Consumption: A Disease For All Seasons, not Just a Winter's Tale

We often talk colloquially about a disease consuming an individual. Examples include AIDS, cancer, or, quite literally flesh-eating bacteria. However, there is one disease that actually has the original claim to that moniker: tuberculosis. 

Consumption was the name of the condition that eventually became known as tuberculosis and its first mentions reach back to the times of Hippocrates and Herodotus. Indeed the Hippocratic corpus distinctively describes consumption (phthisis in Greek) as being nearly always fatal and consisting of symptoms recognizable to a physician practicing over 2000 years later. The disease, in an era without antibiotics and proper nutrition, could be a death sentence and as the infection progress patients would literally waste away as the disease consumed them.

In the developed world, tuberculosis has faded from the mind of the general public and in the US we are now at an all time low with cases falling below 10,000 with 65% of cases occurring in those born outside the US--a statistic often misused by anti-immigration advocates. Because certain types of tuberculosis are transmitted from person-to-person through the air it is one of the instances in which legitimate quarantine orders are issued in the US for non-compliant patients.

A recent movie--in which I had to suspend disbelief about a flying horse, cessation of aging, and Lucifer--reminded me that anti-immigration sentiment over tuberculosis is nothing new. In the supernatural film Winter's Tale a couple arriving in late 19th century America is summarily deported when a "pulmonary" problem is detected on their screening immigration physical examination and later in the film a character dies of it. The pulmonary problem was tuberculosis.

If one reads historical accounts of how immigration and infectious diseases interacted--such as Howard Markel's When Germs Travel--you will learn that fear of tuberculosis led to a very unscientific process of looking for and excluding those with a physical appearance thought to be conducive to tuberculosis infection--ignoring the fact that the disease had stricken many individuals including the famous and the beautiful.

Tuberculosis was, for a time, the reigning king of infectious disease killers before being replaced by HIV and it has not lost its appetite for blood. Now armed with drug resistance genes, tuberculosis control will remain an important task for the foreseeable future.