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Pioneers: Tuberculosis - Anne Brontë and Florence Seibert

In the late 19th century, there was an illness so widespread it became the popular way to die. Consumption was preferred to other diseases as it fit in with the Romanticism movement of the time and the trend towards melancholy that had swept across Europe. . The name consumption was adopted as the disease appeared to consume the sufferers who lost weight as they get worse. The patients waste away – they became pale, frail and thin with rosy cheeks – the latter actually a sign of an underlying fever. These physical traits, however, went on to shape Victorian fashion as they were seen to enhance one’s desirability and femininity at the time Consumption wasn’t only the disease of the poor - it was thought to be a disease of intellectuals with heightened senses. It had to be – after all, various famous artists and writers died from it, including John Keats, Frederic Chopin, and two of the Brontë sisters.

The Brontë sisters – Charlotte, Emily and Anne – were a nineteenth century literary family who grew up in Yorkshire, England. Their works – including Jane Eyre, Wuthering Heights and The Tenant of Wildfell Hall – are widely recognised as masterpieces, continuing to fascinate and be adapted again and again for both stage and screen. However, all three passed away before reaching the age of 40. Anne and Emily Brontë died from consumption, while Charlotte died from a complication of her pregnancy. The sisters lived together for many years, supporting each other’s ambition to write and publish poetry and novels.

Anne Brontë is the least known of the three sisters, but her second and last novel, The Tenant of Wildfell Hall, is now acknowledged to be one of the first feminist novels. The novel was published under a male pseudonym, as was common practice back then, and was deemed scandalous as it told a story of a woman who dared to leave her alcoholic husband at a time where women had no right to seek divorce, custody or to own property.

When consumption struck Anne Brontë in December 1848, she knew death was coming. Her brother Branwell had died in September and her sister Emily died two months later. They were a close-knit family and Anne’s health had deteriorated from what she initially thought was a result of being grief-stricken. Unlike her sister Emily who refused to see a doctor, Anne immediately sought a doctor, who in January 1849 diagnosed her with advanced consumption. Anne took the diagnosis bravely, taking the recommended medications while at the same time acknowledging that there was no cure available. She spent her last days by the coast, hoping that the fresh air or local spa would miraculously cure her. Unfortunately, Anne succumbed to her illness and died in May 1849 at age 29.

One part of Charlotte’s poem “On the Death of Anne Brontë” describes the pain of being the last surviving Brontë sibling:

Although I knew that we had lost

The hope and glory of our life;

And now, benighted, tempest-tossed,

Must bear alone the weary strife.

Tuberculosis cases in Europe began to rise in the 1600s and reached its peak in the 1800s where it was responsible for 25% of all deaths. In 1839 the disease was renamed to tuberculosis, but people continued to call it consumption. In 1865, a French physician Jean-Antoine Villemin proved that TB was, in fact, contagious and not hereditary. In 1882 German scientist Rober Koch discovered the bacteria that caused consumption and eventually in 1908 Calmette and Guérin developed the BCG (Bacillus Calmette-Guérin) vaccine against this illness, although it wasn’t used in humans until 1921. World War I saw a great increase in TB cases due to malnutrition and crowding. In 1928 Alexander Fleming discovered the first antibiotics but it took another decade or so for antibiotics to start being used to treat bacterial infections. Prior to this, fresh air and sunshine are the only prescribed treatment.

Tuberculosis (TB) is a bacterial infection that spreads between individuals through coughing or sneezing. When an individual coughs or sneezes, they contaminate the air around them with tiny droplets of mucus. If this individual has TB, the droplets contain a type of bacterium called Mycobacterium tuberculosis. Depending on the environment, these droplets may remain in the air for several hours. Inhaling these tiny droplets introduce the bacterium into another individual’s body. This explains how the spread of TB is commonly seen in a closed community or a contained space such as a family home.

Diagnoses are generally done with a chest X-ray or blood test, with additional tests if the bacteria have spread beyond the lungs. With treatment, the chance of successfully curing TB is very high. Doctors would generally prescribe a six-month course of antibiotics. Several different antibiotics might be used together depending on the specific form of TB, as some forms are drug-resistant. Without treatment, around 5% of infected individuals will develop TB in the first two years after exposure and another 5% will develop the disease later in life.

In most cases, the immune system is strong enough to fight the bacteria by suppressing it within the body. This is referred to as latent TB, where individuals have the bacteria but show no symptom. While these individuals are not ill nor infectious, they might develop symptoms later in life if their immune system becomes compromised. The diagnoses of latent TB are done by a simple skin test called the PPD test (also known as the Mantoux test) whereby a small amount of a substance called PPD, Purified Protein Derivative, is injected into the skin. A latent TB infection will show up within 48-72 hours as a small, hard red bump at the site of injection. An active TB infection will show up as a strong skin reaction and will need to be confirmed with an X-ray or blood test.

High levels of TB incidence are found in various countries in Africa, Southeast Asia, and the Middle East and in these countries vaccinations against TB are compulsory. The BCG vaccine is up to 80% effective against the most severe forms of TB that can cause meningitis (inflammation of the protective layer of the brain) in children. In various Western countries, vaccination is no longer compulsory as TB cases are almost completely eradicated. These countries instead use PPD skin test to diagnose TB in possible infections from travelling or migration.

The development of the PPD skin test started in 1907 but it was greatly unreliable as the solution used in the injections contained impurities. These impurities varied depending on how the solutions were prepared and subsequently this caused varying degrees of skin reactions. American biochemist Florence Seibert dedicated 10 years to tackle this problem and in 1934 successfully isolated the protein PPD, Purified Protein Derivative, which is the active agent in the solution. This technique got rid of all unwanted impurities in the solution and with further work in 1940, her work became the standard international TB testing. Florence, however, never patented the purification process even though it would have made her rich.

At age 3, Florence Seibert contracted polio and wore leg braces thereafter. This disability didn’t stop her from pursuing her love of science, and after graduating from college in 1918 she worked in a chemistry lab. It was an unusual job for a woman to hold at the time, but World War I saw many male scientists enlisting and it opened up opportunities for women like Florence. She earned her PhD in biochemistry from Yale University in 1923 and went on to become a professor in the University of Pennsylvania and a leader in protein-separation techniques. While she spent her later life researching the role of bacteria in cancer, she was most known for her contribution to TB.

Anne Brontë and Florence Seibert were pioneers in their respective fields. Anne, writing under a male pseudonym, championed equal rights for women, with frank depictions of the issues that women in her time faced and characters that challenged the social and legal structures of the time. Florence Seibert was a pioneer in her field through her protein-purification technique. Her dedication greatly improved the diagnosis of TB and undoubtedly saved countless lives. Their legacy continues to make an impact on our lives even today.

References and further reading:

Anne Brontë Org

Barberis I, Bragazzi NL, Galluzzo L, Martini M. The history of tuberculosis: from the first historical records to the isolation of Koch's bacillus. J Prev Med Hyg. 2017 Mar; 58(1): E9–E12.

CDC: Tuberculosis

Chemical Heritage Foundation

Chemistry Explained: Florence Seibert

Poem: On the Death of Anne Brontë

Smithsonian: How Tuberculosis Shaped Victorian Fashion

NY Times: Dr. Florence B. Seibert, Inventor Of Standard TB Test, Dies at 93

TB Alert

Ogilvie MB and Harvey JD. The Biographical Dictionary of Women in Science: L-Z

The Brontë Sisters BBC

University of Virginia: Historical Collections at the Claude Moore Health Sciences Library

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