Were there any real pre-antibiotic cures for TB?

January 25, 2007 10:58 AM

BackInTime Filter: If I could go back in time to pre-antibiotics, and I caught "consumption" (TB), is there anything I could do to treat it, given my 21st century knowledge?

This is a kind of Conetticutt Yankee question. I've been thinking about what would happen if I could go back in time with the knowledge we routinely have access to now.

TB seems (from what I can tell) to be one of those diseases that only became treatable following the invention of antibiotics. If I went back in time, would there be any other options?

I'm not interested in discussions of routine overuse of antibiotics today, nor a description of pre-antibiotic treatments that were little more than superstition (eg Gurdijeff's sleeping with cows treatment etc).

posted by media_itoku to Science & Nature (25 answers total)

The best you could do was eat well and exercise....TB generally stays dormant in people with strong immune systems. Other than that, you're basically SOL. Unless you enjoy a good bloodletting.
posted by emd3737 at 11:04 AM on January 25, 2007

I think, although I'm not positive, that you've got the right idea. But it's worth pointing out that in healthy folks exposed to TB only ~40% will develop active TB in the first year of exposure, and the chances go down after that. So what you're talking about wanting to treat is active TB, catching TB isn't enough to warrant treatment.
posted by OmieWise at 11:15 AM on January 25, 2007

You could reinvent Penicillin, you just need to find the right mold.
posted by borkencode at 11:34 AM on January 25, 2007

Life in the Sanatorium. The emphasis was on the quality of the air, fresh food, and healthy living. Unsurprisingly, it took years for some to recover; many did not.
posted by ikkyu2 at 11:38 AM on January 25, 2007

I guess that link, while interesting, doesn't really answer your question. The answer is "no." Antibiotics are necessary to treat TB.
posted by ikkyu2 at 11:40 AM on January 25, 2007

Penicillin doesn't work against TB.
posted by Steven C. Den Beste at 12:18 PM on January 25, 2007

You could reinvent Penicillin ... Penicillin doesn't work against TB

Yes, but you could find the leading thinkers of the day and tell them what an antibiotic is and how it works in general, and where they should start looking and hopefully spur them along.

Imagine going back to the pre-Wright Bros days and explaining to Ben Franklin how an airplane works. That kind of thing.
posted by frogan at 12:39 PM on January 25, 2007

Does anyone know how one might go about re-inventing penicillin? As in, from a post Zombie Apocalypse point of view, how do I find, identify, and then manufacture?
posted by bastionofsanity at 1:11 PM on January 25, 2007

Funny, I have a recurring nightmare about this very topic.

I KNOW that I know how to make a battery, but dammit I just... can't... remember! If only I had brough BOOKS with me.

Re TB, it's probably worth noting that not all of the pre-antibiotic surgical treatments were quackery.
posted by rokusan at 1:12 PM on January 25, 2007 [1 favorite]

Penicillin doesn't work against TB.

I doubted you on this one SCDB; I had always just assumed, along with some other people whose articles I found online, that TB had developed resistance to penicillin, but detailed accounts (such as this charming, prize-winning essay by a high-school student) all support your assertion. But I did also find a very interesting account which also bears directly on the OP's question:

Apart from the discovery of Lactobacillus bulgaricus, Dr. Grigorov made a major contribution to the creation of an anti-tuberculosis vaccine. On 20 December 1906, in Paris in issue No104 of the “La Presse Médicale” medical journal, was published his scientific report “The Anti-tuberculosis vaccine”, which informed the scientific community about the results of his research into the application of penicillin fungi for the treatment of tuberculosis. After the publication, the scientific community expressed serious interest in Dr. Grigorov’s vaccine. Through his scientific experiments “in-vitro” and “in-vivo” on lab animals and later on human patients, Dr. Grigorov clearly demonstrated and described the healing effect of penicillin fungi in the treatment of tuberculosis.

This passage was evidently written by the Stamen Grigorov Foundation, but I suppose there could be something to it if penicillin is not the only weapon in the anti-bacterial arsenal of the penicillin fungus-- which would be surprising if it were not the case, really.
posted by jamjam at 2:00 PM on January 25, 2007

If you wait a few years before starting your time travel, there could be some advances in phages. Perhaps they will find some naturally-occurring phages that would combat TB.
posted by joaquim at 2:42 PM on January 25, 2007

Reading about Dr. Edward Livingston Trudeau, who founded a TB sanitorium in Saranac Lake, NY, gives a lot of information about the treatment of TB at the turn of the century. He was diagnosed with TB in 1870, but after moving to the cold, clear climate of the Adirondacks, he went into remission. He later moved his practise to the mountains and was the first U.S. doctor to isolate the bacteria that caused TB.

Saranac Lake is full of turn of the century homes with "cure porches", screened in areas open to the air. So, if you caught TB now, you could move up there and hope for remission. (I actually go to a doctor located in Trudeau's old home, which I think is pretty cool)
posted by saffry at 3:31 PM on January 25, 2007

I may or may not have had the TB virus for many, many years without getting sick or being treated for it (depending on which doctor you believe), and this suggests to me that for plenty of healthy young people with strong immune systems it probably wouldn't be such a big deal.
posted by croutonsupafreak at 3:36 PM on January 25, 2007

This is an awesome question. I am the same as rokusan. ("Let's see, I'll probably need.... a magnet??")

I don't know how you'd cure it. But could you vaccinate yourself ahead of time by somehow coming in contact with dead forms of the bacteria? Leave a TB victim's blankets out in the sun for a few weeks after they died and then deeply inhale from the blankets? (Maybe then you'd catch it -- I don't know.)
posted by salvia at 5:37 PM on January 25, 2007

Your best hope would be to "take the cure." Though if you were learned, you could get a job at one of the new state universities in the western and southwestern US, where the clean, dry air brought a lot of sanitarium construction. The University of Colorado picked up a number of profs this way in the early 20th century, including their first liberal arts dean, Fred Hellems (see #17).
posted by dw at 5:41 PM on January 25, 2007

I may or may not have had the TB virus for many, many years without getting sick or being treated for it

Right. You don't have "consumption," never did.
posted by ikkyu2 at 6:24 PM on January 25, 2007

Deeply inhaling someone's blankets would give you TB, if anything - it's airborne transmitted. The only known 'vaccine' is something known as bacille Calmette-Guerin, which isn't a very good vaccine.

Vaccination with bCG turns your PPD test positive, rendering it impossible to screen you for the presence of tuberculosis; that combined with the vaccine's very low efficacy mean it's not routinely used in much of the world. It's not like the polio or chicken pox vaccines, folks; you can still die of TB even if you were vaccinated with bCG, and thousands do so each year. Many public health experts point out that the loss of the ability to screen for TB accurately probably far outweighs the public health benefits conferred by this vaccine.

I believe the modern era of anti-TB therapy began with streptomycin, a medicine whose systemic toxicities (deafness and kidney damage) have caused it to fall out of modern favor. It can be purified from a pure culture of a particular bacteria; bacteriology and fungology are things the budding time-traveler would do well to study.

I've taken penicillin by mouth, and I've also accidentally bitten into a piece of very moldy bread. So now I know what penicillin and penicillium tastes like; if I had to reinvent the wheel I'd certainly start there. But penicillin doesn't kill TB. I'm not sure how I'd find Streptomyces griseus, but I'm told it's a gram positive rod with an earthy odor and I seem to recall it has a lot of periodic acid-Schiff positive material on its cell wall; I guess I'd try to culture something that fit that description and see if small inocula of it killed lawns of E.coli.
posted by ikkyu2 at 6:33 PM on January 25, 2007

I may or may not have had the TB virus for many, many years without getting sick or being treated for it


and just to be clear, TB is bacterial, not viral.
posted by brandz at 6:55 PM on January 25, 2007

The most important aspect of TB compared to other bacterial diseases is that it reproduces about 25 times slower. Most bacteria divide about every half hour in favorable conditions, whereas TB usually divides about every 12 hours. All other life processes in TB are equally pokey.

That makes it difficult to culture for medical research. And it has an effect on treatment. Because TB lives slow, it also dies slow. Standard treatment for TB is Rifampin and Isoniazid, usually administered for six months continuously. (Most antibiotic treatments last ten days. After ten days TB is barely beginning to notice that the drugs are present.)

Technically speaking both of them are "antibiotics", but they're not what most people think of when they use that term. They're not even remotely like penicillin.

Rifampin is derived from a bacterium, but it's also chemically modified. Isoniazid is chemically related to nicotine, I think. (It's technical name is "isonicotinic acid hydrazide".) The Connecticut Yankee in Queen Victoria's Court ain't gonna be creating either of these with 19th century chemistry and/or biology, and eating moldy bread won't help.
posted by Steven C. Den Beste at 12:22 AM on January 26, 2007

The most important aspect of TB compared to other bacterial diseases is that it reproduces about 25 times slower

No! The most important aspect of Mycobacterium tuberculosis infection compared to other bacterial diseases is the mycolic acid in the cell wall, which prevents opsonization!
posted by ikkyu2 at 1:41 AM on January 26, 2007 [3 favorites]

Imagine going back to the pre-Wright Bros days and explaining to Ben Franklin how an airplane works.

Ah, the Lest Darkness Fall model.
posted by Chrysostom at 5:52 AM on January 26, 2007

Leprosy is also a member of the tuberculosis family ( the mycoplasmas), and I've wondered occasionally if leprosy would give you some immunity to tuberculosis, but according to a fairly recent study the truth is a bit darker:

A weakening of the immune system following infection by leprosy, coupled with the stress, poverty and malnutrition associated with the social isolation and stigma of living with the disease, could have paved the way for opportunistic co-infection by TB which brought a speedier death. In time this would reduce the number of individuals suffering from leprosy, leading to its overall decline.

The last sentence refers to the fact that leprosy was widespread and greatly feared in Europe in the Middle Ages, then mysteriously declined. The authors seek to attribute that decline to the rise of tuberculosis. The linked ariticle includes a shocking statistic I had not previously seen: "one third of the world's population [is] now infected" with the TB bacterium.

But if leprosy gives no protection against TB, and perhaps just the reverse, and vaccines have not worked, does having a TB infection which is under control eliminate the chance of a subsequent infection, perhaps with a more virulent strain, or not? If so, maybe arranging for exposure to the smallest possible amount of TB when you are in the rudest possible health would be a good strategy for the OP.
posted by jamjam at 12:57 PM on January 26, 2007

No, that's the whole point, jamjam: TB pretty much flies under your body's immune surveillance. If your strategy made sense, one of the efforts to create a live TB vaccine would've worked, and none of them have.

By the way, TB and leprosy are mycobacteria, not mycoplasma. Leprosy remains the world's most common cause of peripheral neuropathy, with an estimated 100 million infected worldwide as of 2000.
posted by ikkyu2 at 10:08 AM on January 29, 2007

Thank you for that correction, ikkyu2, I have evidently had mycoplasmas and mycobacteria conflated for years. Perhaps you will by interested to see, in light of your remark about breathing through weeks old sun-exposed blankets of a person with TB, that according to the 1999 edtion of the Merck Manual, "Spread can occur in mycobacteriological laboratories and autopsy rooms, in part because the hydrophobic nature of the organism facilitates aerosolization. Fomites appear to play no role in their spread."

I do appreciate that "TB pretty much flies under your body's immune surveillance," yet the immune system must be able to get some grip on it in most people, or else everyone who harbors the bacterium would develop a clinical case. Also, as I understand it, many of the cases of TB seen in AIDS patients are the result of the reemergence of latent infections, implying that probably the immune system was playing a key role in restraining TB in these individuals. I value your opinion very highly, but I would appreciate seeing a study which tended to demonstrate that the presence of living but controlled TB mycobacteria of the sort which most healthy people who test positive appear to have, does not offer any protection against subsequent development of disease from exposure to a new strain or, indeed, subsequent re-exposure to the same strain.
posted by jamjam at 11:35 AM on January 29, 2007

The way I've always understood this, jamjam - and I'd spend a lot of time thinking about it, commuting on the NYC subway system, staring at a chunky wad of sputum on the floor of the subway car - was that the folks whose immune systems were able to get a grip on that slippery mycolic-acid coat were not at risk of contracting clinical TB pneumonia anyway, and hence didn't need to be vaccinated.

Other people, for whatever reason - the unique conformation of their personal MHC? Something else? - simply couldn't mount an immune response to the mycobacterium, never mind what part of the bug they were inoculated with.

Interestingly, leprosy exists in lepromatous and tuberculoid forms, suggesting that different people mount a wholly different immune response to the same bug - the former being predominantly cell-mediated, and the latter antibody-mediated was the simplistic way that was explained; the reality appears to be more complicated.

Wish I knew more about it.
posted by ikkyu2 at 8:21 PM on January 29, 2007