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Authors: Bryn Barnard
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called the Advisory Committee for the Elimination of Tuberculosis. In retrospect, this seems astoundingly naive.
Back with a vengeance
Once TB was no longer a terror, tuberculosis control systems deteriorated. In the United States during the 1980s, sanitariums were shut down or converted into hospitals. Public health programs were defunded. Salaries stagnated for personnel responsible for monitoring and treating TB. Funding for poverty programs was slashed. Mental hospitals were emptied, pushing people unable to care for themselves onto the street or into crowded homeless shelters. In 1992, the Soviet Union collapsed and with it the expensive TB control program of SanEp, the Russian empire’s unwieldy state health system. Revolution in Africa and Central America ensured that people there with tuberculosis got partial treatment or no treatment.
Under such conditions, many TB patients took only enough antibiotics to feel better but not enough to eradicate all the TB germs in their bodies. They killed off the weak bacteria, allowing the strong ones to reproduce and make them sick again. The next time they took the antibiotic, it didn’t work. The strong microbes were
resistant.
These resistant TB bacteria spread around the world in the bodies of refugees fleeing their crumbling societies. In 1993, the re-emergence of tuberculosis caused the World Health Organization to proclaim a global TB emergency. Today nearly two billion people on earth may host the tuberculosis bacterium. Over the next decade, ninety million will develop active TB. Eventually thirty million will die.
Tuberculosis, once the most Romantic of illnesses, is now the deadliest disease on earth. Controlling the bacterium is the twenty-first century’s greatest public health challenge.
The sausage machine
World War I extinguished ideals of chivalry that since medieval times had cloaked battle in a nimbus of glory, honor, and sacrifice. In this, the world’s first truly industrial war, battle was revealed not as a righteous conflict but as a riot of slaughter. Most of the efficient mass killing machines we are familiar with today got their start here: tanks, long-range artillery, machine guns, aerial bombardment, submarines, and poison gas. In the horrific trench warfare that characterized this struggle, tens of thousands of soldiers lost their lives to win a few feet of ground. Tens of thousands more died to win it back. The war had many names, including “the Great War” and “the war to end all wars.” President Woodrow Wilson’s favorite was “the war to make the world safe for democracy.” Poet Robert Graves called it “the sausage machine,” because “it was fed with live men, churned out corpses, and remained firmly screwed in place.” From 1914 to 1918, over fifteen million people died, nine million of them in combat.
In the last months of the war, however, a new killer appeared, far more efficient than anything devised by man. It was Spanish influenza, the single largest epidemic of the twentieth century, if not world history. As with normal flu, people who caught this illness became lethargic, feverish, and achy. But instead of recovering, many of those who were infected by this strain of influenza then progressed to a deadly pneumonia that filled the lungs with bloody froth. Oxygen was sucked from the tissues, turning the skin a sickly purple before the victim died, gasping for air.
Spanish flu had another fatal peculiarity. Most flu epidemics kill the very young or the very old. This disease, however, was most lethal among those it was most likely to encounter on the battlefields of Europe: twenty-to-thirty-year-olds. Of the one hundred thousand American soldiers who died in World War I, forty-three thousand died from the Spanish flu. Total U.S. flu deaths were about half a million. Globally, death toll estimates range from twenty million to one hundred million people. Up to twenty million may have died in India alone. In some
Back with a vengeance
Once TB was no longer a terror, tuberculosis control systems deteriorated. In the United States during the 1980s, sanitariums were shut down or converted into hospitals. Public health programs were defunded. Salaries stagnated for personnel responsible for monitoring and treating TB. Funding for poverty programs was slashed. Mental hospitals were emptied, pushing people unable to care for themselves onto the street or into crowded homeless shelters. In 1992, the Soviet Union collapsed and with it the expensive TB control program of SanEp, the Russian empire’s unwieldy state health system. Revolution in Africa and Central America ensured that people there with tuberculosis got partial treatment or no treatment.
Under such conditions, many TB patients took only enough antibiotics to feel better but not enough to eradicate all the TB germs in their bodies. They killed off the weak bacteria, allowing the strong ones to reproduce and make them sick again. The next time they took the antibiotic, it didn’t work. The strong microbes were
resistant.
These resistant TB bacteria spread around the world in the bodies of refugees fleeing their crumbling societies. In 1993, the re-emergence of tuberculosis caused the World Health Organization to proclaim a global TB emergency. Today nearly two billion people on earth may host the tuberculosis bacterium. Over the next decade, ninety million will develop active TB. Eventually thirty million will die.
Tuberculosis, once the most Romantic of illnesses, is now the deadliest disease on earth. Controlling the bacterium is the twenty-first century’s greatest public health challenge.
The sausage machine
World War I extinguished ideals of chivalry that since medieval times had cloaked battle in a nimbus of glory, honor, and sacrifice. In this, the world’s first truly industrial war, battle was revealed not as a righteous conflict but as a riot of slaughter. Most of the efficient mass killing machines we are familiar with today got their start here: tanks, long-range artillery, machine guns, aerial bombardment, submarines, and poison gas. In the horrific trench warfare that characterized this struggle, tens of thousands of soldiers lost their lives to win a few feet of ground. Tens of thousands more died to win it back. The war had many names, including “the Great War” and “the war to end all wars.” President Woodrow Wilson’s favorite was “the war to make the world safe for democracy.” Poet Robert Graves called it “the sausage machine,” because “it was fed with live men, churned out corpses, and remained firmly screwed in place.” From 1914 to 1918, over fifteen million people died, nine million of them in combat.
In the last months of the war, however, a new killer appeared, far more efficient than anything devised by man. It was Spanish influenza, the single largest epidemic of the twentieth century, if not world history. As with normal flu, people who caught this illness became lethargic, feverish, and achy. But instead of recovering, many of those who were infected by this strain of influenza then progressed to a deadly pneumonia that filled the lungs with bloody froth. Oxygen was sucked from the tissues, turning the skin a sickly purple before the victim died, gasping for air.
Spanish flu had another fatal peculiarity. Most flu epidemics kill the very young or the very old. This disease, however, was most lethal among those it was most likely to encounter on the battlefields of Europe: twenty-to-thirty-year-olds. Of the one hundred thousand American soldiers who died in World War I, forty-three thousand died from the Spanish flu. Total U.S. flu deaths were about half a million. Globally, death toll estimates range from twenty million to one hundred million people. Up to twenty million may have died in India alone. In some
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