‘Romantic disease’ is anything but, so good job we have antibiotics

A FRIEND of mine once admitted that he had always assumed that historical figures who succumbed to the ailment known as “consumption” had died because they just ate too much.

On the contrary, consumption is a disease so named because of the way it “consumes”its victim, causing them to waste away and eventually die.

Consumption is primarily a respiratory condition. In other words it affects the lungs.

Someone with consumption normally experiences a persistent cough with shortness of breath along with severe fatigue, weight loss, fevers and night sweats.

Due to the pallor it caused in its victims, it was referred to as “the white plague” during the 1700s but it’s a condition with many names. The ancient Greeks called it phtisis and the Romans called it tabes. It wasn’t until 1834, when John Schonlein coined the term tuberculosis, that it got its modern name.

Tuberculosis is thought to have been responsible for around 25 per cent of deaths in Europe between 1600 and 1800, making it hugely significant.

It has remained a big problem globally up to the present day. The World Health Organisation says TB was the second leading infectious killer in 2021 behind only covid.

It affects mainly sub-Saharan Africa, Eastern Europe and Asia but can be found just about anywhere.

Although technically the UK is classed as a low prevalence country, there were still more than 4,000 cases identified in 2021.

Rates had steadily dropped since the Seventies and in 2005 the programe that vaccinated all children with the BCG jab (first given in the Twenties and named after its creators Calmette and Guerin) was replaced with a programme
that targeted only vulnerable groups such as the immunocompromised.

Interestingly, there was a subsequent rise in cases that reached a peak in 2011 before gradually falling once more.

Due to its airborne mode of transmission, TB tends to flourish in built-up areas, especially in deprived neighbourhoods, and disproportionately affects those not born in the UK. It is of little surprise, therefore, that London accounts for around 35 per cent of all UK cases. TB is caused by a particularly hardy bacterium known as mycobacterium tuberculosis, although its bacterial nature wasn’t known about until Robert Koch made the discovery in 1882.

This paved the way not just for a greater understanding of tuberculosis but of infectious disease as a whole. Before that, all manner of interpretations were employed.

This being Halloween, there is some spooky significance here due to something known as the New England vampire panics of the early 1800s.

As the story goes, settlers around that time became victim to an outbreak of what they still referred to as consumption.

After the first death in a family, the communities affected became convinced that the deceased member would feed off the remaining members from the grave unless certain rituals were performed.

This included simply turning them in their grave but also extended to decapitating the corpse or burning its vital organs. The vampiric nature of this was probably something dreamt up by the newspapers at the time.

Although tuberculosis is mainly respiratory, it can technically take hold in locations other than the lungs such as the spine, brain, joints, kidneys or the lymph nodes around the neck.

The small bumps (tubercula in Latin) that would develop around the neck in the latter scenario probably gave rise to the name tuberculosis but during the Middle Ages this was thought to be an entirely separate condition known as scrofula.

It is said that victims of scrofula would seek a cure for this by lining up to be touched by French and English monarchs, something known as the royal touch. Needless to say, this was unsuccessful.

For the more prevalent respiratory form of TB physicians had little more advice to give other than warmth, rest and good food.

After Koch’s discovery, an insight into disease transmission at least helped to limit the spread of TB via close contact, coughing, sneezing and spitting.

It was around this time that public health campaigns to clamp down on spitting in public became commonplace.

This was also the era of the sanatoriums during which retreats for patients suffering from TB started to pop up along European coastlines and on the slopes of mountains in the hope that isolation and fresh air would aid recovery.

These sanatoriums became quite prominent within popular culture, featuring in many films and novels. Well-known sufferers from TB include John Keats, Edgar Allan Poe, Anton Chekhov and Frederic Chopin, leading some to label it the “romantic disease”.

Since the advent of antibiotics around the middle of the last century, doctors have been able to combat TB more effectively.

Rather than a week’s course of an antibiotic that might be expected for most other bacterial infections, however, TB requires a bit more firepower.

Typically between four and six antibacterials are used for at least six months. The number of agents used depends very much on the level of resistance that that particular strain of tuberculosis has. Indeed, antibacterial resistance is becoming an increasing issue in the treatment of tuberculosis.

For a disease that has been so harmful for so long, we must perhaps reflect upon how fortunate we are to live in an age in which we have such treatments.

It follows that those treatments must be employed responsibly so that they remain effective for as long as possible.

As long as we do so, it means that the only vampire panics we have to deal with these days are the trick or treaters turning up on our doorsteps.