By the beginning of the 19th century, tuberculosis, or "consumption," had killed one in seven of all people who had ever lived. Victims suffered from hacking, bloody coughs, debilitating pain in their lungs, and fatigue. There was no known cure, but doctors had come to recognize that fresh air and outdoor living could change the course of the disease. Explore a timeline of the disease's persistent and ever-evolving presence in American life.
Health officials begin recording tuberculosis (or consumption) mortality rates in the U.S. In Massachusetts alone, there are 300 tuberculosis deaths for every 100,000 individuals.
In New England, nearly 2% of the population dies of consumption – the region's peak mortality rate for the disease.
Health seekers begin to move to the newly acquired lands in the West and settle there in an attempt to cure themselves through nature. Pamphlets distributed in the East claim the air in certain western territories -- such as Minnesota and Oregon -- is so pure that it could cure anyone, including consumptives.
Railroad lines expand westward, making the American frontier more accessible than ever before. Property developers launch a campaign to persuade those with consumption to settle along the railroad because, they claim, the clean western air would cure them. These small railroad towns contribute to the rise of cities like Albuquerque and Colorado Springs, though these new environments turn out to be not as effective as projected in curing respiratory diseases.
Health seekers found the city of Colorado Springs, CO. Consumptives flock there and to other similar cities at the advise of their doctors, who believe good climate, ventilation, and rest are the best ways to combat the disease.
Physician Edward Trudeau from New York City arrives in the Adirondack Mountains after he is diagnosed with tuberculosis. His doctor suggests he spend time in the mountains to benefit from the fresh air. Over the next four months, Trudeau grows stronger and gains 15 pounds. When he returns to New York City in September 1873, his health begins to deteriorate again.
Close to death, Trudeau permanently moves his wife and two children to Saranac Lake in the Adirondack Mountains, where his health improves even in the dead of winter.
German physician and scientist Robert Koch presents his discovery of Mycobacterium tuberculosis in a lecture to the Physiological Society of Berlin. His findings reveal the direct cause of TB and verify that the disease is highly contagious.
The medical community, largely convinced that tuberculosis is genetic, dismisses Koch's findings as overly radical. Trudeau, however, is inspired by these discoveries and begins his own research into the tuberculosis bacterium at his makeshift laboratory in Saranac Lake.
Trudeau establishes the Adirondack Cottage Sanatorium as a research facility and a safe haven for those suffering from TB. Trudeau's facility, modeled after similar institutions in Europe, is the first of its kind in the U.S.
Dr. Lawrence F. Flick organizes the Pennsylvania Society for Prevention of Tuberculosis. The organization's goals include educating the public about TB prevention and helping the poor receive medical treatment and protective supplies to combat the disease. It is the first organization of its kind in the U.S.
A report commissioned by the New York City Board of Health finds that more than 6,000 New Yorkers had died from tuberculosis the previous year. The report emphasizes the disease's contagious, yet preventable nature and recommends educating the public about the disease, reporting all cases, and establishing a hospital specifically for consumptives.
The Land of Sunshine, a journal filled with testimonies of Southern California's "healing powers," is first published. Editor Charles Willard -- who himself suffers from TB -- hopes the publication will attract members of the upper class to Los Angeles, but soon thousands of people with consumption swarm Los Angeles. In 1880, the city was described as a "sleepy semi-Mexican pueblo [town] of 11,000," but by 1900, thanks to promotional publications like The Land of Sunshine, 102,000 people had settled in LA.
After his laboratory burns to the ground due to a faulty heater, Trudeau rebuilds and founds the Saranac Laboratory for the Study of Tuberculosis. This is the first United States laboratory devoted solely to tuberculosis research.
Dr. Trudeau and Dr. Flick team up with other physicians to found the National Association for the Study and Prevention of Tuberculosis (which will eventually become the American Lung Association in 1973). Much like Dr. Flick's previous organization, the NASPT aims to educate the public about tuberculosis prevention. The doctors specifically target schools where they teach young children about the benefits of good hygiene and exercise.
The Adirondack Cottage Sanitarium in Saranac Lake founds the first nursing program specifically targeted for the care of TB patients. Trudeau specified that applicants to the D. Ogden Mills Training School for Nurses had to have an arrested case of TB, believing that they would have greater understanding of their patients' situation. It also helped provide former TB patients with a meaningful career that might not otherwise be available to them.
Trudeau succumbs to tuberculosis at the age of 67, 42 years after first being diagnosed. Edward's son Francis B. Trudeau, also a doctor, becomes director of the newly renamed Trudeau Sanatorium until its closing in 1954.
Fifty-four years after Trudeau founds the first sanitarium in the U.S., more than 700 sanatoriums are open nationwide. In the first decades of the 20th century, 1 out of every 170 Americans lived in a sanatorium.
Dr. Selman A. Wakman, an expert on soil microbiology, assigns a research project to Rutgers graduate student Albert Schatz. The research will focus on Streptomyces, organisms that are half bacteria, half fungi, which Wakman believes may prove crucial to a TB-fighting antibiotic.
Under Doctor Wakman's supervision, Schatz discovers a strain of Streptomyces bacterium that is potent in destroying harmful bacteria. After several weeks of sleeping in the lab in order to study the bacteria, Schatz witnesses the destruction of the tubercle bacillus by a bacterium they later name streptomycin.
In the first human trial, tuberculosis patient Patricia T receives five courses of streptomycin. Within days, Patricia T's infection begins to disappear, and she is discharged from the hospital after a few months. A follow-up appointment in August 1954 will determine that Patricia's TB had remained inactive since her streptomycin treatment a decade earlier.
Streptomycin is administered to tuberculosis patients nationwide, though within months of their initial treatment, many patients began to relapse. Researchers come to understand that streptomycin did not destroy all of the TB bacteria, producing organisms that grow stronger and more resistant to the antibiotic. Researchers begin to study other antibiotics that can be added to a streptomycin regimen.
Other TB-fighting antibiotics are developed, including para-amino salicyclic acid, isoniazid, pyrazinamide, cycloserine, and kanamycin. These drugs fight tuberculosis in different ways than streptomycin, and, with them, doctors introduce combination drug therapy, which keeps tuberculosis in remission for longer periods of time than streptomycin on its own. The combination drug therapy also has a longer treatment time of 18 months.
Seventy years after opening, the Trudeau Sanatorium closes its doors due to changing medical techniques and a diminishing rate of tuberculosis infection in America. Former professional baseball player Larry Doyle, a resident of the Sanatorium for 12 years, is the last tuberculosis patient to leave the facility.
Scientists at the Lepetit Pharmaceuticals research lab in Italy discover a new bacterium in a soil sample from a forest on the French Riviera. The new species, which researchers name "rifamycins," produces a new class of antibacterial molecules and becomes a significant development.
The new antibiotic rifampicin – developed from rifamycins – is introduced into the standard TB drug cocktail. The addition of this antibiotic shortens combination-drug treatment for tuberculosis from 18 months to nine months. With the further addition of pyrazinamide, which was developed in the mid-1950s, the treatment period shrinks even further to just six months.
Tuberculosis treatments are now so effective that there are nearly half the number of TB cases reported 15 years earlier in 1953. Health officials in New York City declare TB on the brink of complete eradication, and they begin to close the city's TB clinics. Two-thirds of the clinics will be closed within 20 years.
The first reports of HIV surface in the United States. The ensuing spread of AIDS, which weakens its hosts' immune systems, makes way for the resurgence of several infectious diseases considered by many to be nearly eradicated in the U.S., including tuberculosis. New, multi-drug resistant strains of TB are starting to show up, plaguing a health care system that is ill-equipped to both treat and study them.
The World Health Organization (WHO) and the International Union Against Tuberculosis and Lung Disease (IUATLD) sponsor the first World TB Day to raise awareness about the physical and economic consequences of TB and its continued role in global health.
For the first time since health officials changed the reporting parameters for Tuberculosis in 1975, the number of new TB cases in the U.S. plateaus. The following year, it begins rising.
This increase in tuberculosis cases is largely due to the HIV/AIDS epidemic. Within a decade, AIDS cases in the U.S. will skyrocket from fewer than 100 cases in the early 1980s to over 200,000 by 1991.
The Centers for Disease Control and Prevention (CDC) publishes A Strategic Plan for the Elimination of Tuberculosis in the United States, which proposes a national strategy to eradicate TB from the U.S. by the year 2010. The elimination of the disease is defined as less than one TB case per one million persons per year. In the report, the Advisory Council for the Elimination of Tuberculosis outlines action steps to achieve this goal, including creating new tools for diagnosing, preventing and treating tuberculosis, and applying these to public health practices.
The tuberculosis rate peaks at 26,673 reported cases in the United States. Between 1985 (the year with the lowest number of reported TB cases since reporting began in the 1950s) and 1992, reported TB cases increased by just over 20%, with the largest increases occurring in New York, California and Texas.
Federal funding for tuberculosis treatment, control and research is increased to combat the recent resurgence. The CDC transfers the majority of these new funds to support clinics and laboratories, sponsor clinical and epidemiologic research, increase investigation of latent TB strains in people with high risk for the active disease, and expand surveillance to monitor the impact of these efforts.
Renewed vigilance against the disease pays off, and tuberculosis incidence in the U.S. declines. Between 1992 and 2001, the annual decline averaged 7.3%.
While the number of tuberculosis cases in the U.S. continues to decline, the disease remains a global threat. In its Trends in Tuberculosis publication, the CDC reports that foreign-born persons account for 64.6% of TB cases in 2013. People born outside of the U.S. also account for 88% percent of all U.S. Multi-Drug Resistant (MDR) TB cases in 2012. Four states -- California, Texas, New York and Florida -- reported more than half of the cases of TB in the U.S. in 2013. The CDC attributes this to these states' large at-risk populations for TB, namely foreign-born persons and -- in New York, California and Florida -- high rates of homelessness.
A team of paleogeneticists led by Kirsten Bos at the University of Tubingen discovers that seals were potentially the first carriers of tuberculosis to the Americas around six thousand years ago. This research into the genetic "family tree" of tuberculosis may help scientists understand how the disease is transmitted, and how it might evolve in the future.
My American Experience
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