Medical education does not exist to provide students

“Medical education does not exist to provide students with a way of making a living but to ensure the health of the community” Rudolf Virchow Mid 1800 s

Tuberculosis has been killing millions for centuries

Symptoms of untreated active TB Persistent cough and Low grade-fever Difficulty in breathing Night sweats Blood in sputum Cambodian TB patient Severe weight loss Picture: World Lung Foundation

TB is an ancient human disease! Recent evidence supports a diagnosis of TB in this 500, 000 year old Homo erectus Bone lesions indicative of TB Credit: Marsha Miller, the University of Texas at Austin

TB is an ancient human disease! TB spinal lesions have also been found in Egyptian mummies

It is estimated that from 1700 -1900, TB killed 1 billion people. The annual death rate in the late 1800 s was 7 million. TB Ward, Ellis Island Waverly Hills Tuberculosis Sanatorium. Louisville KT 1926 "Forgotten Ellis Island, ” photographer Stephen Wilkes

After urbanization up to 25% of all European deaths in the 1800’s may have resulted from TB TB Ward, Ellis Island http: //www. birdchildsandgoldsmith. com/acatalog/slums. gif

The famous and the infamous died of TB John Keats Anton Chekhov Frederic Chopin Emily Bronte Simon Bolivar Henry Thoreau

The famous and the infamous died of TB along with countless millions known only to their families George Orwell Eleanor Roosevelt Franz Kafka Eugene O’Neill DH Lawrence

In 1900 TB was still the second leading cause of death in the US CDC

Now infectious diseases are much less prominent as causes of death and TB has dropped off the list CDC

In the early to mid 1900 s TB remained a major public health challenge in the US "Prevent Disease: Careless Spitting, Coughing, Sneezing, Spread Influenza and Tuberculosis. " Rensselaer County Tuberculosis Association (Troy, N. Y. ), [ca. 1925] "'Stamp' Out Tuberculosis: Buy Christmas Seals. " National Tuberculosis Association, 1924. American Red Cross. "The Next to Go: Fight Tuberculosis. " [American Red Cross], 1919.

In the US TB is now an almost forgotten disease US TB deaths in 2009: 547 CDC

In the US TB is now an almost forgotten disease In 2009 US TB deaths: 547 US Influenza deaths: 2125 (90% age >60 years) US deaths due to dog bites: 30 CDC

But not in the developing world! TB KILLS 1. 7 MILLION PEOPLE EVERY YEAR OVER 4600 EVERY DAY ONE PERSON EVERY 21 SECONDS Stats from WHO

TB is present world-wide but Incidence rates differ dramatically CDC

For this Peruvian family mourning a child dead to TB the disease is certainly not forgotten Partners in Health and Harvard Medical School Dept. of Social Medicine Program in Infectious Disease and Social Change http: //www. hms. harvard. edu/news/releases/family_cemetery. html

Two billion people --one third of the world’s population-are infected with the bacteria that causes TB World Lung Foundation (2008)

Worldwide TB causes: 5% of all deaths Morocco ~10% of all adult deaths India China South Africa Stats: NIAID/NIH Pix: World Lung Foundation

Left untreated, a person with active TB will infect 10 -15 other people per year World Lung Foundation (2008) and http: //pathport. vbi. vt. edu/pathinfo/pathogens/Tuberculosis_2. html

Left untreated, a person with active TB will infect 10 -15 other people per year new infections occur at a rate of one per second! World Lung Foundation (2008) and http: //pathport. vbi. vt. edu/pathinfo/pathogens/Tuberculosis_2. html

In most cases TB starts as an infection of the lungs = pulmonary TB http: //library. med. utah. edu/Web. Path/TUTORIAL/DRUG 022. html

X-rays used to be the primary means of diagnosis http: //library. med. utah. edu/Web. Path/TUTORIAL/DRUG 022. html

Now TB exposure is diagnosed by a skin test

A positive test result simply means you have been exposed to TB* at some point and have developed antibodies to it *=Active case Previously “cured” Inactive case Vaccinated with BCG

The next step is a sputum culture

The next frontier: DNA testing to identify different strains of TB and assess drug resistance Dbtechno. com

The next frontier: DNA testing to identify different strains of TB and assess drug resistance July 2008: WHO unveils $26 million program to create labs in poor nations that can do DNA tests Cost: $5 per test Time frame: 24 hours Rather than weeks to months!

However, the TB bacterium can also Infect many other organs, causing distinct “diseases http: //library. med. utah. edu/Web. Path/TUTORIAL/DRUG 022. html

However, the TB bacterium can also Infect many other organs, causing distinct “diseases Renal TB www. vetmed. wsu. edu

However, the TB bacterium can also Infect many other organs, causing distinct “diseases Renal TB Lupus vulgaris http: //www. ecureme. com/atlas/data/Tuberculosis_of_Skin 550_ab. htm

TB infecting the spine Pott’s disease = tuberculous spondylitis Credit: Dr Laughlin Dawes www 3. shropshire-cc. gov. uk/. . . /med_i 03. htm

“Miliary TB” is disseminated throughout the body Here it is presenting in the eye www. aippg. net/forum/ viewtopic. php? t=11673

Scrofula: TB of the lymph nodes of neck King Henry IV of France touching sufferers of scrofula. André de Laurens, 1609

As late as the 1800 s, causes and cures of TB remained mysterious www. nlm. nih. gov

TB sanitoria were built all around the US www. umdnj. edu/librweb

This may seem like ancient history to you Waverly Hills Tuberculosis Sanatorium. Louisville KT 1926 housed over 400 patients, from infants to adults. Waverly Hills closed in 1961 library. louisville. edu

But they remained in operation until after your professor was born Waverly Hills Tuberculosis Sanatorium. Louisville KT 1926 housed over 400 patients, from infants to adults. Waverly Hills closed in 1961 library. louisville. edu

Gravely Building on the other side of the hospital, torn down in 2010, was a TB sanitorium www. med. unc. edu