The Scourge of Tuberculosis
Tuberculosis (or TB, an abbreviation for tubercle bacillus) is a bacterial disease which has been detected in Egyptian mummies and prehistoric human remains dating back to 5000 BC. In the 1800s tuberculosis was responsible for one in four deaths in England and was commonly referred to as consumption due to the weight loss of sufferers. It usually affects the lungs (pulmonary tuberculosis) where it becomes contagious to others, but can involve the kidneys, bones, spine, brain and other parts of the body.
Tuberculosis flourishes in populations with poor social conditions where people are poorly housed and malnourished. The bacteria can be carried but remain inactive if the immune system can fight it (referred to as latent tuberculosis). Such a person is not sick or contagious. Actual TB disease is caused by active TB bacteria, which may occur shortly after the bacteria enter the body or many years later. TB disease causes persistent cough, chest pain, fatigue, weight loss and fever and ultimately leads to death if the infection cannot be arrested. It has been a notifiable disease in WA since 1902.
The medical care and isolation of TB patients in WA was administered from Wooroloo Sanitorium. Medical care at Wooroloo and Royal Perth Hospital involved bed rest (for up to 18 months) and often lung collapse therapy by artificial pneumothorax and thoracoplasty methods. Artificial pneumothorax involved inserting air into the pleural space between the chest wall and lung to collapse the lung and enable it to rest and recover. Sometimes both lungs were collapsed – in one instance a policeman was able to work for several years with a double pneumothorax. The lung could remain collapsed for anywhere between 2 to 7 years depending on the severity of the disease. Thoracoplasty was a surgical procedure that allowed the reduction of the thoracic cavity by removing ribs.
Following medical treatment and bed rest, activities were gradually resumed in a healthy environment to allow work tolerance to develop and to avoid the strain of too quickly returning to full employment which was a major risk factor for disease relapse. The work was a very important part of successful rehabilitation as it occupied the patients while recovering their self esteem and providing an income stream.
The advent of drug therapies in the late 1940s in the form of the antibiotic streptomycin, followed by para-amino salicylic (PAS) and isoniazid revolutionised the treatment of tuberculosis and saved the requirement for collapse therapies.
It was a major public health victory to bring tuberculosis under control in Australia given its spread throughout the general population during the post-war years. TB is now rare in Australia with typically around 100 cases reported in Western Australia each year. However the disease is still prevalent in many parts of the world.