply, to feel oneself part of life,--not separate.

Oh Life! accept me--make me worthy--teach me.

I write that. I look up. The leaves move in the garden, the sky is pale, and I catch myself weeping. It is hard--it is hard to make a good death....

After a dreadful operation I remember that when I thought of the pain of being stretched out, I used to cry. Every time I felt it again, and it was unbearable.

That is what one must control. Queer! The two people left are Tchehov--dead--and unheeding, indifferent Doctor Sorapure. They are the two good men I have known.

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Betty MacDonald (14 pt Bold)

(12 pt regular)

MacDonald, Betty The Plague and I, J. Lippincott New York 1948 pp 31-45

personal account of acquiring tb and trouble with diagnosis(12 pt italic)

(12 pt regular)

"The ironic thing is that, although I knew nothing about tuberculosis and never entertained the thought that I might have the disease, for two years I had been very concerned about a co-worker of mine in the Government service, who looked like a cadaver and coughed constantly, with a dry little hacking cough, much of the time in my face. "I think that man has tuberculosis," I finally told my boss excitedly. "Who don't?" was his laconic reply"

"....by July I coughed a lot. Also in July I had a complete physical examination for $5000 worth of life insurance. I told the examining physician about my cough and he said, "Cigarette, ha-ha, I have one too."

"...In spite of my increasing debility, these seemed to be nothing wrong with me. I was like the frail creature in the golden days who for no apparent reason wasted away and died...I called my sister Mary and she sent me at once to her husband, a pathologist...He concluded, "You will have to go to a sanatorium." "

on sanatoriums (12 pt italic)

(12 pt regular)

"There's one thing to be said in favor of The Pines," I thought, "it's going to make dying seem like a lot of fun."

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Various Quotes Through the Years(14 pt Bold)

(12 pt regular)

"If the number of victims which a disease claims is the measure of its significance, then all diseases particularly the most dreaded infectious disease such as bubonic plague, Asiatic cholera, etc. must rank far behind tuberculosis. Statistics teach that 1/7 of all human beings die of tuberculosis, and that, if one considers any of the productive middle-aged groups, tuberculosis carries away 1/3 and often more of these...when the conviction that tuberculosis is an exquisite infectious disease has become finally established among physicians, the question of an adequate campaign versus tuberculosis will certainly come under discussion and it will develop by itself."

Robert Koch "Die Actiologie der Tuberkulose" (source#22)

Excerpts from Frank Ryan, The Forgotten Plague: How the Battle Against Tuberculosis Was Won--and Lost (Boston: Little, Brown & Co., 1993).

"The Lord shall smite thee with a consumption, and with a fever, and with an inflammation...and they shall pursue thee until thou perish." --Deuteronomy 28:22 (pg. 17)

"Every morning, the vision of home and the moors rushed on her, and darkened and saddened the day. Her white face, attenuated form and failing strength threatened rapid decline. I felt in my heart she would die if she could not go home." --Charlotte Brontë, writing about her sister Emily (pg. 31)

"At the midpoint of the 20th century, tuberculosis was recognised by all as the "White Plague", undeniably the most dreaded enemy of the human race by any measure. Whether measured by prevalence, cost, social consequences, sheer misery or any yardstick, I believe that any observer of the time would consider the bacillus of tuberculosis as the enemy number one of the human race. None of us--myself included--believed that its control could be attained by medical means within this 20th century." --H. Corwin Hinshaw (pg. 49)

"I have been sick as a dog the last two weeks; I caught cold in spite of 18 degrees C. of heat, roses, oranges, palms, figs and three most famous doctors on the island. One sniffed at what I spat up, the second tapped where I spat it from, the third poked about and listened how I spat it. One said I had died, the second that I am dying, the third that I shall die...All this has affected the "Preludes" and God knows when you will get them." --Frédéric Chopin: Mallorca (pg. 61)

"The Tsarevitch Nicholas, presumptive heir to the throne of Russia, was receiving treatment for consumption in Nice. His mother visited him there on several occasions, and in 1865 the Tsar Alexander II came to receive his last words and to order the return of his body to Russia on board the frigate Alexander Nevsky." --René and Jean Dubos: The White Plague (pg. 75)

"Bring me the candle," he called to Brown, with whom he was staying, "and let me see this blood." He looked at the bright red spot on his pillow and then, his excitement and intoxication gone, he said calmly, "I know the colour of that blood. It's arterial blood...That blood is my death warrant." --John Keats (aged twenty six) (pg. 121)

"Your remedy does not treat the real seat of evil. It continually removes the traces of the enemy, but is still leaves him deep in the invaded country." --Sir Arthur Conan Doyle: reporting Koch's invention of a vaccine against tuberculosis (pg. 148)

"Eva..did everything she could to conceal from Picasso the fact that she was suffering not from a passing bout of bronchitis but from tuberculosis. She hid the blood-stained handkerchiefs and applied thicker and thicker layers of rouge to disguise the pallor of her cheeks. She was terrified that if he knew, he would leave her." --Arianna Stassinopoulos Huffington: Picasso, Creator and Destroyer (pg. 209)

"Professor Berglund from Stockholm was visiting Gothenburg and I told him in confidence that I was trying to find a cure for tuberculosis. He replied: "Can you tell me of any garage where they are not trying?" --Jorgen Lehmann (pg. 262)

"Who was this guy, Schatz? Most people have never heard of him. But I knew him well, because he was a graduate student returning to Rutgers the very time that I got there--a poverty stricken, brilliant, Jr Phi Beta Kappa, who worked with a burning intensity, and brought Waksman's attention to focus on his thesis isolate, Streptomyces griseus." --Doris Jones: fellow researcher at Rutgers during the streptomycin discovery (pg. 278)

"The captain of all these men of death that came against him to take him away, was the Consumption, for it was that that brought him down to the grave." --John Bunyna: The Life and Death of Mr Badman (pg. 299)

"I have been horribly ill the last few weeks. I had a bit of a relapse, then they had another go with the streptomycin, which previously did me a lot of good, at least temporarily. This time only one dose of it had ghastly results, as I had built up an allergy or something..." --George Orwell (Pg. 323)

"When Rutgers University needed to save money during the war winter of 1941-42, a budget official had a bright idea: Why not fire Selman Waksman, an obscure Ukranian-born microbiologist who was getting $4,620 a year for 'playing around with microbes in the soil'?" --Time magazine, 7 Nov 1949 (pg. 365)

"Highly contagious tuberculosis close to epidemic level in the city....No matter where you are in New York today, you can be at risk." --Headline in New York Post, 17 Oct 1990

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Voices: Past and Present(14 pt Bold) http://www.pbs.org/ppol/voices/html (12 pt regular link to site)

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Quiz(14 pt Bold) http://www.pbs.org/ppol/ (12 pt link to site)

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Sources(14 pt Bold)

(12 pt regular)

1. http://www.pbs.org/ppol/ (history of tb)

2. http://www.pbl.org/ppol/trudeau.html (Adirondack cottage Sanatorium)

3. http://www.cmb.or.ca/documents/history.html (Chedoke hospital)

4. http://www.cmh.on.ca/documents/history.html (Rehabilitation)

5. http://www.who.ch/programmes/gtb/GTB_Homepage.html (general)

6. http://www.cwru.edu/orgs/tbru/tbru.html (general)

7. http://ets.cis.brown.edu/Research/TB-HIV_Lab/About_TB/TB_History.html

8. http://www.glaxowellcome.uk/intexpl/health/odyssey/tuberc/ (general)

9. http://www.metlife.com/Info/History/Docs/tuber.html (general)

10. http://www.mic.ki.se/West.html (general)

11. http://www-medlib.med.utah.edu/WebPath/MTB.html (general)

12 http://www.cowland.com/josephk/timeln.html

13.http://www.nlm.nih.gov

14. Bloch, Mark The Royal Touch, "Sacred Monarchy and Scrofula in England and France" McGill-Queen's University Pres Montreal, 1973

15. Caldwell, Mark "The Last Crusade" Macmillan Publishing Co. New York, 1988 pp 39-48

16. Carmichael, Ann G. and Richard M. Ratzan "Medicine: A Treasury of Art and Literature", New York: Hugh Lauter Levin Associates, 1991. Pages 227-229

17. Curtis, William J.R. "Modern Architecture Since 1900", Englewood Cliffs: Prentice-Hall 1983 pp230-231

18. Dubois, Rene and Jean "The White Plague" McClellan and Stewart Limited, Canada 1952

19. Hetherington, H.W., M.d and Fannie Wieshleman, RN "Pulmonary Tuberculosis- Prevention and Control" G.P. Putnam and Sons, New York 1958

20. Holmes, Fred G., M.D "Tuberculosis- a Book for the Patient", D. Appleton-Century Company, New York, 1935

21. MacDonald, Betty "The Plague and I", J. Lippincott New York 1948 pp 31-45

22. Meyers, J. Arthur, PhD, MD, F.A.C.D "Man's Greatest Victory Over Tuberculosis" Charles C. Thomas, Baltimore MD 1940 p 199-201

23. Ryan, Frank M.D., "The Forgotten Plague, How the Battle Against Tuberculosis Was Won-and Lost", Little, Brown and Company Boston 1992

24. Waksman, Selman A. "The Conquest of Tuberculosis" University of California Press Berkeley and Los Angeles, 1964 p34

25. Wherrett, George Jasper "The Miracle fo the Empty Beds: A History of Tuberculosis in Canada", University of Toronto Press, Toronto 1977

26. Wise, Thomas James "The Brontes, Their Lives, Friendships, and Correspondence in Four Volumes Vol II Chapters XIII-XX 1844-1849" Shakespeare Head Press Oxford, MCMXXXII.