The death of Thomas Wolfe: a 60-year retrospective

It seems likely that an old tubercular lesion of the lung had been activated during Wolfe's acute pneumonia and that the disease had spread to the brain. The chest x-ray with the right upper lobe infiltrate was certainly typical of pulmonary tuberculosis, and the spinal fluid findings were characteristic of tuberculous meningitis with 230 cells, 75% of which were mononuclear, which Dandy felt "practically made the diagnosis." Tuberculosis was so prevalent worldwide in the early 20th Century, around the time of Wolfe's birth, but began to decline dramatically in the early 1950s with the introduction of modern chemotherapy and isoniazid (INH). In the U.S. the number of reported cases of TB decreased from 84,304 to in 1953 to 22,201 in 1985. Unfortunately, however, the number of cases has been increasing since 1985, due to a variety of factors including decline in public funding for TB control, HIV infection, immigration, homelessness, substance abuse, and incomplete therapy. Today, Wolfe would have been easily treated and probably cured. Would earlier diagnosis of his condition have made any difference in the outcome? The answer is uncertain, since sanatorium therapy (rest and environment) and surgery were the only available treatments at the time of his illness. Had he lived in a later generation, he might not have met his death at the age of 37.