Grantville Gazette 38

and a warm smile was spreading across his angular but handsome face, his icy blue eyes shining. Incredibly, against all hope, he was alive. Alive! Pam's heart skipped like a stone across a pond, her palms grew sweaty and her knees wobbled.

Torbjorn chuckled, that warm, rumbling sound Pam had thought she would never hear again. 'Pam! It is so lovely to see you!' She just stared at him, her mind spinning around on a merry-go-round, unable to find its way off. He nodded, understanding her startled surprise. 'My apologies Pam, I'm sure it's something of a shock, you must think me a ghost! I am so sorry for that. The fates cast me off to the north while you went south. I suppose I must call you Captain Pam now. You have become quite the hero. I always thought there was more to you than meets the eye! It seems I shall have to find a new job! Perhaps you could use an able mate?' He gazed at Pam with great admiration on his face and something more. Something wonderful.

Pam lunged forward, launching herself into an embrace that would have knocked him over if he hadn't been such a large man. She hugged him tightly, unable to form words yet. He hesitated in a gentlemanly way for a moment, then hugged her back with equal strength and affection.

'I am so glad to see you, Pam,' he told her softly, 'I was so afraid that it was you who might have left this world. I thought about you every day, and prayed that-' Torbjorn was unable to finish his sentence because Pam was now kissing him on the lips with a fierce urgency she hadn't felt since she was seventeen. Torbjorn's eyes widened, but the good captain had the presence of mind to kiss her back, and there was no mistaking he was glad to be doing so.

The White Plague

Brad Banner

Run! Yes, run, do not walk . . . to the nearest doctor's office and demand that they write a prescription for a twelve-month supply of isoniazid for every member of your family.

Unfortunately, even if the pharmacy has any of the drug, he is going to tell you 'Hell, no.' He knows just as well as you do that in 1631 you have been dropped in the middle of an epidemic that will last another 250 years. No, it's not the black plague. It's not smallpox, and it's not any of the sexy, fast-burning epidemics.

It is the white plague-tuberculosis.

Every person in Grantville is very likely to be infected with tuberculosis mycobacterium within the first year. One-third of them will get sick. Without modern medical treatment, probably half of those who get sick will die in the next five years. About one-fifth will be chronically sick and eventually die from the disease, and one-third will recover.

How do 'they' prevent that from happening? I'm sorry, but 'they' includes you and you have an important role to play. How? First you have to learn everything you can about tuberculosis.

Mycobacterium tuberculosis and Mycobacterium bovis, the main two causative agents of tuberculosis(TB), have preyed on their human and animal hosts for thousands of years. Tuberculi and tubercular lesions were found in mummies from Egypt that are thousands of years old. They were found in pre-Columbian mummies and skeletons in Peru. On most continents, there is evidence of TB as soon as people gathered in agricultural communities. M. tuberculosis causes most human TB. M. bovis, which also infects cattle, sheep and goats, is responsible for 5-25% of human infections depending on time period, geographic area, and control measures.

The common names for tuberculosis disease include TB, consumption, scrofula, phthisis, Pott's disease, and white plague. Phthisis is the ancient Greek and Roman name for TB and was the name used by doctors until the 1800s. Consumption, the common name for TB for centuries, was so ubiquitous in the 1800s that the pale skin and wasted appearance of its upper-class victims became fashionable. That fashion has persisted to this day. Think of the heroin addict appearance of many top models or the pale-skinned, razor-thin vampires of contemporary fiction. Consumption was associated with vampirism in some superstitious cultures of the Early Modern Era.

The fashionable consumptive appearance of TB is not the only aspect of the disease that has persisted into the present. Up to one-third of the world's population today is or has been infected with TB. One-tenth of those infected with TB develop disease. Of those that develop disease, over half die within five years if not treated. Between one and two million people die each year from tuberculosis. It is the most common infectious disease on Earth . . . just as it has been since antiquity. Most of today's TB infections and disease occur in Asia and Africa, where the same poor living conditions that were common in 1600-1900 Europe predominate. The sub-optimal living conditions include overcrowding (even in rural villages), poor workplace and home ventilation, malnutrition, poor hygiene, other common diseases, and lack of basic healthcare.

TB can affect nearly all of the body's organs. The most common and well known symptoms are related to the respiratory system. Small and large pulmonary granulomatous (cheesy) abscesses, known as tubercles, form and destroy normal lung tissue and rupture blood vessels in the lung. The disease can spread to other organs from the lungs.

The bovine strain of TB is usually acquired by ingesting infected milk (especially) and meat. It most commonly attacks the digestive system forming tubercles in the lining of the intestines. Tubercular meningitis is common in infants exposed to the bacteria. Scrofula refers to the form of the disease in which the lymph nodes of the throat are visibly swollen. In Pott's disease, the bacteria attacks the bones and connective tissue. The skin form of TB is known as lupus vulgaris. It causes terrible ulcerous disfigurations of the face that resemble leprosy.

Most forms of TB are chronic diseases. They take years to kill their victim. The forms that act quickly usually affect the very young or the very old. Infants and young children are very likely to develop TB disease if exposed to the bacteria. School-age children seem to be more resistant to the disease, but, the age group that TB disease affects the most is people in the prime of their life-the 15-50 year-olds.

Not all TB infections lead to disease. The TB organism invades the body, where it attempts to reproduce. In most instances, the body's immune system succeeds in walling off the TB bacteria and killing it. Sometimes the bacteria remains alive, but is not causing disease and cannot be passed to another person. That state is called a latent infection which can become active disease if the host's immune system is compromised. The part of the immune system that is active against TB is called cell-mediated immunity and is moderated and controlled by T-cell lymphocytes. Anything that weakens the controller T-cells weakens the body's resistance to TB. Some of the things that compromise T-cells are: injuries to the lungs (such as silicosis and black lung disease), infectious agents (such as HIV today and measles in the past), malnutrition and low body weight, certain genetic factors, and stress (which cause the body to release corticosteroids, which negatively affects the immune system). Research has shown that those who are 10% underweight are three times as likely to get TB. In overcrowded, unventilated conditions. the body-particularly the lungs-is exposed to many more aerosolized TB bacteria, so there are more infections and more chances for infections to turn into disease. There are some genetic factors that make some people more susceptible to TB disease than others. Cell-mediated immunity is impaired in those more likely to develop disease.

TB epidemics differ from epidemics of other diseases. Other diseases cause epidemics that last months, years, or even decades. TB epidemics last centuries. The number of TB-diseased people steadily rose from the late 1500s to a peak in the late 1800s. The people in Grantville are dropped into the earlier stages of what was called the Great White Plague of Europe. The number of cases gradually dropped off in most of Europe in the late 1800s and early 1900s. This was beforeany effective treatment or vaccination was discovered.

Why did the epidemic wane? To this day, no one knows for sure. Despite the white plague epidemic's centuries old existence, that is still too short a time for natural selection to have any effect. Most experts think that better living conditions and nutrition played a big part. People have a stronger immune system with better nutrition and less crowded living conditions. Also, when people have more breathing room, there is less exposure to the TB bacteria in the air. Some speculate that there was a 'helper infection' to TB that adversely affected their T-cells, much like HIV virus does today. The population became resistant to the helper infection to the point it became much less common. Today we know that there are many mycobacteria that do not cause disease. Some speculate that there was a rise in the exposure to another mycobateria that partially immunized a significant part of the population against TB.

Another characteristic of TB epidemics is that they can wax and wane in geographic areas. One village or