Treating bone and joint tuberculosis at Southfield Sanatorium

In this weeks blog we hear from Rebecca, who will be sharing some of what she has learnt so far from cataloguing tuberculosis case notes...

Work on the Tuberculosis Case notes project is progressing well, with well over 1000 records catalogued. The bulk of the records so far have been from Southfield Sanatorium, covering patients admitted between 1921 and 1953. It’s been really interesting in these case notes to see the range of diseases that people would be admitted with, as the sanatorium would treat patients with non-tuberculous chest diseases as well as extra-pulmonary tuberculosis (that is, tuberculosis of organs other than the lungs). One of the most frequent types of extra-pulmonary tuberculosis in these case notes is osteoarticular tuberculosis, or tuberculosis of the bones and joints.

A front view of Southfield Sanatorium (P/PL41/TB/022)

Osteoarticular tuberculosis can affect virtually any bone or joint in the body, including the vertebrae of the spine. It is caused by a spread of the disease from the lungs, though it can take a while to develop so in about half of cases it appears after the disease has ceased to be active in the lung. Spinal tuberculosis occurs when tuberculosis bacteria spread through the blood and into the vertebrae. If the disease spreads through the vertebrae to affect an entire disc, the disc can collapse. In some cases of osteoarticular tuberculosis, “cold” abscesses can form, which would have been aspirated in order to try to remove the infection.

Treatment of this condition at Southfield Sanatorium was chiefly through rest and immobilisation. The affected limb would be set in a plaster cast or a “shell”, and the patient’s position would be manipulated in order to provide the greatest advantage. Patients would be immobilised in this way for months at a time to give the treatment time to work. For patients who needed to remain mobile, braces and plaster jackets were used so that they could move around whilst still receiving some of the benefits of immobilisation.

Examples of braces used to treat spinal tuberculosis.
By Internet Archive Book Images [No restrictions], via Wikimedia Commons

Immobilisation worked on the basis that the affected area would heal through a process of increased resistance due to prolonged rest. This would enable the formation of fibrous tissue which could diminish the supply of blood to the diseased area, meaning that the disease would not be able to spread. Immobilisation also assisted the patient by preventing inflamed areas from rubbing together, which could lead to pain and erosion. Immobilisation was widely regarded at the time as the best cure for this type of tuberculosis, particularly in children, and whilst surgical treatments such as bone grafts were available for adults, this was not used at Southfield Sanatorium, which tended towards the more conservative treatments.

 Sources:

Sir Henry Gauvain, ‘Treatment of bone and joint tuberculosis’, Tubercle, 17, 8, 1936, pp. 360-363
C. Lee Pattison, ‘The local treatment of acute tuberculous disease of the hip joint and vertebræ’, Tubercle, 5, 4, 1924, pp. 162-167
McDonald and Sexton, ‘Skeletal tuberculosis’, http://www.uptodate.com/contents/skeletal-tuberculosis