![[Image]](images/InvincibleMicrobe-83.jpg)
Photographed in 1908, this man is sitting outside his tiny cure cottage in very chilly Ottawa, Illinois.
Epigraphs
page
vii “The Lord will smite you”: Deuteronomy 28:22. The Holy Bible. Revised standard version. New York: Oxford University Press, 1962, p. 250.
“Yet the captain of all these men of death”: John Bunyan, The Life and Death of Mr. Badman. London: W. Nicholson, 1808, p. 944.
“Tuberculosis—the disease which destroyed”: Frank Ryan, Tuberculosis: The Greatest Story Never Told. Sheffield, United Kingdom: Swift Publishers, 1992, p. 360.
“No matter how carefully we scour”: Baker, p. 17.
THIS IS THE STORY
1 While terms such as microorganism, bacillus, germ, and bacterium have precise definitions for scientists, they are also commonly used interchangeably to refer to very tiny living organisms. In our text we have used all of these terms to describe the organism that causes tuberculosis.
1: IN THE BEGINNING
4 Of course, tuberculosis was around long before this young male contracted it. Details on the origins of TB were found in “Research Paper for the Proceedings of the National Academy of Sciences of the United States of America” (referred to as “A new evolutionary scenario for Mycobacterium tuberculosis complex”), vol. 99, no. 6 (March 19, 2002), pp. 3684–89. A summary of this paper can be found at www.ncbi.nlm.nih.gov/pubmed/11891304.
The earliest physical evidence of tuberculosis was discovered so recently that information is very limited. We were fortunate to find a detailed account at ScienceDaily: sciencedaily.com/ releases/2007/12/071207091852.htm. For additional details see John Noble Wilford, “Signs of TB in Ancient Skull Support Theory on Vitamin D,” New York Times, Science Times, December 18, 2007, p. F3.
4–5 Descriptions of M. tuberculosis were found in Lee Goldman and Dennis Ausiello, eds., Cecil Medicine, 23rd ed. (Philadelphia: Saunders Elsevier, 2008), pp. 2298–307; Caldwell, pp. 5–9. Another source of information was the Merck Manuals Online Medical Library.
6–7 The advent of farming and permanent dwelling places occurred between 10700 and 9400 B.C., an era known as the Neolithic Period. A detailed examination of this period can be found in Peter Bellwood, First Farmers: The Origins of Agricultural Societies (Malden, MA: Blackwell Publishing, 2005). For more on the spread of TB that occurred at this time, see Reichman, p. 11; Ryan, pp. 4, 6. A quick overview of Neolithic medicine in Great Britain can be found on the BBC website: www.bbc.co.uk/history/programmes/stonehenge/article2. shtml.
7 In addition to the human (M. tuberculosis) and bovine (M. bovis) forms, there are three other related mycobacteria. The murine version (M. microti) infects rodents, such as mice and rats; the avian version (M. avium) infects birds; and the piscine version (M. marinum) infects watergoing creatures, such as fish and turtles, and is present in many bodies of water, including aquariums. All three have been shown to infect humans, but such infections are extremely rare and have not been included in our discussion. For more information on these, see Beeson, op. cit. p. 259. Also see these websites: www.ncbi.nlm.nih.gov/pmc/articles/PMC105214/; www.aids-ed.org/ aidsetc?page=cm-522_mac; emedicine.medscape.com/article/223363-overview.
8 Mummified bodies can tell us a great deal about health issues and early attempts at healing. Some very good sources of information are Paul B. Beeson and Walsh McDermott, Textbook of Medicine, vol. 1, 12th ed. (Philadelphia: W. B. Saunders, 1967), p. 259; Cockburn, pp. 42–43, 217; Daniel, pp. 9–11; Dormandy, p. 2 note 2; D. Morse, D. Brothwell, and P. J. Ucko, “Tuberculosis in Ancient Egypt,” American Review of Respiratory Diseases, vol. 90, pp. 524–30; Plinio Prioreschi, A History of Medicine (Omaha, NE: Horatius Press, 1975), pp. 257–358; Reichman, p. 11; Ryan, p. 5.
8–10 Very good discussions of Egyptian healing practices can be found in Caldwell, p. 10; Carmichael, pp. 29–31; Majno, pp. 69–84, 90–128; Nunn, pp. 73–74, 87.
9 “A painful finger or toe”: Caption translation and information are from B. Ebbell, trans., The Papyrus Ebers: The Greatest Egyptian Medical Document (Copenhagen: Levin & Munksgaard, 1937), Formula 618.
10 “an ailment I will treat”: From the Edwin Smith Surgical Papyrus as found in John Merlin Powis Smith, ed., The American Journal of Semitic Languages (Chicago: University of Chicago Press), vol. 38 (1921), p. 322.
10–11 The word tuberculosis was first used by English physician Richard Morton in 1694, but it did not replace phthisis immediately. In 1839 J. L. Schönlein, an Austrian professor of medicine, suggested the word might be more accurate than phthisis because tubercles were always present, though it would take another four decades before tuberculosis came into general use.
10–13 Other ancient advances in understanding and treating TB can be located in Caldwell, p. 10; Carmichael, pp. 33–51, 84; Daniel, pp. 17–21, 69; Dormandy, pp. 2–4; Majno, pp. 141, 337, 339–41, 348–49, 415–17; Reichman, p. 11; Starr, pp. 17–18; Williams, pp. 3–23.
11 “almost always fatal”: Reichman, p. 11.
14–17 Discussions of the healing touch ceremony can be found in Daniel, pp. 22–27; Dormandy, pp. 4–5; Williams, pp. 170–75.
16 “God ... grant that these sick persons”: T. B. Howell, ed., A Complete
Collection of State Trials and Proceedings for High Treason and Other Crimes and Misdemeanors, vol. 11 (London: Haward, 1816), p. 1061; Williams, p. 173.
17 It was sometimes hard to tell quack healers from honest ones during this period. An interesting look at medieval medicine can be found in Nigel Kelly, Bob Rees, and Paul Shuter, Medicine Through Time (Oxford: Heinemann Educational Publishers, 2002), pp. 48–61.
18 Additional discussions of the contributions made by Paracelsus, Fracastoro, and Morgagni can be located in Carmichael, p. 85; Daniel, pp. 69–71; Dormandy, pp. 5–7.
18–20 For further details on early advances in medical equipment, see Daniel, p. 71; Dormandy, pp. 7–8, 26, 32–39.
19 “the cardiac region”: Carmichael, p. 134; Dormandy, p. 34.
20 The theory of vitalism and Denis’s disastrous experiments with blood transfusions are discussed in Starr, pp. 3–6, 10–16. Denis was charged with murder but was exonerated after a lengthy and embarrassing trial: Williams, pp. 224–25.
3: “THERE IS A DREAD DISEASE”
23–25 Information about the Industrial Revolution and its effect on population, the growth of cities, and the spread of disease can be found in Caldwell, p. 9; Dormandy, pp. 73–77, 79–82; Donald Kagan, Steven Ozment, and Frank M. Turner, The Western Heritage, 8th ed. (Upper Saddle River, NJ: Prentice-Hall, 2004), pp. 529–33, 539–40, 756–58.
24 “Tuberculosis slaughtered the poor”: Dormandy, p. 73.
24–25 The effect of the Industrial Revolution on the health of children is compellingly discussed in Susan Campbell Bartoletti, Kids on Strike! (Boston: Houghton Mifflin, 1999), pp. 12, 27–28, 84, 93, 112, 135; Russell Freedman, Kids at Work: Lewis Hine and the Crusade Against Child Labor (New York: Clarion Books, 1994), pp. 35–38, 49, 54.
25 “stunted in growth”: Dormandy, p. 74.
26 “After being one or two months”: Dormandy, p. 81.
“Decay and disease are often beautiful”: Dormandy, p. 91.
26–27 The surprisingly positive depiction of TB patients in novels, plays, poems, and operas is discussed in detail in Caldwell, pp. 16–20, 22–28; Daniel, pp. 30–34; Dormandy, pp. 85–100, 100–104; Ott, pp. 12–15; Sontag, pp. 3–4, 5, 11–13, 16–17, 18–20, 25–35.
27 “It was the fashion”: F. B. Smith, The Retreat of Tuberculosis, 1850–1950 (London: Croom Helm, 1988), p. 271.
29 “Phthisis is an illness of the lofty and noble parts”: Dormandy, p. 93.
“There is a dread disease”: Dormandy, p. 92.
There was little new that a doctor could do to treat people with tuberculosis besides bleed them or send them on a long journey in search of a cure. More about this period of doctoring is talked about in Caldwell, pp. 30–34; Daniel, pp. 62–68, 72–73; Dormandy, pp. 117–25; Ott, pp. 6–7, 16–19.
4: INTO THE MOUNTAINS
31 “the reduced atmospheric pressure”: From Brehmer’s doctoral dissertation, “Tuberculosis Is a Curable Disease,” 1853, p. 1.
32 Hermann Brehmer’s creation of the sanatorium cure and its remarkable popularity are studied in Caldwell, pp. 11, 67–73, 88, 91, 94, 96, 171; Daniel, pp. 178–79; Dormandy, pp. 147–57; Ott, pp. 49, 147.
33 “It is amazing the amount one can eat”: Dormandy, p. 152.
36 “visited only by hunters and fishermen”: Trudeau, pp. 77–78.
“poor, sick people in cities”: Trudeau, p. 157.
“a little porch so small”: Trudeau, p. 170.
36–38 Details about Edward Trudeau and his Adirondack Cottage Sanatorium can be found in Bates, pp. 39, 75; Caldwell, pp. 11–12, 39–52, 72–74, 132–40; Daniel, pp. 180–84; Dormandy, pp. 176–86, 202; Gallos, pp. 2–26; Rinehart, pp. ix-x, 4–5, 7–10, 17–22; Rothman, pp. 201–3; Trudeau, pp. 29–31, 41, 71–73, 77–131, 154–71.
40 “Sanatorium, I knew what that meant”: MacDonald, p. 33.
“Crack goes the whip”: Robert Louis Stevenson, A Child’s Garden of Verses (New York: Charles Scribner’s Sons, 1889), p. 49.
41 “To cure sometimes”: Rinehart, p. 20.
“a depressing place”: MacDonald, pp. 38–39.
41–42 The daily routine in a sanatorium varied from place to place, depending on the doctor in charge and how nurses and other personnel interpreted rules and regulations. Good sources for a look into these institutions are Dormandy, pp. 180–86; Rinehart, pp. 34–37, 39–40, 49–81, 83–95; Rothman, pp. 203–5.
42 “cold sponge”: Rinehart, p. 76.
43 “with a rule book”: Caldwell, p. 117.
“The smallest details”: Bates, p. 201; P. J. Kretzschmar, New York Medical Journal, vol. 47 (1888), p. 175.
“Patients must not read”: MacDonald, p. 53.
“Pretty nearly all TB patients”: Caldwell, p. 118.
44 “There’s one thing to be said”: MacDonald, p. 59.
“We are going to make you well”: MacDonald, p. 60.
46 Although Trudeau was many miles from university and medical facilities that had up-to-date equipment, he was a serious researcher. Several authors discuss his work in detail: Dormandy, pp. 179–80; Rinehart, pp. 23–24; Rothman, pp. 198–204; Trudeau, pp. 205–6.
46–47 The use of animals as research test subjects began with the ancient Greeks in 400 B.C. and is still practiced today, with between 50 and 100 million animals being used annually. Vocal and impassioned protests against animal testing go back a long way; Dr. Edmund O’Meara called it “miserable torture” in 1655. Such organizations as People for the Ethical Treatment of Animals (PETA) and the American Society for the Prevention of Cruelty to Animals (ASPCA) continue to protest animal testing. While we care very deeply about this issue, we have chosen not to explore it in our text. The subject is vast and complex and deserves serious and extensive discussion, and we did not want to shift the focus from the story of tuberculosis.
47 “I was 16”: Marie Shepitka, “I Shall Return” (manuscript) (Saranac Lake, NY: Saranac Free Library, 1971), p. 1.
“in tears, crying constantly”: Marie B. Shay, untitled manuscript (Saranac Lake, NY: Saranac Free Library, 1993), p. 1.
“The cottage may have been normal enough in daylight”: Shay, op. cit. p. 2.
48–49 “a shy, scared, sick teen-ager”: Shepitka, op. cit. p. 1.
49 “We were told to put nothing on the walls”: Shay, op. cit. p. 4.
“cure chairs on unheated porches”: Rinehart, p.138.
“If only I had known”: Shepitka, op. cit. p. 1.
6: THE CAUSE
51–53 Information about Robert Koch’s search to discover the cause of TB and the public reaction to it can be found in Baker, pp. 22, 27;
Caldwell, pp. 21–22, 158–62; Daniel, pp. 75–83; Dormandy, pp. 129–37; Rothman, pp. 179–80; Ryan, p. 12.
52 “became emaciated rapidly” and “Under the microscope”: Rothman, p. 180.
53 “In the future”: Caldwell, p. 160.
54 “bred into trousers”: Caldwell, p. 161.
55 “careful observance of hygienic laws”: Winslow, p. 40.
56–57 Details about Hermann Biggs and his fight to establish and enforce public health laws in New York come from Caldwell, pp. 177, 186— 95, 282–83; Dormandy, pp. 183–84; Rothman, pp. 183, 185, 187–90, 208–9.
57–58 “With every breath”: Leon Stein, Out of the Sweatshop: The Struggle for Industrial Democracy (New York: Quadrangle/NY Times Book Co., 1977), p. 178.
63 “look to New York”: Boston Medical and Surgical Journal, 180, no. 21 (January 8, 1914): 66.
63–64 The story of how postal worker Einar Holboell’s simple idea to help poor children with TB grew into an international drive to fight the disease is detailed in Daniel, pp. 44–45; Dormandy, pp. 300–302.
65 “a Poor boy Afflicted With the ... Lung trouble”: Bates, p. 288.
65–66 Details about Robert Freeman’s request to be admitted to White
Haven Sanatorium and Lawrence Flick’s struggle to provide medical treatment to all people are provided in Bates, pp. 12, 14–16, 19, 288.
66 The historical lack of adequate medical care for minority and poor individuals is documented in Abel, pp. 1–4; Byrd, pp. 1, 398, 400, 402–3; Dormandy, pp. 73–84; Ott, pp. 108–10, 120, 122–23; Rosner, pp. 198–99, 200–202, 206, 207.
66–68 The American Medical Association helped unify the medical profession and make it more professional, but it also fostered racial prejudice and left many minority communities without adequate medical care. See Byrd, pp. 375–93, 400–403.
67 “promote the science and art of medicine”: Scientific and Technical Societies of the United States (Washington, D.C.: National Academy of Sciences, 1968), p. 42.
68 “there is probably no other country”: Abraham Flexner, Medical Education in the United States (Boston: Merrymount Press, 1960), pp. 3–19.
69 “caused a disproportionate reduction”: Harriet A. Washington, “Apology Shines Light on Racial Schism in Medicine,” New York Times, Science Times, July 29, 2008, p. F5.
70–71 Information about the migration of African Americans to the north and advances in their care can be found in Rosner, pp. 1–9; Isabel Wilkerson, The Warmth of Other Suns: The Epic Story of America’s Great Migration (New York: Random House, 2010), pp. 8–15.
72 Chasing a cure, a common practice for those with TB, is discussed in Abel, pp. 5–10; Bates, pp. 25–29, 31–34, 35–37; Daniel, pp. 169–70; Dormandy, pp. 113–16, 117–25; Rothman, pp. 45–56.
“A consumptive”: Abel, p. 6.
73–78 Details about California’s response to the influx of individuals with TB are documented in Abel, pp. 5–38, 61–76, 86–124.
74 “The Mexican problem”: Abel, p. 68.
“Mexicans are possessed”: Abel, p. 68.
“There is no doubt”: Abel, p. 31.
“infected strangers”: Abel, p. 31.
76 “California provides”: Abel, p. 2.
76–77 “deluged at certain seasons”: Abel, p. 30.
77 “The number of TB cases”: Abel, p. 91.
78–79 “It is a far cheaper”: Abel, p. 36.
79–80 The eventual change of heart by health-care providers is described in Abel, pp. 125–40; Dormandy, pp. 297–312.
81 “illegal aliens putting strain on hospitals” comes from a CNN report by Lou Dobbs on April 8, 2005. The transcript can be found at transcripts.cnn.com/TRANSCRIPTS/0504/08/ldt.01.html.
8: THE CURE
82–83 Koch’s determined search for a cure and the disastrous effects of his lymph formula can be found in Caldwell, pp. 163–67, 250–51; Daniel, pp. 113–14, 171–77; Dormandy, pp. 139–44; Ott, pp. 62–63. A concise summary of Koch’s life and work can be found at nobelprize.org/ nobel_prizes/medicine/laureates/1905/koch.html.
While Koch’s tuberculin failed to cure TB, it turned out to be a valuable part of the fight against disease. In 1910 French physician Charles Mantoux introduced the Mantoux screening test. A mild form of tuberculin is injected under the skin, and the area is examined between forty-eight and seventy-two hours later. If the person has been exposed to TB, the skin will swell and turn red as the body mounts an immune response. Improved versions of Mantoux’s test are still widely used today.
83–84 “Three or four hours”: Caldwell, p. 163.
84 “in some cases” and “under certain circumstances”: Caldwell, p. 164.
85 “glad tidings of great joy”: Dormandy, p. 140.
“the consumptive patients”: Dormandy, p. 140.
86 “All workers”: Dormandy, p. 267.
86–87 In the absence of real medical advances in the search for a cure, a startling number of doctors cooked up truly dangerous treatments, some of which are discussed in Dormandy, pp. 265–72.
87–89 The heroic research done by Albert Calmette and Camille Guérin is documented in Caldwell, pp. 261, 278; Daniel, pp. 131–42; Dormandy, pp. 340–49; Reichman, pp. 31–35.
90 “widely used but poorly effective vaccine”: Reichman, p. 34.
91 “introduces copper”: Dormandy, pp. 273–74.
“Initially the germs”: Dormandy, p. 274.
Quack cures, strange elixirs, and patent medicines have always been around and are still with us today. The Hsin Kuang Herbal Store and Clinic claims that its formula consisting of eight herbs (“and possibly others depending on the particular case”) has cured 103 out of 108 observed cases of bone and joint tuberculosis, with improvement to the remaining 5. Information about these “cures” can be found in Caldwell, pp. 10, 39, 47, 53, 206–7; Dormandy, pp. 273–83; Ott, pp. 48–52.
92–93 The aggressive, even brutal surgical attempts to halt a patient’s tuberculosis are described in Caldwell, pp. 251–57; Daniel, pp. 195–202; Dormandy, pp. 249–63, 352–60.
95 “I was so scared”: MacDonald, pp. 150–51.
“one of the bloodiest operations”: Dormandy, p. 354.
9: “LIKE A FAIRY-TALE”
97–100 The Waksman-Schatz-Bugie discovery of streptomycin and Feldman-Hinshaw’s improvements to and testing of it are detailed in Caldwell, pp. 13, 263–65; Daniel, pp. 204–11; Dormandy, pp. 363–66.
99 “Dr. Waksman was afraid of tuberculosis”: Rutgers Oral History Archives: oralhistory.rutgers.edu/Docs/memoirs/schatz_albert/schatz_ albert_memoir.html.
100 “It was like a fairy-tale”: Dormandy, p. 366.
100–1 “with envy,” “I breathed,” and “hurried into”: Rothman, p. 248.
101–2 “All 44 patients”: Time magazine article “Medicine: TB—and Hope,” March 3, 1952, found at www.time.com/time/magazine/ article/0,9171,890255-1,00.html.
102 “[TB] is expected to cease”: Rothman, p. 249.
“Thus, a disease”: Selman A. Waksman, My Life with the Microbes (New York: Simon and Schuster, 1954), p. 279.
Streptomycin brought immediate fame and fortune to Selman Waksman; left behind and forgotten were his assistants. Albert Schatz felt he deserved to be recognized and sued Waksman; the suit was settled out of court for approximately $250,000. Additional information can be found in Daniel, pp. 213–14, 285 note 14; Ryan, pp. 332–39.
104 “Temperature normal” and “temp. of 101.3”: Emil Boyen, “The Treatment of Tuberculosis with Streptomycin: A Review of 110 Patients,” from Streptomycin and Dihydrostreptomycin, H. McL. Riggins and H. C. Hinshaw, eds. (New York: National Tuberculosis Association, 1949), p. 107.
104–6 Information on the limitations of streptomycin and the mutation of M. tuberculosis can be found in Caldwell, pp. 264–65; Daniel, pp. 146–47, 210–11, 216; Dormandy, pp. 211–13, 371 note 19; Reichman, pp. 13–14, 37–38; Ryan, pp. 326–28, 340–41.
106 The development of PAS and other anti-TB drugs is discussed in detail in Caldwell, pp. 256–57, 265–69; Daniel, pp. 216–18; Dormandy, pp. 366–68; Ryan, pp. 242–77.
106–7 The closing of sanatoriums and the consequences of effective drug treatment can be located in Caldwell, pp. 14–15, 245–47, 269–72; Daniel, pp. 219–20; Dormandy, pp. 378–79; Gallos, p. 163; Reichman, pp. 39–41; Rinehart, p. 149; Rothman, p. 249; Ryan, pp. 390–91.
108 The relationship between drug-resistant forms of TB and HIV is discussed in Reichman, pp. 145–50, 153, 189, 193; Ryan, pp. 397–405.
110–11 “Eight pills a day”: Reichman, p. 152.
111 “I never thought”: Reichman, p. 153.
11: HOT SPOTS
112–14 The young Ukrainian man’s story and the follow-up investigation are described in Reichman, pp. 1–10, 55.
115 The alarming rise in the TB rate in Russia and other countries, plus the international response, is well documented in Reichman, pp.
47–49, 52–55, 73–86, 90, 93–97, 114–20, 128, 190, 191–92, 193, 215–16; Tina Rosenberg, “Necessary Treatments: Why the Battle Against Tuberculosis Offers New Hope in the War on AIDS,” New York Times Magazine, September 19, 2004, pp. 26–28.
“can infect”: Nicholas D. Kristof, “A Killer Without Borders,” New York Times editorial pages, December 6, 2006, p. WK11.
118 “Our previous hopeful outcome”: Reichman, p. 216.
119 The arrival of extensively drug-resistant TB (XDR-TB) is very recent, and these strains are still being studied. Our information came from articles in the New York Times (editorial, science, and international sections):
Altman, Lawrence K. “Doctors Warn of Powerful and Resistant Tuberculosis Strain,” August 18, 2006, p. A23.
———. “Drug-Resistant TB in South Africa Draws Attention from U.N.,” September 6, 2006, p. A10.
———. “Drug-Resistant TB Rates Soar in Former Soviet Regions,” February 27, 2008, p. A6.
———. “Officials Praise New Test That Can Quickly Detect Drug-Resistant TB,” July 1, 2010, www.nytimes.com/2008/07/01/ health/01tb.html.
———. “Rise of a Deadly TB Reveals a Global System in Crisis,” March 20, 2007, F6.
Bedelu, Martha. “An Old Disease Needs New Cures,” March 25, 2005, www.nytimes.com/2005/03/26/opinion/26bedelu.html.
Dugger, Celia W. “South Africa Confines the Ill to Fight Severe TB,” March 25, 2008, A10.
———. “Extreme Tuberculosis,” September 14, 2006, www.tballiance.org/newscenter/view-innews.php?id = 623.
Kristof, Nicholas D. “A Killer Without Borders,” December 7, 2006, p. 144.
McNeil, Donald G. “Drug-Resistant TB Is Still Spreading at Deadly Rates, W.H.O. Reports,” March 23, 2010, p. D6.
———. “Technology: For Nations That Lack the Expertise, an Automated System for Detecting TB,” April 12, 2010, p. D6.
———. “W.H.O. Reports Rapid Rise in Resistant Tuberculosis Cases,” March 16, 2004, p. A7.
Wines, Michael. “Virulent TB in South Africa May Imperil Millions Without Quick Action, Experts Warn,” January 28, 2007, p. A6.
In addition, the following websites have been very helpful in providing up-to-date, reliable information and statistics for this chapter:
www.cdc.gov/tb
www.gatesfoundation.org/tuberculosis/Pages/default.aspx
www.umdnj.edu/globaltb/home.htm
www.who.int/topics/tuberculosis/en