TB of the lung: from the 1920s to current treatment

Paul Nunn

Dr Paul Nunn

In 1923, in England and Wales over 32,000 people died of tuberculosis of the lung and over 8,000 people from tuberculosis affecting other parts of the body [image of tuberculosis bacilli: Sanofi Pasteur. Used under Creative Commons].

To understand the significance of these figures, it is important to know what survival rates were for tuberculosis  at the time. Some idea can be gained from data from the Frimley sanatorium for patients admitted there with tuberculosis. For the decade up to 1914, for mild tuberculosis, 10 year survival was 2 out of 3 for men and 6 out of 7 for women, for moderate (Stage 2) disease, 10 year survival was less than 1 in 5 for men, and one in 2 for women, and for severe (Stage 3) tuberculosis, only 1 in 10 man and women survived for 10 years. The focus of treatment in the 1920s involved a combination of rest, in a sanatorium if affordable, surgery to remove affected tissue, or to rest the lung, and a range of often toxic medicines. Despite major advances in understanding, prevention and treatment of tuberculosis, it remains a serious global problem, with, in 2013, according to the World Health Organisation, 9 million people falling ill with TB and 1.5 million dying from the disease.

A Symposium was held on 1st October 2015 by the Fellowship of Postgraduate Medicine to mark the 90th Anniversary of its first official journal, the Postgraduate Medical Journal.

See a paper on the physician’s view of TB of the lung from the first year of publication of the Postgraduate Medical Journal.

Speakers included
Dr Paul Nunn, former Director of the WHO Tuberculosis Programme, who will speak on tuberculosis: the White Plague, 1925-2015: a world of two halves
– FPM Fellow Professor Peter Barnes FRS, London, who will speak on evolution of asthma and COPD over 90 years
– Professor Dame Carol Black, Principal of Newnham College, Cambridge and Past-President of the Royal College of Physicians who will discuss opportunities to improve public health through a focus on health in the workplace,
– Professor Melanie Davies (Leicester) on progress in managing diabetes,
–  vascular surgeon Professor Alison Halliday (Oxford) on carotid surgery to prevent stroke,
– FPM Fellow chemical biologist Andrew Marsh (Warwick) who will discuss advances in drug discovery,
–  FPM Fellow cardiac surgeon Wade Dimitri (Coventry) who will discuss early development of heart surgery
– FPM Fellow Professor Munir Pirmohamed (Liverpool) who will discuss Progress in Personalised Medicine,
– Emeritus Professor Terence Ryan (Oxford) on Sir William Osler
– Professor Karol Sikora (London) on cancer – a disease of our time
– Dr James Wilkinson (London), President of the World Federation of Societies of Anaesthesiologists on on development of anaesthesia over the past 90 years

Speakers on the day commented on what medicine was like in the 1920s, current progress in their field, and what is in prospect over the next 90 years.

More on the Symposium, the Postgraduate Medical Journal and the Fellowship of Postgraduate Medicine.

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