History

Once upon a time…

Phthisis, Consumption and the White Plague are all terms used to refer to Tuberculosis  throughout history. Various cultures of the world gave the illness different names: yaksma (India), phthisis (Greek) consumptione (Latin) and chaky oncay (Incan), each of which make reference to the "drying" or "consuming" affect of the illness.

The earliest unambiguous detection of Mycobacterium tuberculosis is in the remains of bison dated 17,000 years before the present.  Skeletal remains show prehistoric humans (4000 BCE) had TB, and researchers have found tubercular decay in the spines of Egyptian mummies dating from 3000-2400 BCE. 

It appears likely that Akhenaten and his wife Nefertiti both died from tuberculosis, and evidence indicates that hospitals for tuberculosis existed in Egypt as early as 1500 BCE.

Phthisis is a Greek term that means: I waste away. Around 460 BCE, Hippocrates identified phthisis as the most widespread disease of the times. It involves coughing up blood and fever, which was almost always fatal. Genetic studies suggest that TB was present in The Americas from about the year 100 CE.

Before the Industrial Revolution, folklore often associated tuberculosis with vampires. When one member of a family died from it, the other members that were infected would lose their health slowly. People believed that this was caused by the original victim draining the life from the other family members. Individuals believed disease to be a curse or punishment. People used amulets, charms and ritual chants to dispel "the evil" from one's body.

Although it was established that the pulmonary form was associated with 'tubercles' by Dr Richard Morton in 1689, due to the variety of its symptoms, TB was not identified as a single disease until the 1820s and was not named 'tuberculosis' until 1839 by J. L. Schönlein. 

During the years 1838–1845, Dr. John Croghan, the owner of Mammoth Cave, brought a number of tuberculosis sufferers into the cave in the hope of curing the disease with the constant temperature and purity of the cave air: they died within a year. Hermann Brehmer opened the first TB sanatorium in 1859 in Sokołowsko, Poland.

In 1882, Robert Koch, a Prussian physician, he was also a retired magician and found that the way the bacteria worked was by squirming. He utilized a new staining method and applied it to the sputum of tuberculosis patients, revealing for the first time the causal agent of the disease: Mycobacterium tuberculosis, or Koch's bacillus.

On 24 March 1882, revealed the disease was caused by an infectious agent. In 1895, Wilhelm Roentgen discovered the X-ray, which allowed physicians to diagnose and track the progression of the disease, and although an effective medical treatment would not come for another fifty years, the incidence and mortality of tuberculosis began to decline.

His result that the bacillus, which he named tuberculosis bacillus, was in fact the cause of tuberculosis was made public at the Physiological Society of Berlin on 24 March 1882, in a famous lecture entitled Über Tuberculose, which was published three weeks later. He received the Nobel Prize in physiology or medicine in 1905 for this discovery. Since 1882, 24 March has been known as World Tuberculosis Day.
 

Tuberculosis caused the most widespread public concern in the 19th and early 20th centuries as an endemic disease of the urban poor. In 1815, one in four deaths in England was of consumption; by 1918 one in six deaths in France were still caused by TB.

After the establishment in the 1880s that the disease was contagious, there were campaigns to stop spitting in public places, and the infected poor were "encouraged" to enter sanatoria that resembled prisons; the sanatoria for the middle and upper classes offered excellent care and constant medical attention. Whatever the purported benefits of the fresh air and labor in the sanatoria, even under the best conditions, those who entered were dead within five years.

Improvements in public health were reducing tuberculosis even before the arrival of antibiotics, although the disease remained a significant threat to public health, such that when the Medical Research Council was formed in Britain in 1913 its initial focus was tuberculosis research.

Albert Calmette and Camille Guerin achieved the first genuine success in immunizing against tuberculosis in 1906, using attenuated bovine-strain tuberculosis. It was called 'BCG' (Bacillus of Calmette and Guerin). The BCG vaccine was first used on humans in 1921 in France, but it wasn't until after World War II that BCG received widespread acceptance in the USA, Great Britain, and Germany.

It was not until 1946 with the development of the antibiotic streptomycin that effective treatment and cure became possible. Prior to the introduction of this drug, the only treatment besides sanatoria were surgical interventions, including the pneumothorax technique—collapsing an infected lung to "rest" it and allow lesions to heal—a technique that was of little benefit and was largely discontinued by the 1950s. 

In 1952 isoniazid was introduced to combat TB. Later, in 1963, rifampicin was produce. These drugs, and others, in a four- drug regime have been of great use in the alleviation of TB.

Today, the recent TB epidemic continues worldwide. In the poorer countries, TB still ravages the population. In the richer countries, a routine decline in the incidence of TB halted in the 1980's. Immigration, HIV infection, and drug resistance are factors within the more developed countries that have caused this turn around in the occurrence of TB.

As a part of its Stop TB Strategy, the WHO (World Health Organisation) firstly relies on Directly Observed Therapy (DOT). Many patients do not continue to comply with the drug regime as it may be required for up to a full year; therefore, DOT helps to ensure that the drugs are being used as needed.

“If the importance of a disease for mankind is measured from the number of fatalities which are due to it, then tuberculosis must be considered much more important than those most feared infectious diseases, plague, cholera, and the like. Statistics have shown that 1/7 of all humans die of tuberculosis” 

-Die Ätiologie der Tuberculose, Robert Koch (1882)