Review Article Landmarks in

Narayan Mishra1*, Surya Kant2 and Kanchan Srivastava2 1Former Professor,Department of TB and Chest, MKCG Medical College, Berhampur, Orissa, India 2 Professor and Head,3Research ScientistDepartment of Respiratory Medicine, King George's Medical University, UP, Lucknow E mail:[email protected]

Mycobacterium tuberculosis (Mtb) has been infecting the human race since the dawn of history. Archaeological evidence has established the association from Neolithic times. Modern anti-TB treatment can cure virtually all patients. The estimated number of people falling ill with TB each year is declining, although very slowly, which means that the world is on track to reverse the spread of TB by 2025. Some landmarks in TB are:

• TB is the first disease known to mankind. • Consumption, phthisis, scrofula, Pott's disease, and the White Plague are all terms used to refer to TB throughout history. In Sanskrit, the disease has been called "Rajayakshma", "Kshya" and "Sosa". • The word "tuberculosis" is a derivative of the Latin world 'tubercula' which means of 'A small lump' • The first reference to TB in Asian civilization is found in the Vedas. • The oldest of them, Rigveda (1500 B.C.) calls the disease yaksma (Book 10, hymn 161). • The Atharvaveda calls it another name: Balasa. The first description of scrofula is given in the Atharvaveda. • The Sushruta Samhita, (written around 600 B.C.), recommends that the disease be treated with breast milk, various meats, alcohol and rest. • Phthisis word (means "to consume" "to spit", and "to waste away") first appeared in Greek literature around 460 BCE. • Hippocrates "The Father of Medicine" (460 -377 B.C.), identified the TB as the most common cause of illness in his time. • TB was epidemic in Europe and the US in 1600s, probably started in the 17th century and lasted two- hundred years, was known as the "Great White Plague". • The first evidence of the infection of TB in humans was found in a cemetery near Heidelberg, in the Neolithic bone remains that show evidence of the type of angulations often seen with spinal TB, Typical Pott's disease in the body of mummy. Sign of tubercular decay have been found in bone fragments of 40000-year old Egyptian mummies • Franciscus Sylvius (17th and 18th centuries), was the first person to recognize that the skin ulcers caused by scrofula resembled tubercles seen in phthisis. • Ibn Sina / Avicenna, a renowned Arabic physician, known as "Arab Galen" described TB in words, "diqq and sulz" in his book," Al-Quanoon-Fit-Tibb" In 980-1037 AD.

30 • In South America, the first evidence of the disease is found in the Arawak culture around 1050 BCE in Pre-Columbian America. • The first mention of TB in Chinese literature in a medical text written by Emperor Shennong of China in 2700 B.C. The Yellow Emperor, Huangdi Neijing, describes xulao Bing (weak consumptive disease), which is believed to be TB. He describes the persistent cough, abnormal appearance, fever, a weak and fast pulse, chest obstructions, and shortness of breath. • First time in 1774-1816, Gaspard Laurent Bayle introduced the term" Tuberculosis". • In 19th century, TB was seen as a "romantic disease." The slow progress of the disease allowed for a "good death" as sufferers could arrange their affairs. The disease began to represent spiritual purity" • In 1882, Robert Koch, a Prussian physician, discovered the cause of TB, revealing for the first time the causal agent of the disease: Mtb, or Koch's bacillus. He was awarded a Noble Prize in Physiology and Medicine in 1905. 2005 marks the hundredth anniversary of the Nobel Prize for Physiology or Medicine, awarded to Robert Koch (1843- 1910) for his work on TB. • In 1895, Wilhelm Roentgen developed X- rays which further advanced diagnostics of TB. This allowed early diagnosis and isolation of infected individuals. • During 19th century, Villemin's experiments had confirmed the contagious nature of the disease and had forced the medical community to accept that TB was indeed an infectious disease. • During 19th century, High attitude, bed rest, changed environment, good nutrition and fresh air emerged as important forms of treatment of TB. It is also known as "Pre Era" • In 1863, First sanatorium opened by Hermann Brehmer in Görbersdorf (Soko?owsko), Silesia (now Poland), for the treatment of TB. • In 1921, The BCG vaccine was first used in humans when it was given to a child in Paris. The baby's mother, who had TB & died just after the baby was born, and the baby was due to be brought up by its grandmother who also had TB. The baby was given 6 mg. of BCG orally, and was said to have developed into a perfectly normal boy. • First attempt of BCG vaccination was made by Dr Weil- Hale. • There have been references to TB in Arts, Literature and several works of fiction. Such as the" consumptive lover" of Much Ado about Nothing in William Shakespeare's plays and "Scrofula" in Macbeth. Thomas Mann's The Magic Mountain contains one of the most well known descriptions of TB Sanatorium. • In 1928, First Indian Tambaram Sanatorium was started by Dr. Chowry-Muthu. In 1993, it became the first facility to admit patients with HIV. • In 1939 TB Association of India was established. • In 1943 , discovered the antibiotic '' from a fungus called griseus, the first cure for TB and he was awarded the Nobel Prize in Physiology or Medicine in 1952. • The first antibiotic treatment for TB was started in 1943 & the first TB patients were treated in 1944. • In 1948, BCG vaccine laboratory was established in king Institute of Guindy, Madras • In 1946 and 1952, the fortuitous discovery of two other drugs, Para- aminosalicylic acid (PAS) and Isoniazid brought the hope for cure. • In 1950, Tuberculosis Seal Sale campaign started.

31 • In 1951, Mass BCG vaccination was launched. • In 1953, Publication of Indian Journal of Tuberculosis was started. • In 1955-58, National TB sample survey started • In 1956, TB Chemotherapy centre (TCC), Madras was established. • In 1959-60, National TB Institute (NTI), Bangalore was established. • In 1962, Involvement of District TB Programme (DTP) as a part of the National TB programme was started • In 1962 Dr. Nagpal was declared as "Father of NTP", National TB Programme. • In 1967, Discovery of Rifampicin is considered as one of the greatest achievement in the history of development of anti-TB drugs. • In seventies Chemotherapy of TB underwent revolutionary changes, owing to the availability of two well-tolerated and highly effective drugs - Rifampicin and Pyrazinamide. These drugs allowed short course chemotherapy (SCC) and made it possible to simplify treatment and reduce its duration. • A number of medications are being studied for MDR-TB including: Bedaquiline and Delamanid. Bedaquiline received U.S. Food and Drug Administration (FDA) approval in late 2012. • In many countries, diagnosis has depended largely on one archaic test for the last 120 years that is smear microscopy. • The first step towards development of MDR- TB is failing to complete treatment .This not only retards the recovery process but also allows the TB mycobacteria smartly alter its outer coat. • In 2014, first XDR-TB patient was detected in Indore, India. • In 2016, first XDR case treated with Delamanid and Bedaquiline both drugs was 39 year-old female Tibetan refugee living in India. • For the first time in history our Honorable Prime Minister launched a TB-free India campaign to eradicate TB from India by 2025, five years ahead of a globally-set deadline in March 2018

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