Miliary tuberculosis is caused when significant numbers of tubercle bacilli care released from a primary source into the blood stream causing widespread dissemination throughout the body which can result in disease manifesting in other organs. This pathological process usually occurs early after initial infection and is considered to affect infants and malnourished individuals most frequently. In its most common presentation this form of tuberculosis can be seen in plain radiographs as an even scattering of nodules distributed throughout the lungs or abdominal region.

If left untreated miliary tuberculosis has the potential to develop further into TB meningitis, where the tuberculous bacteria attack the membrane and fluid surrounding the spinal cord and the brain. It is, therefore, unsurprising that these conditions were fatal prior to the introduction of effect anti-tuberculosis drugs. Whilst on the whole the death rate in Stannington was relatively low, in the pre-antibiotic era (pre-1947) it is noticeable that a significant number of fatalities are as a result of either miliary TB or TB meningitis.

Patient 294/1946 is one such individual admitted to Stannington with miliary tuberculosis which deteriorated into TB meningitis. On admission this patient was considered to have a good general condition but with miliary tuberculosis in both lungs. She was kept at rest and made steady improvement over the following months. By June 1947 it is noted that the x-rays showed: "progressive improvement in film the areas which were so suggestive of miliary tuberculosis have now almost disappeared from the left lung and the lower right lung field. Still to have complete rest for another month."

However, in July 1947, deterioration began to show with the initial onset of headaches, drowsiness and vomiting. Painless swellings developed on her chest suggestive of underlying osteitis of the junction between the ribs and the sternum. The listlessness, headaches and vomiting continued into September 1947 and the patient was taking nothing more than glucose by mouth. Her medical notes between 9th and 12th September read:

9/9/47 - Rapidly going downhill. Definite neck rigidity today. Still conscious, replies when spoken to. C/o headache & pains behind the eyes.
10/9/47 - Marked change in her general condition now unconscious - no response when spoken to. Taking little fluids. Very irritable, with marked photophobia. Condition too advanced for streptomycin treatment.
11/9/47 - Still unconscious, incontinent and extremely restless & noisy at times.
12/9/47 - Delirious & excited. Incontinent. Was conscious for a short time during the day & recognised her parents. Obvious squint.

This girl had developed TB meningitis; she died on 19th September 1947.

SEX: FEMALE

ADMISSION : 24th Sep 1946

DISCHARGE : 19th Sep 1947

DIAGNOSIS: R.A.3 with miliary spread. TB meningitis