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Thread: Tuberculosis in the 1960s

  1. #1
    New Fish; Learning About Thick Skin SageChild's Avatar
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    Tuberculosis in the 1960s

    How did ordinary people then protect themselves from transmission? For example caring for family while they're sick. Did they wrap a cloth around their mouths?

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    Moderator AW Moderator Maryn's Avatar
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    I knew a few people who had TB in the late 1970s, not all that close to your era but not that far away, either.

    The caregivers did not mask or glove or anything. Perhaps they should have, or perhaps once it was under treatment the risk of transmission was greatly reduced. At that time, most of the TB cases were among people who lived on the fringes--the homeless, the lifestyle drug users, hippie types who opened the door to anybody with hair and weed--and the level of care others gave was low, as was the responsibility of the person with the illness. The ones I knew were drug users who spent every day high. They were supposed to take a lot of prescription drugs for two years, but often forgot for days at a time. By now, they might well have died of their illness.
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  3. #3
    practical experience, FTW cornflake's Avatar
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    People get TB now -- you don't really need to do that once people are on drugs, and it's hard to get TB anyhow. It's not very easily transmissible.

  4. #4
    practical experience, FTW MaeZe's Avatar
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    Until the 1950s, TB was not recognized as an occupational risk to caregivers. The reason being the delay between when one contracts TB infection and when TB disease develops can be anywhere from months to decades. And a certain percentage of caregivers were already infected when they began working with TB patients. So despite the fact TB was recognized as a contagious disease, it was thought that many people were not susceptible.

    That is true to a certain extent. For one in good health, only about 10% of those infected will develop disease.

    Typically people are infected in crowded living conditions after prolonged exposure.

    You should look into the tuberculosis sanitariums like this paper: The Culture of Death and the Tuberculosis Sanatorium. These hospitals began closing in the 60s as treatment for TB improved, but it would have been a transition time and the sanitariums were still a big part of TB treatment in the timeframe you ask about.

    The fear of being forced to leave everyone and everything was a big deal at the time.

    As for respiratory protection, again, since it wasn't clear why some people got TB and when they acquired it, respiratory protection was not common. Instead people with active disease were isolated. Look up images of TB sanitariums and you will not see the nurses wearing masks at all.

  5. #5
    Dragging myself from the mire. Thorberta's Avatar
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    Oh! My grandfather had TB in the 1960s! Actually it was for the second time in his life. He was sent to a sanatorium. My mom (who was in high school at the time) had to go visit him in a special visiting area. Apparently, they had the patients sewing wallets for something to do and my mom said the drugs they gave him for the TB made him surprisingly happy to be doing this.

  6. #6
    practical experience, FTW Tsu Dho Nimh's Avatar
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    At the time, the TB drugs were effective - resistant strains had not shown up - so a person would be isolated until a culture showed they were not spreading bacteria. It could be at home, it could be in a sanatarium (although they were scarce), or in the contagious isolation room of a hospital. Occasionally a person who refused treatment and/or isolation would be jailed as a threat to public health.

    The drugs act quickly, so it's not months and months.

    And someone with TB is normally able to care for themselves.

    Household members were usually given preventive doses of the TB drugs unless their skin tests showed they were already exposed and immune.

  7. #7
    ever seeking GeorgeK's Avatar
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    Quote Originally Posted by Tsu Dho Nimh View Post
    A
    The drugs act quickly, so it's not months and months.
    .
    No, actually TB is a slow growing but relentless organism and it takes a minimum of 6 weeks of culturing to say it is a negative culture. In recalcitrant cases they may even run the culture times out to 3 months. IT's slow growth is the reason that it is assumed some people do fight off the infection on their own, which is why they can test positive and have no evidence of disease

    Quote Originally Posted by Tsu Dho Nimh View Post
    Household members were usually given preventive doses of the TB drugs unless their skin tests showed they were already exposed and immune.
    A TB skin test whether positive or negative does not confer a status of, "immune." If you have a history of exposure and a positive skin test then it is often assumed that you've been exposed, cultures are taken and you are started on presumptive antibiotics, at least that's how it was done before the multi-drug resistant strains. I wouldn't be surprised if there are more non-invasive scans nowadays and holding off on antibiotics. That seemed to be the way the trend was going around the time that I retired. If you had a history of exposure and a negative skin test then they do an anergy panel (a skin test against a panel of things that everyone should react to, like bread mold, locally ubiquitous bacteria etc). If you don't react to an anergy panel then it is assumed that you have a weakened immune system and won't react to a TB skin test whether or not you have an active infection. There's a whole lot of dominoes involved and the skin test is only an early part of it and doesn't on it's own prove anything


    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.
    Last edited by GeorgeK; 04-23-2017 at 10:28 PM.

  8. #8
    practical experience, FTW MaeZe's Avatar
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    Quote Originally Posted by Tsu Dho Nimh View Post
    At the time, the TB drugs were effective - resistant strains had not shown up - so a person would be isolated until a culture showed they were not spreading bacteria. It could be at home, it could be in a sanatarium (although they were scarce), or in the contagious isolation room of a hospital. Occasionally a person who refused treatment and/or isolation would be jailed as a threat to public health.

    The drugs act quickly, so it's not months and months.

    And someone with TB is normally able to care for themselves.

    Household members were usually given preventive doses of the TB drugs unless their skin tests showed they were already exposed and immune.
    My apologies but most all of this is inaccurate.
    Last edited by MaeZe; 04-23-2017 at 10:25 PM.

  9. #9
    Herder of Hamsters AW Admin's Avatar
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    There's also "Bovine TB"; from a related bacteria Mycobacterium bovis, which dairy farmers are still very very vigilant about.

    It's pretty common in India even now.

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    ever seeking GeorgeK's Avatar
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    Quote Originally Posted by AW Admin View Post
    There's also "Bovine TB"; from a related bacteria Mycobacterium bovis, which dairy farmers are still very very vigilant about.

    It's pretty common in India even now.
    We actually use it to treat bladder cancer as a topically instilled agent in the US. So it's always very important to do a skin test first so we can document down the road if they have a skin test conversion which TB it's likely to be.

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    What I remember most — probably because we (my husband and I) were just talking about it — is that there were vans with X-ray equipment that periodically parked on the main street of town. Anybody could step inside and get a free chest x-ray. Test results were mailed to you. Pretty cool. When they came out with the skin tests, the vans disappeared.

  12. #12
    Who's going for a beer? waylander's Avatar
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    Quote Originally Posted by AW Admin View Post
    There's also "Bovine TB"; from a related bacteria Mycobacterium bovis, which dairy farmers are still very very vigilant about.

    It's pretty common in India even now.
    And still a problem for farmers in the UK

  13. #13
    practical experience, FTW Twick's Avatar
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    I was born approximately 1960. When I was six months old, my mother was diagnosed with tuberculosis, and was immediately removed from the home. She spent several months in a local sanatorium until she was considered "clear." (One doctor admitted after the fact the diagnosis was probably a mistake, and marvelled that she didn't actually become sick when put in with a lot of people who did have the disease.)

    Do I have abandonment issues because of it? Don't know but ... please don't leave until we find out.

  14. #14
    New Fish; Learning About Thick Skin SageChild's Avatar
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    Thanks you for your answers! The help is much appreciated

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    Cat whisperer Mark HJ's Avatar
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    I do remember when I was a kid, so mid-sixties, that my grandfather disappeared for quite a long period because he was ill. We were not allowed to visit, but I was reasonably clear that he was not in hospital but 'something like hospital'. Reading between the lines, I now suspect that it may have been TB. It's hard to tell because my family really doesn't talk about this stuff. (Earlier this year Dad mentioned some really wobbly plastering he did when I was in my early teens. I sort of remember a lot of swearing and sanding. Apparently it was the last time his malaria flared up and he couldn't keep his hands steady. Parents. They never tell you the fun stuff.)
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  16. #16
    practical experience, FTW maryland's Avatar
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    A friend had a baby while suffering from TB in the1970s (England,) the baby was immediately taken away and cared for by her sister's family and the mother and child only reunited after several months. My own mother had TB and went off to a sanatorium for about a year when I was an infant too, returning when I was 2 years old.

  17. #17
    Beastly Fido Roxxsmom's Avatar
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    Quote Originally Posted by GeorgeK View Post
    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?
    Last edited by Roxxsmom; 07-12-2017 at 11:26 PM.
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  18. #18
    practical experience, FTW MaeZe's Avatar
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    Quote Originally Posted by Roxxsmom View Post
    ... 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?
    We no longer consider BCG vaccine a problem when giving/reading a TB skin test. It is now thought that BCG only causes small reactions and if one's test meets the size criteria for a positive test it is because the person was infected with TB despite the BCG.

    BCG is given here in the US but only rarely. It doesn't prevent TB infection, but it does decrease a severe neurological consequence of TB infection in young children. Thus its usefulness is limited to protecting young kids who you cannot remove from exposure risk, and treatment of early bladder cancer. Western countries cut back on BCG use but the timeframe varied with different countries. And in the US in some places, TB risks are higher (such as in indigenous villages in AK) so the vaccine may still be used selectively. I'd have to look it up to see where it is still used.

    As for the chest X-ray, the reason we aren't looking for extrapulmonary TB is that active TB disease not in the lung is only transmissible under certain conditions like direct contamination from a TB abscess.

    The TB skin test is looking for inactive TB infection. The X-ray is looking for active disease. Neither test really substitutes for the other.

    TB skin test screening is done in populations at risk of exposure. There is no reason to screen everyone. The idea is to find new infections and treat them before they become active disease. And given TB is very slow developing, a positive test requires ruling out early active disease. But once you have an established positive test, you don't need regular X-rays. There's no point.

    When TB disease develops there are symptoms that tell a provider like myself to look for active disease. While you might do a skin test if you suspect TB disease, a negative test doesn't mean the person doesn't have TB.

    All in all it's a bit of a complex clinical picture. I give hundreds of TB tests to employees every year. To explain all the ins and outs here would take a few more pages so my apologies if some of this post is confusing.

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