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Tuberculosis has been known to mankind since ancient times. Earlier this disease has been called by numerous names including consumption (because of the severe weight loss and the way the infection appeared to “consume” the patient), phthisis pulmonaris and the white plague (because of the extreme pallor seen among those infected).
Even today after the development of advanced screening, diagnostic and treatment methods for the disease, a third of the world’s population has been exposed and is infected with the organism. The numbers are over 90% in the developing world.
With advent of HIV infection there is a dramatic resurgence of tuberculosis with more than 8 million new cases each year worldwide and more than 2 million persons dying from it. In the nineteenth century, tuberculosis was known as “the captain of all men of death”. It is still true to a large extent today.
The organism causing tuberculosis - Mycobacterium tuberculosis existed 15,000 to 20,000 years ago. It has been found in relics from ancient Egypt, India, and China. Among Egyptian mummies spinal tuberculosis, known as Pott’s disease has been detected by archaeologists.
Evidence of tuberculosis of the cervical lymph nodes or lymph nodes of the neck termed scrofula is found in the Middle ages. It was termed as the “king’s evil” and was widely believed that the kings of England and France could cure scrofula simply by touching those affected.
In the 18th century in Western Europe, tuberculosis reached its peak with a prevalence as high as 900 deaths per 100,000. Poorly ventilated and overcrowded housing, primitive sanitation, malnutrition and other risk factors led to the rise. The term White plague emerged around this time.
Famous men and women over ages suffered from this disease. Notable among these were poets John Keats and Percy Bysshe Shelley, the authors Robert Louis Stevenson, Emily Bronte, and Edgar Allen Poe, the musicians Nicolo Paganini and Frederic Chopin to name a few.
The tubercle bacilli or the causative organism of tuberculosis was demonstrated by Robert Koch in 1882. He showed that the organism’s unique protein coat made it difficult to visualize earlier until a specific stain called the Zeihl Neelson stain was discovered.
The bacteria was called Koch’s bacillus and since it took up the red acidic dye, it was called AFB or acid fast bacilli. Koch was awarded the Nobel Prize in 1905. In 1895 Wilhelm Roentgen developed X rays which further advanced diagnostics of tuberculosis. This allowed early diagnosis and isolation of infected individuals.
In the nineteenth century the concept of keeping tuberculosis patients isolated in a sanatorium started. Initially started in Silelsia in 1859 by Hermann Brehmer the idea caught on. In 1884, Edward Livingston Trudeau started the first sanatorium in the United States. Infectious persons were isolated from society and treated with rest and improved nutrition.
The association National Tuberculosis Association, which later evolved into the American Lung Association came into being in 1904.
In the 1880s Louis Pasteur began the concept of development of vaccines against anthrax, chicken cholera, and, later, rabies. In 1908, the French scientists Albert Calmette and Camille Guerin grew Koch’s bacillus in several mediums to decrease their virulence and increase the capacity to produce immunity. This led to the now famous vaccine called BCG named after the two founders. BCG was introduced in 1921.
Before antibiotics were found effective against tuberculosis, surgical treatment of tuberculosis was common and often life saving. Dr. James Carson, a Scottish physician (1821), began treatment by draining pleural effusion from around the lungs and found surgery helped prolong life. Various techniques evolved but due to lack of efficacy faded away after advent of anti-tubercular drugs.
Antibiotics were used against tuberculosis for the first time in 1944 after the discovery of streptomycin. Use of this agent alone led to antibiotic resistance that is still a major problem.
Better results followed the development of PAS (para-aminosalicyclic acid). PAS was an oral agent unlike streptomycin. Thereafter more effective drugs like INH (isoniazid) came in 1950’s and treatment with rifampicin followed. Currently, there are fewer than 20 agents with activity against mycobacterium.