June 5, 2025 • 21 mins
Tuberculosis: What is it? What causes it? And what are the symptoms? In this episode, we will explore the history of Tuberculosis, the tests we use to diagnose it, and how we currently treat it, including the preventative methods. So tune in to learn more!
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Resources:
TB alliance: https://www.tballiance.org/
References:
https://pmc.ncbi.nlm.nih.gov/articles/PMC5432783/
https://www.mayoclinic.org/diseases-conditions/tuberculosis/symptoms-causes/syc-20351250
https://my.clevelandclinic.org/health/diseases/11301-tuberculosis
https://education.nationalgeographic.org/resource/giant-rats-trained-sniff-out-tuberculosis-africa/
https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-024-09313-0
https://www.museumofhealthcare.ca/explore/exhibits/breath/famous-people-with-tuberculosis.html
https://pmc.ncbi.nlm.nih.gov/articles/PMC1360500/
https://www.sots.ac.uk/wiki/deuteronomy/
https://www.learnreligions.com/book-of-leviticus-701146
https://www.britannica.com/science/kings-evil
https://www.cfsph.iastate.edu/FastFacts/pdfs/bovine_tuberculosis_F.pdf
https://lungfoundation.com.au/lung-health/protecting-your-lungs/how-your-lungs-work/
*This podcast is for entertainment purposes only. If you suspect you have a medical condition, please seek out an opinion of a medical professional.*
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
For the past few weeks, you have had an awful cough.
(00:02):
You have been blaming it on the colds and flus
that were going around,
but you have never had one last this long.
It has gotten to the point where you have constant chest pain
that is worse when you breathe or cough.
You are exhausted, feeling like you've hardly slept at night
due to the constant coughing.
And when you do sleep, you wake up in puddles of sweat.
This morning, you coughed up blood,
which made you feel concerned.
(00:23):
This is definitely no normal flu.
Because of this, you decide to see a doctor.
(upbeat music)
- Hello, and Welcome to Anatomy Of Illness.
(00:44):
Today's episode is about tuberculosis.
Before we get into the condition,
we are going to start with history.
So why do we know tuberculosis exists?
Buckle up, we are going to be jumping
pretty far back in time.
We are going to begin 150 million years ago,
as this is when it was believed
that the genus Mycobacterium originated.
The genus Mycobacterium is the family
(01:04):
that tuberculosis comes from.
Moving forward to 3 million years ago,
an early ancestor of Mycobacterium tuberculosis
was believed to be infecting early hominids
across East Africa.
Hominids refers to the class known as the great apes.
So us, chimpanzees, gorillas,
and also the extinct ancestors that would lead to us.
Think Neanderthals.
(01:25):
We are going to jump quite far ahead in history,
all the way to the ancient Egyptians.
We are going to around 2,400 BC,
as we are going to examine some mummies,
some Egyptian mummies specifically.
So these mummies displayed characteristics of tuberculosis.
But didn't mummies around that time
have their organs removed?
So there were no lungs in the actual mummy.
(01:45):
So where were the signs of tuberculosis?
Well, I am glad you asked.
Tuberculosis does not just affect the lungs,
like in the mummies in this case.
These mummies had skeletal deformities
that are considered to be Potts lesions.
Potts with a double T, not the dysautonomia type POTS.
Potts lesions indicate that these mummies
had tuberculosis in their bones.
(02:06):
There are also similar abnormalities depicted
in the early Egyptian art at the time.
However, there is no mention of tuberculosis in any papyrus.
The first written accounts of tuberculosis
would actually come from ancient India,
around 3,300 years ago, and ancient China, 2,300 years ago.
And now with this being such an old disease,
there is of course biblical mentions of it.
(02:28):
We are going to talk about the books
of Leviticus and Deuteronomy.
Leviticus is believed to be written
between 1,440 to 1,400 BC.
Whereas it is argued with Deuteronomy,
it's either around the same time, 7th century BC,
or even 5th century BC.
So we are just going to ignore the timeline there
with Deuteronomy.
The book is here.
(02:48):
That is all that matters.
So these two biblical books mentioned
something called Schachepeth.
Although there are other references
to wasting diseases in the Bible,
and there were other diseases
that called wasting away symptoms,
it is believed that these two are most likely
to specifically reference tuberculosis.
Staying in this time and quickly shifting over
to the Andean region, as we are going to be looking
(03:09):
at some Peruvian mummies for a moment.
These mummies also had evidence of tuberculosis
through Potts deformities that were found in the mummies.
There's hints that this disease was there
before the Europeans would even come to South America.
Now we move to ancient Greece to meet with a show regular.
You guessed it, Hippocrates.
In ancient Greece, tuberculosis was known as Phthisis.
Hippocrates would describe the fatal nature of this disease,
(03:31):
especially for young adults.
He would also accurately describe the symptoms
of tuberculosis and the tubercular lung lesions.
Hippocrates would not be the only ancient Greek
to discuss tuberculosis.
We would also have Isocrates,
who lived between 436 to 338 BC.
He was the first to describe tuberculosis
as an infectious disease.
And Aristotle, also in the Greek era,
(03:53):
would highlight that the disease was also contagious
in pigs and oxen.
Moving on to the Roman times,
this is where it would be known as Tabes.
Galen would describe in 174 AD the symptoms of tuberculosis.
He would include in these symptoms,
fevers, blood-stained sputum,
so this is mucus that you cough up, sweating, and coughing.
For this, he recommended several things
(04:14):
for the treatment of tuberculosis.
This included sea voyages, fresh air, and milk.
Now we move on to the Middle Ages.
Tuberculosis gains yet another new name, the king's evil.
It is called this in both England and France,
in the 12th century and onwards.
This is where it was believed that the royal touch
could cure the condition.
A report at the time by William of Malmesbury
(04:36):
would come up with reported complimentary cures
for tuberculosis.
These included a coin talisman,
visiting the royal tombs, or the king's touch.
The king's touch would be done until 1714 in England,
with Queen Anne being the last monarch
to participate in the practice.
King George I was against the idea of it,
and said no to doing it anymore in 1714.
(04:58):
However, this practice would last a little longer in France,
with it being continued until 1825.
Jumping back to the 12th century for a moment,
there were also, at the time,
reports of a new form of tuberculosis popping up.
This was called scrofula.
It was tuberculosis affecting the lymph nodes in the neck.
In 1363, there would be a proposed cure
for the king's evil by Guy de Chauliac.
(05:20):
He suggested the removal of the scrofulous gland,
so the infected glands.
Moving on to 1679, Francis Silvius would illustrate
the pathological and anatomical descriptions
of the disease in his book, "Opera Medica."
In this, he discusses how tuberculosis infections
go from tubercles to abscesses, then cavities and empyemas.
(05:41):
He described these as being both in the lungs
and in other affected sites in the body.
Empyemas are pus-filled cavities.
Moving on to 1735 in Italy.
This is where there would be a compulsory notification
by the health board in part of Italy.
This declared that consumptive,
which is what they called those with tuberculosis
(06:01):
or the consumption, had to be isolated.
They were not allowed to be admitted to public hospitals,
and it defined what should be done with them.
The health board also had to be notified
about those diagnosed with tuberculosis.
The term consumption and physicists had been used
in the 17th, 18th, and up to the mid-19th century.
The consumption was the term used
due to the way the disease consumed someone,
(06:23):
not only their health, but also their wellbeing.
It was also called the robber of youth.
It was considered a wasting disease because of this.
The robber of youth nickname was due to the higher death rate
in younger people in the 18th century in Western Europe.
It would gain another nickname in the 18th century,
the white plague.
This was due to the extreme paleness caused by the anemia
(06:43):
that tuberculosis causes.
In 1793, the caseous necrosis cheese-like abscesses
would be called tubercles by Matthew Baille.
He was a Scottish pathologist at the time.
Now in the mid-19th century, Johann Lukas Shönlein
would rename the disease tuberculosis.
Moving on to 1854, this is when a botany student
by the name of Hermann Brehmer would claim
(07:04):
that tuberculosis was a curable disease.
This was after he, who was suffering from tuberculosis,
would return from a trip to the Himalayan mountains,
claiming himself as healed after this.
This is how we would get the sanatorium cure.
This would lead to him founding the institution Gorbersdorf.
This was in a mountain town in the middle of a fear forest.
This was done in order to attempt to cure those
(07:25):
with tuberculosis by supplying them
with good nutrition and clean air.
This would be the template for other sanatoriums
built for the same purpose.
Moving on to the 24th of March, 1882.
This is when Robert Koch would present his results
to the Society of Physiology of Berlin.
These results were his isolation of the tubercle bacillus.
(07:46):
If you're enjoying this episode,
then you should share it with a friend.
So what causes tuberculosis?
Tuberculosis is caused by a bacteria
known as Mycobacterium tuberculosis,
which is normally spread by someone
who has an active tuberculosis infection
of the voice box or lungs.
With this, the droplets produced by the person
when they sing, laugh, talk, or cough, or even sneeze,
(08:06):
contain the bacteria which is spread through the air.
Someone can get this infection
from inhaling these droplets.
There are also other ways of catching tuberculosis,
however, less common due to changes
in food and health practices.
One of the big ones being consuming raw milk.
This is milk that has not been pasteurized.
I don't care if your mom's uncle's donkey's
grandfather's neighbour drank raw milk back on the farm
(08:27):
and was fine, it's called a survivorship bias,
and anecdotal evidence is the lowest form of evidence.
I don't wanna hear it, really don't.
But anyway, back to drinking raw milk, which you should not.
You can get bovine tuberculosis if the cow was infected
and many other diseases because it's not clean.
This can cause, obviously, the lung form of tuberculosis,
but also other forms, so an infection in the kidneys,
(08:48):
brain, or in the spine.
You don't want any of these, especially in the brain.
You can also get it from being around cows in rarer cases,
from inhaling the bacteria
or having cuts or breaks in your skin.
You kind of need to be around the cow for that,
so, you know, this is quite a hard version
of the infection to get.
This type of bacteria is known as Mycobacterium bovis.
You can also get it from being around other animals
(09:10):
like deer, buffalo, sheep, goats, horses,
dogs, cats, and pigs,
and they can show symptoms of having it,
like diarrhoea or even constipation.
However, those are symptoms of like many other diseases,
including gastroenteritis,
which you can also get from cows.
Joys of zoonotic diseases.
How to be diagnosed tuberculosis.
A doctor will first ask some questions
about recent symptoms, medical history,
(09:31):
and other important questions to better understand
what may be going on.
For example, how long have you been coughing for?
Have you been exposed to anyone who was sick?
Have you traveled anywhere recently?
Do you live or work around anyone who has tuberculosis?
The doctor will then listen to your lungs
through a stethoscope and check for swollen lymph nodes.
If a doctor suspects you have tuberculosis,
they will order several tests done,
(09:53):
one of these tests being a skin test.
With this test, a tiny amount of a substance
known as tuberculin is injected just under the skin.
This is then checked 48 to 72 hours later for a reaction.
If it is positive, it means your body makes an antibody
for tuberculosis and has reacted to do so.
In this case, it could mean three things.
You have an active tuberculosis infection.
(10:14):
You have a latent tuberculosis infection.
So an infection that is not causing symptoms,
nor is it able to spread to others,
or you have been vaccinated against tuberculosis,
as this can sometimes cause a positive reaction to the test
without having a tuberculosis infection.
If it is a negative infection,
so no reaction does not always mean
you don't have tuberculosis.
All it means is you don't make antibodies to this.
(10:37):
A reaction is considered positive
if there is raised skin or swelling at the site.
Other tests a doctor is likely to run in order to test
if they suspect tuberculosis include blood tests.
Certain tests of the blood can be done,
including one to see if the immune cells
within the blood recognise tuberculosis.
If the immune cells recognize the tuberculosis bacteria,
then it is considered a positive
(10:58):
and shows that you either have a latent or active infection.
A negative means it's unlikely you have tuberculosis.
With a positive tuberculosis result,
other tests are likely to be done.
These include x-rays.
X-rays of the chest are able to show us
if tuberculosis is active.
As with this, you will find irregular patches in the lungs.
This is obviously if the tuberculosis is in the lungs.
(11:19):
Sputum tests.
This is a test that gets you to cough up a sample of mucus,
which is tested for bacteria.
Several tests are run on these samples.
The first is to test for bacteria
and if it has features of tuberculosis bacteria.
However, with this test, it is not a definitive diagnosis,
as there are some bacteria that are similar feature-wise.
Another test will confirm
(11:39):
if it is definitely tuberculosis bacteria.
This can also tell you
if it is a drug-resistant strain of tuberculosis.
This is specifically if you have tuberculosis in the lungs
or in the voice box, which is the larynx.
Tuberculosis can occur in other places.
Other tests can be done to help with diagnosing tuberculosis.
These include urine tests, breath tests,
tests of the cerebrospinal fluid,
which is the fluid around the brain and spine,
(12:01):
and a procedure that removes the sputum from your lungs
with a special tube.
This test will, of course,
depend on where the tuberculosis is suspected to be
and your circumstances.
Purely out of fun fact interests,
with the sputum tests,
we are going to take a quick flight over to Africa,
stopping over in Mozambique, Tanzania,
and a few other countries.
I hope everyone has their passports.
(12:21):
Otherwise, I will send you a postcard.
Not my fault if you didn't grab your passport.
But what is so fun about spitting mucus into a cup?
Well, it is more about what is going to happen to it,
as it's not fun to actually do this test.
But what happens?
Well, this is where we have specially trained
African giant pouched rats come in.
In some laboratories,
there are these specially trained rodents
that have been taught how to sniff out tuberculosis
(12:43):
in sputum samples.
These rats are able to pick up on missed cases,
increasing the amount of people
getting treatment for tuberculosis.
They are well taken care of
and are well-rewarded for their work
in tuberculosis detection.
We'll get right into symptoms and presentation
right after this little break.
(upbeat music)
(Upbeat music)
(13:05):
This podcast is supported by listeners like you
on Buy Me a Coffee.
What are the symptoms of tuberculosis?
Well, the symptoms of tuberculosis
will depend on several things.
Firstly, where the infection is,
and secondly, what stage is the infection at?
So what are the stages of a tuberculosis infection?
(13:25):
When it comes to tuberculosis,
there are three main stages.
There are the primary tuberculosis infection stage.
This is the first stage of the infection.
This is where the immune system
will attempt to kill the tuberculosis bacteria.
However, some of the bacteria do manage to survive
this process, which is what causes the second stage.
Most people do not get symptoms
in the primary stage of tuberculosis.
(13:46):
However, if there are symptoms,
they are normally flu-like.
The symptoms associated with the primary tuberculosis stage
are low fever, tiredness, or a cough.
The second stage of the tuberculosis infection
is called the latent stage.
This stage is where the immune cells have built walls
to contain the tuberculosis bacteria.
The bacteria are alive.
However, they are under control,
(14:07):
so they are unable to cause harm.
So in this stage, there are no symptoms.
You are also unable to spread the infection
during this time.
Moving on to the third stage.
This is an active tuberculosis infection.
With this, the immune system is no longer able
to keep the tuberculosis bacteria under control,
leading to disease in the lungs
or in other parts of the body.
Active tuberculosis can happen after primary tuberculosis,
(14:29):
or it can happen after months to years
of latent tuberculosis.
With an active infection,
the symptoms will slowly come on, worsening over time.
It can even cause death if left untreated.
If the infection is in the lungs,
the symptoms may include a bad cough,
normally lasting more than three weeks.
So it is no longer an acute cough, it is a chronic cough.
This cough may even bring up blood or mucus.
(14:51):
You could also have pain with this coughing
or also with breathing.
Chest pain, fever, chills, and night sweats.
You may feel tired and generally unwell.
You may lose your appetite and may also lose weight.
Tuberculosis can occur in areas outside of the lungs.
Symptoms for these include tiredness
and feeling generally unwell,
weight loss and not wanting to eat,
(15:11):
fevers, chills, and night sweats,
dark or cloudy urine, swollen glands,
constipation, a headache, feeling confused, a stiff neck,
a rash on the legs, face, or any other part of the body,
and also pain near the site of infection.
Common sites of tuberculosis infections
outside of the lungs include the larynx,
you may know this as your voice box,
the cerebrospinal fluid.
This is the fluid that surrounds your brain and spinal cord.
(15:34):
Bones and joints are another site of infection,
the walls of blood vessels, the heart muscles, lymph nodes,
this is what they call scrofula,
the kidneys and liver, genitals, and even the skin.
When it comes to children,
they can also display different symptoms
of active tuberculosis infections.
For those aged between one to 12 years old,
they can have fevers that just won't go away
and weight loss.
(15:55):
This is especially for younger children.
For infants, it can cause several symptoms.
The baby may not gain weight or grow as expected.
They may also display symptoms of swelling
in the cerebrospinal fluid.
These are symptoms like being unusually fussy,
being inactive or sluggish,
having poor reflexes, vomiting, and poor feeding.
They can also have a bulging soft spot on their head.
(16:15):
So this is the fontanelle, this is the part like
on the top of the head in the middle of the skull.
This is the reason why you can actually pop a child out
because their skull kind of squishes together.
I know, weird, but also cool.
What should a doctor be aware of
when it comes to tuberculosis?
When it comes to tuberculosis,
doctors should be aware of several things.
These include miliary tuberculosis.
This is when tuberculosis is able to spread
(16:36):
throughout the body,
which can cause several other conditions.
The name miliary tuberculosis comes from millet seeds
because apparently it has a millet seed appearance.
Well, it was given that name as it appeared
like millet seeds, according to the dude who named this.
So the other conditions it can cause include meningitis.
This is an inflammation
of the protective outer lining of the brain, the meninges.
This can be fatal.
(16:57):
Signs to keep an eye out for when it comes to meningitis
are sensitivity to light, a stiff neck, severe headache,
sudden changes in behaviour.
So this may be confusion, aggression, you know,
anything that just isn't their normal, seizures or fits,
and weakness or loss of movement in one part of the body.
These are signs you should skip the GP waiting room
and just head straight to the emergency room.
(17:17):
These are also signs if it's just a different form
of meningitis, you know, not from tuberculosis,
but other types of bacteria.
Scrofula, this is when the lymph nodes
in your neck are affected.
This causes them to be swollen.
Potts disease, again, this is Potts with a double T.
This is when the spine is affected by tuberculosis.
It is also called tuberculosis spondylitis
or spinal tuberculosis.
(17:37):
Hepatitis, this is an inflammation of the liver.
So the tuberculosis is gone to the liver.
Addison's disease, we covered this in episode 14,
if you want to know more about it,
but essentially it is a condition
that causes the adrenal glands
to not produce enough hormones.
Doctors should also be aware of drug resistant tuberculosis.
This form of tuberculosis exists for several reasons.
These include using ineffective medications.
(17:58):
So this could be using only one medication
in attempt to treat tuberculosis for quality medications
or storing them incorrectly
as well as stopping treatments early.
Due to this, the tuberculosis bacteria can gain immunity
to antibiotics, making it harder to treat in the future.
So this is why we type the bacteria
and see what it's immune to or sensitive to,
which gives us a better picture of how to treat it.
(18:19):
How do we treat tuberculosis?
Well, the treatment of tuberculosis
would depend on several things.
This includes, is it active or is it latent?
Is it drug resistant?
What other medical conditions do you have?
When it comes to latent tuberculosis infections,
if you have other conditions like HIV/AIDS,
doctors are likely to recommend treating it
due to the risk of infection becoming active.
As with immune disorders, you have less immune system
(18:41):
to keep that tuberculosis infection latent.
This treatment normally takes
around three to four months to complete.
When it comes to active tuberculosis infection,
it takes longer to complete the course of treatment.
This can be for four, six, or even nine months,
depending on your specific situation.
Do not stop the treatment partway through
just because you feel fit as a fiddle.
That does not mean anything
(19:01):
unless you are cleared by a doctor to stop the treatment.
As this is part of the reason
why we have drug resistant tuberculosis
and recurrent infections.
When it comes to treating tuberculosis,
a combination of antibiotics may be used.
We can also prevent tuberculosis by a vaccine.
This is called the BCG vaccine.
However, this is used in high risk areas
and high risk people.
So do you live in a country
(19:22):
that has high amounts of tuberculosis cases?
Do you work in areas that may have a higher risk
of catching tuberculosis?
Or are you going to spend, you know,
a few weeks to a few months in an area
that may increase your risk of catching tuberculosis?
Are there any famous people who have had tuberculosis?
Yes, there are several famous people
who have had tuberculosis,
including the author, George Orwell.
(19:43):
You might know him if you ever read the book,
"1984" in English literature.
Fun little tidbit about that book.
He was sick with tuberculosis whilst writing the novel.
He actually thought he ruined it
because he was rushing to write it
before he was hospitalised.
We know this from a letter he sent to F.J. Warburg.
Here is part of that letter.
"I am really very unwell indeed
and am arranging to go into a sanatorium early in January.
(20:05):
I ought to have done this two months ago,
but I wanted to get that bloody book finished."
Several months after publishing "1984",
Orwell did die of complications caused by his tuberculosis.
If you would like to check out a book about tuberculosis,
then you should check out
"The Black Angels, The Untold Story of the Nurses
Who Helped Cure Tuberculosis" by Maria Smilios.
This book is about the nurses who helped
(20:26):
to take care of those who had tuberculosis
in the sanatoriums before the invention of antibiotics.
If you would like to read a memoir,
there is "The Little Locksmith" by Catherine Butler Hathaway.
It is about the life of Hathaway,
who at age five was strapped to a board
to avoid getting a hunchback
due to having spinal tuberculosis,
also known as Pott's disease.
She was forced to stay that way until she was 15.
(20:48):
This story follows her after the failed attempt
to fix her back and what she goes through
on a day-to-day basis.
Because tuberculosis is not as common as it once was,
there are not many foundations for the condition,
especially ones that only work in specific countries.
However, there are global foundations.
For example, the TB Alliance.
This foundation is dedicated to discovering
new and better treatments for tuberculosis,
(21:10):
as tuberculosis takes quite a while to treat
and can be expensive to treat.
If you want to check out the sources,
social media links, or any other links,
you can head to anatomyofillness.com.
If you enjoyed this episode and would like to hear more,
subscribe to be notified about our latest episodes.
If you want to join our community,
then you can join us on Discord or Instagram.
Otherwise, stick around for the next episode.
(upbeat music)
(21:38):
(upbeat music)
Did you know that no matter how hard you exhale,
there will always be a litre of air in your lungs?
This makes them the only organ that can float on water.
For the past few weeks, you have had an awful cough.
(00:02):
You have been blaming it on the colds and flus
that were going around,
but you have never had one last this long.
It has gotten to the point where you have constant chest pain
that is worse when you breathe or cough.
You are exhausted, feeling like you've hardly slept at night
due to the constant coughing.
And when you do sleep, you wake up in puddles of sweat.
This morning, you coughed up blood,
which made you feel concerned.
(00:23):
This is definitely no normal flu.
Because of this, you decide to see a doctor.
(upbeat music)
- Hello, and Welcome to Anatomy Of Illness.
(00:44):
Today's episode is about tuberculosis.
Before we get into the condition,
we are going to start with history.
So why do we know tuberculosis exists?
Buckle up, we are going to be jumping
pretty far back in time.
We are going to begin 150 million years ago,
as this is when it was believed
that the genus Mycobacterium originated.
The genus Mycobacterium is the family
(01:04):
that tuberculosis comes from.
Moving forward to 3 million years ago,
an early ancestor of Mycobacterium tuberculosis
was believed to be infecting early hominids
across East Africa.
Hominids refers to the class known as the great apes.
So us, chimpanzees, gorillas,
and also the extinct ancestors that would lead to us.
Think Neanderthals.
(01:25):
We are going to jump quite far ahead in history,
all the way to the ancient Egyptians.
We are going to around 2,400 BC,
as we are going to examine some mummies,
some Egyptian mummies specifically.
So these mummies displayed characteristics of tuberculosis.
But didn't mummies around that time
have their organs removed?
So there were no lungs in the actual mummy.
(01:45):
So where were the signs of tuberculosis?
Well, I am glad you asked.
Tuberculosis does not just affect the lungs,
like in the mummies in this case.
These mummies had skeletal deformities
that are considered to be Potts lesions.
Potts with a double T, not the dysautonomia type POTS.
Potts lesions indicate that these mummies
had tuberculosis in their bones.
(02:06):
There are also similar abnormalities depicted
in the early Egyptian art at the time.
However, there is no mention of tuberculosis in any papyrus.
The first written accounts of tuberculosis
would actually come from ancient India,
around 3,300 years ago, and ancient China, 2,300 years ago.
And now with this being such an old disease,
there is of course biblical mentions of it.
(02:28):
We are going to talk about the books
of Leviticus and Deuteronomy.
Leviticus is believed to be written
between 1,440 to 1,400 BC.
Whereas it is argued with Deuteronomy,
it's either around the same time, 7th century BC,
or even 5th century BC.
So we are just going to ignore the timeline there
with Deuteronomy.
The book is here.
(02:48):
That is all that matters.
So these two biblical books mentioned
something called Schachepeth.
Although there are other references
to wasting diseases in the Bible,
and there were other diseases
that called wasting away symptoms,
it is believed that these two are most likely
to specifically reference tuberculosis.
Staying in this time and quickly shifting over
to the Andean region, as we are going to be looking
(03:09):
at some Peruvian mummies for a moment.
These mummies also had evidence of tuberculosis
through Potts deformities that were found in the mummies.
There's hints that this disease was there
before the Europeans would even come to South America.
Now we move to ancient Greece to meet with a show regular.
You guessed it, Hippocrates.
In ancient Greece, tuberculosis was known as Phthisis.
Hippocrates would describe the fatal nature of this disease,
(03:31):
especially for young adults.
He would also accurately describe the symptoms
of tuberculosis and the tubercular lung lesions.
Hippocrates would not be the only ancient Greek
to discuss tuberculosis.
We would also have Isocrates,
who lived between 436 to 338 BC.
He was the first to describe tuberculosis
as an infectious disease.
And Aristotle, also in the Greek era,
(03:53):
would highlight that the disease was also contagious
in pigs and oxen.
Moving on to the Roman times,
this is where it would be known as Tabes.
Galen would describe in 174 AD the symptoms of tuberculosis.
He would include in these symptoms,
fevers, blood-stained sputum,
so this is mucus that you cough up, sweating, and coughing.
For this, he recommended several things
(04:14):
for the treatment of tuberculosis.
This included sea voyages, fresh air, and milk.
Now we move on to the Middle Ages.
Tuberculosis gains yet another new name, the king's evil.
It is called this in both England and France,
in the 12th century and onwards.
This is where it was believed that the royal touch
could cure the condition.
A report at the time by William of Malmesbury
(04:36):
would come up with reported complimentary cures
for tuberculosis.
These included a coin talisman,
visiting the royal tombs, or the king's touch.
The king's touch would be done until 1714 in England,
with Queen Anne being the last monarch
to participate in the practice.
King George I was against the idea of it,
and said no to doing it anymore in 1714.
(04:58):
However, this practice would last a little longer in France,
with it being continued until 1825.
Jumping back to the 12th century for a moment,
there were also, at the time,
reports of a new form of tuberculosis popping up.
This was called scrofula.
It was tuberculosis affecting the lymph nodes in the neck.
In 1363, there would be a proposed cure
for the king's evil by Guy de Chauliac.
(05:20):
He suggested the removal of the scrofulous gland,
so the infected glands.
Moving on to 1679, Francis Silvius would illustrate
the pathological and anatomical descriptions
of the disease in his book, "Opera Medica."
In this, he discusses how tuberculosis infections
go from tubercles to abscesses, then cavities and empyemas.
(05:41):
He described these as being both in the lungs
and in other affected sites in the body.
Empyemas are pus-filled cavities.
Moving on to 1735 in Italy.
This is where there would be a compulsory notification
by the health board in part of Italy.
This declared that consumptive,
which is what they called those with tuberculosis
(06:01):
or the consumption, had to be isolated.
They were not allowed to be admitted to public hospitals,
and it defined what should be done with them.
The health board also had to be notified
about those diagnosed with tuberculosis.
The term consumption and physicists had been used
in the 17th, 18th, and up to the mid-19th century.
The consumption was the term used
due to the way the disease consumed someone,
(06:23):
not only their health, but also their wellbeing.
It was also called the robber of youth.
It was considered a wasting disease because of this.
The robber of youth nickname was due to the higher death rate
in younger people in the 18th century in Western Europe.
It would gain another nickname in the 18th century,
the white plague.
This was due to the extreme paleness caused by the anemia
(06:43):
that tuberculosis causes.
In 1793, the caseous necrosis cheese-like abscesses
would be called tubercles by Matthew Baille.
He was a Scottish pathologist at the time.
Now in the mid-19th century, Johann Lukas Shönlein
would rename the disease tuberculosis.
Moving on to 1854, this is when a botany student
by the name of Hermann Brehmer would claim
(07:04):
that tuberculosis was a curable disease.
This was after he, who was suffering from tuberculosis,
would return from a trip to the Himalayan mountains,
claiming himself as healed after this.
This is how we would get the sanatorium cure.
This would lead to him founding the institution Gorbersdorf.
This was in a mountain town in the middle of a fear forest.
This was done in order to attempt to cure those
(07:25):
with tuberculosis by supplying them
with good nutrition and clean air.
This would be the template for other sanatoriums
built for the same purpose.
Moving on to the 24th of March, 1882.
This is when Robert Koch would present his results
to the Society of Physiology of Berlin.
These results were his isolation of the tubercle bacillus.
(07:46):
If you're enjoying this episode,
then you should share it with a friend.
So what causes tuberculosis?
Tuberculosis is caused by a bacteria
known as Mycobacterium tuberculosis,
which is normally spread by someone
who has an active tuberculosis infection
of the voice box or lungs.
With this, the droplets produced by the person
when they sing, laugh, talk, or cough, or even sneeze,
(08:06):
contain the bacteria which is spread through the air.
Someone can get this infection
from inhaling these droplets.
There are also other ways of catching tuberculosis,
however, less common due to changes
in food and health practices.
One of the big ones being consuming raw milk.
This is milk that has not been pasteurized.
I don't care if your mom's uncle's donkey's
grandfather's neighbour drank raw milk back on the farm
(08:27):
and was fine, it's called a survivorship bias,
and anecdotal evidence is the lowest form of evidence.
I don't wanna hear it, really don't.
But anyway, back to drinking raw milk, which you should not.
You can get bovine tuberculosis if the cow was infected
and many other diseases because it's not clean.
This can cause, obviously, the lung form of tuberculosis,
but also other forms, so an infection in the kidneys,
(08:48):
brain, or in the spine.
You don't want any of these, especially in the brain.
You can also get it from being around cows in rarer cases,
from inhaling the bacteria
or having cuts or breaks in your skin.
You kind of need to be around the cow for that,
so, you know, this is quite a hard version
of the infection to get.
This type of bacteria is known as Mycobacterium bovis.
You can also get it from being around other animals
(09:10):
like deer, buffalo, sheep, goats, horses,
dogs, cats, and pigs,
and they can show symptoms of having it,
like diarrhoea or even constipation.
However, those are symptoms of like many other diseases,
including gastroenteritis,
which you can also get from cows.
Joys of zoonotic diseases.
How to be diagnosed tuberculosis.
A doctor will first ask some questions
about recent symptoms, medical history,
(09:31):
and other important questions to better understand
what may be going on.
For example, how long have you been coughing for?
Have you been exposed to anyone who was sick?
Have you traveled anywhere recently?
Do you live or work around anyone who has tuberculosis?
The doctor will then listen to your lungs
through a stethoscope and check for swollen lymph nodes.
If a doctor suspects you have tuberculosis,
they will order several tests done,
(09:53):
one of these tests being a skin test.
With this test, a tiny amount of a substance
known as tuberculin is injected just under the skin.
This is then checked 48 to 72 hours later for a reaction.
If it is positive, it means your body makes an antibody
for tuberculosis and has reacted to do so.
In this case, it could mean three things.
You have an active tuberculosis infection.
(10:14):
You have a latent tuberculosis infection.
So an infection that is not causing symptoms,
nor is it able to spread to others,
or you have been vaccinated against tuberculosis,
as this can sometimes cause a positive reaction to the test
without having a tuberculosis infection.
If it is a negative infection,
so no reaction does not always mean
you don't have tuberculosis.
All it means is you don't make antibodies to this.
(10:37):
A reaction is considered positive
if there is raised skin or swelling at the site.
Other tests a doctor is likely to run in order to test
if they suspect tuberculosis include blood tests.
Certain tests of the blood can be done,
including one to see if the immune cells
within the blood recognise tuberculosis.
If the immune cells recognize the tuberculosis bacteria,
then it is considered a positive
(10:58):
and shows that you either have a latent or active infection.
A negative means it's unlikely you have tuberculosis.
With a positive tuberculosis result,
other tests are likely to be done.
These include x-rays.
X-rays of the chest are able to show us
if tuberculosis is active.
As with this, you will find irregular patches in the lungs.
This is obviously if the tuberculosis is in the lungs.
(11:19):
Sputum tests.
This is a test that gets you to cough up a sample of mucus,
which is tested for bacteria.
Several tests are run on these samples.
The first is to test for bacteria
and if it has features of tuberculosis bacteria.
However, with this test, it is not a definitive diagnosis,
as there are some bacteria that are similar feature-wise.
Another test will confirm
(11:39):
if it is definitely tuberculosis bacteria.
This can also tell you
if it is a drug-resistant strain of tuberculosis.
This is specifically if you have tuberculosis in the lungs
or in the voice box, which is the larynx.
Tuberculosis can occur in other places.
Other tests can be done to help with diagnosing tuberculosis.
These include urine tests, breath tests,
tests of the cerebrospinal fluid,
which is the fluid around the brain and spine,
(12:01):
and a procedure that removes the sputum from your lungs
with a special tube.
This test will, of course,
depend on where the tuberculosis is suspected to be
and your circumstances.
Purely out of fun fact interests,
with the sputum tests,
we are going to take a quick flight over to Africa,
stopping over in Mozambique, Tanzania,
and a few other countries.
I hope everyone has their passports.
(12:21):
Otherwise, I will send you a postcard.
Not my fault if you didn't grab your passport.
But what is so fun about spitting mucus into a cup?
Well, it is more about what is going to happen to it,
as it's not fun to actually do this test.
But what happens?
Well, this is where we have specially trained
African giant pouched rats come in.
In some laboratories,
there are these specially trained rodents
that have been taught how to sniff out tuberculosis
(12:43):
in sputum samples.
These rats are able to pick up on missed cases,
increasing the amount of people
getting treatment for tuberculosis.
They are well taken care of
and are well-rewarded for their work
in tuberculosis detection.
We'll get right into symptoms and presentation
right after this little break.
(upbeat music)
(Upbeat music)
(13:05):
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What are the symptoms of tuberculosis?
Well, the symptoms of tuberculosis
will depend on several things.
Firstly, where the infection is,
and secondly, what stage is the infection at?
So what are the stages of a tuberculosis infection?
(13:25):
When it comes to tuberculosis,
there are three main stages.
There are the primary tuberculosis infection stage.
This is the first stage of the infection.
This is where the immune system
will attempt to kill the tuberculosis bacteria.
However, some of the bacteria do manage to survive
this process, which is what causes the second stage.
Most people do not get symptoms
in the primary stage of tuberculosis.
(13:46):
However, if there are symptoms,
they are normally flu-like.
The symptoms associated with the primary tuberculosis stage
are low fever, tiredness, or a cough.
The second stage of the tuberculosis infection
is called the latent stage.
This stage is where the immune cells have built walls
to contain the tuberculosis bacteria.
The bacteria are alive.
However, they are under control,
(14:07):
so they are unable to cause harm.
So in this stage, there are no symptoms.
You are also unable to spread the infection
during this time.
Moving on to the third stage.
This is an active tuberculosis infection.
With this, the immune system is no longer able
to keep the tuberculosis bacteria under control,
leading to disease in the lungs
or in other parts of the body.
Active tuberculosis can happen after primary tuberculosis,
(14:29):
or it can happen after months to years
of latent tuberculosis.
With an active infection,
the symptoms will slowly come on, worsening over time.
It can even cause death if left untreated.
If the infection is in the lungs,
the symptoms may include a bad cough,
normally lasting more than three weeks.
So it is no longer an acute cough, it is a chronic cough.
This cough may even bring up blood or mucus.
(14:51):
You could also have pain with this coughing
or also with breathing.
Chest pain, fever, chills, and night sweats.
You may feel tired and generally unwell.
You may lose your appetite and may also lose weight.
Tuberculosis can occur in areas outside of the lungs.
Symptoms for these include tiredness
and feeling generally unwell,
weight loss and not wanting to eat,
(15:11):
fevers, chills, and night sweats,
dark or cloudy urine, swollen glands,
constipation, a headache, feeling confused, a stiff neck,
a rash on the legs, face, or any other part of the body,
and also pain near the site of infection.
Common sites of tuberculosis infections
outside of the lungs include the larynx,
you may know this as your voice box,
the cerebrospinal fluid.
This is the fluid that surrounds your brain and spinal cord.
(15:34):
Bones and joints are another site of infection,
the walls of blood vessels, the heart muscles, lymph nodes,
this is what they call scrofula,
the kidneys and liver, genitals, and even the skin.
When it comes to children,
they can also display different symptoms
of active tuberculosis infections.
For those aged between one to 12 years old,
they can have fevers that just won't go away
and weight loss.
(15:55):
This is especially for younger children.
For infants, it can cause several symptoms.
The baby may not gain weight or grow as expected.
They may also display symptoms of swelling
in the cerebrospinal fluid.
These are symptoms like being unusually fussy,
being inactive or sluggish,
having poor reflexes, vomiting, and poor feeding.
They can also have a bulging soft spot on their head.
(16:15):
So this is the fontanelle, this is the part like
on the top of the head in the middle of the skull.
This is the reason why you can actually pop a child out
because their skull kind of squishes together.
I know, weird, but also cool.
What should a doctor be aware of
when it comes to tuberculosis?
When it comes to tuberculosis,
doctors should be aware of several things.
These include miliary tuberculosis.
This is when tuberculosis is able to spread
(16:36):
throughout the body,
which can cause several other conditions.
The name miliary tuberculosis comes from millet seeds
because apparently it has a millet seed appearance.
Well, it was given that name as it appeared
like millet seeds, according to the dude who named this.
So the other conditions it can cause include meningitis.
This is an inflammation
of the protective outer lining of the brain, the meninges.
This can be fatal.
(16:57):
Signs to keep an eye out for when it comes to meningitis
are sensitivity to light, a stiff neck, severe headache,
sudden changes in behaviour.
So this may be confusion, aggression, you know,
anything that just isn't their normal, seizures or fits,
and weakness or loss of movement in one part of the body.
These are signs you should skip the GP waiting room
and just head straight to the emergency room.
(17:17):
These are also signs if it's just a different form
of meningitis, you know, not from tuberculosis,
but other types of bacteria.
Scrofula, this is when the lymph nodes
in your neck are affected.
This causes them to be swollen.
Potts disease, again, this is Potts with a double T.
This is when the spine is affected by tuberculosis.
It is also called tuberculosis spondylitis
or spinal tuberculosis.
(17:37):
Hepatitis, this is an inflammation of the liver.
So the tuberculosis is gone to the liver.
Addison's disease, we covered this in episode 14,
if you want to know more about it,
but essentially it is a condition
that causes the adrenal glands
to not produce enough hormones.
Doctors should also be aware of drug resistant tuberculosis.
This form of tuberculosis exists for several reasons.
These include using ineffective medications.
(17:58):
So this could be using only one medication
in attempt to treat tuberculosis for quality medications
or storing them incorrectly
as well as stopping treatments early.
Due to this, the tuberculosis bacteria can gain immunity
to antibiotics, making it harder to treat in the future.
So this is why we type the bacteria
and see what it's immune to or sensitive to,
which gives us a better picture of how to treat it.
(18:19):
How do we treat tuberculosis?
Well, the treatment of tuberculosis
would depend on several things.
This includes, is it active or is it latent?
Is it drug resistant?
What other medical conditions do you have?
When it comes to latent tuberculosis infections,
if you have other conditions like HIV/AIDS,
doctors are likely to recommend treating it
due to the risk of infection becoming active.
As with immune disorders, you have less immune system
(18:41):
to keep that tuberculosis infection latent.
This treatment normally takes
around three to four months to complete.
When it comes to active tuberculosis infection,
it takes longer to complete the course of treatment.
This can be for four, six, or even nine months,
depending on your specific situation.
Do not stop the treatment partway through
just because you feel fit as a fiddle.
That does not mean anything
(19:01):
unless you are cleared by a doctor to stop the treatment.
As this is part of the reason
why we have drug resistant tuberculosis
and recurrent infections.
When it comes to treating tuberculosis,
a combination of antibiotics may be used.
We can also prevent tuberculosis by a vaccine.
This is called the BCG vaccine.
However, this is used in high risk areas
and high risk people.
So do you live in a country
(19:22):
that has high amounts of tuberculosis cases?
Do you work in areas that may have a higher risk
of catching tuberculosis?
Or are you going to spend, you know,
a few weeks to a few months in an area
that may increase your risk of catching tuberculosis?
Are there any famous people who have had tuberculosis?
Yes, there are several famous people
who have had tuberculosis,
including the author, George Orwell.
(19:43):
You might know him if you ever read the book,
"1984" in English literature.
Fun little tidbit about that book.
He was sick with tuberculosis whilst writing the novel.
He actually thought he ruined it
because he was rushing to write it
before he was hospitalised.
We know this from a letter he sent to F.J. Warburg.
Here is part of that letter.
"I am really very unwell indeed
and am arranging to go into a sanatorium early in January.
(20:05):
I ought to have done this two months ago,
but I wanted to get that bloody book finished."
Several months after publishing "1984",
Orwell did die of complications caused by his tuberculosis.
If you would like to check out a book about tuberculosis,
then you should check out
"The Black Angels, The Untold Story of the Nurses
Who Helped Cure Tuberculosis" by Maria Smilios.
This book is about the nurses who helped
(20:26):
to take care of those who had tuberculosis
in the sanatoriums before the invention of antibiotics.
If you would like to read a memoir,
there is "The Little Locksmith" by Catherine Butler Hathaway.
It is about the life of Hathaway,
who at age five was strapped to a board
to avoid getting a hunchback
due to having spinal tuberculosis,
also known as Pott's disease.
She was forced to stay that way until she was 15.
(20:48):
This story follows her after the failed attempt
to fix her back and what she goes through
on a day-to-day basis.
Because tuberculosis is not as common as it once was,
there are not many foundations for the condition,
especially ones that only work in specific countries.
However, there are global foundations.
For example, the TB Alliance.
This foundation is dedicated to discovering
new and better treatments for tuberculosis,
(21:10):
as tuberculosis takes quite a while to treat
and can be expensive to treat.
If you want to check out the sources,
social media links, or any other links,
you can head to anatomyofillness.com.
If you enjoyed this episode and would like to hear more,
subscribe to be notified about our latest episodes.
If you want to join our community,
then you can join us on Discord or Instagram.
Otherwise, stick around for the next episode.
(upbeat music)
(21:38):
(upbeat music)
Did you know that no matter how hard you exhale,
there will always be a litre of air in your lungs?
This makes them the only organ that can float on water.
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