Fun Fact: Consumption

Anatomy Def: Consumption is a progressive wasting away of the body, particularly from pulmonary tuberculosis.

Outlander Def: Sad demise of Mary Hawkins true love, Alexander Randall; age 30 – brother of Captain Black Jack Randall!

History: Back in the 1700s, the disease now recognized as tuberculosis was identified by the odd term, consumption. It was named consumption because the disease literally consumed the sufferer; health was ravaged, tissues lost (weight loss), and the patient wasted away.  This disease was so widespread and feared that it was depicted in many novels, operas, and paintings, such as “The Sick Child,” (1885-86) by Edvard Munch.

Types: The word consumption now has several meanings but all refer to the using of resources:

    • Conspicuous = consumerism (😉, 😉)
    • Economic = use of goods and services by households
    • Sociological = resource use at the national level
    • Tuberculosis =  TB!

Pandemic: We may think  that COVID-19 is the only current pandemic, but this is not so. Humanity suffers from another, much older pandemic: tuberculosis. Yep, tuberculosis is a global disease, found in every country in the world!  It is also the leading cause of infectious deaths worldwide. The WHO estimates that about 1.8 billion people are infected with TB, almost 1/4 of the world’s population! And, TB has been a scourge for thousands of years as signs of tuberculosis have been found in Egyptian mummies dating to 3000-2400 BCE.  

What’s in a Name? OK, consumption is now called tuberculosis. So, what does this word mean? Tuberculosis is Latin for tuberculum (tubercle) + -osis (condition). Ergo, tuberculosis is the condition of having tubercles. 

TB produces tubercles (rounded) growths in tissues, especially the lungs. This a bit gross, but over time, the centers of such nodules undergo cell death, a term known as caseous necrosis because to the naked eye, the areas resemble white creamy cheese! 🤢

Lung x-rays of advanced pulmonary TB typically show large “holes” surrounded by a white border (see arrow in image below). These are clusters of tubercles (white rim) with caseous necrosis in the center (the hole). 

Cause: TB occurs if the body is successfully invaded by a bacterium known as Mycobacterium tuberculosis (M.tb). But, M.tb isn’t the only culprit as four other species of Mycobacterium also cause TB, including one which survives in un-pasteurized milk! Moo…🐄

Body Distribution: Without question, TB is a ghastly disease that can attack any tissue of the body. Pulmonary TB harbors in the lungs; extra-pulmonary TB invades other body parts, including heart, lymph nodes, bone and joints, pancreas, gastrointestinal tract, and brain/spinal cord, to name a few.  Although about 90% of TB settles in the lungs, some poor victims suffer both pulmonary and extra-pulmonary disease! 😲

TB Symptoms:

    • Chest pain
    • Poor appetite
    • Night sweats
    • Weakness
    • Fever
    • Gastrointestinal symptoms
    • Coughing spells
    • Clubbing of the nails

As if this isn’t enough, TB may become dormant in a patient only to return with a vengeance causing prolonged cough with mucus and, eventually, blood if the tubercles erode through pulmonary blood vessels. 😳

Spread: TB is a disease to be feared and respected! When people with active pulmonary TB cough, sneeze, speak, yell, sing, or spit, they expel tiny infectious aerosol droplets. A single sneeze may release up to 40,000 such droplets, each one capable of transmitting disease. Especially horrifying, inhaling fewer than 10 M.tb particles is sufficient to infect a new host! 😲

There are other risk factors besides proximity. Here are a few:

What about Claire? Do I worry about Claire’s contact with Alex? Not so much because her contact with him was minimal. Mary, most assuredly, would be at risk for contracting TB  since she spent much time with Alex in his final weeks and carried his unborn child.

Treatment: Today, a number of drugs are used to treat active TB, including isoniazid, ethambutol, and rifampin.  Alarmingly, there is also growing resistance of M.tb to treatment regimens – more than a half million drug-resistant cases of TB were identified  in 2020.

In Outlander, episode 212, The Hail Mary, Claire cannot cure Alex, but she does offer palliative therapy using thorn-apple smoke as she did with Ned Gowan in Outlander, episode 105, Rent. (Note: Ned suffered from asthma, not TB). During prolonged coughing, airways undergo spasm making it difficult for the sufferer to breathe.

Thorn-apple smoke allayed the cough by relaxing the airways (bronchi) and quieting the patient.  Surprisingly, thorn-apple is considered a better cough-remedy than opium, but must be used with extreme caution, as it is a strong narcotic poison! ☠️

Read about Alex’s consumption (and congestive heart failure) in Diana’s second big book, Dragonfly in Amber (chapter 39): 

The man who lay on the mattress had thrown off the quilts, over-heated by the effort of coughing, I assumed. He was quite red in the face, and the force of his coughing shook the bed frame, sturdy as it was. 

…The coughing gradually eased, and Alexander Randall’s flushed countenance faded to a pasty white. His lips were slightly blue, and his chest labored as he fought to recover his breath. 

I glanced around the room, but didn’t see anything suitable to my purpose. I opened my medical kit and drew out a stiff sheet of parchment. It was a trifle frayed at the edges, but would still serve. I sat down on the edge of the bed, smiling as reassuringly at Alexander as I could manage.

“It was … kind of you … to come,” he said, struggling not to cough between words. 

“You’ll be better in a moment,” I said. “Don’t talk, and don’t fight the cough. I’ll need to hear it.” 

His shirt was unfastened already; I spread it apart to expose a shockingly sunken chest. It was nearly visible from abdomen to clavicle. He had always been thin, but the last year’s illness had left him emaciated. 

I rolled the parchment into a tube and placed one end against his chest, my ear against the other. It was a crude stethoscope, but amazingly effective. 

I listened at various spots, instructing him to breathe deeply. I didn’t need to tell him to cough, poor boy.

…What is it?” His dark hair was disordered by the coughing; trying to restrain the feelings it roused in me, I smoothed it for him. I didn’t want to tell him, but he clearly knew already. 

“You have got catarrh. You also have tuberculosis—consumption.” 

“And?” 

“And congestive heart failure,” I said, meeting his eyes straight on. “Ah. I thought … something of the kind. It flutters in my chest sometimes … like a very small bird.” He laid a hand lightly over his heart. 

I couldn’t bear the look of his chest, heaving under its impossible burden, and I gently closed his shirt and fastened the tie at the neck. One long, white hand grasped mine.

“How long?” he said. His tone was light, almost unconcerned, displaying no more than a mild curiosity. 

“I don’t know,” I said. “That’s the truth. I don’t know.” 

“But not long,” he said, with certainty. 

“No. Not long. Months perhaps, but almost surely less than a year.” 

“Can you … stop the coughing?” I reached for my kit. “Yes. I can help it, at least. And the heart palpitations; I can make you a digitalin extract that will help.” I found the small packet of dried foxglove leaves; it would take a little time to brew them.”

BTW, Alex’s congestive heart failure could be the result of extra-pulmonary TB or some other unidentified cause.

See Alex slow demise and decline played to perfection by actor, Laurence Dobiesz, in Outlander episode 212, The Hail Mary.  Puir lad! 😢

The deeply grateful,

Outlander Anatomist

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Photo Credits: Sony/Starz; www.aerzteblatt.de; www.infectioncontroltoday.com; www.munchmuseet.no; www.wikipedia.com

6 Replies to “Fun Fact: Consumption”

  1. Very interesting. A mind my mither telling me a story of when she queued aroon George Square for many hours to get an X Ray when there was an outbreak of TB in Glasgow – dinnae ken the year. – 1940’s – 1950’s? She then went on tae tell me aboot the fowk oan the street that had lost loved ones ower the years fae TB. She ay said that sufferers had pale, translucent skin. Her wee friends sister died o it and she said her skin was like ‘fine china’. That memory o loss and the misery o TB ay stayed wi my ma and she was a great supporter of the TB jag.
    Jist thinking. Did (auld) Ian no die o TB efter catching it in the gaol?
    So pandemics are nothing new tae some – get yon sleeve rolled up fowk and get yer jag. 😉🏴󠁧󠁢󠁳󠁣󠁴󠁿

    1. Hi Ann. This is a sad but common experience of folks during the 20th century. I have also read of the skin becoming almost translucent. I assume this is due to reduced blood flow to the subcutaneous layer under the skin.

      I can understand how deeply this affected your mother. TB has been a terrible scourge and while greatly reduced in many countries still remains very active in others.

      Yes, Ian Sr. Also died of TB which he contracted when imprisoned in the Tollbooth after Culloden. His death is described by Diana is a classic decline as the body wastes. When and if the series gets to his death, I will likely write a full lesson on the horrors of TB.

      Take care. OA

  2. Thank you, I’d been curious about this very recently while reading Echo in the Bone (book 7) where another character has consumption. Now that I know it’s a bacterial infection I’m worried about the other characters who are nearby! Thanks for your posts.

    1. Hi Jenny. Yes, consumption or TB is caused by a bacterium, not a virus.clearly, either can cause a pandemic since COVID-19 is a viral disease. In AEITB, Ian Sr. Died from consumption. Diana’s follows the course of the wretched disease in much more detail than Alex’s demise. If that book gets filmed, I plan to write a full lesson on Consumption. Thank you for writing!

      OA

  3. I thought consumption should be tuberculosis but i wasn´t sure.
    Thanks for the brilliant clarification.
    My maternal grandfather died in 1945 in an outbreak of tobercolous miningitis, in two weeks, at the age of 37, my mother was 11.
    Your delighted and very grateful student
    Mena

    1. Hi Mena

      Thank you for your comment. Yes, consumption is TB.

      I am very sorry to hear about your mother’s father dying of tuberculous meningitis. The organism does attack the meninges covering the brain and can lead to a swift and unpleasant death. She was so young to lose her parent like that.

      At the turn of the 20th century, TB was the leading cause of death in the US, so it has left its mark on this country as well as the world at large.

      Thank you for being my student. I hope you continue to follow my lessons. 🙂

      OA

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