Speaker 1: There is a dread disease which so prepares its victims,
Speaker 1: as it were, for death. A dread disease in which
Speaker 1: the struggle between soul and body is so gradual, quiet, solemn,
Speaker 1: and the result so sure that, day by day and
Speaker 1: grain by grain, the mortal part wastes and withers away,
Speaker 1: so that the spirit grows light. A disease in which
Speaker 1: death and life are so strangely blended that death takes
Speaker 1: the glow and hue of life, and life the gaunt
Speaker 1: and grisly form of death. A disease which medicine never cured.
Speaker 1: Wealth warded off or poverty could boast exemption from which
Speaker 1: sometimes moves in giant strides, or sometimes at a tardy,
Speaker 1: sluggish pace, but slower quick. It is ever sure and.
Speaker 2: Certain that that was incredible.
Speaker 1: That was very dramatic.
Speaker 2: Yeah, you did a great job.
Speaker 1: Thank you.
Speaker 2: So what is that from?
Speaker 1: That was from Charles Dickens eighteen seventy nine novel Nicholas Nickleby,
Speaker 1: in which he described tuberculosis.
Speaker 2: Is that why we're here this week?
Speaker 1: That's why we're here this week? Good?
Speaker 2: I think that set us up nicely.
Speaker 1: I think so too. Hi, everybody, welcome.
Speaker 2: Hi, welcome to this podcast, Will Kill.
Speaker 1: You, Episode nine nine. Holy cow.
Speaker 2: I know.
Speaker 1: I'm Aaron Welsh and I'm Erin almon Updyke.
Speaker 2: Thanks for joining us.
Speaker 1: We're very excited. All right.
Speaker 2: Do we have any business to take care of? I
Speaker 2: don't know, do we? Okay, I actually do.
Speaker 1: Oh, I have a self correction.
Speaker 2: Okay, two weeks ago or whenever malaria came out, that
Speaker 2: will be two.
Speaker 1: Weeks ago from when you're listening to this. Yeah.
Speaker 2: I kept using the word sincone to talk about these
Speaker 2: Actually the Sincona tree, which is the tree that whose
Speaker 2: bark contains quinine. So I just you know, whoops.
Speaker 1: It happened. Pronunciations are hard. It's sincona, you know.
Speaker 2: I just needed to I needed to say that. Yeah,
Speaker 2: And I think the other bit of business is, you know,
Speaker 2: I hope everyone is having a great winter break.
Speaker 1: Yeah, if you have that. If you have a break,
Speaker 1: we do for now. So yeah, and have a happy
Speaker 1: New Year. Oh it's already New Year's by now. Yeah,
Speaker 1: this is January tewod Yeah, happy happy. Oh my god,
Speaker 1: it's twenty eighteen. I wonder what it's like like. We
Speaker 1: don't know now because it's not there yet.
Speaker 2: Yeah, I mean maybe everything's magically better.
Speaker 1: Oh, wouldn't that be wonderful?
Speaker 2: All right, wow, well, on that note, let's start drinking.
Speaker 1: Well, let's do it. What are we drinking? Quarantiney time?
Speaker 2: We are drinking alcohol consumption. So thus named because tuberculosis
Speaker 2: was often referred to as consumption, particularly in like the
Speaker 2: seventeen eighteen hundreds.
Speaker 1: Oh that's cool. I never knew the time period of it.
Speaker 1: I just knew like back in the day.
Speaker 2: Yeah, I mean that's a rough estimate.
Speaker 1: I'll go with it. Seventeen hundreds, chios darling. Yeah, I
Speaker 1: don't think it's gonna I don't know if it's not
Speaker 1: a good clink. They're coffee mugs. Oh. By the way,
Speaker 1: an alcohol consumption is essentially a hot toddy, And as always,
Speaker 1: we'll post the recipe on all of our social media,
Speaker 1: so check it out.
Speaker 2: It's delicious.
Speaker 1: It is really good.
Speaker 2: It's way better than I was expecting. That's gonna be
Speaker 2: my winter drink.
Speaker 1: Yeah, it's a good winter drink. So tuberculosis. Tuberculosis a
Speaker 1: big nasty. It's a bigger nasty than I realized.
Speaker 2: I'm thrilled to hear all about the biology of it.
Speaker 2: So take us away, let's do it.
Speaker 1: So tuberculosis is caused by a bacterium. It's not so
Speaker 1: very different from one that we've seen already. Do you
Speaker 1: remember which one so many weeks ago leprosy leprosy, So
Speaker 1: tuberculosis is another bacterium in the same genus, Mycobacterium, this
Speaker 1: time Mycobacterium tuberculosis. So they name them so that you
Speaker 1: can remember them easily. It probably evolved from a cattle bacteria.
Speaker 1: I don't know if you're going to talk about its
Speaker 1: evolutionary history later, very briefly, all right, so we'll very
Speaker 1: briefly cover it here too. Probably evolve from cattle bacteria.
Speaker 1: There's actually still cases of zoonotic tuberculosis that are caused
Speaker 1: by the bacterium that normally causes bovine tb very similar bacteria,
Speaker 1: also similar to leprosy. Tuberculousis is transmitted via respiratory droplets,
Speaker 1: so you cough or whatever, and the spittle that you
Speaker 1: spit out is full of bacteria and when it gets
Speaker 1: into someone's face or also, and this is what's different
Speaker 1: than leprosy, tb can hang out in the actual air
Speaker 1: because they're teeny tiny, little particles, so you can cough.
Speaker 1: If you have TB, and you cough a bunch and
Speaker 1: then another person walks into the room and breathes, they
Speaker 1: can get TB.
Speaker 2: That is a nightmare. I know, that's a horror movie.
Speaker 1: It's crazy. But what's really interesting about TB is that
Speaker 1: if you get infected, you only have about a five
Speaker 1: to fifteen percent chance of actually developing active TV, which
Speaker 1: is the disease TB. So TB can get a little
Speaker 1: bit confusing. So I'm gonna do something a little different today. Okay,
Speaker 1: I'm gonna walk you through what happens in your body
Speaker 1: when you get exposed to tuberculosis.
Speaker 2: Oh my gosh, I'm so excited.
Speaker 1: Oh good, I'm excited that you're excited. Okay. So, so
Speaker 1: you're a little micobacteria. Okay, Hi, I'm going to call
Speaker 1: you teebs. Oh my gosh. Cute. Right, So you're just
Speaker 1: swimming along and then all of a sudden, cho uh oh,
Speaker 1: you get sneezed out into the open air. Luckily, the
Speaker 1: person that you came from was a close talker. So
Speaker 1: you end up flying pretty I know, right, You end
Speaker 1: up flying pretty much directly into the face of a
Speaker 1: brand spanking new human.
Speaker 2: I hope this one is also a close talker, because
Speaker 2: I want to be.
Speaker 1: Exposed to as many people as possible. You will be okay.
Speaker 1: So now here you are with a few of your
Speaker 1: friends that you brought with you, and you find yourself
Speaker 1: in the upper respiratory tract of a new human.
Speaker 2: It's pretty cool, right, Yeah.
Speaker 1: You get settled in, you make yourself at home near
Speaker 1: a bunch of cells that make mucus that are kind
Speaker 1: of trying to get rid of you. It's not exactly
Speaker 1: a warm welcome. They're like beating, they're cilia at you, like,
Speaker 1: who the heck are you? Get out of here? Hey? Man?
Speaker 1: Yeah right, let me hang out here.
Speaker 2: It's no big deal.
Speaker 1: And for most people, or for most bacteria rather, that
Speaker 1: would be enough. They're like, man, I just can't take this.
Speaker 1: I'm out of here and that's the end of the story.
Speaker 2: But I'm not most bacteria, am I?
Speaker 1: No, You're not, little tebes, You're really not all all right?
Speaker 1: So you made it past the beaters and the bloodgers
Speaker 1: up in the upper respiratory drag and you're finding your
Speaker 1: way down to the bottom of the lungs the alveoli,
Speaker 1: all right, these are the pockets in your lungs where
Speaker 1: the gas exchange actually happens.
Speaker 2: And that's what I want.
Speaker 1: That's where you want to be. So you make it there,
Speaker 1: and then all of a sudden, some freaking macrophages. Oh right,
Speaker 1: they're basically like pac men. Okay, they're giant pass back
Speaker 1: and they come in and they are literally trying.
Speaker 2: To eat you. Uh huh. I'm not going to stand
Speaker 2: for that exactly.
Speaker 1: So at this point, your human host he knows you're there,
Speaker 1: right they I mean, they probably don't actually, but their
Speaker 1: their immune system does. So the immune system is now
Speaker 1: basically surrounding you. You and your brothers and your friends
Speaker 1: are just like surrounded by the immune system.
Speaker 2: Uh oh.
Speaker 1: So in a lot of stories, this would be the end.
Speaker 1: The human would kick the infection.
Speaker 2: But is this not most stories?
Speaker 1: This is not most stories. Yes, you little tubes, you
Speaker 1: keep right on kicking. Oh man, you just slowly multiply,
Speaker 1: not as slow as your cousin mike lepre remember him.
Speaker 1: Oh yeah, oh mikey man, what a slow poke, real slow.
Speaker 1: But you're you know, you're pretty slow too. Maybe once
Speaker 1: every twenty five thirty two hours you.
Speaker 2: Might divide, you know, that's fast for some people.
Speaker 1: Your right tubes. Sure, So the immune system just keeps
Speaker 1: trying to fight you off, and you just keep slowly growing.
Speaker 1: And this goes on and on for like two maybe
Speaker 1: twelve weeks. Somewhere in that range.
Speaker 2: Man, we're like at a standoff. Yes you really are,
Speaker 2: but I'm secretly back there, just like building my army.
Speaker 1: Just building building, And eventually you end up pretty trapped
Speaker 1: in a little ball, surrounded by immune cells. The tissue
Speaker 1: around you might become necrotic, it might die a little bit,
Speaker 1: the pH might drop, and the environment will become really acidic.
Speaker 1: They'll stop sending food to you, but you just keep living.
Speaker 1: That's not fair. It's not fair. But you don't do anything.
Speaker 1: You're not even growing much anymore. You're just still there.
Speaker 2: I can just picture myself leaning back, elbows crossed, like,
Speaker 2: go on, keep coming exactly everything you got at me.
Speaker 1: And this, my friends, is the latent stage of tuberculosis.
Speaker 1: So you're here isn't infectious at this point, But that
Speaker 1: doesn't mean you're dead.
Speaker 2: Mm mmm.
Speaker 1: You're just biding your time because eventually, your human host
Speaker 1: it's gonna get old. Listen, Patience is a virtue. Exactly.
Speaker 1: They're gonna get old or they're gonna get sick, and
Speaker 1: then those immune cells around you are gonna have to
Speaker 1: go off and deal with the oldness and the sickness,
Speaker 1: and you, well, your time has.
Speaker 2: Come just when their backs are turned.
Speaker 1: So you'll break free with your friends and your family,
Speaker 1: and you'll go forth and you'll multiply, and that is
Speaker 1: when you get an active TB infection.
Speaker 2: Oh yeah, that fun I loved that good. I could
Speaker 2: see it perfectly, so much better than osmosis Jones.
Speaker 1: Right, make that a movie. Oh my god, I forgot
Speaker 1: about osmosis Jones.
Speaker 2: So I remember our eighth grade science teacher got real
Speaker 2: up in arms about it because it should be really
Speaker 2: called diffusion Jones.
Speaker 1: I remember the sides teachers saying the same thing.
Speaker 2: Because osmosis is only water, right exactly.
Speaker 1: Oh man, that's funny.
Speaker 2: Anyway, that was fantastic.
Speaker 1: Oh good, I'm glad. So that is sort of how
Speaker 1: TB initially happens. So do you want to talk about
Speaker 1: the symptoms?
Speaker 2: Yeah, so am I what's happening now that I'm inside
Speaker 2: somebody else?
Speaker 1: Great question. So the symptoms associated with active TB are
Speaker 1: actually pretty nonspecific, but they are really long lasting, so
Speaker 1: you often end up with progressive fatigue, malaise, general weakness,
Speaker 1: maybe some weight loss. You'll definitely get a cough, right
Speaker 1: because teabes and all of your friends and family are
Speaker 1: just filling your lungs with bacteria. You'll probably have fever,
Speaker 1: night sweats. You probably don't have much of an appetite
Speaker 1: since your immune response is like on high alert. So
Speaker 1: that's why you end up losing a lot of weight.
Speaker 1: And that cough might be not descript and unproductive at first,
Speaker 1: but it eventually will end up with what they call
Speaker 1: purulent sputum.
Speaker 2: That does not that does not sound good.
Speaker 1: Right, and it's often bloody. You've seen the movie, right,
Speaker 1: the movie mo On Moge. Oh, yes, yeah, you've seen that.
Speaker 1: You've probably seen a hundred other movies where somebody dies
Speaker 1: of TB. And the way that you know they're dying
Speaker 1: of TB is they're coughing up blood. And you're like, well,
Speaker 1: there you go.
Speaker 2: I just watched Bleak House, the BBC production, and yeah,
Speaker 2: I don't.
Speaker 1: Know what that is.
Speaker 2: It's a Charles Dickens novel.
Speaker 1: And not Nicholas Nickleby.
Speaker 2: Yeah, anyway, yeah, and so one of the characters spoilers.
Speaker 2: But the book's been out for like over one hundred.
Speaker 1: Hundred years, forty years. Yes, dies of TV. It's not
Speaker 1: much of a spoiler at that point. Yeah. So the
Speaker 1: infection might be mild for like months. You literally could
Speaker 1: be coughing up teabs and friends and family for months
Speaker 1: without going to the doctor because you're like, oh, I've
Speaker 1: got bronchitis or I just have it called or whatever.
Speaker 1: So remember when we talked about are not the number
Speaker 1: of secondary infections that you get from a single infectious person? Right?
Speaker 1: Guess what it is for TV?
Speaker 2: Ooh, and this is under current circumstances, like in today's
Speaker 2: population level.
Speaker 1: You know, that's a good question. This number is from
Speaker 1: the World Health Organization, So I would guess that it's
Speaker 1: in current Okay, if a person goes like undetected and untreated.
Speaker 2: Okay, So I'm gonna guess that are not so the
Speaker 2: number of people that one infectious person can infect with TV?
Speaker 1: Yeah, I'm gonna guess three. Wow, keep going, six.
Speaker 2: Keep going nine, keep going ten.
Speaker 1: Ten to fifteen. Literally you could infect ten to fifteen
Speaker 1: people with TV over the course of a year. My
Speaker 1: jaw drops, I know, and without treatment, the mortality rate
Speaker 1: is forty five percent. I did not I really did
Speaker 1: not know that.
Speaker 2: I have so many questions, but I know that the
Speaker 2: all going to be answered in the current events. So
Speaker 2: I'm just gonna have to hold them in.
Speaker 1: Hold them in, hold them so tight. Yeah. Wow, I know,
Speaker 1: Like I knew that back in the day everybody died
Speaker 1: it was either syphilis or TV that everyone was dying from,
Speaker 1: But I really didn't know that the mortality rate was
Speaker 1: that high.
Speaker 2: It also sounds like a really horrible way to die.
Speaker 1: It's also that's the mortality rate if your immunal competent ooh,
Speaker 1: people with HIV are twenty to thirty times more likely
Speaker 1: to develop active TB and it's almost one hundred percent fatal.
Speaker 2: Twenty to thirty times more likely to develop exactly TB. Yeah,
Speaker 2: and one hundred percent fatal.
Speaker 1: And almost every one of them will die. Like it's
Speaker 1: that's really awful. It's really gnarly. And so, while the
Speaker 1: respiratory system is the most commonplace that tuberculosis invades and
Speaker 1: effects because the root of transmission is respiratory, it's not
Speaker 1: the only place you can get some weird TV as
Speaker 1: it turns out they call it extra pulmonary tb M.
Speaker 2: This is sounding weird, right, keep going.
Speaker 1: It's basically just when you have Mycobacterium tuberculosis growing in
Speaker 1: literally any tissue that's not your lungs, it's considered extra pulmonary.
Speaker 1: The most serious of these, as you might guess because
Speaker 1: it's kind of the most serious place for any creature
Speaker 1: to invade, is your central nervous system.
Speaker 2: Aha.
Speaker 1: So you can end up with meningitis. They call it
Speaker 1: tubercular meningitis. Ok And we've talked about meningitis before. It's
Speaker 1: basically just an inflammation of the outer layer that surrounds
Speaker 1: your brain and spinal cord, your mining's You can also
Speaker 1: end up with essentially almost tumors where you have tons
Speaker 1: of bacteria surrounded by immune cells that just take up
Speaker 1: space in your nervous system, which you can imagine is
Speaker 1: really problematic.
Speaker 2: Yeah. What happens in that case, like do you become
Speaker 2: paralyzed in certain areas or just lose motor function.
Speaker 1: They're called space occupying tuberculomas, Okay, which I'm as far
Speaker 1: as I know, is just a granulma that takes up
Speaker 1: space in your central nervous system, so I would guess
Speaker 1: that you're going to have some kind of nervous involvement,
Speaker 1: but I didn't really look that much into the symptoms
Speaker 1: of it. That's okay. Sorry. Another form of extra pulmonary
Speaker 1: TV that's almost always fatal is when it invades your bloodstream.
Speaker 1: Ooh yeah. You can imagine that having having any bacteria
Speaker 1: grow in your bloodstream is pretty much bad news. And this,
Speaker 1: which is called disseminated TV, is particularly hard to deal
Speaker 1: with because it progresses really rapidly and it's really difficult
Speaker 1: to diagnose. So that sucks. Yeah, that sounds terrible. Yeah.
Speaker 2: Side note is that also is disseminated also called milliary yes, okay.
Speaker 1: Yeah, disseminated TV is also called milliary TV.
Speaker 2: Okay. I kept seeing that pop up in different areas
Speaker 2: than I was like, and yeah, yeah, but it sounded
Speaker 2: like the same thing. And you know why they call
Speaker 2: it milliary, no tell me, because they look.
Speaker 1: Like little millet seeds. So it disperses through your body garrody, yep, garrody.
Speaker 1: You also can get invasion of your lymph system, which
Speaker 1: is actually the most common form of extra pulmonary TV.
Speaker 1: It can infect your bones, your joints, your GI tract,
Speaker 1: your genital tract. Ooh yeah, genital TB is a thing.
Speaker 1: You also can get TB in your skin like it
Speaker 1: just can grow everything.
Speaker 2: You just like throw a dart at a body, and
Speaker 2: you can have TB in any part of that ooh yep, yikes.
Speaker 1: But it's primarily pulmonary. It is primarily pulmonary lungs. Lungs. Yeah,
Speaker 1: and that's basically what I think you want to know
Speaker 1: about the biology of tuberculosis. What do you think.
Speaker 2: I think that's great. I mean, I think you did great.
Speaker 2: I think tuberculosis is terrible.
Speaker 1: It is. Yeah, it's more terrible than I even realized. Yeah,
Speaker 1: that's true of almost almost every disease that we've talked about. Yep. Yeah.
Speaker 2: It turns out the more you read, the more you're horrified.
Speaker 1: The more you know, the more you know, the satter
Speaker 1: you'll be want to stay home and never touch anyone.
Speaker 2: Yeah, not to mention airplanes.
Speaker 1: Oh my god. So you want to tell me how
Speaker 1: this all started?
Speaker 2: I absolutely do you know that. I do.
Speaker 1: I know.
Speaker 2: Okay, every week I start with where the earliest evidence
Speaker 2: for infection can be found for whatever disease we're talking about.
Speaker 1: Can I guess? Can I guess?
Speaker 2: I was gonna say, yeah, please guess is it? No?
Speaker 1: No? No, no, Egypt you got it?
Speaker 2: Winn winner Yep, yeah, Egyptian mummies. As per usual, tuberculosis
Speaker 2: leaves traces of infection on bone, kind of like its
Speaker 2: cousin disease, leprosy. So researchers can actually do post mortem
Speaker 2: diagnosis on skeletons that are thousands of years old, which
Speaker 2: is really cool.
Speaker 1: That's amazing.
Speaker 2: Okay, So we've got skeletal evidence of tuberculosis in Egyptian
Speaker 2: mummies dating from around thirty seven hundred BC. We've also
Speaker 2: got keletal evidence of TB dating back a few thousand
Speaker 2: years in other Old World regions such as India and China.
Speaker 1: Wow.
Speaker 2: But oh, another thing we have, and this is really exciting.
Speaker 2: We have skeletal evidence of tuberculosis in a mummy from
Speaker 2: Peru dating back to almost three thousand years ago. No,
Speaker 2: that means that tuberculosis was in the America's long before
Speaker 2: the European invasion.
Speaker 1: What.
Speaker 2: Yeah, isn't that insane?
Speaker 1: Wait, that's really cool. I mean, it's that's really interesting.
Speaker 2: Yeah, it's incredible. So from what I read It could
Speaker 2: have either been brought over during the early migrations to
Speaker 2: North and South America, or it could have evolved to
Speaker 2: infect humans from the cattleborn version of tuberculosis like you mentioned,
Speaker 2: which was present in ungulates during that time, like alpaca
Speaker 2: or lamas or bison.
Speaker 1: So would that mean that there was like more than
Speaker 1: one evolution of tuberculosis. I don't know if that's the case.
Speaker 2: So the thing is, I don't know the different clinical
Speaker 2: manifestations of the cattle born version of the disease and
Speaker 2: what was on the skeletal remains.
Speaker 1: Okay, but you maybe can't tell in a mummy if
Speaker 1: it was maybe from above I TV versus like actual
Speaker 1: microbactium tuberculosis exactly interesting.
Speaker 2: So I don't know.
Speaker 1: Oh that's so.
Speaker 2: Cool though, Yeah, very cool. Wow. Ancient Greek physicians described
Speaker 2: the pulmonary form of tuberculosis and called it tysis, which
Speaker 2: is spelled horribly all right, you ready ready pH th
Speaker 2: I S, I S.
Speaker 1: Yeah, that's a pH and.
Speaker 2: The thh at the beginnings. I had to look it up.
Speaker 2: I'm pretty sure it's tysis.
Speaker 1: You always look up how to pronounce things, and I don't,
Speaker 1: so probably people are like oh God.
Speaker 2: Also, it just seemed too ridiculous to have to pronounce
Speaker 2: it pthysis phthysis. Well, and anyway, tysus means wasting away,
Speaker 2: which is kind of the precursor of consumption.
Speaker 1: Yep.
Speaker 2: Tuberculosis and ancient Greece was devastating enough to be written
Speaker 2: about for hundreds of years, and writers often noted that
Speaker 2: children were particularly affected by the disease.
Speaker 1: Oh yeah, yep.
Speaker 2: And their method for treating TV blood letting. Of course,
Speaker 2: of course, ancient Greek physicians believed that disease was caused
Speaker 2: by an imbalance in one of the four humors of
Speaker 2: the body, one of them being blood. So when someone
Speaker 2: started coughing up a bunch of blood and showing their doctor,
Speaker 2: the doctor was like, Ugh, you know, you've got too
Speaker 2: much blood in your body.
Speaker 1: Way too much.
Speaker 2: I can't help me.
Speaker 1: Let's get that back.
Speaker 2: Give me your arm, No big deal, oh dear. Obviously
Speaker 2: this did nothing to help the patient and probably made
Speaker 2: them sicker, but I guess you can't really fault them
Speaker 2: for trying something I don't know. For the next oh,
Speaker 2: sixteen hundred years or so, basically until the Industrial Revolution,
Speaker 2: tuberculosis continued at a slow burn throughout much of the world,
Speaker 2: with no crazy pandemic that wiped out the majority of
Speaker 2: a population like the plague did.
Speaker 1: Okay, but that.
Speaker 2: Doesn't mean that it wasn't super impactful or that it
Speaker 2: wasn't noticed enough to be written about, because it was.
Speaker 2: And around one thousand a d. The reign of the
Speaker 2: crazy Greek physicians had long since ended and a new
Speaker 2: cure came on the scene, and this one may have
Speaker 2: actually done some good.
Speaker 1: Question mark.
Speaker 2: The poor and the sick flocked by the thousands to
Speaker 2: the castles of European royalty, where the king or queen
Speaker 2: would perform quote the royal touch.
Speaker 1: Oh ooh sounds creepy.
Speaker 2: It sounds really creepy. An afflicted individual would kneel at
Speaker 2: the feet of a monarch. The monarch would then place
Speaker 2: their hands on the sores or affected areas of the
Speaker 2: patient while a priest said a prayer. Sometimes the patient
Speaker 2: would be allowed to stay for a few days or
Speaker 2: weeks in the castle area, and for many of them,
Speaker 2: the royals touch actually did some good, but not because
Speaker 2: the monarch had any kind of magical heath power. It's
Speaker 2: more likely that rest in an improved diet helped bolster
Speaker 2: their immune system.
Speaker 1: They were like eating off of the king's table instead
Speaker 1: of not eating Oh vegetables, right.
Speaker 2: This is amazing. And once they were back home working
Speaker 2: in the fields and eating what little they could afford,
Speaker 2: the TB probably came back with a vengeance.
Speaker 1: Yeap.
Speaker 2: Nevertheless, the practice remained pretty popular. The last royal touch
Speaker 2: in Europe was done in eighteen eighty six. Wow.
Speaker 1: Yeah Dickens was around. Yeah he was good old Dickens. Wow.
Speaker 2: It's important to note that the contagious nature of tuberculosis
Speaker 2: was still unknown throughout all of this royal touching.
Speaker 1: I was gonna ask, like they were just exposing themselves
Speaker 1: like crazy. It doesn't seem like a royal thing to do.
Speaker 2: I mean, if they knew that it was contagious, do
Speaker 2: you think that any monarch would be like, oh, yes,
Speaker 2: come here, there's let me touch you.
Speaker 1: Literally, no way, no, not at all.
Speaker 2: By the early seventeen hundreds, tuberculosis was fairly common and
Speaker 2: extremely widespread. Although it wasn't exclusively a disease of poverty,
Speaker 2: it did disproportionately affect those who were forced to live
Speaker 2: but to elbows and cramped dingy houses with poor ventilation
Speaker 2: and The number of people living in these conditions took
Speaker 2: a huge upsurge following the Industrial Revolution.
Speaker 1: Before the Industrial Revolution.
Speaker 2: Which happened around the mid seventeen hundreds to the mid
Speaker 2: eighteen hundreds, the norm was small scale farming and manufacturing,
Speaker 2: with much of the population living in dispersed villages. Under
Speaker 2: these conditions, tuberculosis can still exist, but it's not going
Speaker 2: to thrive the way it would during the Industrial Revolution. Basically,
Speaker 2: what happened during this time was a shift away from
Speaker 2: these individual hand production methods to large scale mechanized production
Speaker 2: of things like textiles, steel, equipment, tools, et cetera. Cities
Speaker 2: became centers for production, and people flocked there in mass. Soon,
Speaker 2: thousands or millions of people were living in these new
Speaker 2: metropolitan areas. To give you some idea of just how
Speaker 2: massive this influx was, between eighteen hundred and eighteen fifty,
Speaker 2: in just fifty years, New York grew in population from
Speaker 2: sixty thousand to over five hundred thousand.
Speaker 1: What in fifty years, that's insane.
Speaker 2: Massive, almost tenfold. Yeah yeah, wow.
Speaker 1: Yeah. So everyone was just like coming to cities which
Speaker 1: were also filthy and dirty, as we've talked about before.
Speaker 2: And made more filthy and dirty by people.
Speaker 1: Coming, and then they're just breathing on each other positive
Speaker 1: feedback loop. Yeah.
Speaker 2: And there was no way that housing or building construction
Speaker 2: could keep pace with this kind of population growth. So
Speaker 2: many people were forced to live in extraordinarily crowded conditions.
Speaker 2: Houses meant to hold a single family were instead occupied
Speaker 2: by seven families. Oh.
Speaker 1: Man.
Speaker 2: In many boarding houses, people rented bed in shifts, and
Speaker 2: when your shift ended, you had to give up your
Speaker 2: bed to someone else. This way, the bed never got cold.
Speaker 1: Oh my god. Oh can you just sleeping in someone
Speaker 1: else's filth?
Speaker 2: Can you just imagine that? I mean, I've I've been
Speaker 2: through some pretty sketchy, hostile situations.
Speaker 1: Yeah, me too, But I still feel like there's like,
Speaker 1: I don't.
Speaker 2: Know, I mean, you're also you're not just sleeping in
Speaker 2: someone else's filth. You're sharing bed bugs.
Speaker 1: Yeah, you're sharing everything.
Speaker 2: Please. Yeah. Oh, we can't stress enough how disgusting this was.
Speaker 1: We are disgusted.
Speaker 2: And although jobs were plentiful, working conditions were even more
Speaker 2: hazardous than living conditions. Wages could barely get you clothed
Speaker 2: and fed. It's no wonder really that under these crowded
Speaker 2: malnutritious and poor conditions, tuberculosis flourished.
Speaker 1: It was probably really happy. Teebs was just like this
Speaker 1: is a dream world.
Speaker 2: I mean, flourish doesn't really even begin to describe the
Speaker 2: uptick in cases during the Industrial Revolution. Yeah, it's estimated.
Speaker 2: Oh yeah, here's some numbers. Give me, Give me that
Speaker 2: by eighteen fifty, between seventy five and ninety percent of
Speaker 2: all people on Earth had the tuberculosis bacterium in them.
Speaker 2: What and twenty percent of those would go on to
Speaker 2: develop the disease.
Speaker 1: Holy whoa. So you have ninety percent of people that
Speaker 1: have the bacterium and twenty percent of them end up
Speaker 1: getting I mean that's higher than we see today, probably
Speaker 1: because of how horrible everyone's immune status was.
Speaker 2: I mean, because you weren't just infected with TB. Probably
Speaker 2: we're going to be exposed to cholera, everything, smallpox at
Speaker 2: some point, all.
Speaker 1: The things we've talked about, malaria.
Speaker 2: Syphilists, I mean, the list goes on and on, and
Speaker 2: it really does. So yeah, it I mean, tuberculos has
Speaker 2: really had like a grip on the world.
Speaker 1: Wow.
Speaker 2: At one hospital in Paris, because you know how I
Speaker 2: love stats, I do. Yeah, at one hospital in Paris.
Speaker 2: In the early eighteen hundreds, tuberculosis was identified to be
Speaker 2: the cause of death in more than one third of
Speaker 2: all autopsies. Whoa at least a contributing factor, if not
Speaker 2: the cause of death in the majority I think of
Speaker 2: all autopsies, probably dang, dude. And it was during this
Speaker 2: period of high tuberculosis spread that tuberculosis got its reputation
Speaker 2: as a disease of creative types, of those with low
Speaker 2: morals who indulged in too much drink and too much sex.
Speaker 1: I don't think I knew that about TV. I mean,
Speaker 1: think of Mulan rouge. Oh that's true. Yeah, that's definitely true.
Speaker 2: Tuberculosis, or consumption, as it was known during this time,
Speaker 2: due to the way that a person wasted away while infected,
Speaker 2: was almost fashionable.
Speaker 1: Yeah, like if you had DV you must be in
Speaker 1: with the in crowd. Well kind of.
Speaker 2: It was. The look so appearing pale and gaunt became
Speaker 2: in style, and women began starving themselves, drinking only lemon
Speaker 2: water or in one case, eating sand to achieve the
Speaker 2: ic consumptive look.
Speaker 1: I'm sorry, was it Gwyneth Paltrow did she next on Goop?
Speaker 1: The consumption. Look how to get yours.
Speaker 2: Here's a bag of sand for only eighty nine ninety
Speaker 2: five for small installments.
Speaker 1: Oh my god, that's awful. Mm hmm, I hate that idea.
Speaker 2: Yeah, it's really it's really bizarre. And reading a list
Speaker 2: of famous victims of tuberculosis during the eighteen hundreds reads
Speaker 2: like a who's who of the art music, literary world.
Speaker 2: We've got the Bronte sisters who wrote Jane Eyre Weathering Heights.
Speaker 2: We got Edgar Allan Poe, The Raven of Course, Telltale Heart,
Speaker 2: et cetera, Robert Lewis Stevenson, Treasure Island, Ah Henry David Thireaux,
Speaker 2: Walden like Walden, Pond, The Pond, Franz Kafka, Metamorphosis.
Speaker 1: I remember that, it's one of my favorites.
Speaker 2: Yeah, George Orwell nineteen eighty four, Animal Farm mm hmm.
Speaker 1: Wow.
Speaker 2: And that's not including the composers Chopin, Paganini. I mean,
Speaker 2: the list goes on and on and on. That was
Speaker 2: just a small sampling, like a tiny, teeny tiny sampling
Speaker 2: of all the celebs who died of tuberculosis.
Speaker 1: Eleanor Roosevelt tuberculosis.
Speaker 2: Really, why was this disease, so in a way celebrated
Speaker 2: when other slow burning diseases like leprosy or syphilis elicited
Speaker 2: feelings of terror and disgust.
Speaker 1: Well, leprosy probably was gnarlier to look at.
Speaker 2: Well, that's the thing. So at this point people didn't
Speaker 2: know that it was contagious, and except for looking pale
Speaker 2: and emaciated, which was in vogue, there were no other
Speaker 2: superficial signs of tuberculosis, most commonly.
Speaker 1: Not many open swords.
Speaker 2: There's no nervous system involvement for them for the typical cases. Yeah, exactly,
Speaker 2: And so it was viewed as almost a romantic disease,
Speaker 2: a great plot device. I mean, we already know from
Speaker 2: the intro that Dickens loved tuberculosis. Yeah.
Speaker 1: Wow, that's so interesting. Yeah, God, I've said interesting like
Speaker 1: one hundred times already. I mean, it is interesting, though,
Speaker 1: you need to look up some synonyms in the future.
Speaker 2: So we know now, of course that tuberculosis is transmitted
Speaker 2: through respiratory droplets. But when and how was this discovered? Yeah?
Speaker 1: Good question.
Speaker 2: Well, to answer that, I'm going to tell you a
Speaker 2: little story, Yes, a story of a bitter rivalry, of
Speaker 2: scientific revolution and of hopes raised so high, only to
Speaker 2: be dashed to the ground, resulting in ruined reputation and
Speaker 2: heartbreaking despair.
Speaker 1: Okay, I am like really into this right now. I
Speaker 1: hope it lives up to it.
Speaker 2: The star of this story is none other than Robert Koch.
Speaker 1: Ah.
Speaker 2: If you've ever taken a microbiology course aka the study
Speaker 2: of microorganisms like bacteria, viruses, fungi, et cetera, you've heard
Speaker 2: the name Coke Koh, probably in reference to Coke's postulates.
Speaker 2: We'll get to that first, though. Let's meet the man himself. Yes,
Speaker 2: Robert Koch was born in Germany in eighteen forty three,
Speaker 2: and as a young man during the Franco Prussian War,
Speaker 2: which is between France and Germany, Coke worked in field hospitals,
Speaker 2: performing hundreds of misguided amputations and generally witnessing the horror
Speaker 2: of war firsthand. This experience would stay with him for
Speaker 2: the rest of his life and provided some of the
Speaker 2: basis for his belief in germ theory and his resentment
Speaker 2: toward the leading microbiologists of the day, the Frenchman Louis Pasteur.
Speaker 2: Because it was Germany versus France. Oh that's fine, No,
Speaker 2: I was like, oh, my gosh, there's a political side
Speaker 2: to this. Pastor were rivals.
Speaker 1: I didn't know that.
Speaker 2: Oh, there is some like pure venom oo in public
Speaker 2: letters to catch Oh, except they never used to be
Speaker 2: mad love right, they just were only bad luod only
Speaker 2: Oh my god, yeah, Okay. After getting burnt out on
Speaker 2: the fields of war, Cooke returned home to a small
Speaker 2: village in western Germany, where he acted as the town doctor.
Speaker 2: On his birthday, I don't know. Sometime in his thirties,
Speaker 2: I saw conflicting things. His wife gave him a gift
Speaker 2: that would change the course of.
Speaker 1: Medicine and history. Way to go, wife, a microscope. Yeah.
Speaker 2: Immediately he was enamored with it and used it to
Speaker 2: examine everything he could think of. At this time, which
Speaker 2: was in the eighteen seventies, germ theory was making major
Speaker 2: splashes but still remained a controversial topic. And as a reminder,
Speaker 2: germ theory is the idea that certain diseases are caused
Speaker 2: by microscopic organisms, such as bacteria or viruses.
Speaker 1: It's like, not a very shocking theory today in twenty seventeen.
Speaker 2: No, but at the time it was revolutionary.
Speaker 1: Exactly. Yeah, it's so hard to imagine living in a
Speaker 1: time like that.
Speaker 2: I mean we are, though, you know that there's bound
Speaker 2: to be something, you know, fifty one hundred, two hundred
Speaker 2: years from now that they're going to look back and go, Wow.
Speaker 1: How did you not know? Man? I never thought about that.
Speaker 2: Wow. I mean we even like look at practices, medical
Speaker 2: practices of the seventies and eighties, and that's very true.
Speaker 1: Come on, what were you thinking. It's gonna be antibiotics,
Speaker 1: that's gonna be the thing.
Speaker 2: Antibiotics I've heard chemotherapy is one that they're going to
Speaker 2: look back and go that that's a torture.
Speaker 1: It kind of is, man, Yeah it is. Yeah.
Speaker 2: Yeah. So anyway, Coke, aware of germ theory but not
Speaker 2: completely convinced, decided to examine the blood of some sheep
Speaker 2: who had recently died in an anthrax epidemic in his town. Oh.
Speaker 2: To his surprise, he saw millions of rod shape bacteria
Speaker 2: under the microscope.
Speaker 1: Oh that's cool.
Speaker 2: Not wanting to jump the gun, which was unlike pretty
Speaker 2: much every other scientist during this time, he set about
Speaker 2: designing a series of experiments which would conclusively show that
Speaker 2: anthrax was caused by this bacilla that he saw.
Speaker 1: Oh, that's awesome.
Speaker 2: First he would isolate the bacterium from a sick animal.
Speaker 2: Then he would reproduce the bacteria in culture. Then he
Speaker 2: would inoculate a healthy animal with some of this bacteria
Speaker 2: ridden culture. Finally, he would isolate the bacterium once again
Speaker 2: from this sick and this newly sick animal. And these
Speaker 2: dear listeners are what is known as Cox postulates.
Speaker 1: You just took biology one oh one yep.
Speaker 2: I mean essentially, no, really, isolate, reproduce, inoculate, and isolate again.
Speaker 2: Easy four steps, and these became standard practice for determining
Speaker 2: the infectious agent responsible for a particular disease. Because he
Speaker 2: was able to successfully do that with the Anthrax bacilli.
Speaker 2: This set him apart and made his evidence for German
Speaker 2: theory much more convincing. Louis Pasteur, a huge name in microbiology,
Speaker 2: was more than a bit salty that it was a
Speaker 2: German Man who would take credit for this discovery and
Speaker 2: that his evidence would be accepted so readily when Pasture
Speaker 2: had fought so hard in previous years.
Speaker 1: Yeah. Just he was so messy though, Like Pastor was
Speaker 1: just all over the place.
Speaker 2: Yeah, yeah, he was just like this was like the
Speaker 2: development of actual scientific methods.
Speaker 1: Right degree.
Speaker 2: Yeah, and so Pasture decided that he was going to
Speaker 2: develop the anthrax vaccine.
Speaker 1: How'd that go? Pastor?
Speaker 2: It worked? Oh cool, he did it, I mean, and
Speaker 2: it was great. But Coke was like, this is this
Speaker 2: frenchman came in here and he took my research and
Speaker 2: he didn't even credit me. He was so upset about it.
Speaker 2: It was I mean, these letters are hilarious to read.
Speaker 1: Did they write to each other or did they write
Speaker 1: to like their newspapers about how angry they were?
Speaker 2: Yeah? It was. It was if I'm using this word correctly, subtweeting.
Speaker 2: They were just like, well, this guy, I'm not sure.
Speaker 2: I don't I don't do Twitter.
Speaker 1: I'm sorry. That was really good. Yeah, I guess which
Speaker 1: one of us manages the Twitter?
Speaker 2: So I didn't use it, right, No, it's perfect, okay,
Speaker 2: blisful innocence, yes, blissful ignorance perfect.
Speaker 1: Yeah.
Speaker 2: So nationalistic pride ran pretty deep in these two and
Speaker 2: their feud was famous in its day because it was
Speaker 2: not only very vicious, but as I mentioned, very public.
Speaker 1: But very productive. So at least there's that.
Speaker 2: Yeah, yeah, for the most part. But we're not here
Speaker 2: to talk about anthrax. This week Future Future weird to
Speaker 2: talk about tuberculosis. Contemporary theories as to the cause of
Speaker 2: tuberculosis ran from having a weak heart to too much
Speaker 2: horse riding in youth yeah, to a genetic predisposition or
Speaker 2: maybe playing instruments too much. Wow. But Coke had a
Speaker 2: different idea as to its origin. After the anthrax success,
Speaker 2: Coke set his sights upon tuberculosis, and with tuberculosis he
Speaker 2: took the same tack as he did with anthrax isolate
Speaker 2: reproduce inoculate isolate again and he was successful. Wow, which
Speaker 2: was huge because it required him to develop staining methods
Speaker 2: which were really difficult.
Speaker 1: Yeah. I was going to say, I actually didn't expect
Speaker 1: him to be successful so easily because tuberculosis is notoriously
Speaker 1: difficult to culture. It takes forever to grow.
Speaker 2: He had to be patient.
Speaker 1: What a baller. And then his.
Speaker 2: Also, this is a side note, but his student or
Speaker 2: assistant was named Paul Erlick, like yeah, yeah, and he
Speaker 2: also he's a great microbiologist in his own right.
Speaker 1: Yeah.
Speaker 2: Actually, Erlik who developed the staining method for or improved
Speaker 2: upon the staining method for the acid fast bacteria like
Speaker 2: microbacteria diagnosed himself with tuberculosis using this technique.
Speaker 1: Oh my gosh, that's so sad and poetic, also romantic.
Speaker 1: There you go.
Speaker 2: Yeah, Hollywood, get on it.
Speaker 1: Yeah, let's make a movie about Coke and airlick. I'd
Speaker 1: watch it. I'd watch it for his wife, who was like,
Speaker 1: I'm going to give you the tool that you need
Speaker 1: to be so famous.
Speaker 2: Well sidebar. He left her for a seventeen year old
Speaker 2: art student.
Speaker 1: When he was in his No longer on the coke train,
Speaker 1: like late forties, early fifties. No longer on that train. Yeah,
Speaker 1: not into it. Oh, I mean you would have jumped
Speaker 1: off before that happened.
Speaker 2: Okay, So yeah, As I mentioned, he was successful in
Speaker 2: isolating the to bberculosis bacterium, but he still wasn't satisfied,
Speaker 2: so he repeated this experiment over and over again until
Speaker 2: he was sure. In a public presentation in an October
Speaker 2: day in eighteen eighty two, Coke announced his findings to
Speaker 2: the most notable doctors and researchers of the day, who
Speaker 2: were knocked speechless.
Speaker 1: Wow.
Speaker 2: It was really one of the most momentous occasions for
Speaker 2: science ever. Apparently that's pretty cool, according to contemporary accounts,
Speaker 2: I do want to note that Coke was not the
Speaker 2: first to suggest, or even experimentally indicate that tuberculosis was infectious,
Speaker 2: but his experimental evidence, backed up with microscopic demonstrations, would
Speaker 2: make his voice the one that was heard.
Speaker 1: The guy who actually did it.
Speaker 2: Was French, and so Pasture was so annoyed, just kept building,
Speaker 2: Poor Pastore.
Speaker 1: I know.
Speaker 2: Unlike the ready acceptance of the anthex pacilla, the announcement
Speaker 2: of tuberculosis as infectious was met with resistance initially. Eventually, though,
Speaker 2: it gained traction as scientists, including Pasture, set their sights
Speaker 2: on a cure. It was a race to the finish
Speaker 2: line who would develop the first tuberculosis vaccine. Coch determined
Speaker 2: that he would be the victor, threw himself into his
Speaker 2: work and emerged less than two years after his first
Speaker 2: announcement of tuberculosis bearing another supposedly ground breaking discovery. Oh
Speaker 2: he had concocted a cure for tuberculosis. This supposed cure,
Speaker 2: when injected, was supposed to reverse the damaged areas of
Speaker 2: the lungs and leave the sufferer disease free. He called
Speaker 2: the substance tuberculin. Almost immediately tuberculin was one of the
Speaker 2: most in demand substances in the world, and people rejoiced
Speaker 2: for the long awaited tuberculosis treatment that would relieve so
Speaker 2: many of their suffering. Supply was nowhere near enough to
Speaker 2: keep up with the demand, obviously, which was probably for
Speaker 2: the best, because I'm guessing it didn't work. Did not work. Sure,
Speaker 2: it produced an immune reaction in the person who has
Speaker 2: been injected, but it does nothing to heal the patient. Instead,
Speaker 2: it causes fever, pain, and often death. Oh my god,
Speaker 2: particularly in those that were most severely afflicted with tuberculosis. Coke,
Speaker 2: so intent on beating pasture to the finish line, wasn't
Speaker 2: thorough in his testing of tuberculin and prematurely announced success.
Speaker 1: Toxic masculinitybra you go every time.
Speaker 2: It's ego come on. Yeah, And it would nearly ruin
Speaker 2: his reputation as a scientist, and he was all but
Speaker 2: chased out of Germany at least immediately after so tuberculin escalated.
Speaker 2: You may have heard that word because it's what people
Speaker 2: use in skin test. He'd be skin tests for today. Yeah, Yeah,
Speaker 2: that's where it came from. That's really cool. I didn't
Speaker 2: know that's where that came from. Yeah, that's so interesting.
Speaker 2: So there the world stood at the end of the
Speaker 2: nineteenth century with the knowledge that tuberculosis was infectious but
Speaker 2: no cure to treat the ill. Tuberculosis was no longer
Speaker 2: the romantic disease of poets and artists. It was something
Speaker 2: that would get you reported by your neighbor to the
Speaker 2: health authority for a nice cash reward. Whoa yeah. Predictably,
Speaker 2: tuberculosis patients began to be ostracized, their clothing burned, and
Speaker 2: forced into treatment centers called sanatoria.
Speaker 1: Oh yes, not yes.
Speaker 2: But you're excited to learn about sanatoria.
Speaker 1: Love this.
Speaker 2: At the time, fresh mountain air, combined with a healthy
Speaker 2: diet and ample lung rest I eat, no exercise, talking, laughing, singing, etc.
Speaker 2: Was thought to be a cure for tuberculosis. All over
Speaker 2: the world, these.
Speaker 1: Sanatorias started popping up.
Speaker 2: Not many kept stats on how many people actually recovered,
Speaker 2: and in reality, your chances weren't much better in a
Speaker 2: sanatorium than in your dingy home. Yeah, but at least
Speaker 2: in a sanatorium you had someone feeding you and you
Speaker 2: were resting, which probably provided and immune boost. Tuberculosis patients
Speaker 2: flocked to these places, most of which were a racially
Speaker 2: segregated and b reserved spots for paying customers only. There
Speaker 2: were exceptions for many tuberculosis sufferers, this was the only choice,
Speaker 2: and this would remain the only choice well into the
Speaker 2: twentieth century for the next fifty years. After cokes failed
Speaker 2: tuberculin experiment, there would be many attempts to come up
Speaker 2: with a cure for tuberculosis, but none were successful until
Speaker 2: a lowly grad student named Albert Schatz studying soil microbes,
Speaker 2: isolated one that when exposed to some bacteria, killed them. Awesome,
Speaker 2: So we tested it on a bunch of different types
Speaker 2: of bacteria killed them all. So Shats was pretty excited
Speaker 2: about this, and he begged his reluctant adviser to let
Speaker 2: him test it on tuberculosis. He got permission. Awesome, and
Speaker 2: it worked. Finally there was a very promising cure for tuberculosis,
Speaker 2: and it was called streptomycin AH. Over the next few
Speaker 2: years and after many animal and human trials, streptomycin was
Speaker 2: ready for distribution. The effects were astonishing. Here finally was
Speaker 2: the cure that humanity had been waiting on for hundreds
Speaker 2: thousands of years. Almost overnight, tuberculos the sanatoria emptied and
Speaker 2: many sit abandoned to this day. Yeah, there's one in Louisville,
Speaker 2: Kentucky called Waverley Sanatorium.
Speaker 1: Its huge.
Speaker 2: I haven't but it's been turned into a haunted house.
Speaker 1: Oh yes, this is why. Oh I love this because
Speaker 1: they're always really like creepy places. There are always the
Speaker 1: kind of places where people are like, oh, that building
Speaker 1: is definitely haunted yet like no question.
Speaker 2: Yeah, they're like body shoots and stuff like that.
Speaker 1: Yes, they're so creepy. We should do a field trip.
Speaker 2: Oh my god, we Google.
Speaker 1: We need to get a digital recorder so that we
Speaker 1: can record our whole trip.
Speaker 2: Yeah. And so for his amazing discovery which completely changed
Speaker 2: the world in terms of tuberculosis, Shatz's advisor would receive
Speaker 2: the Nobel Prize zero percent surprised about. That's just a
Speaker 2: real bummer. That is typical Selman Waksman. He got the
Speaker 2: Nobel Prize.
Speaker 1: Shats we're looking at you. Yeah, we know, thanks buddy,
Speaker 1: we're giving you credit.
Speaker 2: Thanks al.
Speaker 1: Not that it comes with much, but.
Speaker 2: For many years streptomycin seemed like it would bring about
Speaker 2: the end of tuberculosis, and it came kind of close
Speaker 2: in some ways, particularly when used in combination with other antibiotics.
Speaker 2: But TB would return again with a vengeance during the
Speaker 2: AIDS epidemic of the nineteen eighties, and this time antibiotics
Speaker 2: were no match for resistance strains. I'm gonna let you
Speaker 2: pick up here. Tell me about tuberculosis in the world today.
Speaker 1: Oh okay, I wish actually that I had a happier
Speaker 1: way to end this episode, but I don't. I mean
Speaker 1: so tuberculosis. This actually blew my mind. Tuberculosis is the
Speaker 1: ninth leading cause of death worldwide. Nine number nine, isn't that?
Speaker 1: I mean seriously, tuberculosis. This is a bacteria that we
Speaker 1: can treat, and it is to this day the ninth
Speaker 1: leading cause of death worldwide.
Speaker 2: That is astonishing, I know.
Speaker 1: And for the period from twenty twelve to twenty sixteen,
Speaker 1: it was the number one cause of death from a
Speaker 1: single infectious agent. So, because most of the other causes
Speaker 1: of death are either not infectious or they're kind of generalized,
Speaker 1: like lower respiratory infections, which is like pneumonia, it's kind
Speaker 1: of it could be caused by a number of different things,
Speaker 1: TB was the leading cause of death by a single agent.
Speaker 1: What the f WHOA, Yeah.
Speaker 2: What does that put the mean annual mortality rate.
Speaker 1: At let's talk about it. So in twenty sixteen, the incidents,
Speaker 1: so the number of cases that were reported of tuberculosis
Speaker 1: was ten point four million. What ten point four million
Speaker 1: people in the world were diagnosed with tuberculosis in the
Speaker 1: year twenty sixteen, and the mortality was one point seven million. Literally,
Speaker 1: one point seven million people died in twenty sixteen because
Speaker 1: of tuberculosis. One point three million of those were HIV negatives.
Speaker 1: So these are generally immunocompetent people. Okay, about three hundred
Speaker 1: and seventy four thousand of them were HIV positive.
Speaker 2: Tuberculosis is a leading cause of death and HIV patients.
Speaker 1: Yeah, it's forty percent. These are just so many numbers.
Speaker 1: Forty percent of all deaths due to HIV are actually
Speaker 1: to TV. On the death certificate, it will say HIV,
Speaker 1: but forty of those are because of TB and we'll
Speaker 1: talk so two weeks from now will be HIV and
Speaker 1: we'll talk so much more about it then. But no
Speaker 1: one really dies from HIV itself. HIV is not what
Speaker 1: kills you. HIV kills your immune system, and then opportunistic
Speaker 1: bacteria and other things, but opportunistic bacteria like tu loses
Speaker 1: just jump right in there and they sit there and
Speaker 1: just wait for you to get sick. So, yeah, do
Speaker 1: you want to get even sadder? One point seven million
Speaker 1: people dying last year isn't enough? A million of the
Speaker 1: new cases that were diagnosed were children, and two hundred
Speaker 1: and fifty thousand of those deaths or children. Okay, that
Speaker 1: is horrifying.
Speaker 2: Is this related to drug resistance at all or just
Speaker 2: not getting the treatment to the people that need it?
Speaker 1: So it definitely has to do with drug resistance. So
Speaker 1: the World Health Organization estimates that of the cases that
Speaker 1: are reported to them, treatment is effective if it's not resistant,
Speaker 1: and about eighty five percent of cases. Okay, so about
Speaker 1: eighty five percent of people without the resistant form will
Speaker 1: recover completely and others might sort of go back to
Speaker 1: the latent state and not die from it, but not
Speaker 1: be rid of it either. Drug resistant TV definitely has
Speaker 1: a major effect. So in twenty sixteen, about six hundred
Speaker 1: thousand of those cases were resistant to at least one
Speaker 1: drug and about five hundred thousand were resistant to multiple drugs.
Speaker 2: And so the evolution of drug resistance I didn't really
Speaker 2: talk about it very much, and I don't know if
Speaker 2: you're going to cover it.
Speaker 1: I'd love to. You want to talk about it right now, please.
Speaker 1: So basically, the reason that tuberculosis is so susceptible to
Speaker 1: becoming resistant is in large part because of how dang
Speaker 1: long it takes to be treated in order to cure it.
Speaker 1: So if you have a non resistant form, a normal
Speaker 1: TB that's susceptible to antibiotics, it still takes six months
Speaker 1: of treatment. Wow. If you have a form that's resistant
Speaker 1: to only one or two drugs, they now recommend nine
Speaker 1: to twelve months of treatment. They used to recommend twenty
Speaker 1: months of treatment. Wow. Yeah. So let's talk really quickly
Speaker 1: about how antibiotic resistance evolves. Basically, if you're treating something
Speaker 1: like strep throat, for example, with antibiotics, you are pummeling
Speaker 1: those bacteria, and you do it really hard and really
Speaker 1: fast because the strep bacteria are just hanging out right
Speaker 1: in your mouth, in your throat, so you pummel them
Speaker 1: with antibiotics and they basically all die really quickly, so
Speaker 1: it's no problem. But with TB, the bacteria aren't just
Speaker 1: hanging out. Remember, they're really well hidden. They're covered in
Speaker 1: sacks of your immune cells and of tissue, and they're
Speaker 1: infiltrated really deep into your lungs, and they're slow growing
Speaker 1: and they're hearty as hell. So you hit them with antibiotics,
Speaker 1: but you have to keep hitting them, and you have
Speaker 1: to keep hitting them, and it takes so long that
Speaker 1: first of all, not everyone is finishing their course of antibiotics,
Speaker 1: but also the populations of bacteria in your lungs are
Speaker 1: just living under this selection pressure for a really long time.
Speaker 2: All the susceptible ones are being picked off, and all
Speaker 2: the resistant ones are staying and being allowed to reproduce.
Speaker 1: Exactly, and the chances that eventually one of these is
Speaker 1: going to reproduce with some random mutation that allows them
Speaker 1: to be super resistant is just a lot higher because
Speaker 1: of the amount of time that they're able to sit
Speaker 1: there and reproduce. So essentially, if you're under pressure from
Speaker 1: an antibiotic for this long and you happen to pick
Speaker 1: up resistance, then you're going to be the one who's
Speaker 1: able to keep reproducing, and then all of your friends
Speaker 1: are going to die off, and eventually all that's left
Speaker 1: are you and clones of you and then you end
Speaker 1: up within bbiotic resistance. Yikes. So the longer you take
Speaker 1: an abiotics in a situation like this, the more likely
Speaker 1: it is that something like this can happen. That makes sense.
Speaker 1: It's scary, it's scary, and it sucks. And it's also
Speaker 1: so much more expensive to treat drug resistant tuberculosis as
Speaker 1: compared to regular tuberculosis.
Speaker 2: Okay, I have a question, Okay, what are the most
Speaker 2: susceptible populations today?
Speaker 1: Today? For sure, people who are immunocompromised are by far
Speaker 1: the most susceptible, So people living with HIV, children and
Speaker 1: anyone who has any sort of autoimmune disease or other,
Speaker 1: if you're on chemotherapy, anything that would make you more
Speaker 1: susceptible to general oh, prison populations, anywhere where you have crowding,
Speaker 1: crowding and not great sort of sanitation and access to
Speaker 1: nutrition and things like that. So it's definitely more prevalent
Speaker 1: in developing countries, but it's also everywhere. I mean TB
Speaker 1: is absolutely everywhere. Huh yeah, whenever.
Speaker 2: So okay, So the status of TV today is if
Speaker 2: I had a magic eight ball, it would be outlook
Speaker 2: not so good.
Speaker 1: Outlook not so great.
Speaker 2: And that the who apparently needs to step up its
Speaker 2: game and actually, you know, practice what they preach.
Speaker 1: I think, Yeah, it's interesting because they definitely do a
Speaker 1: lot of work on TV. It's one of their major focuses.
Speaker 1: And I just really am curious to know. I don't know,
Speaker 1: doesn't even work there? Like what are the gaps that
Speaker 1: are not I'm very curious to know, really, like what
Speaker 1: are the logistical hurdles that are not being met?
Speaker 2: What are the biggest things standing in the way and
Speaker 2: actually reaching these goals?
Speaker 1: And is it like is it just money? Is it
Speaker 1: just that they don't have enough money to treat all
Speaker 1: of these and or to put the money where it
Speaker 1: needs to go, Like I'm or compliance with antibiotics. Compliance
Speaker 1: is a big thing. But the thing is you also
Speaker 1: see resistance developing in areas where you have really high compliance.
Speaker 1: So it's just the nature of TV exactly. TV is
Speaker 1: a gnarly one. It is.
Speaker 2: Yeah, it's not a disease of the past, it's not
Speaker 2: at all.
Speaker 1: It's not.
Speaker 2: Okay, Well, I think on that note, we should.
Speaker 1: Read out our sources. Let's do it.
Speaker 2: I have a couple of books for you guys. One
Speaker 2: is called Invincible Microbe by Jim Murphy and Alison Blank
Speaker 2: And this is more of like a I don't know,
Speaker 2: young adult book, but I got it from the library
Speaker 2: and it was actually super accessible, easy to read, provided
Speaker 2: a great overview of the history and biology of tuberculosis.
Speaker 2: Another one is called The White Death by Thomas Dormandy.
Speaker 2: That is the opposite of The Invisible Microbe in terms
Speaker 2: of its accessibility. It's just man author reveled in detail,
Speaker 2: but it does do a lot of in depth history.
Speaker 2: Another one is The Remedy by Thomas Getz and this
Speaker 2: is a really interesting book. So this is the one
Speaker 2: that explores in depth coke pasture. And also Sir Arthur
Speaker 2: Conan Doyle, whom I didn't talk about. But he was
Speaker 2: a physician before he was a writer.
Speaker 1: I didn't know that.
Speaker 2: And he was a science communicator. He loved to try
Speaker 2: to bring science to the public.
Speaker 1: Wow hashtag psicon.
Speaker 2: Yeah, and this is why Sherlock Holmes was such a
Speaker 2: logically minded, careful person.
Speaker 1: Cool. Yeah, I never knew that. Very cool scientific thinker.
Speaker 2: The last one is a book called The Plague and
Speaker 2: I by Betty MacDonald and this is a memoir book
Speaker 2: written by this woman Betty MacDonald who went to a
Speaker 2: sanatorium in Washington State in the thirties. I think it
Speaker 2: is hilarious.
Speaker 1: Oh, I was not expecting that.
Speaker 2: It is so funny. She is so clever, so witty.
Speaker 2: It's full of great observant humor that is so ahead
Speaker 2: of her time. It reads all it's like a little
Speaker 2: bit got a little flavor of Gilmour girls. I really
Speaker 2: highly recommend it. It's got some great parts in it.
Speaker 1: I should check it out.
Speaker 2: And that's all I got.
Speaker 1: I obviously cited the who want wah waht. They have
Speaker 1: the Global Tuberculosis report from twenty seventeen, so it's recent.
Speaker 1: But also I got all the awesome gory details on
Speaker 1: the clinical path of physiology from this article called Tuberculosis Pathophysiology,
Speaker 1: Clinical Features and Diagnosis, written by Nancy Knietchel Netchell m
Speaker 1: just sorry nance run with it, published in the Critical
Speaker 1: Care Nurses Journal. So yeah, that's all I have. Cool shortlist.
Speaker 2: Well, thanks so much for listening.
Speaker 1: Yeah, thanks, this was maybe kind of a rough one. Yeah,
Speaker 1: have an alcohol consumption. Yeah we hope you learned something.
Speaker 1: Yeah I definitely did.
Speaker 2: Yeah, so did I.
Speaker 1: So thank you also to Bloodmobile for the music as always,
Speaker 1: as always, love it, love it and join us next
Speaker 1: week when we're talking about yellow fevers. Oh yeah, Oh
Speaker 1: I can't wait. Make sure you rate, review, and subscribe.
Speaker 1: We really love it when you do that. It helps
Speaker 1: other people find our podcast. Follow us on social media. Yep,
Speaker 1: and wash your hands, you have filthy animals.