D helps bolster the immune system.
Minimize war. TB always flourishes during or right after wars. Overcrowding, infected refugees moving from place to place, malnutrition, exposure to other diseases, and stress are just some of the wartime conditions that greatly increase the incidence of TB.
Good general sanitation and the mindset that accompanies it will help. Infection with other diseases makes it more likely that a person will develop TB disease. In the 1800s those who contracted measles or whooping cough were very likely to develop TB disease afterward.
Eradicate the bovine form of TB. Milk, meat and herd inspection are essential. Pasteurizing or boiling milk products is a must. Boiling milk is a very easy practice to implement. Culling TB infected animals is needed to insure the long-term safety of the food supply. The same tuberculin that is used in human skin tests can be used in intradermal tests of livestock. If livestock show signs of TB or react on a tuberculin test, then don't sleep in the same enclosed building with them.
Tuberculin skin testing to detect latent (inactive) infection and early TB disease are very important. Find people before they spread the TB bacilli.
Separating those with active TB disease and those who react to tuberculin skin testing is another method of protecting the uninfected. It may have to be done, but there are many social and medical problems with this.
•For one, how do you sequester the infected and sick when in some areas the rate of infection is nearly 100%?
•Do you want to create a new class of medical and social 'lepers'?
•How do you enforce quarantine?
•Those with latent (inactive) infection are not contagious. If you sequester them with those with active infection they are very likely to get re-infected with TB and develop active disease.
•Overcrowding in quarantine facilities will make those with TB disease worse.
•People will hide their infections rather than be singled out.
Developing BCG vaccine as quickly as possible is essential. All should be tuberculin skin tested and vaccinated if negative to the test. Policies will need to be developed concerning the vaccination of tuberculin- positive people. There are too many variables to have a 'one size fits all' policy on vaccinating tuberculin reactors. Along with vaccinating, there must be an education program that informs all about the limitations of the vaccine. BCG does not protect against all forms of TB. It is generally much more effective in the young than in adults. Today in India, BCG does not prevent pulmonary TB in adults. Once a person is vaccinated with BCG, they will test positive for TB on a tuberculin skin test. More effective vaccines are in the final testing stages today. Most of them rely on technology, such as recombinant DNA, that is not going to possible for a long time in the 1630s.
TB can be prevented by a daily dose of isoniazid. The dose is less than that used for treatment. The drawbacks are lack of patient compliance and the tendency to forget other forms of control when you have a magic bullet. Treating TB infected people with isoniazid or other drugs will eventually eliminate the bacilli from their sputum and other body fluids.
Until the discovery of antimicrobial drugs, there was no effective treatment for TB. Most of the drugs used to treat TB today are chemical antimicrobials rather than antibiotics. Antibiotics are gathered from micro-organisms, while chemical antimicrobials are produced in the chemistry lab. The two antibiotics are streptomycin and the rifamycins. The rest are chemical antimicrobials. Isoniazid is the most effective and seems to be the easiest to make. Pyridine is necessary to produce isoniazid. Today pyridine is produced with petrochemicals, while in the past it was produced from coal tar, which is available in the 1630s. There may not be enough pyridine produced for industrial users, but there should be enough for medical chemical production. While I was unable to find any references to whether chloramphenicol is effective in treating TB in people, the antibiotic can be tested on those with TB disease. Most anti-TB antimicrobials eventually produce resistant strains of bacilli when used alone in the treatment of diseased individuals. They don't cause resistance when used as a preventative or as a treatment for latent (inactive) infection. Luckily, isoniazid treatment takes much longer to produce resistant TB bacilli, so it can be used alone for a time. If chloramphenicol is effective against TB, it can be used in combination with isoniazid as the first line treatment of the disease. That will take some pressure off those trying to develop a second drug to use with isoniazid. Thioacetazone seems to me to be the most likely candidate as a second drug. It was produced by Bayer in post WWII Germany with limited production facilities. Other chemical antimicrobials are PAS, ethambutol, and pyrazinamide.
Mitigation of the Great White Plague of Europe is not going to be easy. It is going to take decades, rather than months or years. The elimination of TB is going to take centuries if what has happened up-time is any consideration. I certainly don't presume to have all the answers. Smarter, more knowledgeable people than me are still trying to control TB in this century. Today up to one-third of the world's population has been infected with TB. The good news is the leaders in the fight against TB know what needs to be done. The bad news is that gaining compliance with control measures has been-and still is-an uphill battle. Our down-timers have an advantage over those left up-time: they have a huge head start in the fight against TB. They can see how others triumphed and how they failed, building on the past successes. They can build programs that are more likely to get local compliance which is absolutely essential for the programs to succeed. There are forward looking universities in Jena and Padua to work with them.
I am an optimist. I see control and prevention of TB moving outward in concentric rings from Grantville and places that accept help and knowledge from Grantville until the epidemic is finally controlled in a future decade or century. I see breakthroughs coming from downtime scientists in the coming decades and centuries. What will you do to help blunt the effects of the Great White Plague?
Daniel, Thomas M.
Ryan, Frank, MD.
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