About Tuberculosis

Mycobacterium tuberculosis has infected humans as early as 2400 BC, as evident from fragments of the spinal column from Egyptian mummies showing definite pathological signs of tubercular decay. In 460 BC, Hipocrates identified "phthisis" (a Greek work meaning consumption) as the most prevalent disease of the times. He also observed that the disease was almost always fatal. In the 17th century people began to describe and record the exact pathology of the disease. In 1679, Sylvius wrote his Opera Medica in which he described actual tubercles as a characteristic change in the lungs and other parts of the body in consumptive patients. He also described their progression to abscesses and cavities. The infectious nature of the disease was soon noted. In 1720, Benjamin Marten, an English physician, theorized that TB could be caused by "wonderfully minute living creatures." He thought that a healthy person could catch TB if they had close contact with an infected person but the disease was seldom transmitted via a brief contact. In 1854, Hermann Brehmer introduced the idea that TB was a curable disease based on self-experience and built the first sanatorium, a place where patients could get plenty of fresh air and good nutrition. In 1865, Jean-Antoine Villemin, a French doctor demonstrated that consumption could be passed from humans to cows to rabbits. On the basis of this evidence, he postulated that the disease was caused by a specific microorganism, as opposed to the old belief that the disease arose spontaneously in each affected organism. Mycobacterium tuberculosis was first seen in 1882 by Robert Koch with a special staining technique.

At that time, sanatoria were widely found throughout Europe and the United States. Such places helped the sick strengthen the body's defense mechanism and expedite the healing process by providing rest, good nutrition, and a healthy environment, and they also served to isolate the sick from the healthy population. Forlanini, an Italian physician found that lung collapse had a favorable impact on the outcome of the disease. Given this observation, surgical methods to reduce lung volume and artificial pneumothorax were then introduced, marking the beginning of active therapy for TB. In 1895, Wilhelm Konrad bon Rontgen discovered the radiation, which could be used to view the progress and severity of a patient's disease. A milestone development was the introduction of the BCG vaccine, which is still used widely today. Calmette, a French bacteriologist, and Guerin were able to lower the virulence of the bovine strain of TB which led to the creation of the vaccine. In 1943 Selman A. Waksman discovered Streptomycin purified from Streptomyces griseus that was first administered to a human on November 20, 1944 and demonstrated impressive results. Thereafter, more and more anti-TB drugs were developed. Combination of multiple drugs turned out to be an important strategy as resistant mutants quickly emerged against a single drug.

Despite all the drugs available today, TB is still a problem in developing nations. The highest incidences are in countries like Africa, Asia, and Latin America with low gross national products. The World Health Organization estimates that each year 3 million people die from TB, and eight million people are infected with the disease. The annual rate of increase in TB incidence is 3% globally, 7% in Eastern Europe, and over 10% in the African countries that are most affected by HIV/AIDS.

New Jersey Medical School National Tuberculosis Center. Brief History of Tuberculosis. (July 1996). www.umdnj.edu/~ntbcweb/history.htm.