Shropshire Routes to Roots

3. Tuberculosis

What is tuberculosis?

Tuberculosis like leprosy is a chronic infectious disease. It has a long history, but there is a rising prevalence in the later middle ages continuing well into the 20th century until the introduction of antibiotics. In the 17th century it accounted for 20% of all deaths in London in non plague years.

Are there different types of tuberculosis?

Two types of tuberculosis would have affected man in antiquity, the human or bovine tuberculosis.
Bovine tuberculosis would have been secondary in humans and is dependent upon a close co-existence between man and animal, with the infection spreading to man through infected milk and meat. The stomach and bones are commonly involved, the individual would not only have suffered loss of appetite but also vomiting and diarrhoea. This was probably the most common form of tuberculosis in pre-industrial Europe. Milk supplies in the 18th century were notorious and were often watered down. Some milk from tuberculosis infected cows contained blood or pus. The Lancet Medical Journal in 1847 blamed London's milk supply for the rise in scorfula a form of glandular tuberculosis.

Vertebrae showing Tuberculosis Larger image, in a new window [33kb] [Reproduced with permission of Frances Lee]

There is plenty of evidence for this form of tuberculosis as it attacks the bones of its sufferer. Abscess formation seen here takes place in the vertebral body which later collapses anteriorly giving the typical hunch back appearance of the Potts spine

Human tuberculosis is often known as consumption. This form of the disease is much more common in our recent history and was spread from person to person by droplet infection. It is therefore a population density dependent disease which thrives on closely gathered groups, increasing greatly with urbanisation. The site of infection is the lung and resulted in breathlessness, a distressing cough and blood stained sputum.

How were people with tuberculosis treated?

Until the 1880's there was no real treatment for tuberculosis other than herbal remedies. Most were cared for at home. Unfortunately here they were likely to infect the other members of the household.

This plant is the Bugle which was given to sufferers of tuberculosis to help them cough up blood.

The Purple Bugle Larger image, in a new window [33kb] [Reproduced with kind permission of Secret Shropshire]

In the early 18th century tuberculosis was recognised as a contagious condition. Hospitals began to exclude tuberculosis patients and many were ostracised from communities and even their own families. This had far reaching implications not just on the life of the sufferer. Often the whole family were affected as employers saw consumptives as an employment, as well as, health risk.

TB card (with the name of the patient obscured) Larger image and transcript, in a new window [Shropshire Archive reference: 6175/B/12/5/3]

Until comparatively recently any employment working with food, or in the Health Services, required a chest X ray before a contract of employment would be issued. This image is a tuberculosis caution card.

Why were tuberculosis sufferers sent to sanatoriums?

Clearly there was a need to do something about treatment. From the mid 19th century and for the next 100 years sanatoriums fulfilled this role.

Here patients were placed outside whatever the weather. The sunlight, fresh air, and a good diet were thought to help. Long periods of bed rest were prescribed to rest the lungs. Sanatoriums taught patients about hygiene and the spread of the disease. Simple things like covering the mouth when coughing and burning blood stained and bacilli filled handkerchiefs. This image show the opening of Shirlett sanatorium near Much Wenlock. With the introduction of antibiotics the number of sanatorium beds gradually fell until eventually Shirlett was closed.

Opening of Shirlett Sanatorium Larger image, in a new window [83kb] [Shropshire Archive reference: 1147/1-6]

Did hospitals also contribute to the treatment of tuberculosis?

The Home for Crippled Children at Baschurch, run by Agnes Hunt was the beginnings of the Robert Jones and Agnes Hunt Orthopaedic Hospital at Oswestry. Here children suffering from tuberculosis were treated. Most of these had bovine tuberculosis which had affected the bones and joints.

Treatment book Larger image and transcript, in a new window [Reproduced with kind permission of Robert Jones and Agnes Hunt Orthopaedic Hospital ]

The changes to the skeleton, as a result of TB, are pus formation and destruction. The swollen knee and burst abscess both indicate just such an infection.

Many of the children were operated on by Mr Robert Jones. After their operations they were put in plaster casts and prescribed bed rest. The picture shows the TB cast room in the 1930's at The Orthopaedic Hospital.

TB plaster room Larger image, in a new window [62kb] [Reproduced with kind permission of Robert Jones and Agnes Hunt Orthopaedic Hospital ]

Violet Ray treatment Room Larger image, in a new window [67kb] [Reproduced with kind permission of Robert Jones and Agnes Hunt Orthopaedic Hospital ]

Another form of treatment was Ultraviolet light which was found to inhibit the growth of the tuberculosis bacillus. This was also used at Oswestry.

In the 1930's thoracic surgery became common. In particular artificial pneumothorax was hoped to bring a cure. This was an operation in which the lung was collapsed artificially to give the diseased lung a chance to rest and recover.
Happily between 1945 and 1960 the production and use of antibiotics became common. This has resulted in a dramatic decline in tuberculosis which is now not as common among young people as it used to be.

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