120-573: The Pneumatic Institution (also referred to as Pneumatic Institute ) was a medical research facility in Bristol , England, in 1799–1802. It was established by physician and science writer Thomas Beddoes to study the medical effects of gases, known as factitious airs , that had recently been discovered. Humphry Davy headed the Institution's laboratory, examining the effects of laughing gas on himself and others, and James Watt designed much of
240-415: A Rasmussen aneurysm , resulting in massive bleeding. Tuberculosis may become a chronic illness and cause extensive scarring in the upper lobes of the lungs. The upper lung lobes are more frequently affected by tuberculosis than the lower ones. The reason for this difference is not clear. It may be due to either better air flow, or poor lymph drainage within the upper lungs. In 15–20% of active cases,
360-470: A Roman road ); another was at the present-day Inns Court . Isolated Roman villas and small forts and settlements were also scattered throughout the area. Bristol was founded by 1000; by about 1020, it was a trading centre with a mint producing silver pennies bearing its name. By 1067, Brycgstow was a well-fortified burh , and that year the townsmen beat back a raiding party from Ireland led by three of Harold Godwinson 's sons. Under Norman rule,
480-411: A statue of Colston was pulled down from its plinth by protestors and pushed into Bristol Harbour. The statue was recovered on 11 June and has become a museum exhibit. Bristol City council consists of 70 councillors representing 34 wards, with between one and three per ward serving four-year terms. As of May 2024, no party has an overall controlling majority, but Green Party are the largest group on
600-591: A car, van, motorbike or taxi, 2.2% commute by rail and 9.8% by bus, while 19.6% walk. The Runnymede Trust found in 2017 that Bristol "ranked 7th out of the 348 districts of England & Wales (1=worst) on the Index of Multiple Inequality." In terms of employment, the report found that "ethnic minorities are disadvantaged compared to white British people nationally, but this is to a greater extent in Bristol, particularly for black groups." Black people in Bristol experience
720-417: A compulsory load line on ships. By 1867, ships were getting larger and the meanders in the river Avon prevented boats over 300 ft (90 m) from reaching the harbour, resulting in falling trade. The port facilities were migrating downstream to Avonmouth and new industrial complexes were founded there. Some of the traditional industries including copper and brass manufacture went into decline, but
840-687: A developed area between the Bristol city boundary and the M4, M5 and M32 motorways (now in South Gloucestershire) was so named as part of a 1987 plan prepared by the Northavon District Council of Avon county. The West of England Combined Authority was created on 9 February 2017. Covering Bristol and the rest of the old Avon county with the exception of North Somerset, the new combined authority has responsibility for regional planning, roads, and local transport, and to
960-400: A family died from the disease, the other infected members would lose their health slowly. People believed this was caused by the original person with TB draining the life from the other family members. Although Richard Morton established the pulmonary form associated with tubercles as a pathology in 1689, due to the variety of its symptoms, TB was not identified as a single disease until
1080-631: A latent infection of TB. New infections occur in about 1% of the population each year. In 2022, an estimated 10.6 million people developed active TB, resulting in 1.3 million deaths, making it the second leading cause of death from an infectious disease after COVID-19 . As of 2018, most TB cases occurred in the WHO regions of South-East Asia (44%), Africa (24%), and the Western Pacific (18%), with more than 50% of cases being diagnosed in seven countries: India (27%), China (9%), Indonesia (8%),
1200-509: A lesser extent, education and business investment. The authority is led by the Mayor of the West of England , Dan Norris . Bristol's boundaries can be defined in several ways, including those of the city itself, the developed area, or Greater Bristol . The city council boundary is the narrowest definition of the city itself. However, it unusually includes a large, roughly rectangular section of
1320-685: A microscope. Since MTB retains certain stains even after being treated with acidic solution, it is classified as an acid-fast bacillus . The most common acid-fast staining techniques are the Ziehl–Neelsen stain and the Kinyoun stain , which dye acid-fast bacilli a bright red that stands out against a blue background. Auramine-rhodamine staining and fluorescence microscopy are also used. The M. tuberculosis complex (MTBC) includes four other TB-causing mycobacteria : M. bovis , M. africanum , M. canettii , and M. microti . M. africanum
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#17327728868521440-658: A number of people with tuberculosis into the cave in the hope of curing the disease with the constant temperature and purity of the cave air; each died within a year. Hermann Brehmer opened the first TB sanatorium in 1859 in Görbersdorf (now Sokołowsko ) in Silesia . In 1865, Jean Antoine Villemin demonstrated that tuberculosis could be transmitted, via inoculation, from humans to animals and among animals. (Villemin's findings were confirmed in 1867 and 1868 by John Burdon-Sanderson . ) Robert Koch identified and described
1560-487: A shipbuilding and manufacturing centre. By the 14th century, Bristol, York and Norwich were England's largest medieval towns after London. One-third to one-half of the population died in the Black Death of 1348–49, which checked population growth, and its population remained between 10,000 and 12,000 for most of the 15th and 16th centuries. During the 15th century, Bristol was the second most important port in
1680-407: A small decrease in case numbers. Some countries have legislation to involuntarily detain or examine those suspected to have tuberculosis, or involuntarily treat them if infected. The only available vaccine as of 2021 is bacillus Calmette-Guérin (BCG). In children it decreases the risk of getting the infection by 20% and the risk of infection turning into active disease by nearly 60%. It
1800-401: A tuberculosis infection does become active, it most commonly involves the lungs (in about 90% of cases). Symptoms may include chest pain and a prolonged cough producing sputum. About 25% of people may not have any symptoms (i.e., they remain asymptomatic). Occasionally, people may cough up blood in small amounts, and in very rare cases, the infection may erode into the pulmonary artery or
1920-398: Is Mycobacterium tuberculosis (MTB), a small, aerobic , nonmotile bacillus . The high lipid content of this pathogen accounts for many of its unique clinical characteristics. It divides every 16 to 20 hours, which is an extremely slow rate compared with other bacteria, which usually divide in less than an hour. Mycobacteria have an outer membrane lipid bilayer. If a Gram stain
2040-475: Is 106 mi (171 km) west of London, 77 mi (124 km) south-southwest of Birmingham and 26 mi (42 km) east of the Welsh capital Cardiff . Areas adjoining the city fall within a loosely defined area known as Greater Bristol . Bath is located 11 mi (18 km) south east of the city centre, Weston-super-Mare is 18 mi (29 km) to the south west and the Welsh city of Newport
2160-503: Is 19 mi (31 km) to the north west. The climate is oceanic ( Köppen : Cfb) , milder than most places in England and United Kingdom. Located in southern England, Bristol is one of the warmest cities in the UK with a mean annual temperature of approximately 10.5 °C (50.9 °F). It is among the sunniest, with 1,541–1,885 hours of sunshine per year. Although the city
2280-449: Is able to reproduce inside the macrophage and will eventually kill the immune cell. The primary site of infection in the lungs, known as the Ghon focus , is generally located in either the upper part of the lower lobe, or the lower part of the upper lobe . Tuberculosis of the lungs may also occur via infection from the blood stream. This is known as a Simon focus and is typically found in
2400-653: Is also rare and is seen almost only in immunodeficient people, although its prevalence may be significantly underestimated. Other known pathogenic mycobacteria include M. leprae , M. avium , and M. kansasii . The latter two species are classified as " nontuberculous mycobacteria " (NTM) or atypical mycobacteria. NTM cause neither TB nor leprosy , but they do cause lung diseases that resemble TB. When people with active pulmonary TB cough, sneeze, speak, sing, or spit, they expel infectious aerosol droplets 0.5 to 5.0 μm in diameter. A single sneeze can release up to 40,000 droplets. Each one of these droplets may transmit
2520-444: Is difficult, as is diagnosing the disease in those who have a weakened immune system. A diagnosis of TB should, however, be considered in those with signs of lung disease or constitutional symptoms lasting longer than two weeks. A chest X-ray and multiple sputum cultures for acid-fast bacilli are typically part of the initial evaluation. Interferon-γ release assays (IGRA) and tuberculin skin tests are of little use in most of
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#17327728868522640-412: Is known as latent tuberculosis . Around 10% of latent infections progress to active disease that, if left untreated, kill about half of those affected. Typical symptoms of active TB are chronic cough with blood-containing mucus , fever , night sweats , and weight loss . Infection of other organs can cause a wide range of symptoms. Tuberculosis is spread from one person to the next through
2760-509: Is not widespread, but it is a significant cause of tuberculosis in parts of Africa. M. bovis was once a common cause of tuberculosis, but the introduction of pasteurized milk has almost eliminated this as a public health problem in developed countries. M. canettii is rare and seems to be limited to the Horn of Africa , although a few cases have been seen in African emigrants. M. microti
2880-489: Is often used to screen people at high risk for TB. Those who have been previously immunized with the Bacille Calmette-Guerin vaccine may have a false-positive test result. The test may be falsely negative in those with sarcoidosis , Hodgkin's lymphoma , malnutrition , and most notably, active tuberculosis. Interferon gamma release assays , on a blood sample, are recommended in those who are positive to
3000-692: Is partially sheltered by the Mendip Hills, it is exposed to the Severn Estuary and the Bristol Channel . Rain is fairly evenly distributed throughout the year, with autumn and winter the wetter seasons. The Atlantic Ocean influences Bristol's weather, keeping its average temperature above freezing throughout the year, but winter frosts are frequent and snow occasionally falls from early November to late April. Summers are warm and drier, with variable sunshine, rain and clouds, and spring weather
3120-501: Is performed, MTB either stains very weakly "Gram-positive" or does not retain dye as a result of the high lipid and mycolic acid content of its cell wall. MTB can withstand weak disinfectants and survive in a dry state for weeks. In nature, the bacterium can grow only within the cells of a host organism, but M. tuberculosis can be cultured in the laboratory . Using histological stains on expectorated samples from phlegm (also called sputum), scientists can identify MTB under
3240-423: Is poor as of 2019 . The Centers for Disease Control and Prevention (CDC) stopped recommending yearly testing of health care workers without known exposure in 2019. Tuberculosis prevention and control efforts rely primarily on the vaccination of infants and the detection and appropriate treatment of active cases. The World Health Organization (WHO) has achieved some success with improved treatment regimens, and
3360-405: Is represented by 5 constituencies, East , North East , North West , South , and Central . The city has a tradition of political activism. Edmund Burke , MP for the Bristol constituency for six years beginning in 1774, insisted that he was a Member of Parliament first and a representative of his constituents' interests second. Women's-rights advocate Emmeline Pethick-Lawrence (1867–1954)
3480-464: Is termed caseous necrosis . If TB bacteria gain entry to the blood stream from an area of damaged tissue, they can spread throughout the body and set up many foci of infection, all appearing as tiny, white tubercles in the tissues. This severe form of TB disease, most common in young children and those with HIV, is called miliary tuberculosis. People with this disseminated TB have a high fatality rate even with treatment (about 30%). In many people,
3600-483: Is the most widely used vaccine worldwide, with more than 90% of all children being vaccinated. The immunity it induces decreases after about ten years. As tuberculosis is uncommon in most of Canada, Western Europe, and the United States, BCG is administered to only those people at high risk. Part of the reasoning against the use of the vaccine is that it makes the tuberculin skin test falsely positive, reducing
3720-1035: Is unsettled. The weather stations nearest Bristol for which long-term climate data are available are Long Ashton (about 5 mi (8 km) south west of the city centre) and Bristol Weather Station, in the city centre. Data collection at these locations ended in 2002 and 2001, respectively, and following the closure of Filton Airfield, Almondsbury is the nearest weather station to the city. Temperatures at Long Ashton from 1959 to 2002 ranged from 33.5 °C (92.3 °F) in July 1976 to −14.4 °C (6.1 °F) in January 1982. Monthly high temperatures since 2002 at Filton exceeding those recorded at Long Ashton include 25.7 °C (78.3 °F) in April 2003, 34.5 °C (94.1 °F) in July 2006 and 26.8 °C (80.2 °F) in October 2011. The lowest recent temperature at Filton
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3840-596: Is unusual among major British towns and cities in its larger black than Asian population. These statistics apply to the Bristol Unitary Authority area, excluding areas of the urban area (2006 estimated population 587,400) in South Gloucestershire, Bath and North East Somerset (BANES) and North Somerset—such as Kingswood, Mangotsfield, Filton and Warmley. 56.2% of the 209,995 Bristol residents who are employed commute to work using either
3960-921: The Ashton Court Estate , South Bristol crematorium and cemetery, High Ridge common and Whitchurch, with a further area around Frenchay Farm. The belt extends outside the city boundaries into surrounding counties and districts, for several miles in places, to afford a protection from urban sprawl to surrounding villages and towns. According to the 2011 census , 84% of the population was White (77.9% White British , 0.9% White Irish , 0.1% Gypsy or Irish Travellers and 5.1% Other White ); 3.6% mixed-race (1.7% white-and-black Caribbean, 0.4% white-and-black African, 0.8% white and Asian and 0.7% other mixed); 5.5% Asian (1.6% Pakistani , 1.5% Indian , 0.9% Chinese , 0.5% Bangladeshi , and 1% other Asian); 6% Black (2.8% African, 1.6% Caribbean , 1.6% Other Black ), 0.3% Arab and 0.6% with other heritage. Bristol
4080-536: The French Revolution . Even a supporting request from Watt did not change Banks' mind. Beddoes had moved from Oxford in 1793 and established himself as a physician. He moved to the Hotwells area of Bristol, where the geothermal springs had been credited with healing properties since the 15th century, and which had become a locus for tuberculosis sufferers seeking a cure. By 1794 Beddoes had arranged for
4200-534: The IRA , in 1974 and again in 1978 . The 20th-century relocation of the docks to Avonmouth Docks and Royal Portbury Dock , 7 mi (11 km) downstream from the city centre, has allowed the redevelopment of the old dock area (the Floating Harbour). Although the docks' existence was once in jeopardy (since the area was seen as a derelict industrial site), the inaugural 1996 International Festival of
4320-453: The Kennet and Avon Canal , which had fully opened in 1810 as the main route for the transport of goods between Bristol and London. Competition from Liverpool (beginning around 1760), disruptions of maritime commerce due to war with France (1793) and the abolition of the slave trade (1807) contributed to Bristol's failure to keep pace with the newer manufacturing centres of Northern England and
4440-644: The Levallois technique , indicate the presence of Neanderthals in the Shirehampton and St Annes areas of Bristol during the Middle Palaeolithic . Iron Age hill forts near the city are at Leigh Woods and Clifton Down , on the side of the Avon Gorge , and on Kings Weston Hill near Henbury . A Roman settlement, Abona, existed at what is now Sea Mills (connected to Bath by
4560-578: The Old English Brycgstow , meaning "assembly place by the bridge" or simply "site of the bridge", presumably in reference to a crossing over the Avon. The final l is an unetymological addition that first appears in the 12th century. An older form of the name survives as the surname Bristow , which is derived from the city. Archaeological finds, including flint tools believed to be between 300,000 and 126,000 years old made with
4680-558: The West Midlands . The tidal Avon Gorge, which had secured the port during the Middle Ages, had become a liability. An 1804–09 plan to improve the city's port with a floating harbour designed by William Jessop was a costly error, requiring high harbour fees. During the 19th century, Samuel Plimsoll , known as "the sailor's friend", campaigned to make the seas safer; shocked by overloaded vessels, he successfully fought for
4800-416: The bacillus Calmette-Guérin (BCG) vaccine. Those at high risk include household, workplace, and social contacts of people with active TB. Treatment requires the use of multiple antibiotics over a long period of time. Antibiotic resistance is a growing problem, with increasing rates of multiple drug-resistant tuberculosis (MDR-TB). In 2018, one quarter of the world's population was thought to have
4920-402: The confluence of the rivers Frome and Avon. Bristol received a royal charter in 1155 and was historically divided between Gloucestershire and Somerset until 1373 when it became a county corporate . From the 13th to the 18th century, Bristol was among the top three English cities, after London, in tax receipts. A major port , Bristol was a starting place for early voyages of exploration to
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5040-458: The lymphatic system (in scrofula of the neck), the genitourinary system (in urogenital tuberculosis ), and the bones and joints (in Pott disease of the spine), among others. A potentially more serious, widespread form of TB is called "disseminated tuberculosis"; it is also known as miliary tuberculosis . Miliary TB currently makes up about 10% of extrapulmonary cases. The main cause of TB
5160-620: The 1640's, during the English Civil War , the city was occupied by Royalists , who built the Royal Fort House on the site of an earlier Parliamentarian stronghold. Fishermen from Bristol, who had fished the Grand Banks of Newfoundland since the 16th century, began settling Newfoundland permanently in larger numbers during the 17th century, establishing colonies at Bristol's Hope and Cuper's Cove . Growth of
5280-631: The 16th century, Bristol merchants concentrated on developing trade with Spain and its American colonies. This included the smuggling of prohibited goods, such as food and guns, to Iberia during the Anglo-Spanish War (1585–1604) . Bristol's illicit trade grew enormously after 1558, becoming integral to its economy. The original Diocese of Bristol was founded in 1542, when the former Abbey of St. Augustine (founded by Robert Fitzharding four hundred years earlier) became Bristol Cathedral . Bristol also gained city status that year. In
5400-547: The 1820s. Benjamin Marten conjectured in 1720 that consumptions were caused by microbes which were spread by people living close to each other. In 1819, René Laennec claimed that tubercles were the cause of pulmonary tuberculosis. J. L. Schönlein first published the name "tuberculosis" (German: Tuberkulose ) in 1832. Between 1838 and 1845, John Croghan, the owner of Mammoth Cave in Kentucky from 1839 onwards, brought
5520-592: The 19th and early 20th centuries as the disease became common among the urban poor. In 1815, one in four deaths in England was due to "consumption". By 1918, TB still caused one in six deaths in France. After TB was determined to be contagious, in the 1880s, it was put on a notifiable-disease list in Britain. Campaigns started to stop people from spitting in public places, and the infected poor were "encouraged" to enter sanatoria that resembled prisons. The sanatoria for
5640-449: The 3rd highest level of educational inequality in England and Wales. Pulmonary tuberculosis Tuberculosis ( TB ), also known colloquially as the " white death ", or historically as consumption , is an infectious disease usually caused by Mycobacterium tuberculosis (MTB) bacteria . Tuberculosis generally affects the lungs , but it can also affect other parts of the body. Most infections show no symptoms, in which case it
5760-582: The Future 's 2008 Sustainable Cities Index. Local initiatives include Sustrans (creators of the National Cycle Network , founded as Cyclebag in 1977) and Resourcesaver, a non-profit business established in 1988 by Avon Friends of the Earth. In 2014 The Sunday Times named it as the best city in Britain in which to live. The city received the 2015 European Green Capital Award , becoming
5880-698: The Mantoux test. These are not affected by immunization or most environmental mycobacteria , so they generate fewer false-positive results. However, they are affected by M. szulgai , M. marinum , and M. kansasii . IGRAs may increase sensitivity when used in addition to the skin test, but may be less sensitive than the skin test when used alone. The US Preventive Services Task Force (USPSTF) has recommended screening people who are at high risk for latent tuberculosis with either tuberculin skin tests or interferon-gamma release assays . While some have recommend testing health care workers, evidence of benefit for this
6000-603: The New World. At the height of the Bristol slave trade , from 1700 to 1807, more than 2,000 slave ships carried an estimated 500,000 people from Africa to slavery in the Americas. The Port of Bristol has since moved from Bristol Harbour in the city centre to the Severn Estuary at Avonmouth and Royal Portbury Dock . The city's modern economy is built on the creative media, electronics and aerospace industries;
6120-550: The Philippines (6%), Pakistan (6%), Nigeria (4%), and Bangladesh (4%). By 2021, the number of new cases each year was decreasing by around 2% annually. About 80% of people in many Asian and African countries test positive, while 5–10% of people in the United States test positive via the tuberculin test. Tuberculosis has been present in humans since ancient times . Tuberculosis has existed since antiquity . The oldest unambiguously detected M. tuberculosis gives evidence of
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#17327728868526240-628: The Sea held in and around the docks affirmed the area as a leisure asset of the city. From 2018, there were lively discussions about a new explicative plaque under a commemorative statue of one of the city's major benefactors in the 17th and 18th centuries. The plaque was meant to replace an original which made no reference to Edward Colston 's past with the Royal African Company and the Bristol Slave Trade . On 7 June 2020
6360-572: The absence of suitable equipment. The treatment had no beneficial effect and Watt's daughter died. Watt designed many of the apparatuses and techniques necessary to produce and administer various gases. The Pneumatic Institution was converted into a normal hospital when typhus broke out in Bristol in 1800. Davy left in 1801 to join Sir Joseph at the Royal Institution . The Bristol Pneumatic Institution closed down in 1802. Many of
6480-688: The active disease. Use of certain medications, such as corticosteroids and infliximab (an anti-αTNF monoclonal antibody), is another important risk factor, especially in the developed world . Other risk factors include: alcoholism , diabetes mellitus (3-fold increased risk), silicosis (30-fold increased risk), tobacco smoking (2-fold increased risk), indoor air pollution , malnutrition, young age, recently acquired TB infection, recreational drug use, severe kidney disease, low body weight, organ transplant, head and neck cancer, and genetic susceptibility (the overall importance of genetic risk factors remains undefined ). Tobacco smoking increases
6600-554: The air when people who have active TB in their lungs cough, spit, speak, or sneeze . People with latent TB do not spread the disease. Active infection occurs more often in people with HIV/AIDS and in those who smoke . Diagnosis of active TB is based on chest X-rays , as well as microscopic examination and culture of bodily fluids. Diagnosis of latent TB relies on the tuberculin skin test (TST) or blood tests. Prevention of TB involves screening those at high risk, early detection and treatment of cases, and vaccination with
6720-566: The arrest, trial and subsequent acquittal of a local slaver captain named Kimber. The city was associated with Victorian engineer Isambard Kingdom Brunel , who designed the Great Western Railway between Bristol and London Paddington , two pioneering Bristol-built oceangoing steamships ( SS Great Britain and SS Great Western ), and the Clifton Suspension Bridge . The new railway replaced
6840-458: The arrival of streptomycin and other antibiotics, although the disease remained a significant threat. In 1946, the development of the antibiotic streptomycin made effective treatment and cure of TB a reality. Prior to the introduction of this medication, the only treatment was surgical intervention, including the " pneumothorax technique", which involved collapsing an infected lung to "rest" it and to allow tuberculous lesions to heal. Because of
6960-628: The bacillus causing tuberculosis, M. tuberculosis , on 24 March 1882. In 1905, he was awarded the Nobel Prize in Physiology or Medicine for this discovery. In Europe, rates of tuberculosis began to rise in the early 1600s to a peak level in the 1800s, when it caused nearly 25% of all deaths. In the 18th and 19th century, tuberculosis had become epidemic in Europe , showing a seasonal pattern. Tuberculosis caused widespread public concern in
7080-423: The bacterium is enveloped by the macrophage and stored temporarily in a membrane-bound vesicle called a phagosome. The phagosome then combines with a lysosome to create a phagolysosome. In the phagolysosome, the cell attempts to use reactive oxygen species and acid to kill the bacterium. However, M. tuberculosis has a thick, waxy mycolic acid capsule that protects it from these toxic substances. M. tuberculosis
7200-560: The castle. A third bomb-damaged church nearby, St Nicholas was restored and after a period as a museum has now re-opened as a church. It houses a 1756 William Hogarth triptych painted for the high altar of St Mary Redcliffe . The church also has statues of King Edward I (moved from Arno's Court Triumphal Arch ) and King Edward III (taken from Lawfords' Gate in the city walls when they were demolished about 1760), and 13th-century statues of Robert, 1st Earl of Gloucester (builder of Bristol Castle ) and Geoffrey de Montbray (who built
7320-425: The cattle and human tuberculosis diseases were similar, which delayed the recognition of infected milk as a source of infection. During the first half of the 1900s, the risk of transmission from this source was dramatically reduced after the application of the pasteurization process. Koch announced a glycerine extract of the tubercle bacilli as a "remedy" for tuberculosis in 1890, calling it "tuberculin". Although it
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#17327728868527440-423: The city and trade came with the rise of England's American colonies in the 17th century. Bristol's location on the west side of Great Britain gave its ships an advantage in sailing to and from the New World, and the city's merchants made the most of it, with the city becoming one of the two leading outports in all of England by the middle of the 18th century. Bristol was the slave capital of England: In 1755, it had
7560-551: The city's walls) from Bristol's Newgate . The rebuilding of Bristol city centre was characterised by 1960s and 1970s skyscrapers , mid-century modern architecture and road building . Beginning in the 1980s some main roads were closed , the Georgian-era Queen Square and Portland Square were restored, the Broadmead shopping area regenerated, and one of the city centre's tallest mid-century towers
7680-1111: The city, and its surrounding land has been protected from development as The Downs and Leigh Woods. The Avon estuary and the gorge form the county boundary with North Somerset , and the river flows into the Severn Estuary at Avonmouth . A smaller gorge, cut by the Hazel Brook which flows into the River Trym , crosses the Blaise Castle estate in northern Bristol. Bristol is sometimes described, by its inhabitants, as being built on seven hills, like Rome. From 18th-century guidebooks, these 7 hills were known as simply Bristol (the Old Town), Castle Hill, College Green, Kingsdown, St Michaels Hill, Brandon Hill and Redcliffe Hill. Other local hills include Red Lion Hill, Barton Hill , Lawrence Hill , Black Boy Hill, Constitution Hill, Staple Hill , Windmill Hill , Malborough Hill, Nine Tree Hill, Talbot, Brook Hill and Granby Hill. Bristol
7800-663: The city-centre docks have been redeveloped as cultural and heritage centres. There are a variety of artistic and sporting organisations and venues including the Royal West of England Academy , the Arnolfini , Ashton Gate and the Memorial Stadium . The city has two universities; the University of Bristol and the University of the West of England (UWE Bristol). It is connected to the world by Bristol Airport ; to
7920-583: The city-council boundary, such as Kingswood , Mangotsfield , Stoke Gifford , Winterbourne , Almondsbury , Easton in Gordano , Whitchurch village, Filton , Patchway and Bradley Stoke , but excludes undeveloped areas within that boundary. Bristol lies within a limestone area running from the Mendip Hills in the south to the Cotswolds in the northeast. The rivers Avon and Frome cut through
8040-450: The council. Between 2012 and 2024, the council was led by a directly elected mayor, the Mayor of Bristol . The post was abolished following a 2022 referendum, in which voters chose to replace it with a council committee system. The lord mayor of Bristol is a figurehead elected each May by the city council. The lord mayor is Councillor Andrew Varney. In the House of Commons , Bristol
8160-610: The country, and principally concerning the inhalation of oxygen and hydrogen . In November 1798, Beddoes rented two buildings at 6 and 7 Dowry Square , in Hotwells, and in March 1799 the laboratory was moved into the smaller one and the Institution was publicly announced. Beddoes anticipated that scientific investigations and medical treatment would be carried out side by side. In March 1798 Humphry Davy had become interested in
8280-519: The country, trading with Ireland, Iceland and Gascony . It was the starting point for many voyages, including Robert Sturmy 's (1457–58) unsuccessful attempt to break the Italian monopoly of Eastern Mediterranean trade. New exploration voyages were launched by Venetian John Cabot , who in 1497 made landfall in North America. A 1499 voyage, led by merchant William Weston of Bristol, was
8400-711: The declaration of a global health emergency by the World Health Organization (WHO) in 1993. There is a popular misconception that tuberculosis is purely a disease of the lungs that manifests as coughing . Tuberculosis may infect many organs, even though it most commonly occurs in the lungs (known as pulmonary tuberculosis). Extrapulmonary TB occurs when tuberculosis develops outside of the lungs, although extrapulmonary TB may coexist with pulmonary TB. General signs and symptoms include fever, chills , night sweats, loss of appetite , weight loss, and fatigue . Significant nail clubbing may also occur. If
8520-640: The developing world. IGRA have similar limitations in those with HIV. A definitive diagnosis of TB is made by identifying M. tuberculosis in a clinical sample (e.g., sputum, pus , or a tissue biopsy ). However, the difficult culture process for this slow-growing organism can take two to six weeks for blood or sputum culture. Thus, treatment is often begun before cultures are confirmed. Nucleic acid amplification tests and adenosine deaminase testing may allow rapid diagnosis of TB. Blood tests to detect antibodies are not specific or sensitive , so they are not recommended. The Mantoux tuberculin skin test
8640-538: The disease in the remains of bison in Wyoming dated to around 17,000 years ago. However, whether tuberculosis originated in bovines, then transferred to humans, or whether both bovine and human tuberculosis diverged from a common ancestor, remains unclear. A comparison of the genes of M. tuberculosis complex (MTBC) in humans to MTBC in animals suggests humans did not acquire MTBC from animals during animal domestication, as researchers previously believed. Both strains of
8760-620: The disease, since the infectious dose of tuberculosis is very small (the inhalation of fewer than 10 bacteria may cause an infection). People with prolonged, frequent, or close contact with people with TB are at particularly high risk of becoming infected, with an estimated 22% infection rate. A person with active but untreated tuberculosis may infect 10–15 (or more) other people per year. Transmission should occur from only people with active TB – those with latent infection are not thought to be contagious. The probability of transmission from one person to another depends upon several factors, including
8880-599: The early 1900s by the Royal Edward Dock. Another new dock, the Royal Portbury Dock , opened across the river from Avonmouth during the 1970s. As air travel grew in the first half of the century, aircraft manufacturers built factories. The unsuccessful Bristol International Exhibition was held on Ashton Meadows in the Bower Ashton area in 1914. After the premature closure of the exhibition
9000-463: The emergence of multidrug-resistant tuberculosis (MDR-TB), surgery has been re-introduced for certain cases of TB infections. It involves the removal of infected chest cavities ("bullae") in the lungs to reduce the number of bacteria and to increase exposure of the remaining bacteria to antibiotics in the bloodstream. Hopes of eliminating TB ended with the rise of drug-resistant strains in the 1980s. The subsequent resurgence of tuberculosis resulted in
9120-539: The enslaved captives were transported across the Atlantic to the Americas in the Middle Passage under brutal conditions. Plantation goods such as sugar, tobacco, rum, rice, cotton and a few slaves (sold to the aristocracy as house servants) returned across the Atlantic to England. Some household slaves were baptised in the hope this would lead them to be freed. The Somersett Case of 1772 clarified that slavery
9240-521: The first UK city to receive this award. In 2019 Bristol City Council voted in favour of banning all privately owned diesel cars from the city centre. Since then, the plans have been revised in favour of a clean air zone whereby older and more polluting vehicles will be charged to drive through the city centre. The Clean Air Zone came into effect in November 2022. The city has green belt mainly along its southern fringes, taking in small areas within
9360-511: The first expedition commanded by an Englishman to North America . During the first decade of the 16th century Bristol's merchants undertook a series of exploration voyages to North America and even founded a commercial organisation, 'The Company Adventurers to the New Found Land', to assist their endeavours. However, they seem to have lost interest in North America after 1509, having incurred great expenses and made little profit. During
9480-569: The first genuine success in immunization against tuberculosis in 1906, using attenuated bovine-strain tuberculosis. It was called bacille Calmette–Guérin (BCG). The BCG vaccine was first used on humans in 1921 in France, but achieved widespread acceptance in the US, Great Britain, and Germany only after World War II. By the 1950s mortality in Europe had decreased about 90%. Improvements in sanitation, vaccination, and other public-health measures began significantly reducing rates of tuberculosis even before
9600-461: The history of the Irish slave trade from Bristol, which he provocatively claimed continued into the reign of Henry VII . Hannah More , originally from Bristol, and a good friend of both Wilberforce and Clarkson, published "Slavery, A Poem" in 1788, just as Wilberforce began his parliamentary campaign. His major speech on 2 April 1792 likewise described the Bristol slave trade specifically, and led to
9720-431: The host's immune system. Macrophages and dendritic cells in the granulomas are unable to present antigen to lymphocytes; thus the immune response is suppressed. Bacteria inside the granuloma can become dormant, resulting in latent infection. Another feature of the granulomas is the development of abnormal cell death ( necrosis ) in the center of tubercles . To the naked eye, this has the texture of soft, white cheese and
9840-539: The import and processing of tobacco flourished with the expansion of the W.D. & H.O. Wills business. Supported by new industry and growing commerce, Bristol's population (66,000 in 1801), quintupled during the 19th century, resulting in the creation of new suburbs such as Clifton and Cotham . These provide architectural examples from the Georgian to the Regency style, with many fine terraces and villas facing
9960-400: The infected macrophages. When other macrophages attack the infected macrophage, they fuse together to form a giant multinucleated cell in the alveolar lumen. The granuloma may prevent dissemination of the mycobacteria and provide a local environment for interaction of cells of the immune system. However, more recent evidence suggests that the bacteria use the granulomas to avoid destruction by
10080-439: The infection spreads outside the lungs, causing other kinds of TB. These are collectively denoted as extrapulmonary tuberculosis. Extrapulmonary TB occurs more commonly in people with a weakened immune system and young children. In those with HIV, this occurs in more than 50% of cases. Notable extrapulmonary infection sites include the pleura (in tuberculous pleurisy), the central nervous system (in tuberculous meningitis ),
10200-613: The infection waxes and wanes. Tissue destruction and necrosis are often balanced by healing and fibrosis . Affected tissue is replaced by scarring and cavities filled with caseous necrotic material. During active disease, some of these cavities are joined to the air passages ( bronchi ) and this material can be coughed up. It contains living bacteria and thus can spread the infection. Treatment with appropriate antibiotics kills bacteria and allows healing to take place. Upon cure, affected areas are eventually replaced by scar tissue. Diagnosing active tuberculosis based only on signs and symptoms
10320-474: The issue after reading Samuel Latham Mitchell's Remarks on the gaseous oxyd of nitrogen and its effects (1795) which claimed that nitrous oxide would have a catastrophic impact if inhaled or placed in contact with a patient's skin, going as far as to suggest that it was the very "principle of contagion". Davy joined the Pneumatic Institution in 1798 as the laboratory operator, largely through
10440-783: The lab's equipment. After Lavoisier had established the role of oxygen in animal respiration, members of the Lunar Society , such as Joseph Priestley (who had co-discovered oxygen), originated pneumatic chemistry , which eventually led to the establishment of the Pneumatic Institution. Georgiana, Duchess of Devonshire , who was unusually educated about Chemistry, visited Thomas Beddoes in his laboratory in Hope Square, Bristol, in December 1793. He had set it up earlier that year to study possible medical uses of
10560-643: The largest number of slave traders in the country with 237, as against London's 147. It was a major supplier of slaves to South Carolina before 1750. The 18th century saw an expansion of Bristol's population (45,000 in 1750) and its role in the Atlantic trade in Africans taken for slavery to the Americas. Bristol and later Liverpool became centres of the Triangular Trade . Manufactured goods were shipped to West Africa and exchanged for Africans;
10680-490: The limestone to the underlying clay, creating Bristol's characteristically hilly landscape. The Avon flows from Bath in the east, through flood plains and areas which were marshes before the city's growth. To the west the Avon cuts through the limestone to form the Avon Gorge, formed largely by glacial meltwater after the last ice age . The gorge, which helped protect Bristol Harbour, has been quarried for stone to build
10800-561: The manufacture of suitable apparatus by the firm of Boulton and Watt and the first of the "pneumatic patients" was a Mr Knight of Painswick , whom Beddoes treated with "unrespirable airs" for a pelvic ulcer. By 5 March 1795 Beddoes was reporting successful treatment of paralytic patients and ordering an apparatus and oxygen for a Mr Gladwell in Clifton. Between 1792 and 1798, Beddoes had collected and published many "case histories" sent to him by other sympathetic physicians, from many parts of
10920-537: The middle and upper classes offered excellent care and constant medical attention. What later became known as the Alexandra Hospital for Children with Hip Disease (tuberculous arthritis) was opened in London in 1867. Whatever the benefits of the "fresh air" and labor in the sanatoria, even under the best conditions, 50% of those who entered died within five years ( c. 1916). Robert Koch did not believe
11040-495: The neighbouring village of Kingswood , often in the open air. Wesley published a pamphlet on slavery, titled Thoughts Upon Slavery, in 1774 and the Society of Friends began lobbying against slavery in Bristol in 1783. The city's scions remained nonetheless strongly anti-abolitionist. Thomas Clarkson came to Bristol to study the slave trade and gained access to the Society of Merchant Venturers records. One of his contacts
11160-596: The newly infected person becomes infectious enough to transmit the disease to others. A number of factors make individuals more susceptible to TB infection and/or disease. The most important risk factor globally for developing active TB is concurrent HIV infection; 13% of those with TB are also infected with HIV. This is a particular problem in sub-Saharan Africa , where HIV infection rates are high. Of those without HIV infection who are infected with tuberculosis, about 5–10% develop active disease during their lifetimes; in contrast, 30% of those co-infected with HIV develop
11280-599: The number of infectious droplets expelled by the carrier, the effectiveness of ventilation, the duration of exposure, the virulence of the M. tuberculosis strain , the level of immunity in the uninfected person, and others. The cascade of person-to-person spread can be circumvented by segregating those with active ("overt") TB and putting them on anti-TB drug regimens. After about two weeks of effective treatment, subjects with nonresistant active infections generally do not remain contagious to others. If someone does become infected, it typically takes three to four weeks before
11400-523: The recently discovered gases. During her second, extended, visit, "the idea of replacing the existing outpatient facility with a hospital—a Medical Pneumatic Institution—was first formulated." In 1794, she tried to persuade Sir Joseph Banks , who was President of the Royal Society of London at the time, to lend support to Beddoes' efforts. Banks refused, citing scientific objections in addition to his political concerns about Beddoes' sympathising with
11520-568: The recommendation of Davies Giddy , and it was here that he undertook experiments that included himself inhaling nitrous oxide , which he called laughing gas for its effects. Davy wrote up an account of his investigations at the Institution which was published by John Murray in 1800 as, Researches, chemical and philosophical, chiefly concerning nitrous oxide, or dephlogisticated nitrous air, and its respiration . This and other gases were administered, without charge, to willing subjects, particularly those with diseases considered to be incurable at
11640-647: The region. Built around the River Avon , it is bordered by the ceremonial counties of Gloucestershire to the north and Somerset to the south. The county is in the West of England combined authority area, which includes the Greater Bristol area ( eleventh most populous urban area in the United Kingdom) and nearby places such as Bath . Iron Age hillforts and Roman villas were built near
11760-610: The rest of the Great Britain via Bristol Temple Meads and Bristol Parkway mainline rail stations; by road by both the south-west to West Midlands M5 and the London to South Wales M4 (which connect to the city centre by the Portway and M32 ). Bristol was named the best city in Britain in which to live in 2014 and 2017; it won the European Green Capital Award in 2015. The name derives from
11880-435: The risk of developing active TB increases to nearly 10% a year. If effective treatment is not given, the death rate for active TB cases is up to 66%. TB infection begins when the mycobacteria reach the alveolar air sacs of the lungs, where they invade and replicate within endosomes of alveolar macrophages . Macrophages identify the bacterium as foreign and attempt to eliminate it by phagocytosis . During this process,
12000-414: The risk of infections (in addition to increasing the risk of active disease and death). Additional factors increasing infection susceptibility include young age. About 90% of those infected with M. tuberculosis have asymptomatic , latent TB infections (sometimes called LTBI), with only a 10% lifetime chance that the latent infection will progress to overt, active tuberculous disease. In those with HIV,
12120-492: The road, and at right angles to it. In the early 19th century, the romantic medieval gothic style appeared, partially as a reaction against the symmetry of Palladianism , and can be seen in buildings such as the Bristol City Museum and Art Gallery , the Royal West of England Academy , and The Victoria Rooms . Riots broke out in 1793 and 1831; the first over the renewal of tolls on Bristol Bridge, and
12240-462: The second against the rejection of the second Reform Bill by the House of Lords . The population by 1841 had reached 140,158. The Diocese of Bristol had undergone several boundary changes by 1897 when it was "reconstituted" into the configuration which has lasted into the 21st century. From a population of about 330,000 in 1901, Bristol grew steadily during the 20th century, peaking at 428,089 in 1971. Its Avonmouth docklands were enlarged during
12360-517: The site was used, until 1919, as barracks for the Gloucestershire Regiment during World War I . Bristol was heavily damaged by Luftwaffe raids during World War II ; about 1,300 people living or working in the city were killed and nearly 100,000 buildings were damaged, at least 3,000 beyond repair. The original central shopping area, near the bridge and castle, is now a park containing two bombed churches and fragments of
12480-403: The socioeconomic circumstances of the city's Afro-Caribbean residents. Local support of fair trade was recognised in 2005, when Bristol became a fairtrade zone . Bristol is both a city and a county, since King Edward III granted it a county charter in 1373. The county was expanded in 1835 to include suburbs such as Clifton , and it was named a county borough in 1889 when that designation
12600-476: The techniques and tools developed by Watt for the Pneumatic Institution are still used in modern medicine. 51°27′5″N 2°37′13″W / 51.45139°N 2.62028°W / 51.45139; -2.62028 Bristol Bristol ( / ˈ b r ɪ s t əl / ) is a city , unitary authority area and ceremonial county in South West England , the most populous city in
12720-465: The test's usefulness as a screening tool. Several vaccines are being developed. Intradermal MVA85A vaccine in addition to BCG injection is not effective in preventing tuberculosis. Public health campaigns which have focused on overcrowding, public spitting and regular sanitation (including hand washing) during the 1800s helped to either interrupt or slow spread which when combined with contact tracing, isolation and treatment helped to dramatically curb
12840-530: The time. Although the initial aim had been to treat patients with tuberculosis, most of the patients treated suffered from some form of paralysis. James Watt supported the Institution because conventional methods had failed to help against his son's pulmonary tuberculosis (known as consumption at the time), which had previously claimed his daughter Jessie. The suggestion of engaging Beddoes to treat Jessie had been made by Erasmus Darwin , and Beddoes undertook to administer "fixt air" ( carbon dioxide ), despite
12960-565: The top of the lung. This hematogenous transmission can also spread infection to more distant sites, such as peripheral lymph nodes, the kidneys, the brain, and the bones. All parts of the body can be affected by the disease, though for unknown reasons it rarely affects the heart , skeletal muscles , pancreas , or thyroid . Tuberculosis is classified as one of the granulomatous inflammatory diseases. Macrophages , epithelioid cells , T lymphocytes , B lymphocytes , and fibroblasts aggregate to form granulomas, with lymphocytes surrounding
13080-622: The town had one of the strongest castles in southern England . Bristol was the place of exile for Diarmait Mac Murchada , the Irish king of Leinster , after being overthrown. The Bristol merchants subsequently played a prominent role in funding Richard Strongbow de Clare and the Norman invasion of Ireland . The port developed in the 11th century around the confluence of the Rivers Frome and Avon , adjacent to Bristol Bridge just outside
13200-432: The town walls. By the 12th century, there was an important Jewish community in Bristol which survived through to the late 13th century when all Jews were expelled from England. The stone bridge built in 1247 was replaced by the current bridge during the 1760s. The town incorporated neighbouring suburbs and became a county in 1373, the first town in England to be given this status. During this period, Bristol became
13320-467: The transmission of both tuberculosis and other airborne diseases which led to the elimination of tuberculosis as a major public health issue in most developed economies. Other risk factors which worsened TB spread such as malnutrition were also ameliorated, but since the emergence of HIV a new population of immunocompromised individuals was available for TB to infect. During the HIV/AIDS epidemic in
13440-639: The tuberculosis bacteria share a common ancestor, which could have infected humans even before the Neolithic Revolution . Skeletal remains show some prehistoric humans (4000 BC ) had TB, and researchers have found tubercular decay in the spines of Egyptian mummies dating from 3000 to 2400 BC. Genetic studies suggest the presence of TB in the Americas from about AD 100. Before the Industrial Revolution , folklore often associated tuberculosis with vampires . When one member of
13560-540: The western Severn Estuary ending at (but not including) the islands of Flat Holm (in Cardiff , Wales) and Steep Holm . This "seaward extension" can be traced back to the original boundary of the County of Bristol laid out in the charter granted to the city by Edward III in 1373. The Office for National Statistics (ONS) has defined a Bristol Urban Area , which includes developed areas adjoining Bristol but outside
13680-576: Was born in Bristol, and the left-winger Tony Benn served as MP for Bristol South East in 1950–1960 and again from 1963 to 1983. In 1963 the Bristol Bus Boycott , following the Bristol Omnibus Company 's refusal to hire black drivers and conductors, drove the passage of the UK's 1965 Race Relations Act . The 1980 St. Pauls riot protested against racism and police harassment and showed mounting dissatisfaction with
13800-523: Was demolished. Bristol's road infrastructure changed dramatically during the 1960s and 1970s with the development of the M4 and M5 motorways , which meet at the Almondsbury Interchange just north of the city and link Bristol with London (M4 eastbound), Swansea (M4 westbound across the Severn Estuary ), Exeter (M5 southbound) and Birmingham (M5 northbound). Bristol was bombed twice by
13920-472: Was illegal in England. At the height of the Bristol slave trade from 1700 to 1807, more than 2,000 slave ships carried a conservatively estimated 500,000 people from Africa to slavery in the Americas. In 1739, John Wesley founded the first Methodist chapel, the New Room , in Bristol. Wesley, along with his brother Charles Wesley and George Whitefield , preached to large congregations in Bristol and
14040-633: Was introduced. On 1 April 1974, Bristol became a local government district of the county of Avon . On 1 April 1996, Avon was abolished and Bristol became a unitary authority . The former Avon area, called Greater Bristol by the Government Office of the South West (now abolished) and others, refers to the city and the three neighbouring local authorities— Bath and North East Somerset , North Somerset and South Gloucestershire previously in Avon. The North Fringe of Bristol ,
14160-478: Was not effective, it was later successfully adapted as a screening test for the presence of pre-symptomatic tuberculosis. World Tuberculosis Day is marked on 24 March each year, the anniversary of Koch's original scientific announcement. When the Medical Research Council formed in Britain in 1913, it initially focused on tuberculosis research. Albert Calmette and Camille Guérin achieved
14280-460: Was the owner of the Seven Stars public house , who boarded sailors Clarkson sought to meet. Through these sailors he was able to observe how slaver captains and first mates "plied and stupefied seamen with drink" to sign them up. Other informants included ship surgeons and seamen seeking redress. When William Wilberforce began his parliamentary abolition campaign on 12 May 1788, he recalled
14400-463: Was −10.1 °C (13.8 °F) in December 2010. Although large cities in general experience an urban heat island effect, with warmer temperatures than their surrounding rural areas, this phenomenon is minimal in Bristol. Bristol was ranked as Britain's most sustainable city (based on its environmental performance, quality of life, future-proofing and approaches to climate change, recycling and biodiversity), topping environmental charity Forum for
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