THE CHANGING FACE OF THE GREAT MIMIC: a look at TB through the years. Introduction Tuberculosis has been known by many different names over the centuries; such names include the phthisis, consumption, scrofula and the white plague.
Doctors developed a much better understanding of the risk factors for TB in the 1800s. In the fifth chapter of their book titled “Researches on the phthisis: anatomical, pathological and therapeutical” (1844), Louis and Walshe describe the risk factors as “Age, female sex ... Delicacy and weakness of constitution ... Respiration of impure air; habitation of confined places”
They also challenged some of the older beliefs that the condition had a hereditary influence or that it was effected by the type of climate a person lived in.
1900s and beyond
The books within the historic collection do not cover the risk factors for TB in the 1900s. This means that we are unable to describe how that may have differed from our current understanding
Modern text gives a very detailed list of risk factors for TB, which includes living in areas where the disease is common and having a weakened immune system. This knowledge has developed as a result of our improved understanding of the pathophysiology of TB.
Doctors in the 1700s did not have many tools for diagnosing disease. In fact a basic tool such as the stethoscope was only invented in the 1816, in Paris by Rene Laennec. therefore many diseases, including TB, were diagnosed on the basis of their clinical presentation. Once again Thomas Reid provides a good description of this in his “essay on the nature and cure of the phthisis pulmonalis”:
“I would define the phthisis pulmonalis when confirmed, to be an expectoration of purulent matter from the lungs by means of frequent coughing: attended with a fever of a peculiar kind, having morning sweats and remissions in the afternoon, occasioning a wasting of the flesh and strength.”
1900s and beyond
The content of the collection highlights the introduction of medical imaging techniques to the diagnosis of respiratory disease.
Seymour Shanks and sir peter Kerley provide a very detailed look at the use chest x-rays for diagnosis of disease in their book “a text book of x-ray diagnosis: in four volumes” (1950).
Sadly the collection does not include any books that highlight the use of microbiological techniques in the diagnosis of TB, which were introduced in the late 1800. and early 1900s.
Rene Laennec invented the stethoscope in the early 1800s, which had a significant impact on the diagnosis of respiratory disease. Doctors were no longer limited to the symptoms that the patient displays, but they could elicit specific signs on examination. William stokes provides a good description of this in his “treatise on the diagnosis and treatment of diseases of the chest” (1837):
“in some a single occasional mucous bubble is the only sign, while in others the respiration is altogether masked by a combination of the sonorous, sibilous and muco-crepitating rails, these signs are audible under the clavicle.”
The treatment of TB was once again limited by the lack of tools at the time. Therefore, as described by Thomas Reid in his “essay on the nature and cure of the phthisis pulmonalis”, non-targeted therapy was usually used:
“principles of which are bleeding, blisters, issues, caustics, and drains of every kind, bark and tonics, oils, balsams, and pectorals.”
But even the author recognised how ineffective this type of therapy was, this is put best by a quote from the same book.
“I fear the observation has been but too much verified “that more die by the lancet than the lance.””
Doctors in the 1800s continued to use the same general measures as their older counter parts. William stokes recommended in his “treatise on the diagnosis and treatment of diseases of the chest (1837) that:
“leeches are to be applied in small numbers alternately to the sub-clavicular and axillary regions of the effected side”
Other doctors recommended more targeted therapy. Charles scudamore (1834) produced many cases recommending the use of inhalation therapy:
“i prescribed a weak solution of iodine, with the addition of some saturated tincture of conium, mixed with water of 120 degrees of heat, to be inhaled for fifteen or twenty minutes, three times a day.”
If you are interested in learning more about the history of TB, we recommend the following books from the collection:
Reid, Thomas – an essay on the nature and cure of the phthisis pulmonalis – 1785.
Stokes, William – a treatise on the diagnosis and treatment of diseases of the chest – 1837.
Louis, P.C.A.; Walshe, Walter hayle – researches on phthisis: anatomical, pathological and therapeutical – 1844.