A Scourge Returns

Contagious, variable, for centuries intractable, tuberculosis has long plagued humankind. TB can afflict bones or skin, lungs or lymph; the bacteria that cause consumption also produce scrofula. In every generation, tuberculosis killed some victims outright, wore others down gradually into their graves, and left still others weakened and susceptible to different diseases.

Alaska did not escape its ravages. Robert Fortuine, in his book Chills and Fever: Health and Disease in the Early History of Alaska, an authoritative source of information on northern medical matters, suggests that Native Alaskans probably were not infected with tuberculosis until European explorers brought it to these shores. Certainly Alaskans had little immunity against the particular forms of the disease that arrived with the Russians and the British, and then again with the Yankee whalers, the Chinese cannery workers, or the citizens of everywhere who poured in during the gold rushes.

Often enough, the people who brought the disease died of it. William Anderson, a scientist and surgeon for Captain Cook, could diagnose but not cure his own fatal tuberculosis; he was buried at sea off St. Lawrence Island in 1778. A year later Cook's second-in-command, Captain Clerke, also died of tuberculosis and was buried in the Bering Sea. Alexei Chirikov (a Russian explorer after whom Alaska's Chirikov Island is named) died of "consumption" after returning to St. Petersburg; so did Virus Bering's son.

Grim though the many individual deaths were, even more grim were the increasing numbers of decimated villages and families among the Natives. Fortuine believes that by the first half of this century, TB posed "a serious threat to the survival of the Alaska Native peoples.

The threat was not fulfilled largely because of modern science. Although improving hygiene and therapies had helped more people survive TB infections, it took the arrival of modern antibiotics---chemical germ-killers---to bring tuberculosis under control. Some of these, such as isoniazid, were so effective that tuberculosis virtually vanished from the industrialized countries of the world. If they became infected, people had to work at dying of tuberculosis, either by abusing their bodies with alcohol or malnutrition, for example, or by avoiding the long treatment with bacteria-killing drugs.

Yet, perhaps because little food and less medicine is often a given in underdeveloped countries, tuberculosis still out kills more headline-grabbing diseases like AIDS or more conspicuous epidemic-causers like cholera. TB is the leading cause of death from infectious disease worldwide: 2.9 million people each year die of tuberculosis. But we well-fed, well-washed, and well-medicated northerners have no cause to feel smug and safe from this old killer. Mycobacterium tuberculosis, the organism causing the disease, has mutated. New drug-resistant strains of tuberculosis have appeared, and they're killing people in Europe and the United States.

With new technology at their service, scientists may have been able to pinpoint exactly what has happened to M. tuberculosis so that it now ignores what was formerly the most effective drug used against it. Researchers at Hammersmith Hospital in London analyzed isoniazid-resistant bacteria and found they had lost one crucial gene. The missing gene apparently coded for an enzyme that broke the drug down into component chemicals, one of which was deadly to the bacterium.

Entirely different mechanisms may be responsible for the bacterial resistance to other drugs. No one yet knows. What is known is that TB infections caused by a strain of bacteria resistant to two or more drugs have a mortality rate of 50 percent.

Tuberculosis was down but not out, and it's back. The scientific establishment is working on new, more effective drugs; doctors are learning again to recognize TB's various symptoms. For the rest of us, the best course may be a return to the stay-healthy regimen that worked in the era before antibiotics.