King's College London
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The great leveller: humanity's struggle against infectious disease

Charles Creighton on tuberculosis

Colour illustration of a lung and liver affected by Bovine tuberculosisPlate 1: Lung and liver affected by Bovine tuberculosisAlthough the advent of mass urban and industrial society created opportunities for tuberculosis to spread and to kill millions - through crowding, bad nutrition and poor working conditions - on a par with bubonic plague and cholera, this disease did not capture professional medical attention until the 1880s, when the German bacteriologist Robert Koch isolated the tubercle bacillus.

The reasons for this comparative neglect lie in the nature of this condition. It did not manifest itself in terrifying epidemics; nor was death often dramatically quick. Instead, the disease was often, but not always, chronic, the symptoms could take months or years to manifest themselves, there could be long periods of apparent remission, and many recovered without knowing that they had had the disease.

Colour illustration of a diaphragm, lungs and spleen affected by Bovine tuberculosisPlate 2: Diaphragm, lungs and spleen affected by Bovine tuberculosisTuberculosis is most commonly associated with the lungs, but can occur in any part of the body.  Until the medical profession had accepted the findings of bacteriology, debate raged about the causation of this disease. Both the treatises, by Creighton and Klein, shown here were written on the brink of the transformation of clinical medicine by bacteriology.

The medical scholar Charles Creighton (1847-1927), whose claim to fame lies in his study of the history of disease and in his opposition to smallpox vaccination, was deeply involved in these discussions, though, unfortunately for his reputation, on the wrong side. Creighton believed that tuberculosis was hereditary.

This was a belief held by many medical practitioners of the time, including the eminent German pathologist Rudolf Virchow, who had taught Creighton. In fact, most believed that tuberculosis was either hereditary or inhered in the patient’s personality, and so was very difficult to treat. As it often occurred in different generations of the same family, there was apparent evidence for this belief.

Colour illustration of lungs and lymphatic gland affected by Bovine tuberculosisPlate 3: Lungs and lymphatic gland affected by Bovine tuberculosisIf anybody was looking for evidence that tuberculosis was not caused by person-to-person infection, they would look to bovine tuberculosis, as Creighton does in this book, as its occurrence in humans was caused by consuming unpasteurised milk.  Although Creighton was an expert pathologist, he was unable to accept the important contribution which bacteriology was making to medical science.

Tuberculosis had only become a separate disease entity in the 19th century. Before then, there had been three recognised diseases with tubercular symptoms, of which scrofula was one. The book was inscribed by the author to Sir John Simon.

In the images from Creighton’s book shown here, figure 1 from plate 1 shows tubercles on the lung, and figure 2 shows tubercles on the liver. Figures 3 to 6 in plate 2 show tubercular nodules under the surface of the diaphragm, on the lower lobe of the lung, on the lateral convex surface of the lung, and on the surface of the spleen, respectively. Figures 7 to 9 in plate 3 show sections of the lung, and figure 10 shows a bronchial lymphatic gland.

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