22 World Health • 46th Year, No. 4, July-August 1993 Brief history of an age·old disease

The captain of all these men of death that came against him to take him away was the consumption; for it was that that brought him down to the grave. John Bunyan, The life and death of Mr Badman, 1680

The origins: Humanity has probably recognized tuberculosis (TB) as a killer disease since the last Ice Age, if not before. Traces of tuberculosis lesions have been found in the lungs of 3000-year-old Egyptian mummies. The Greek physician Hippocrates (460-370 BC)- "the father of medicine" - wrote a description of the disease.

Name: In Classic Greek times it was known as phthisis, from the verb phthinein, to waste away. Right up to the present century, it was commonly called consumption - for the same reason. But it was in the 17th century that a Dutchman, Franciscus Silvius of Leyden, flrst used the term "tubercle" to describe the knobby lesions found In the 1950s, tuberculosis patients were confined to bed and told to breathe the fresh air in in the lungs of people who had died of sanatoria built in the mountains. the wasting disease. The name tuberculosis seems first to have been used in 1839, by Johann Schonlein. X-rays: Wilhelm Conrad Roentgen A first drug: Selman A. W aksman discovered the use of X-rays in 1895 and his colleagues, working in the The bacillus: In 1882, German and made it possible for the flrst time USA in 1944 ~ discovered physician Robert Koch announced the to visualize the chest of living persons streptomycin, the first antibiotic discovery of the tubercle bacillus, and for signs of tubercular lesions. His effective against tuberculosis. published an article entitled "Etiology Nobel Prize for Physics was awarded Waksman received the 1952 Nobel of tuberculosis". Within eight years he in 1901. Prize for Medicine. was able to make an extract of dead bacilli to form tuberculin, which could A vaccine: In 1921, French scientists Mass vaccination: The first mass then be used as a diagnostic test for Albert Calmette and Camille Guerin vaccination campaign was carried out tuberculous infection. Koch was created a vaccine against tuberculosis in 1948-51 by the Scandinavian Red awarded the Nobel Prize for Medicine from an attenuated form of the bovine Cross Societies, with the support of in 1905. Today the bacillus bacillus. BCG, standing for Bacillus­ UNICEF. From 1951 it became the responsible for TB is called Calmette-Guerin, is still the only responsibility of WHO, which helped Mycobacterium tuberculosis. vaccine we have against the disease. governments progressively to World Health • 46th Veer, No. 4, July-August 1993 23

HIV: While TB remained a major And TB did indeed kill - at all too health problem in the developing young an age - poets, artists, countries, from the mid-1980s the musicians. Among the many whose advent and spread of HIV, the virus lives were cut short were painters that leads to AIDS, paved the way for Antoine W atteau and Amedeo TB to stage a comeback in the Modigliani, poet John Keats, industrialized countries, and thus on composers Carl Maria von Weber and the world scene. Frederic Chopin, South American liberator Simon Bolivar, writer Chemotherapy: Today, WHO Anton Chekhov and philosopher recommends short-course Henry David Thoreau. Tens of chemotherapy as the most effective millions more fell victim to TB before way of curing every infectious patient they had a chance just to live a normal and preventing the spread of life span. tuberculosis in the community. Cure is Robert Koch ( 1843-191 0}, discoverer of several bacilli, among which was easily achieved through the use of If we are continually guided in this Mycobacterium tuberculosis, which he modem medicines - treatment with enterprise by the spirit of genuine identified in 1882. four or five widely available preventive medical science; if we inexpensive drugs, which can cure utilize the experience gained in over 90% of TB patients in the conflict with other pestilences, and developing world - provided they are aim - with clear recognition of the continued for a minimum of 6 months. purpose and resolute avoidance of undertake their own BCG (See page 25) wrong roads - at striking the evil programmes. at its roots, then the battle against tuberculosis cannot fail to have a Sanatoria: For more than a century, Death of poets: victorious issue. physicians used to send TB patients Robert Koch, for rest and exercise to sanatoria, often [In the early 1820s] it was all the The fight against tuberculosis, 1902 in mountain areas where there would fashion to suffer from chest be plenty of fresh air. By 1960, it complaints; everyone was became apparent that these cases consumptive, poets especially; it could be treated with the new anti-TB was good form to die before drugs just as effectively in their own reaching the age of thirty. homes. Sanatoria began to close all Alexandre Dumas pere, around the world. Memoires, 1854

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The bacilli of tuberculosis as Koch saw them under the microscope. Mycobacterium tuberculosis, enlarged I 2 000 times by on electron microscope.