Wednesday, 4 April 2012

Why we need new treatments for tuberculosis

Tuberculosis is second only to HIV/AIDS as the greatest killer worldwide due to a single infectious agent. Nearly 9 million people a year become ill with TB and over 1 million die. TB causes a quarter of all deaths in people with HIV. Cases of tuberculosis continue to increase in Britain with about 9000 cases a year, 40 per cent of which are in London.

Worryingly, there is also an increase in multi-drug resistant TB (MDR-TB) and even extensively drug-resistant TB (XDR-TB) which means that the bacteria causing some people's disease fails to respond to conventional treatment. The extensive therapy necessary to treat these people is very expensive, can produce adverse drug reactions and must be taken for up to 2 years. Death rates of people with MDR-TB are much higher than other forms of the disease. For example, in 2010, about 440,000 people fell ill with MDR-TB and 150,000 died (34 per cent).

Tuberculomucin - a forgotten treatment - may give us a powerful 'new' method of combatting this ancient but continually burdensome disease which has always claimed more lives amongst the young and economically active than any other age group.

Photograph by Mary Hinkley, UCL Media Services, Photography

Prior Place Sanatorium, Camberley

Prior Place Sanatorium, Camberley, Surrey, was aquired in January 1941 as a country branch of the London Chest Hospital. I can't seem to find a photograph of it but if anyone does have any photos I'd be grateful to see them. Similarly, if anyone was a patient there during the war or is the descendant of a relative who was there, I'd like to hear from you because there are now very few remaining archives. I'm also interested in discovering more about the (illicit) use of Tuberculomucin at Prior Place where staff nurse Marianne Hartstein successfully treated some patients. Marianne worked at Prior Place from 4 February 1941 to 31 July 1943. Her daughter, Charlotte recalls her mother talking about treating a very sick patient named Dr Smith, who she thinks was a physicist. There are only three remaining books of patient case records from this period of the London Chest Hospital and Dr Smith does not appear in any of them but I suspect that Prior Place kept its own records separately and these have not survived.

Tuesday, 3 April 2012

Treating tuberculosis in the 1940s

I initially wondered why Charlotte's mother, Marianne, was able to persuade a patient in Prior Place Sanatorium to be treated 'illicitly' with a substance (Tuberculomucin) not on the list of orthodox treatments in Britain. But what were the available treatments? Fresh air and bedrest - sometimes for years on balconies open to all weathers such as one above at Craig-y-nos Sanatorium in the Swansea Valley; immobilisation in plaster casts; light therapy; surgical operations such as artificial pneumothorax (collapsing lungs in order to 'rest' them and hope the TB lesions heal); gold injections - yes, really; tonics and nourishing food. In London, in 1941, the TB death rate was 100 per 100,000 population, a 72 per cent increase over 1938, and 4500 people caught the infection that year. Perhaps it's understandable that patients would jump at the chance of trying a new treatment.

Charlotte Jones remembers her grandfather

Marianne's daughter, Charlotte (above), recalls her grandfather bringing Tuberculomucin culture with him to London. 'My mother went on making it in our kitchen in West Hampstead, boiling good lean mince for hours to make the broth. We then ate this totally tasteless meat afterwards.' With her stock of Tuberculomucin, Marianne began to treat desperately ill patients in Prior Place Sanatorium. This was done quite illicitly, without the knowledge or permission of the medical staff. Full treatment would have taken about six months starting off with weekly intradermal injections which left skin reactions of varying intensities. Did anybody notice these? I have looked at what's left of the archive of the London Chest Hospital and certainly nothing is flagged up and Marianne's nursing records contain no evidence that she was 'caught out'. Indeed, she is praised in the Matron's Register as 'a highly intelligent nurse'. Charlotte remembers her mother talking of a physicist, Dr Smith, who was hopelessly sick, having had all the 'orthodox' treatments, but who recovered after she gave him a course of Tuberculomucin.

Charlotte has written an article about her grandfather in the Association of Jewish Refugees journal (July 2011, page 5), telling the Tuberculomucin story and hinting at why it's important to produce it once again. Charlotte herself was a medical student at the Royal Free Hospital, London, in 1946 when she caught tuberculosis and was successfully treated by her mother with Tuberculomucin. She became a GP and now lives in Monmouth on the Welsh borders.

Tuberculomucin moves to London

In 1938 Tuberculomucin was about to be introduced into the western world by a Belgian pharmaceutical company called Sanders (probably Sanders Probel, founded in 1910, and is now part of Nycomed which has a site in Brussels) when the Second World War started and everything fizzled out. Fritz and Jenny Weleminsky, their widowed daughter Marianne (pictured above) and her 11-year-old daughter Charlotte (seen as a baby in the top photo) escaped to London in January 1939. Marianne, a nurse, found work in various tuberculosis sanatoria including Burrow Hill Colony for ex-servicemen with TB, in Frimley, Surrey, and Prior Place in nearby Camberley, the country sanatorium of the London Chest Hospital.

Treating cows with Tuberculomucin

This is Harvest Festival at the family estate in Thalheim, lower Austria, 1929. Fritz Weleminsky stands, hat in hand, in the centre, along with his daughter Marianne and her two-year-old daughter Charlotte. Thalheim had been in his wife Jenny's family for a generation. The estate had a large herd of cows which were brought inside during the harsh winters, and as a result caught tuberculosis from being in close confinement. Bovine tuberculosis was very common. In 1890, for example, it was discovered that 87 per cent of Queen Victoria's cows were infected with the TB bacteria (Mycobacterium bovis). At Thalheim, over-wintered cows did not survive more than two years until Fritz treated them (as well as his human patients) with tuberculomucin, after which they recovered and went on producing milk.

Friedrich (Fritz) Weleminsky creates Tuberculomucin

Dr Friedrich (Fritz) Weleminsky (1868-1945) was a lecturer in Hygiene (now called Microbiology) at the German University, Prague, when he invented Tuberculomucin (Tbm). At the time there was no cure for tuberculosis which, in Britain, killed one person in eight, most of whom were young adults. Experience with tuberculin, invented in 1890 by a German bacteriologist, Robert Koch (1843-1910) had proved disappointing so Fritz Weleminsky worked hard to produce a more effective treatment. Many doctors in Czechoslovakia, Austria and Germany used Tbm successfully but there is no evidence for its use anywhere else, and Dr Weleminsky's scientific papers were not translated from the German.