The first antimicrobials that were effective against TB were developed in the 1940s in the US, Sweden, and Germany. Streptomycin was developed in the US, PAS in Sweden, and thioacetazone was developed in Germany. At first they were considered miracle drugs because they were so effective in treating all forms of TB. Within a couple of years many patients treated with the drugs were relapsing with TB. Even worse, the TB bacteria in the relapses were now resistant to the drug first used to treat the TB.
In their race to find better drugs, three competing drug companies nearly simultaneously discovered that isoniazid had very strong ant-TB effects. Isoniazid is a coal tar derivative that was discovered by Czech chemists in 1912. It has remained one of the first-line treatments of TB to this day. Treatment is more effective and less drug resistance develops when two or more anti-TB drugs are used together. Ethambutol, thioacetazone, rifamycins, pyrazinamide, and PAS, are other drugs that are used to treat TB.
Chloramphenicol kills mycobacteria in test tubes. I have not found any references to testing the drug in humans for control of TB. Strains of TB that are resistant to multiple drugs are emerging. Most multi-drug resistance stems from improper drug use. Some patients don't comply with the often months-long therapy. When they don't, resistant bacteria are more likely to occur.
What measures can Grantville take to protect their citizens and their neighbors from White Plague? First, start a new fashion trend. Surgical masks for everyone in indoor gathering and work places. It is the single most important step that can be taken for immediate protection from airborne TB bugs. Never ingest a milk product unless you know the milk was boiled or pasteurized. Segregate all people who show obvious signs of TB disease. None of the measures are going to be very popular. Public health education about the danger that TB and other diseases pose is essential. Establish good exhaust ventilation in indoor meeting and work places. Re-circulating air in those places is a very bad idea unless the air is treated with strong UV light.
It is going to take some time to develop tuberculin for testing, BCG for vaccination, and isoniazid for treatment and prevention. The technology is there to begin right away and all can be achieved in a reasonable amount of time.
"Immediately" is the time to spread the word throughout Europe that much about TB is known in Grantville. That many cases of TB can be prevented and treatments are on the way in the near future.
The short-term goal is to protect Grantville and its neighbors with public health measures and education. The medium-term goal is develop tests, vaccine, and treatment. The long-term goals include shortening and eventually eliminating the European TB epidemic. It cannot be allowed to rage unchecked until the twentieth century. Up-timers must find effective ways to disseminate their knowledge of TB to all corners of Europe. The up-timers have centuries of discoveries to build on and share. They can stand on the shoulders of the OTL heroes of the fight against TB. They have a wealth of information from the current TB epidemic in the third world about which programs work and which have failed.
Prevention
Good ventilation in workplaces, public meeting places, and habitations is essential. TB bacilli can stay aerosolized for several hours in a room after they are coughed into the atmosphere. Evacuating the air to the outside clears the room. The TB germ will be quickly killed by UV light once it is outside. If a recirculating air system is used, the bacilli can be moved to the air in other rooms as well as the first room. Recirculating systems must have a micro filter or UV light filter to prevent the spread of TB. The type of filters needed will probably not be developed right away because of technology and manufacturing limitations. Surgical masks worn by the infected and the uninfected are a cheap, easy way to cut the number of exposures to aerosolized TB mycobacteria.
Preventing and alleviating overcrowded living conditions is essential in controlling TB over the long haul. In all ages, overcrowded people are much more susceptible to TB.
Eliminating malnutrition is absolutely necessary if TB is to be effectively controlled. Low body weight from malnutrition makes a person many times more likely to develop TB disease. Malnourished people's immune system(especially the T-cells) are much less robust than those with a good plane of nutrition. Supplementing with vitamin D helps bolster the immune system.
Minimize war. TB always flourishes during or right after wars. Overcrowding, infected refugees moving from place to place, malnutrition, exposure to other diseases, and stress are just some of the wartime conditions that greatly increase the incidence of TB.
Good general sanitation and the mindset that accompanies it will help. Infection with other diseases makes it more likely that a person will develop TB disease. In the 1800s those who contracted measles or whooping cough were very likely to develop TB disease afterward.
Eradicate the bovine form of TB. Milk, meat and herd inspection are essential. Pasteurizing or boiling milk products is a must. Boiling milk is a very easy practice to implement. Culling TB infected animals is needed to insure the long-term safety of the food supply. The same tuberculin that is used in human skin tests can be used in intradermal tests of livestock. If livestock show signs of TB or react on a tuberculin test, then don't sleep in the same enclosed building with them.
Tuberculin skin testing to detect latent (inactive) infection and early TB disease are very important. Find people before they spread the TB bacilli.
Separating those with active TB disease and those who react to tuberculin skin testing is another method of protecting the uninfected. It may have to be done, but there are many social and medical problems with this.
•For one, how do you sequester the infected and sick when in some areas the rate of infection is nearly 100%?
•Do you want to create a new class of medical and social "lepers"?
•How do you enforce quarantine?
•Those with latent (inactive) infection are not contagious. If you sequester them with those with active infection they are very likely to get re-infected with TB and develop active disease.
•Overcrowding in quarantine facilities will make those with TB disease worse.
•People will hide their infections rather than be singled out.
Developing BCG vaccine as quickly as possible is essential. All should be tuberculin skin tested and vaccinated if negative to the test. Policies will need to be developed concerning the vaccination of tuberculin-positive people. There are too many variables to have a "one size fits all" policy on vaccinating tuberculin reactors. Along with vaccinating, there must be an education program that informs all about the limitations of the vaccine. BCG does not protect against all forms of TB. It is generally much more effective in the young than in adults. Today in India, BCG does not prevent pulmonary TB in adults. Once a person is vaccinated with BCG, they will test positive for TB on a tuberculin skin test. More effective vaccines are in the final testing stages today. Most of them rely on technology, such as recombinant DNA, that is not going to possible for a long time in the 1630s.
TB can be prevented by a daily dose of isoniazid. The dose is less than that used for treatment. The drawbacks are lack of patient compliance and the tendency to forget other forms of control when you have a magic bullet. Treating TB infected people with isoniazid or other drugs will eventually eliminate the bacilli from their sputum and other body fluids.