Also to the OP, it is not always a pulmonary infection. I've seen it as solid tumors mimicking both testicular and prostate cancer, even to the point of elevating tumor markers because the tumor markers are generally chemicals that are also made by the normal tissue and when it is irritated for whatever reason, the markers can be elevated. Putting the tumors like these in formalin which used to the be norm in the operating room will kill the bacteria so it went unnoticed for a long time and why any good surgeon should call the pathologist and hand off the specimen in person if it looks particularly odd.
This. There are different ways the infection can manifest, and it can
mimic other diseases I am guessing it has something to do with the way it entered the body and with the particulars of a given person's immune response. I'm not a microbiologist (or an MD like Georgek), so I have huge gaps in my knowledge about TB. To me, it seems like there is a lot of inconsistent and self-contradictory information out there about the disease, even today, so I'm guessing there would have been in the 60s as well.
My husband tells me that his mother had it some time in the 60s, and they had to choose between a treatment that would have required her to be isolated for a while and another, less radical treatment (which she chose). She is disease free today. He's never been able to provide details about this, and I've never had occasion to ask my MIL about it. I gather her case was mild and not deemed contagious, but I have no idea what was behind this thinking at the time. I think there was concern about her passing it on to my husband, who would have been a baby at the time, but there was also the issue of her being needed as his primary caregiver, and this factored into the choices they made re treatment. I don't think my husband was vaccinated at the time, as he's never had an issue with false positives on his skin tests (my dad was vaccinated as a child, and he always reacted to skin tests).
Because of the vaccine, my dad always reacted to the TB skin test. When someone gets a positive skin test, the next step is a chest x-ray. If that's normal, they evidently decide that the person doesn't have TB and is not a risk to others. I never understood this, because (as mentioned already),
TB doesn't always settle in the lungs. About 20% of cases are extrapulmonary in immunocompetent people. So I've no idea why when someone has a positive skin test, they just do an x-ray and assume the person is clear if it doesn't show up there.
I'm guessing that in the 60s, health care workers were screened regularly, or perhaps they were required to have the vaccine if they worked in TB wards.
The vaccine isn't recommended for wide use the US today. I'm not sure why they're so cautious about using it here. Maybe it has more risks that many vaccines, or it isn't super effective?