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A side character, a sister of my main character, has been stricken with an unidentifiable disease in an early 19th century circa 1800 - 1850 setting. She's had the disease for a few years. Country doctors with little education but an intent to scam have done ample bloodletting, and given her chalky medicine that did not help.

Later in the story when her father travels to a coastal city, a doctor informs him from information given that his daughter has tuberculosis. He recommends the girl come to the coast where there is "better air." From my cursory reading on the subject, what actually heals her is simply time and being outside, as she was shut up indoors for much of her sickness.

So my big concerns - I am sure this is not being presented realistically, how can I do so? What hints can I drop for what this is? What views did people have on tuberculosis that would've been realistic for the time period (I'm considering the possibility that my world has an early understanding of germ theory at this time).

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    $\begingroup$ potentially worthwhile read. $\endgroup$ Sep 12 '21 at 0:00
  • $\begingroup$ @ProjectApex thanks, I appreciate it $\endgroup$ Sep 12 '21 at 0:32
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    $\begingroup$ First point -- she has consumption. Yes, it was given the new name in this period, but it was not until 1832 and the term did not spread instantaneously. $\endgroup$
    – Mary
    Sep 12 '21 at 0:43
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    $\begingroup$ Incidentally, blood letting can help TB patients. At first, it decreases blood volume. Then it diminishes the viscosity as the liquid part recovers faster than the solid part. Both ease strain on the heart. $\endgroup$
    – Mary
    Sep 12 '21 at 0:47
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    $\begingroup$ @Mary huh, wouldn't have thought. I'd imagine that doing it to an extensive degree wouldn't be the best, but I'll keep this in mind. $\endgroup$ Sep 12 '21 at 0:51
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To your question: Yes, that is quite in line with practices of that era, and can somewhat actually occur like that.

Some facts about Tuberculosis: (historical perspective. Modern treatment is a whole other field of complexity)

  • TB was known as "consumption".
  • It is an infection by the bacterium Mycobacterium tuberculosis
  • By the 1800's, consumption has been the cause of 1 in 7 deaths in all of history.
  • Without antibiotic treatment, it is almost impossible to actually defeat TB. It is possible for a sufferer to push the disease into remission, and be apparently healthy. However once you have had active TB, the disease is permanently in your lungs and just waiting for your immune system to weaken a bit, and let it back in. Only with a vigorous and highly targeted antibiotic regime can the disease be fully removed from a patient. In your scenario, this is what the patient achieves: a full remission, not an actual cure.
  • In Europe in the 1800's, as much as 25% of the population were in this state of TB remission!!
  • Better air, less pollution to irritate the lungs, and higher air pressure all ease the function of the lungs, allowing the body to spend a bit more strength on healing and fighting the disease, rather than just gasping for oxygen. Also, relocating from an indoors self-inflicted prison to a countryside setting will promote some healthy exercise. So yes, a "good air" relocation is advantageous.
  • Bloodletting can provide immediate partial symptomatic relief, it is speculated that the efficacy of bloodletting on TB (and malaria) is what caused its popularity as a traditional treatment. Unfortunately bloodletting also weakens the system on the longer term, and can easily be so overdone in the short term as to kill the patient. (not to mention the unsanitary methods of traditional bloodletting. Dirty knives! Leeches!! )
    There are several other folk remedies that ease the immediate symptoms a bit and provide support, but do absolutely nothing to actually cure the disease.
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    $\begingroup$ Leeches are not dirty by themselves, they are still being used in modern medical treatments. But you have to keep the leeches in a clean environment and given the right time and handling between uses. $\endgroup$
    – Willeke
    Sep 12 '21 at 11:03
  • $\begingroup$ What does it take to defeat TB in this era? Crazy high luck? Catching it real early and immune response is dumbfoundingly good? $\endgroup$
    – Malady
    Sep 12 '21 at 13:38
  • $\begingroup$ @Malady To push the TB to dormancy, just a good robust constitution. Healthy eating and exercise, that sort of thing. As long as you live in a healthy way otherwise, you could usually overcome the disease, but on top of malnutrition or vitamin deficiencies or bad air, it was nasty. To actually permanently defeat the TB? You didn't. You got it and then lived with it, or died with it. $\endgroup$
    – PcMan
    Sep 12 '21 at 16:20
  • $\begingroup$ If you really wanted a character to recover from consumption, what you needed was, perhaps, overwork and a propensity to colds. They didn't have any tests for TB. Consumption was diagnosed purely on symptoms. Indeed, the discovery of antibiotics led to a slew of diseases being discovered in patients who had been thought to have TB and didn't. $\endgroup$
    – Mary
    Sep 12 '21 at 16:24
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    $\begingroup$ @Malady it is possible to completely eradicate the bacterium in a person. The same way a person can (but almost never does) recover from an apparently terminal cancer. The human immune system can do powerful things, except usually it ...doesn't. $\endgroup$
    – PcMan
    Sep 12 '21 at 21:18
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Tuberculosis would have been recognized by anyone in that period.

It was super common. Oslers medical textbook covered the entirety of medicine at the time and it devotes 80 pages to tuberculosis: 10% of the book.

Here is some back reading for you: William Osler on tuberculosis, 1892.

https://archive.org/details/principlesandpr00mccrgoog/page/n252/mode/2up

I linked the part where he is talking about treatment. If you want to accurately depict a tubercular person of this period the whole 80 pages is gold. He has many anecdotes, minutae about hemoptysis and other things that are coughed up (pearls of calcium, which your girl could wash off and collect), fevers etc. When you get to treatment you will see details about the fresh air treatment as you intend for your character, as well as medical treatments like creosote and arsenic that you could have as the treatments early on.

I think Oslers textbook is great. It is so accessible and well written, with clear descriptions of diseases and disease processes and detailed recommendations for treatment. It comes from a period shortly after when yours is set but that is OK.

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