TB: Ten Years After

Tuberculosis patients danced in the corridors of New York City's Sea View Hospital ten years ago to celebrate their speeding recovery on new drugs, mainly isoniazid, or INH (for isonicotinic acid hydrazide). Last week in Manhattan, the National Tuberculosis Association summed up the good that isoniazid has done in a decade--and surveyed what still must be done to keep TB on the run and eventually make it as rare as smallpox or typhoid.

The greatest single killer in the U.S. in 1900 (39,000 deaths in a population of 76 million), TB dropped by 1950 to seventh rank (34,000 deaths in a population of 151 million). Doctors still do not know all the reasons for this happy decline, but they do know what happened next. Isoniazid, first synthesized in Prague in 1912 and then forgotten, was rediscovered simultaneously by three groups of chemists (two in the U.S.). By 1960, despite the population boom, TB deaths dropped to 10,500. New TB cases reported fell from 86,000 in 1952 to 55,000 in 1960 (the decline is not as sharp as the drop in the death rate partly because of better public-health detective work in finding cases). Sea View, which housed 1,500 tuberculous patients in 1951, now has only 21, is being turned mainly into a hospital and home for the aged. Famed Trudeau Sanatorium in New York's Adirondack Mountains, which treated 12,500 victims, has shut its doors to them and turned to research and other chest diseases. So have scores of other sanatoriums, and most of the "preventoriums" where TB-infected children were exposed to sun, air and snow.

Stunned Bacilli. Isoniazid does not kill the tubercle bacilli or work a swift cure. What it does, explained Cornell University's Dr. Walsh McDermott, one of the first to test it, "is to incapacitate the bacilli so that they either die naturally or can be swept away by the body's natural defenses. A few may remain dormant, so we cannot say the patient is cured--only that his disease is arrested." But many patients can be treated at home from the start. "Others can be treated briefly, in a general hospital, and then go home. Bold surgery to remove parts of lungs was at its peak ten years ago and now is rarely necessary."

Patients must take the little white isoniazid pill three times a day with meals, for at least a year after their disease is arrested. Members of a TB victim's immediate family should also take isoniazid, especially youngsters with a positive tuberculin test reaction. The cost, never great, is now down to $1.50 per 100 pills for private patients; and health agencies, which distribute most of the pills free, can get them for as little as $2 per 1,000.

Resistant Strains. One early fear about isoniazid has been justified: from 3% to 6% of new TB cases are caused by isoniazid-resistant bacilli. But the multiplication of these resistant strains can usually be checked by giving isoniazid with a second drug (streptomycin, para-aminosalicylic acid or cycloserine), and occasionally switching the combination.

With an assist from BCG vaccine for people likely to be exposed to TB--nurses, medical students, and travelers to high-risk areas, such as members of the Peace Corps--the disease can be wiped out for all practical purposes, the conference agreed. If and when it is, isoniazid will be largely responsible--and it can already take much of the credit for having saved 125,000 Americans who otherwise would probably have died of TB.

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