History of Tuberculosis (TB)

When was TB discovered?

A history of Tuberculosis (TB) should start with its discovery at least 35,000 years ago and probably closer to 2.6 million or even 3 million years ago.1Tuberculosis and Leprosy in Perspective, https://www.ncbi.nlm.nih.gov/pubmed/198990861 2S. Gagneux "Host-pathogen coevolution in human tuberculosis 3M. Cristina Gutierrez, Ancient Origin and Gene Mosaicism of the Progenitor of Mycobacterium tuberculosis, 2005, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1238740/

Previously it has been suggested that there is an animal origin for TB. But recent studies using molecular genetics now suggest that human TB predated that in other animals, including cattle, when it is known as bovine TB.

Out of Africa?

Mycobacterium tuberculosis complex (MTBC) may have emerged as a human pathogen in Africa. It then may have colonized the world accompanying the migrations of modern humans out of Africa some 70,000 - 100,000 years ago.4https://www.khanacademy.org/humanities/world-history/world-history-beginnings/origin-humans-early-societies/a/where-did-humans-come-from Could this perhaps be the same route followed by AIDS?

TB in Ancient Times

The earliest historical references to TB in Egypt are in a medical papyrus dated to 1550 BC.5Molecular evidence for Tuberculosis in an ancient Egyptian mummy Among Egyptian mummies spinal tuberculosis, one particular type of TB, known as Pott's disease has been detected.

TB has also been identified from India in a Sanskrit hymn (Rig Veda) which has been dated to 1550 BC. TB has also been identified in a medical text from China dated 2700 BC.

Hippocrates

Hippocrates in Book 1, Of the Epidemics (410-400 BCE) described a disease of "weakness of the lung" with fever and cough which he referred to as phthisis. Phthisis was descibed as the commonest disease of the period and usually as being fatal.

"Early in the beginning of spring, and through the summer, and towards winter, many of those who had been long gradually declining, took to bed with symptoms of phthisis .. Many, and in fact, most of them died."

Hippocrates recognised the predilection of the disease for young adults, saying that:

"Phthisis makes its attacks chiefly between the age of eighteen and thirty five."

History of TB in the Middle Ages

The middle ages is usually defined as being the one thousand years that followed the fall of the Roman empire and preceded the renaissance in Europe. During this period Tuberculosis was often referred to as Scrofula.6Daniel, Thomas, Captain of Death, The Story of Tuberculosis, University of Rochester Press, 1997

It was also called the Kings Evil with the Kings Touch being another one of the names for TB. It was widely believed that the kings of England and France could cure TB by simply touching affected people.

"a regular custom of touching the scrofulous .. developed in the French royal court probably in Louis IX's reign" (1226-1270) or before.7Murray, J, The King's Evil and the Royal Touch: the medical history of scrofula, 2016, https://www.ingentaconnect.com/content/iuatld/ijtld/2016/

In England, royal touching was already in vogue under the rule of Edward I (1272-1307).

History of TB in the 17th Century

Although Tuberculosis was present in Europe in the middle Ages, it was in the seventeenth century that the disease reached astounding epidemic proportions. 8Daniel, Thomas, Captain of Death, The Story of Tuberculosis, University of Rochester Press, 1997 By the mid seventeenth century it was recorded in the London Bills of Mortality that one in five of the deaths in the city was due to consumption. From the seventeenth to the nineteenth century in England, like the other great towns and cities of Europe and America, it swept on in a continuing epidemic of such monstrous proportion, the disease was called the White Plague of Europe.9F.Ryan, Tuberculosis: The greatest Story Never Told, 1992, Swift Publishers But in the later part of the 17th century Tuberculosis mortality slowly decreased.

In 1650 doubts had been expressed as to the contagiousness of phthisis, by the faculty of Paris. Soon TB spread over Northern Europe. Northern physicians seem to have been led to believe that the disease was due to a constitutional hereditary defect rather than due to contagion by the fact that it was particularly common and severe in certain families.10Dubos R, Dubos J. The White Plague:Tuberculosis, Man, and Society. Brunswick, New Jersey: Rutgers University Press; 1952

In 1679 Sylvius de la Boe, an Amsterdam physician, in his work Opera Medica, was probably the first to use the term tubercles in phthisis of the lung which he called tubercula glandulosa. In addition Sylvius described the association between phthisis and a disease of the lymph glands of the neck called scrofula.

TB in the 18th Century

Tuberculosis mortality probably peaked in England in 1780, at a death rate of one thousand, one hundred and twenty for each one hundred thousand living people each year. This means that one and a quarter percent of the entire population died of the disease each year.11Daniel, Thomas, Captain of Death, The Story of Tuberculosis, University of Rochester Press, 1997 By the end of the 18th century one in every four deaths in England was attributable to the disease. Then a major reversal occurred and death rates began to fall.

At this time knowledge of disease was derived almost exclusively from its symptoms. But dissatisfied with vague explanations of the disease physicians started to search for more concrete knowledge by dissecting the bodies of dead patients. In 1700 John Manget was carrying out such an autopsy when he observed tubercles so small as to resemble "millet seed" present in all parts of the body. This type of disseminated disease is now called "miliary" tuberculosis.

TB in the 19th Century

Around the turn of the 19th century, the death rate worldwide was estimated at 7 million people a year, with 50 million people openly infected and London and New York two of the worst affected cities.12Ryan, Frank, The Forgotten Plague,  little, Brown and Company, 1992 Consumption was probably the most common killer of American colonial adults. It accounted for more than 25% of deaths in New York city between 1810 and 1815.13S.D.Holmberg, the Rise of Tuberculosis in America before 1820,

Developing the stethoscope

In 1803 a French doctor Rene Laennec announced that he had found tubercles in all organs of the body, with muscle and body included. Some doctors believed at this time that phthisis corresponded to at least six independent diseases. But Laennec soon became convinced that the various lesions found in the phthisical lung were in reality different phases in the evolution of the same pathological process.

In 1804 Laennec delivered a famous lecture in which he set forth his revolutionary views on the genesis of pulmonary TB.

In 1816 physicians would perform physical examinations by such means as immediate auscultation which required the physician to place their ear directly on the patient to listen to internal sounds. Laennec invented the first stethoscope to amplify the sounds as well as to reduce physical contact between the physician and their patient.

The Name Tuberculosis

In 1839 J.L. Schonlein suggested that the word "tuberculosis" be used as a generic name for all the manifestations of phthisis, since the tubercle was the anatomical basis of the disease. This brought to an end the multiplicity of names for TB.

The First Sanatoriums

In 1854 the German physician Dr Hermann Brehmer opened his sanatorium in Gorbbersdorf, Silesia in an abandoned hydrotherapeutic sanitorium. German sanatorium doctors particularly valued the open air rest treatments, where the emphasis was put on remaining outdoors in all weather conditions combined with a rich diet.14F, Condrau, Tuberculosis then & now, McGill-Queen's University Press, 2010 Later in 1885 Dr Edward Livingston Trudeau started the first sanatorium in the United States.15Magaret Hort Trudeau Sanatorium Photograph Collection, https://nyheritage.org/collections/margaret-hort-trudeau-sanatorium-photograph-collection

A contagious disease

Some people had considered that TB might be a contagious disease. But this was only proved in 1865.  Jean Antoine Villemin, an army doctor in Paris, showed that it could be transmitted from tuberculous animals to healthy animals by inoculation.

Who died from TB?

Back in the 1800s if you had to die consumption was the way to go. It claimed many famous victims, including the poets John Keats and Robert Louis Stevenson and the novelists George Orwell and the Bronte sisters. It provided a romantic demise for the heroines of operas such as La Traviata and La Boheme.16Krista Burton, A "Fashionable Death, 2014, https://www.rookiemag.com/2014/03/a-fashionable-death/

The artificial pneumothorax

A pneumothorax is a collapsed lung and it  occurs when air gets into the space between a lung and the chest wall. The air pushes on the outside of the lung and makes it collapse. The creation of an artificial pneumothorax was probably the first surgical treatment for TB. The Italian doctor Carlo Forlanini who was born in 1847 had always had an interest in Tuberculosis. Having carefully considered the theory of what he planned to do, Forlanini proceeded in 1888 to induce the first artificial pneumothorax in a patient with TB. Subsequently a number of patients appeared cured.17Alex Sakula, Carlo Forlanini, inventor of artificial pneumothorax for treatment of pulmonary tuberculosis, Thorax, 1983, https://thorax.bmj.com/content/thoraxjnl/38/5/326.full.pdf

Robert Koch & his contribution to the History of TB

Robert Koch was an important person in the history of Tuberculosis

Robert Koch was an important person in the history of Tuberculosis

In March 1882 Robert Koch proved conclusively that the cause of Tuberculosis was infection by a specific micro-organism, the tubercle bacillus which he had isolated. His discovery made the headlines of the world's press. Subsequently Paul Ehrlich developed an improved staining method. With further later improvements, the result was the Ziehl-Neelsen stain. 18A. Sakula, Robert Koch: centenary of the discovery of the tubercle bacillus, 1882, https://thorax.bmj.com/content/37/4/246

Koch also laid down the conditions, known as Koch's postulates, which must be satisfied before it can be accepted that particular bacteria cause particular diseases.

Then in 1890 Koch announced that he had discovered a substance that could "in some cases" protect against tuberculosis and even "under certain circumstances" cure the disease. 19Sakula, A, Robert Koch: Centenary of the Discovery of the Tubercle Bacillus, 1882, 1992, https://thorax.bmj.com/content/37/4/246.long The immediate effect of Koch's announcement was electrifying. 20T, Dormandy, A History of Tuberculosis, the White Death, 1999, Hambledon Press 21Dubos R, Dubos J. The White Plague:Tuberculosis, Man, and Society. Brunswick, New Jersey: Rutgers University Press; 1952 This substance was Tuberculin. But it soon became clear that Tuberculin killed many more patients than it helped. The treatment was discredited almost everywhere and Koch was severely criticised.

The Decline of Consumption

Consumption declined slowly after the mid nineteenth century. Although on the continent and in the United States it peaked several decades after England. It remained until the 1940s the commonest cause of death among those about to enter what should have been the most productive period of their lives. 22T, Dormandy, A History of Tuberculosis, the White Death, 1999, Hambledon Press So unexpected was the decrease in mortality that occurred during the second half of the nineteenth century that it remained unnoticed for several decades.23Dubos R, Dubos J. The White Plague:Tuberculosis, Man, and Society. Brunswick, New Jersey: Rutgers University Press; 1952

TB in the 20th Century

This was the century when everything was to change for TB. At the start of the century there was still no treatment but by the end of the century a number of drugs were available and TB could effectively be cured. It was though also the century when the problem of drug resistant TB was first identified.

In 1900 it was estimated that the death rate for TB for white Americans was between 190 and 200 per 100,000. Among black Americans the comparable figure was 400 deaths per 100,000.24Dubos R, Dubos J. The White Plague:Tuberculosis, Man, and Society. Brunswick, New Jersey: Rutgers University Press; 1952

Around 1908 a new use was found for Tuberculin. But this was not for the treatment of TB, but instead it was for the diagnosis of TB.25https://en.wikipedia.org/wiki/Mantoux_test#BCG_vaccine_and_the_Mantoux_test The test was named after the French physician Charles Mantoux

Then in 1921 the BCG vaccine was used for the first time in humans. There is much more about the BCG vaccine

History of TB drugs

The history of TB drugs starts around 1940 with the development of para-amino salicylic (PAS). Drug development is still ongoing in 2019. There is much more about the history of TB drugs. However, after the development of the rifamycins in the 1950s, no new drugs were to become available for the next fifty years

The Madras Experiment

Starting around 1956 the Madras Experiment was carried out in India to determine whether treatment in a Sanitorium provided any benefits as compared with treatment at home. Patients were followed up for five years, and the result showed that there was no significant differences between the two groups. This experiment marked the end of the sanitoriums with most of them closing or radically changing the services they provided.26Frank Ryan, The Forgotten Plague, Little, Brown and Company, 1992

Drug Resistant TB

Signs of single drug resistance had been seen as early as 1948 but then there started to be reports of strains of the disease that were resistant to two or even more drugs.

The greatest disaster that can happen to a patient with Tuberculosis is that his organisms become resistant to two or more of the standard drugs. The development of drug resistance may be a tragedy not only for the patient himself but also for others, for he can infect other people with his drug resistant organisms. Sir John Crofton (1959)

DOTS

In 1994 the World Health Organisation (WHO) announced a new strategy called DOTS, for the global control of TB.

Would you like to send us a comment about this page?

You might like to read more about