Mycobacterium tuberculosis

You can't read Keats' life without also thinking about TB, which killed him before he was 26. He probably got it from nursing his younger brother Tom, who also died of the disease, aged 19 but where did Tom get it? From the stables at the inn where both boys partly grew up? Who knows? We tend to think of consumption, as it was then known, as a quintessentially 19th century disease but that's simply not true: it is estimated that 1.7 billion people today have been infected with the disease, nearly a third of the entire planet's population. This astonishing statistic may include those who have had it and recovered, I don't know; but there are certainly large numbers of people, especially in Africa and Asia, who are still infected, about a third of whom will die. Many of those with HIV-AIDs die of TB, a fact which is increasing the rate of infection in non-HIV sufferers. Another factor is the propensity of those who are lucky enough to receive drug treatment to stop taking the medicine once the symptoms disappear: this ineluctably leads to resistent strains of a bacillus which is highly mutable anyway. The term for this is MDRTB - multi-drug resistant TB.

My grandmother had TB. It left her with massively impaired lung capacity, she breathed using one half of one lung, was extremely thin and, while sleeping, sounded like she was on the point of expiring with every breath. There'd be a strange, high-pitched hhnnnnnhhh as she inhaled and then a long hhhuuuurrrrgggghhhh when she exhaled. I haven't ever heard a death-rattle but, as I lay in my bedroom, aged about 12, up above the Chemist shop on Main Street listening to her in the double bed in the tent on the back lawn, I thought each exhalation was it. Sometimes I committed the awful mental sin of wishing that it would be, partly because we did not have a happy relationship, her and I. This, I found out much later, had it's origin in the death of her youngest son, John, by his own hand at the age of, I think, 21. John had TB as well. He probably contracted it from his mother, who was extremely protective of him and liked to keep him physically close to her, even, or especially, when she was ill. He'd sit on the bed where she lay, reading to her. I resemble my Uncle John and, according to my father, this was the reason why my grandmother could never look upon me without anger. How dare I exist when he did not?

Children of my generation were all innoculated against TB as a matter of course, but the six kids in my family got our jabs much earlier, I think some time in the 1950s when my grandmother had a scare. I've got a round scar about the size of a sixpence high on my upper left arm where the needle went in. They were compound needles, a set of six or maybe even more, that looked a bit like those multi-prong plugs used for printer cables. When my class at school had their turn to get their BCG (Bacillus Calmette-Guerin)s, as they were called, I was given something different, I think because, in the preliminary testing we all underwent, I had come up positive. This was with the same kind of multi-pronged needle but they put it in on the inside of my arm and it didn't leave a scar. For some reason, we were very proud of our scars. They were like a mark of distinction. BCG is a live vaccine, it turns out, and doesn't stop you getting the disease, however, it will perhaps protect against some of the more virulent forms. Australia stopped vaccinating kids with BCG in 1984. The thing is, TB is never far away, especially in a time of migration like today. It's been estimated that 50% of immigrants into first world countries have the disease. Although Australia seems to have it under control (only about 1000 cases per year), the two most afflicted regions, South East Asia and the Western Pacific, are just over the horizon. And, anyway, with proper treatment, recovery rate is 100% when HIV is not involved- so why is this so?