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History of Tuberculosis

TB has a lineage that can be traced to the earliest history of mankind.   The tubercle bacillus, the organism that causes TB disease, can be traced as far back as 5000 BC when archeologists found evidence in human bones of the existence of TB.  Evidence was found in ancient Egyptian mummies which showed deformities consistent with TB disease. 

Evidence of TB appears in Biblical scripture, in Chinese literature dating back to around 4000 BC, and in religious books in India around 2000 BC.  In ancient Greece around 400 BC, Hippocrates mentions TB, as does Aristotle, who talked about "phthisis and its cure"
(ca. 350 BC).

It was thought that Columbus brought TB to the new world in 1492.   Evidence was found in 1994, when scientists reported that they had identified TB bacterium DNA in the mummified remains of a woman who died in the Americas 500 years before Columbus set sail for the New World.

The "Great White Plague" which started in Europe in the 1600's and continued for 200 years was Tuberculosis.  Other names throughout history for Tuberculosis are Phthisis (from the Greek word to waste away), scrofula (swellings of the lymph nodes of the neck), consumption (progressive wasting away of the body), and TB (the presence or products of the tubercle bacillus).

In 1720, in his publication, A New Theory of Consumption, the English physician Benjamin Marten was the first to conjecture that TB could be caused by "wonderfully minute living creatures," which, once they had gained a foothold in the body, could generate the lesions and symptoms of the disease.  He continued that "It may be therefore very likely that by an habitual lying in the same bed with a consumptive patient, constantly eating and drinking with him, or by very frequently conversing so nearly as to draw in part of the breath he emits from the Lungs, a consumption may be caught by a sound person.  I imagine that slightly conversing with consumptive patients is seldom or never sufficient to catch the disease."  For a physician living in such an early era, Dr. Marten showed much medical insight.

In 1882, at a time when TB was raging through Europe and the Americas, killing one in seven people, a German biologist by the name of Robert Koch presented to the scientific community his discovery of the organism that caused TB.  It was called a tubercle bacillus because small rounded bodies (tubercles) occurred in the diseased tissue and where characteristic of the disease.  Through his many experiments with the organism, Dr. Koch worked on developing a cure for TB.  Koch was able to isolate a protein from the tubercle bacillus that he tried as an immunizing agent and later as a treatment for TB; in both cases it failed.  However, the substance called "old tuberculin," was to be later used as the screening tool (tuberculin skin tests) for identifying people and animals infected with tubercle bacilli.

A further significant advance came in 1895 when Wilhelm Konrad von Roentgen discovered the radiation (x-rays) that bears his name.  This allowed the progress and severity of a patient's disease to be accurately followed and reviewed.

TB in America during the colonial period was accepted as a scourge of humanity that was common to the poor and rich alike.  The first available mortality figures from Massachusetts in 1796 indicated 300 deaths per 100,000 population.  The peak mortality figure reached in New England was 1,600 per 100,000 in 1800.  With the industrial development, the epidemic traveled to the Midwest in 1840 and to the West in 1880.  The American Indians and Alaskans were the last American populations to become effected by the TB epidemic.  At the turn of the century it was estimated that 10% of all deaths in the United States were due to TB.

In 1886, Edward Livingston Trudeau a physician who recovered from TB, started the sanatorium movement in the United States at Saranac Lake, New York.  He based it on the European model of strict supervision in providing fresh air and sunshine, bed rest, and nutritious foods.  As infection control measures took hold in large urban centers of the country, TB patients who could not be treated in local dispensaries were removed from the general population and place into sanatoriums.   By 1938 there were more than 700 sanatoriums throughout the U.S., yet the number of patients outnumbered the beds available.

In 1892, Dr. Herman Biggs of New York started mandatory reporting of TB cases.  He thought that we should:

  • educate the public of the dangers that the disease posed to the person and his/her contacts.

  • properly dispose of and immediately destroy sputum or the "discharges from the lungs" of the individuals with disease.

  • Have all physicians of pulmonary cases report such cases to the health department.

  • Have health inspectors visit the families where TB exists and deliver proper literature and take specific measures to disinfect the areas as may be required.

  • Obtain and submit sputum specimens to the laboratory for analysis

  • Create a consumptive hospital to care for indigent patients.

The board adopted most of the recommendations made by Biggs, including the creation of the Consumptive Hospital.  These recommendations created a storm of controversy among the medical community.  Many private doctors objected to the mandatory reporting, believing that it violated physician-patient confidentiality.   Because of the resistance from the medical community, reporting practices were not fully implemented for several years.  In the end, Biggs' recommendations to the Board and their implementation in New York City created the model for TB control programs that was emulated by other health departments across the country and laid the groundwork for a campaign called the "War on Consumption."

In 1904 a voluntary health agency was organized under the National Association for the Study and Prevention of Tuberculosis, later renamed the National Tuberculosis Association (NTA) and now known as the American Lung Association.

On November 20, 1944, the antibiotic "Streptomycin" was administered for the first time to an critically ill TB patient. The effect was almost immediate and impressive.  His advanced disease was visibly arrested, the bacteria disappeared from his sputum, and he made a rapid recovery.  The new drug had side effects - especially on the inner ear - but the fact remained, M. Tuberculosis was no longer a bacteriological exception; it could be assailed and beaten into retreat within the human body.

A rapid succession of anti-TB drugs appeared in the following years.   These were important because with streptomycin monotherapy, resistant mutants began to appear within a few months, endangering the success of antibiotic therapy.   However, it was soon demonstrated that this problem could be overcome with the combination of two or three drugs.

Turning the Page on a New Century