History of Tuberculosis

The bacteria that causes tuberculosis, Mycobacterium tuberculosis, has been present in the human population at least since 2400 B.C.. Fragments of a spinal column from Egyptian mummies from that date show definite pathological signs of tubercular decay. The Greek term for consumption, phthisis, appears in Greek literature before 460 B.C.. Hippocrates identify consumption as the most widespread disease of the times and noted that it was almost always fatal. Because of the deaths related to consumption, Hippocrates recommended something no doctor today would dare think of. Because of the inevitable death associated with consumption he recommended that his colleagues not visit patients who were suffering from the late stages of the disease because it might damage their reputation.

Although tuberculosis was common and fatal, exact pathological descriptions of the disease only began to appear in the 17th century. In Opera Medica, Silvius was the first to identify the tubercles as a consistent and characteristic change in the lungs. He also gave a good description of the progression of tubercles to abscesses and then cavities.

The earliest references to the infectious nature of the disease appeared in the 17th century Italian literature. Public Law in the Republic of Lucca in 1699 ordered that human health should not be endangered by objects that remain after the death of an individual who suffered from consumption. The names of the dead should be reported to the authorities and measures undertaken to have the area disinfected.

In 1720 the English Dr. Benjamin Marten was the first to theorize that tuberculosis could be caused by minute living creatures. He wrote that once they gained a foothold in the body they were responsible for generating lesions and symptoms of the disease. In his early 18th century writings, Dr. Martin displayed a great degree of epidemiological insight. He theorized that one was likely to catch consumption by habitually sharing space with an individual who suffered from consumption, but that slight conversing with the patient is seldom or never sufficient to catch the disease.

In stark contrast to this increasing level of understanding about the spread of tuberculosis was the knowledge of those who were attempting to cure the disease. Hermann Brehmer, a botany student who suffered from tuberculosis was instructed by his primary care physician to seek out a healthier climate. He traveled to the Himalayan mountains where he was cured of his disease. He returned home to study medicine and in 1854 presented a dissertation theorizing that tuberculosis was curable. It was Dr. Brehmer who built the first sanatoria, an institution which delivered good nutrition and fresh air to patients, in the battle against tuberculosis.

In 1865 a French military doctor demonstrated that tuberculosis could be passed from humans to animals. On the basis of this evidence he postulated that a specific microorganism was the cause of the disease. And then, in 1882, Robert Koch discovered a staining mechanism that allowed him to see the tuberculosis bacteria. It was at this time that the world became excited about the certainty of being able to fight against what was at that time humanity\’s deadliest enemy.

An Italian doctor, in 1890, created the first therapy for patients with tuberculosis. He found that collapsing the lungs had a positive effect on the recovery of the disease and doctors began to reduce lung volume to 2/3 in tuberculosis pateints. The technique of radiation was developed in 1895.

In the early 20th century the most common age group continued to be the elderly. Because patients can suffer from the reinfection of tuberculosis the world began to use sanitariums and hospitals to isolate those infected in an effort to prevent future generations from contracting the disease. This isolation prevented spread and by 1973 the mortality rate for tuberculosis had been reduced.

Treatment methods for tuberculosis were both controversial and dangerous throughout the history of the disease. The first therapy, proposed by the Italian physician, created a lung collapse that was either achieved artificially by compression of the diseased lung or artificial compression of both lungs. In the more extreme cases a thoracoplasty was used. During this procedure ribs from one side of the thorax was removed in order to collapse the infected portion of the lungs permanently. In 1925, a doctors introduced the gold therapy which initially tested safe on animals. However, despite claims to the contrary, it was finally was considered toxic.

In 1944 streptomycin was administered to a human patients and was found to be an effective treatment for tuberculosis. In 1946 another drug was found to be moderately effective. And then, in 1947, Mycobacterium tuberculosis began to show resistance to the initial drug, streptomycin. In 1948 physicians began combining streptomycin and PAS to treat the disease. It wasn\’t until 1951 that isoniazid was created and, when used with PAS, was shown to be more effective.

Over the next 10 years another four drugs were developed for the treatment of tuberculosis. At the onset of their developments they were found to be effective against the disease, but it wasn\’t long before they needed to be used in combination because the tuberculosis bacterium had become resistant to the drug therapy.

Many famous names and families were affected by the tuberculosis bacteria. Among these were several generations of the Brontë family, John Keats, Chopin, Robert Louis Stevenson, Anton Chekhov and Franz Kafka.

Today the world is seeing a new reemergence of tuberculosis as a disease that is the seventh leading cause of death around the world. One of the main reasons for the reemergence is due to the compromise of the immune system in patients who carry the HIV virus. Overcrowded cities, poverty, poor nutrition, lack of public health and the reemergence of multidrug resistance tuberculosis bacteria all combine to increase the number of individuals were diagnosed with tuberculosis annually.

RESOURCES

Respiratory Medicine: The History of Tuberculosis

New Jersey medical School: The History of Tuberculosis Treatment

American Journal of Respiratory and Critical Care Medicine: A Century of Tuberculosis

Center for Disease Control and Prevention: History of the World TB Day