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Human Disease

Few other diseases carry more public concern, and no disease is more difficult to describe, than tuberculosis; as the tubercle germ can attack may different parts of the body and manifest itself in many ways. Furthermore, it is a widely spread disease, infecting not only humans but also cattle, birds and reptiles. But here we are concerned with those types common to man - the human and bovine (i.e. the type occurring in cattle which can be spread to man by infected milk).

The tubercle bacillus is particularly hardy, so that when coughed or spat out on the ground it continues to be infectious for a long time. Infection is therefore caused by:

  • drinking infected milk;

  • droplet infection from aerosols produced by coughing;

  • breathing in infected dust.

In other words, tuberculosis is caused by absorption through either the lungs or the intestines; the former is common in adults, the latter in children.

But there is a good deal more to the problem than this; we know, for example, that over 90% of people in industrial countries have been infected with TB in early life and have conquered the infection. So the question arises: what conditions pre-dispose to TB - why do some people get over the early infection and others not? There are two answers to this question: one is certain - that those who are impoverished and do not get enough food are liable to TB; the second is not so certain - that mental stress plays some part. Stress causes a general reduction in immunity, predisposing the body to several infections including TB.

In children, lung tuberculosis is not common, but tuberculosis of the bones and glands is, as is also infection in the abdomen, the kidney or spine, and, worst of all, tuberculous meningitis. These are often of the bovine type from infected milk. Ordinarily, TB in children is less serious than adult infections; but tuberculous meningitis used to be almost invariably fatal until streptomycin was discovered.

Adult tuberculosis usually occurs in the lungs or the pleura - the thin membrane surrounding the lungs. In younger people miliary tuberculosis, which is a form of TB. blood-poisoning or septicaemia, is a very serious condition, and the infection spreads throughout the whole body in a few weeks.

Lung infection begins gradually in someone who has previously felt unwell. There may be cough, and later blood-stained sputum (although blood which is coughed up does not necessarily prove that TB is present). Whatever means of treatment is used, the struggle between disease and patient is likely to be fairly long, but the outlook is now generally good. The closure of the Swiss sanatoria is due partly to modern disbelief that air in one place is better than that in another, but mainly to improved treatment.

Prevention depends on legal action ensuring tuberculosis-free herds of cattle; on control of spread of the disease by those “open” cases who carry germs in their sputum; on the use of vaccination in childhood with the safe BCG vaccine.

Many methods are used in treatment: drugs, such as streptomycin, isoniazid, and PAS, lung surgery, rest, and so on. TB is now a fairly rare disease in developed countries, but there are increasing worries that the emergence of antibiotic-resistant strains will lead to an upsurge in its frequency in the developed western world. Like many aspects of third-world healthcare provision, the money needed to make very serious reductions in the number of people struck down by TB is relatively small, but the political will do make the efforts has not been there. Sadly, as the HIV/AIDS infection takes hold in greater numbers of people in the third-world, the ability to provide safe effective vaccines, will be increasingly compromised.

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