The Birmingham Historical Society marked the place, now in English Village, where tuberculosis was first fought in North Alabama. Photo by Nick Patterson.
It may have been a stunning irony that on World TB Day, which is celebrated March 24 every year, the Homewood City Schools posted the following on their website:
Dear Parents:
We have been notified by the Jefferson County Department of Health (JCDH) that a freshmen student at Homewood High School has been diagnosed with tuberculosis. TB is a contagious airborne respiratory disease; however, it does not live long in the environment, nor does it pass through the air over significant distances. We have met with Jefferson County Department of Health (JCDH) officials, who are overseeing our response to this situation per their guidelines, those of the Centers for Disease Control and Prevention (CDC) in Atlanta, and our Homewood Board Policy JGC (“Communicable/Infectious Disease or Conditions”).
Personnel from JCDH will offer a TB skin test tomorrow, March 25, to all interested students and staff members in order to allow the results to be read before the Spring Break holiday. Testing consists of two phases: an injection of tuberculin purified protein derivative (PPD) will be given into the inner surface of the forearm tomorrow, and the skin test reaction will be read on Friday. Students will need to be present at school tomorrow and Friday to complete testing. If students are not able to participate in both tests, please consult with your pediatrician or the JCDH for testing. Permission forms must be returned to the school tomorrow for the test to be administered.
Attached is information from the CDC and JCDH about TB and the TB Skin Test that will be administered by the JCDH.
I am sure you understand that the identity of the individual is strictly protected by federal privacy laws.
We wanted to be certain that all of our parents, whether their students are to be tested or not, received accurate first-hand information about this situation to avoid the spread of confusion and misinformation.
Sincerely,
Dr. Bill Cleveland, Superintendent
Long before this latest and, for many, surprising incidence of TB in an over-the-mountain suburb of Birmingham, March 24 had long been commemorated as the date when, in 1882, Dr. Robert Koch “astounded the scientific community by announcing that he had discovered the cause of tuberculosis, the TB bacillus,” according to StopTB.org.
Image of Mycobacterium tuberculosis MEB by NIAID/Flickr/Wikimedia Commons.
Back then, TB was anything but rare, and it remained, as it had been for most of human history, one of mankind’s deadliest diseases. “At the time of Koch’s announcement in Berlin, TB was raging through Europe and the Americas, causing the death of one out of every seven people,” noted stoptb.org.
And while TB seems to be regarded by some as almost an anachronism in modern America, the StopTB website notes that it remains “an epidemic in much of the world, causing the deaths of nearly one-and-a half million people each year, mostly in developing countries.”
The Global Tuberculosis Institute at the New Jersey Medical School agrees with that assessment, noting on its website that, “The registered number of new cases of TB worldwide roughly correlates with economic conditions: the highest incidences are seen in those countries of Africa, Asia, and Latin America with the lowest gross national products. The World Health Organization estimates that nine million people get TB every year, of whom 95 percent live in developing countries.”
Tuberculosis is caused by a bacterium called Mycobacterium tuberculosis. The bacteria usually attack the lungs, but TB bacteria can attack any part of the body such as the kidney, spine and brain. If not treated properly, TB disease can be fatal, according to the Centers for Disease Control and Prevention in Atlanta.
The U.S. is not “a developing country” but the CDC says on its website that, “in the United States the number of tuberculosis (TB) cases has been declining since 1993; however TB is still a life-threatening problem in this country. TB knows no borders, and people here in the United States are suffering from TB.”
The Global Tuberculosis Institute traces increases of the disease in the U.S. and other industrialized countries partly to “a high rate of immigration from countries with a high incidence of TB.” HIV infection also leads to increases in TB cases, especially in developing nations, as does multi-drug resistant, mutant forms of the disease.
Alabama is also not a part of the developing world, but is experiencing a resurgence of the disease in some quarters. The case in Homewood, for instance, led to testing the student, teacher and administrative population of the school, which resulted in several other people seeming to be infected. Public health officials, who have not indicated how many additional cases have been found in Homewood, did note that the skin test given after the first confirmed student case is known for false positive and false negative results.
What’s next for the cases in Homewood? Not clear. A representative of the Homewood City Schools referred Weld to the Jefferson County Department of Health. The doctor who has taken the lead in dealing with the Homewood cases could not be reached for comment.
Alabama’s overcrowded prisons are also seeing an increase in tuberculosis cases. The Associated Press reported last August that the number of cases in state correctional institutions had dramatically risen: “Alabama’s prison system…is facing its worst outbreak of tuberculosis in five years, a health official said Thursday. Pam Barrett, director of tuberculosis control for the Alabama Department of Public Health, said medical officials have diagnosed nine active cases of the infectious respiratory disease in state prisons so far this year.”
The AP story quoted Barrett as saying that the prison cases — with eight of the nine cases being at St. Clair County Correctional Facility — constitute “a very serious outbreak.” Although the outbreak appeared near its end at the time of the article, with no new cases reported for several prior, Barrett said that “The Department of Corrections is a hotbed of TB because of the living arrangements.” At the time the St. Clair prison, designed to hold 984 men, actually held 1,292.
Image of Catawba Sanitorium from the book “Tuberculosis hospitals and sanatorium construction” taken in Catawba, Virginia about 1911 (Internet Archive Book Images/Flickr Commons).
History
Tuberculosis, also known as consumption, is one of the oldest known diseases. According to the Global Tuberculosis Institute at the New Jersey Medical School, TB “has been present in the human population since antiquity — fragments of the spinal column from Egyptian mummies from 2400 BCE show definite signs of tuberculosis.”
History shows, the website notes, that about 460 BCE Hippocrates identified consumption, in Greek phthisis, as “the most widespread disease of the times, and…almost always fatal.”
Evidence exists for tuberculosis throughout human history and across civilization. In Europe the 200-year epidemic of the disease from the 17th to the 19th centuries was called The Great White Plague.
According to the Journal of Military and Veteran’s Health, “During the 18th and 19th centuries tuberculosis was epidemic in Europe and caused millions of deaths, particularly in the poorer classes of society. Tuberculosis declined after the late 19th century but remained a major public health issue as it still is today.”
The disease that wiped out nearly a quarter of Europe’s population during the height of its rampage also inspired a lot of art.
“The disease also inspired some of the great plays, books and operas of the 19th century. Think Victor Hugo’s epic novel Les Miserables and Giacomo Puccini’s heart-wrenching masterpiece La Boheme,” wrote Michaeleen Doucleff, digital editor for the National Public Radio Science Desk, in a look at TB in 2013.
The list of famous people who contracted TB is a who’s who of notable names, including (to mention just a few): Pocahontas, gun-slinging dentist Doc Holliday; an untold number of writers, including members of the Brontë family, Albert Camus, Robert Burns, Anton Chekov, Stephen Crane, Dashiell Hammett, Robert Heinlein, Washington Irving, Franz Kafka, John Keats, D.H. Lawrence, George Orwell, Dylan Thomas, Robert Louis Stevenson, Henry David Thoureau and Thomas Wolfe; artists including Paul Gauguin; composers including Frederic Chopin and Igor Stravinski; freedom fighter and politician Nelson Mandela; religious reformer John Calvin; U.S. President Andrew Jackson; U.S. First Lady Eleanor Roosevelt; archbishop and activist Desmond Tutu; nurse Florence Nightingale; inventor Alexander Graham Bell; actors W.C. Fields, Vivien Leigh; singers and musicians Sarah Bernhardt, Jimmie Rodgers, Tom Jones, Ringo Starr and Cat Stevens; Birmingham-born novelist Walker Percy, local madam Louise Wooster and train robber and outlaw Rube Burrow.
Artists and writers seemed to accept, if not welcome, TB, as noted in Doucleff’s piece.
“’It was the fashion to suffer from the lungs; everybody was consumptive, poets especially,’ wrote Alexandre Dumas, author of The Three Musketeers, in his memoir. ‘It was good form to spit blood after each emotion that was at all sensational, and to die before the age of 30.’
“From the works of John Keats and Lord Byron to Charles Dickens and Fyodor Dostoevsky, references to TB pervade art and literature in the 19th and early 20th centuries. “ The story quotes Dr. Mel Spigelman, who leads the nonprofit TB Alliance: ‘George Orwell’s Animal Farm is probably based on his experience living in a sanatorium.’”
Not surprisingly, TB has a long history in Alabama as well. A marker erected by the Birmingham Historical Society in Lane Park takes note of the tent city created there in 1910 as the first site in North Alabama’s battles against TB. Nevertheless, in 1955, the Jefferson County Department of Health listed TB as the leading cause of death in the county, according to the website Bhamwiki. By 1958, the JCDH reported 1,521 new TB cases in the county.
In 1964, lights in the shape of a Christmas tree decorated the side of the Vulcan tower and would glow red whenever there was a new TB diagnosis — like the statue’s torch did at the time for traffic fatalities.
Sanatoria — facilities for TB patients to rest, be exposed to fresh air and, it was hoped, recover — were common sights in Alabama as elsewhere. Until the advent of antibacterial medicines to treat the disease — which is today managed with as many as four drugs at once — TB was often, but not always, fatal.
Today, TB is treatable, and it is noteworthy that not everybody who carries the bacterium or is exposed to it becomes sick with TB. Latent TB infection leads to a course of treatment, as described by the CDC: “If you have latent TB infection but not TB disease, your health care provider may want you be treated to keep you from developing TB disease. Treatment of latent TB infection reduces the risk that TB infection will progress to TB disease. Treatment of latent TB infection is essential to controlling and eliminating TB in the United States. The decision about taking treatment for latent TB infection will be based on your chances of developing TB disease.”
Taking several drugs, usually for 6 to 9 months, can treat those who contract the disease, the CDC says. “It is very important to finish the medicine, and take the drugs exactly as prescribed. If you stop taking the drugs too soon, you can become sick again. If you do not take the drugs correctly, the germs that are still alive may become resistant to those drugs. TB that is resistant to drugs is harder and more expensive to treat.”
The Alabama Department of Public Health maintains a Division of TB Control. On the ADPH website, the department notes that it’s ultimate “is the elimination of tuberculosis in Alabama. Until that goal is reached, the Division strives to reduce the annual burden of disease, limit transmission and prevent future cases through the provision of diagnostic, treatment, and case management activities. The Division of TB Control provides these services to all persons in Alabama, regardless of the ability to pay. This commitment to the citizens of Alabama has contributed to historic declines in TB morbidity and mortality.”
So, while TB has reared its fearsome head in the state again, experts believe that it is possible to control the disease. Its days of ravaging the world as it did throughout history may be over, but tuberculosis continues to make it’s presence felt.
For more information, visit adph.org/TB