Tuberculosis: A biosocial study of admissions to a children's sanatorium (1936-1954) in Stannington, Northumberland, England.

This study considers the biosocial profile of children admitted to the Philipson Children's Sanatorium at Stannington, Morpeth, Northumberland, England (1936-1954). The objective was to understand the differential impact of TB on male and female admissions at Stannington, according to a number of variables. A total of 1987 medical files were analysed. More females than males were admitted, peaks of admission at age six and 13 were documented, and the majority of children derived from poor urban areas. Over 60% (1199, 63.5%) of children had pulmonary TB, and 12% (230) had bone or joint involvement. The implementation of chemotherapy (streptomycin) at Stannington (1946), the end of the 2nd World War (1945), and the founding of the National Health Service (1948) did not have any great effect on the biosocial profile of children admitted to the sanatorium and treated (age, sex, origin, type of TB suffered, and socioeconomic status). Reasons for these finding are discussed.

Trends in mortality from pulmonary tuberculosis before and after antibiotics in the Portuguese sanatorium Carlos Vasconcelos Porto (1918-1991): Archival evidence and its paleopathological relevance.

The comparative study of patients' profiles and outcomes from pulmonary tuberculosis (TB), before and after the discovery of antibiotic therapy, using sanatoria archives is an unexplored approach in paleopathology. Although higher mortality rates are assumed before chemotherapy, scarce information exists regarding the disease's duration in institutionalized patients and to what extent tuberculous sufferers lived enough to develop skeletal lesions. To fill this gap, 315 clinical files from the former male Sanatorium Carlos Vasconcelos Porto, located in São Brás de Alportel, Portugal, were studied. Two periods of hospitalization were considered: 1931-1944 (n = 128, Group 1) and 1955-1961 (n = 187, Group 2). The average duration of hospitalization (350.3 days for Group 1 and 371.8 for Group 2) and the crude mortality (18.2% and 11.2%, respectively in Groups 1 and 2) did not differ significantly between groups. However, Cox's regression revealed significant differences between survival curves, after adjusting for age at admission (14-74 years old), with pre-chemotherapy patients presenting a higher risk of dying during hospitalization (p = 0.037, hazard ratio = 1.94, IC95% = 1.03-3.63). This study also confirms poorer prognoses for pulmonary tuberculosis sufferers hospitalized in sanatoria before antibiotics and reveals that a significant number of patients survived enough time to develop bone lesions.

The changing face of tuberculosis: trends in tuberculosis-associated skeletal changes.

Tuberculosis remains a major health problem in many areas of the world. Previous research suggested that the frequency of bone lesions has decreased in the modern (but pre-antibiotic) period, and that the predominantly spinal involvement have changed to affect other parts of the skeleton, in particular ribs. The purpose of this study was to investigate whether bone lesions associated with TB became more or less common in the post-antibiotic period, and if the pattern of skeletal involvement has changed. The skeletons of 147 individuals from South Africa who died from TB were assessed. These were divided into three groups - those dying before 1950 and presumed to have had no antibiotic intervention (n = 52); those dying between 1950 and 1985 presumed to have been treated with antibiotics (n = 34); and those dying after 1985 where co-infection with HIV and drug-resistant disease emerged (n = 61). Overall, 33.3% of all individuals showed signs that could be associated with TB, with corresponding figures in each of the three groups being 21.1%, 38.2% and 41.0%. The increase from group 1 to 3 was statistically significant. Rib lesions are becoming more common, while spinal lesions are decreasing. It may be suggested that patients are surviving for longer due to antibiotic treatment, allowing more time for the development of lesions.

Chemotherapy and diagnosis of tuberculosis.

Since after the first streptomycin 1944 trials, anti-tuberculous chemotherapy research has been focused upon establishing drug combination regimens capable of overcoming drug resistance and amenable to ambulatory treatment in resource strapped countries. The first milestone being the 1959 Madras trial comparing home and sanatorium treatment in South India. Subsequently, the MRC trials led Fox and Mitchison to indicate rifampicin, isoniazid and pyrazinamide as the first line drugs for short course, 6 month, regimens and the 1982 Hong Kong Chest Service trials established intermittent therapy as the ambulatory treatment standard for directly observed therapy (DOT). The rising of the HIV epidemic at the beginning of the 1980s has refuelled tuberculosis spread in Africa and Asia and contributed to the expansion of drug-resistant tuberculosis worldwide making the development of new drugs and drug regimens for ambulatory treatment a top priority. Led by biotechnological advances, molecular biology has been brought into TB laboratory diagnosis for the highly sensitive and specific rapid identification of Mycobacterium tuberculosis in biological samples. The field of immunological diagnosis of TB infection, dominated since the early 1900s by the intradermal tuberculin reaction has been put back in motion by the discovery of M. tuberculosis-specific proteins and peptides, now employed in blood tests of high sensitivity and specificity for the diagnosis of latent TB which may help with the identification of contacts at higher risk of active disease and the eradication of epidemic cases.

The health care experiments at Many Farms: the Navajo, tuberculosis, and the limits of modern medicine, 1952-1962.

In January 1952 a team of medical researchers from Cornell Medical College learned that tuberculosis raged untreated on the Navajo Reservation in Arizona. These researchers, led by Walsh McDermott, recognized a valuable opportunity for medical research, and they began a ten-year project to evaluate the efficacy of new antibiotics and test the power of modern medicine to improve the health conditions of an impoverished rural society. The history of this endeavor exposes a series of tensions at the heart of medical research and practice. Researchers exploited the opportunities made possible by the ill-health of a marginalized population, but did so with the cooperation and gratitude of the Navajo. They introduced new antibiotics that liberated patients from hospitals, but erected an intrusive system of outpatient surveillance. They provided innovative health-care services, but failed to reduce the dominant causes of morbidity and mortality. As every act of treatment became an experiment, they risked undermining the trust on which research and clinical care depended.