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Introduction
5000 to 2400 BC
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The earliest evidence of tuberculosis (TB) in humans is from a Neolithic grave in Germany, dating back to 5000BC. Egyptian mummies showed evidence of spinal tuberculosis. The Babylonians, Greeks and Hindus also mention a consumptive disease, which caused widespread death. Hippocrates, the Greek physician, documented the early stages of 'phthisis' (meaning, "I waste away") and its inescapable course of destruction. (1, 2, 3)
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| 1600's |
Writings discussed the potential infectious nature of the disease and described pathophysiologic conditions. By the early 1700's, Dr. Benjamin Martin (an English physician) wrote about "amiculae": tiny, minute creatures, which could generate the symptoms of Tuberculosis . In his work, A New Theory of Consumption, Dr. Martin contemplated the contagious nature of the disease. He warned against "...habitual lying in the same bed with a consumptive person...or very frequently conversing so nearly as to draw in part of the breath..." (2)
Cures or effective treatment for consumption (early term for TB) remained elusive. In ancient times, individuals believed disease to be a curse or punishment. People used amulets, charms and ritual chants to dispel "the evil" from one's body.
At the height of the epidemic, TB was believed to be an aristocratic disease, infecting primarily artists and scholars.(3) |
| Early to Mid-1800's |
As the disease spread, it became clear that consumption was not a disease restricted to the upper class. Nearly all Europeans were infected and one in four deaths was due to consumption (TB). In the US, one in five deaths were due to TB. Urbanization, crowded living conditions and malnutrition were all factors in the spread of TB. (2, 3) |
| In the mid-1800's |
Discovery of a specific infectious agent dispelled any previous belief that TB occurs spontaneously. A French surgeon, Jean-Antoine Villemin, was able to "infect" healthy rabbits with the sputum of humans and cows.(3) |
| 1881 |
Robert Koch isolated Mycobacterium tuberculosis (M. tuberculosis, or Mtb) as the cause of "consumption". Institutionalizing individuals with TB in "sanitariums" soon followed, in effect isolating diseased individuals from the general population. Tuberculosis sanitariums provide the consumptive individual with proper nutrition and fresh air. Surgical interventions (collapsing the lung and reducing lung volume) and the use of roentgenograms (x-rays) to monitor patients was instituted as part of patient therapy.(1, 2, 3) |
| 1921 |
Bacteriologists Calmette and Guerin attenuated a strain of Mycobacterium bovis (M. bovis) at the Pasteur Institute and administered it as a vaccine (known simply as BCG).(1, 2) |
| 1943 |
Discovery of streptomycin provided the first effective treatment for those afflicted with TB. However, streptomycin-resistant TB appeared almost immediately (2) |
| 1952, 1963 |
In 1952 isoniazid was introduced to combat TB. Later, in 1963, rifampicin was produce. These drugs, and others, in a four- drug regime have been of great use in the alleviation of TB(2). |
| 1993 |
World Health Organization (WHO) declares rise of TB cases a global health emergency. |
| 2006 |
WHO launches the Stop TB Strategy(35) |
Today, the recent TB epidemic continues worldwide. In the poorer countries, TB still ravages the population. In the richer countries, a routine decline in the incidence of TB halted in the 1980's. Immigration, HIV infection, and drug resistance are factors within the more developed countries that have caused this turnaround in the occurrence of TB(2).
As a part of its Stop TB Strategy, the WHO firstly relies on Directly Observed Therapy (DOT). Many patients do not continue to comply with the drug regime as it may be required for up to a full year; therefore, DOT helps to ensure that the drugs are being used as needed(1).
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