Review Article History of Tuberculosis S.P. Tripathy1, Kanchan Srivastava2, Surya Kant3 and Rohit Sarin4* 1Director-in-charge, National Institute forResearch in Tuberculosis, Chennai 2Research Scientist, 3 Prof and Head, Department of Respiratory Medicine, King George's Medical University, UP, Lucknow, India 4 Director, The National Institute of Tuberculosis and Respiratory Diseases (NITRD), New Delhi *Email: [email protected] ABSTRACT The culprit, Mycobacterium tuberculosis is for sure the most successful conqueror of the human lives as it infects one in three people worldwide every year on a global scale. Thought to be one of the oldest human diseases, over the years not only the medical implications but also the social and economic impact of tuberculosis has been enormous. To make matter worse, the TB bug is infamous for turning resistant to common drugs and invading almost every tissue in the human body, poses a challenge to" Masters of Medicine" with its baffling unsolved problems. Alexander the Great has been indisputably, the greatest of conquerors mankind has witnessed since the dawn of human civilization. But unimaginably, the strength and valor of this all time hero appears stumpy when viewed against the triumphs of the single celled bug that unleashes, across the globe, spelled out as tuberculosis, the captain of all the men of death". KEY WORDS: Robert Koch, Mycobacterium tuberculosis, Romantic Disease, Sanatorium INTRODUCTION Tuberculosis (TB) and humans have had a long relationship with each other. The relationship has not been a friendly one. For centuries, TB has been a major killer of humans. TB was very common among U.S. in 1940. The devastation wreaked by TB stimulated research that led to several medical breakthroughs during the 19th and 20th centuries. The control of infectious disease, including TB, is regarded as one of the 10 great public health achievements in the 20th century. Indeed, after 1945, our success in treating infectious diseases, including TB, was remarkable. That was "time to close the book on infectious diseases". In 1959, the following words appeared in a report from a conference organized by the Public Health Service (PHS) and the National Tuberculosis Association (now the American Lung Association): "Tuberculosis can be extinguished as a public health problem...If the opportunity to end tuberculosis is not seized now, it may be lost indefinitely" [1, 2, 3]. However, with the important exception of smallpox, we have not closed the book on infectious diseases. Although, a victims of TB occur all over the globe, this disease posses a tough challenge in the developing countries, which accounts for about 95% of all TB cases. The resurgence of TB in between 1985 and 1992 was a reminder that while TB is an ancient malady, it is very much a contemporary problem as well- even in industrialized societies and even though we know its cause, how to prevent it, how to treat it, and how to cure it [4]. More than 50 years ago, the microbiologist René Dubos said this about TB; "Tuberculosis is a social disease, and presents problems that transcend the conventional medical approach...Its understanding demands that the impact of social and economic factors on the individual be considered as much as the mechanism by which tubercle bacilli cause damage to the human body." 18 Thought to be one of the oldest human diseases, over the years not only the medical implications but also the social and economic impact of TB has been enormous. To make matter worse, the TB bug is infamous for turning resistant to common drugs and invading almost every tissue in the human body, poses a challenge to" Masters of Medicine" with its baffling unsolved problems. There is a silver line regarding the elimination of TB, our honorable Prime Minister launched a campaign to eradicate TB from India by 2025, five years ahead of a globally-set deadline during inauguration of the Delhi End-TB Summit. He also launched the TB-free India Campaign to take the activities under the National Strategic Plan for TB Elimination forward in a mission mode for ending the epidemic by 2025. Affecting the poorest people in society who live in overcrowded areas and maintained poor hygiene, TB is an airborne communicable disease plaguing human populations since antiquity. Sign of tubercular decay have been found in bone fragments of 40000-year old Egyptian mummies. The word "tuberculosis" is a derivative of the Latin world 'tubercula' which means of 'A small lump'. Several names have been used to refer TB. Pulmonary TB has been referred to as "tabes pumonali," Cutaneous TB has been called "lupus vulgaris", Abdominal TB has been called as "tabes Mesenterica,"Acute progressive TB has called "galloping TB"[ 2, 5, 6]. The Stigma of being a victim of TB was so much in total isolation until death. The first reference to TB in early Asian civilization and in The East Ancient India is found in the Vedas. In Sanskrit, the disease has been called "Rajayakshma", "Ksayah" and "Sosa". In Yajurveda Samhita, there is a reference to how "Soma" (moon) had been affected by Yakshma. Since Soma was "King and Ruler" was affected by "Yakshma". It came to be known a Rajayakshma". The Yajurveda advises sufferers to move to higher altitudes. The oldest of them (Rigveda, 1500 B.C.) calls the disease yaksma (Book 10, hymn 161).The Atharvaveda calls it another name: balasa. It is in the Atharvaveda that the first description of scrofula is given. The Sushruta Samhita, written around 600 B.C., recommends that the disease be treated with breast milk, various meats, alcohol and rest. The Manu Smriti, written around 1500 B.C., states that sufferers of yaksma are impure and prohibits Brahmans from marrying any women that has a family history of the disease. Apasmaara-Kusstta-Kssaya-Arshah Prameha_ Jvaro[a-U]nmaada-Gulma-Adi-Rogaa Mahaantah | Pishaacaash-Ca Sarve Bhavat-Patra-Bhuutim Vilokya Kssannaat-Taaraka-Are Dravante ||25|| (25.1… Apasmara (Epilepsy), Kussttha (Leprosy), Kssaya (Consumption), Arsha (Piles), Prameha (Urinary diseases like Diabetes)… 25.2: … Jwara (Fever), Unmada (Madness, Insanity), Gulma (Enlargement of Spleen or other glands in the abdomen) and other formidable Diseases … 25.3: … as also all types of Pisachas (Evil Spirits) … (when) in Your Bibhuti (Sacred Ash) contained in a Leaf … 25.4: … sees You, Who is the Enemy of the formidable Taraka (i.e demon Tarakasura), they hasten to Run away immediately). "The Father of Medicine", identified the illness as the most common cause of illness in his time. Phthisis, Means "to consume" "to spit", and "to waste away" first appeared in Greek literature around 460 BCE. Hippocrates (460 -377 B.C.) Although, Aristotle believed that the disease might be contagious and to be hereditary. Galen, the most eminent Greek physician after Hippocrates, defined phthisis as the "ulceration of the lungs, thorax or throat, accompanied by a cough, fever, and consumption of the body by pus. Ibn Sina/ 19 Avicenna (980-1037 A.D.), a renowned Arabic physician, known as "Arab Galen" described TB in words, "diqq and sulz" in his book," Al-Quanoon-Fit-Tibb," also called "Canon of Avicenna" praised as "Medical Bible". 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". In Pre-Columbian America/ South America, the first evidence of the disease is found in the Arawak culture around 1050 BCE. Although the most significant finding belongs to the mummy of an 8 to 10-year-old Nascan child from Hacienda Agua Sala, dated to 700 CE. The first evidence of the infection 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. Some authors call TB, the first disease known to mankind [7, 8, 9]. The 12th century contained a very extend explanation of the illnesses' cause. With the spread of Christianity, monarchs were seen as religious figures with magical or curative powers. It was believed that Royal Touch, the touch of the sovereign of England or France, could cure diseases due to the divine right of sovereigns. This practice was so common in France, that scrofula became known as the "mal du roi" or the "King's Evil". The first mention of TB in Chinese literature in a medical text written by Emperor Shennong of China (2700 BC). Girolamo Fracastoro became the first person to propose, in his work De contagione, that phthisis was transmitted by an invisible virus, usually transmitted through direct contact or the discharged fluids of the infected, what he called fomes [5, 10]. In Seventeenth and eighteenth centuries, Franciscus Sylvius began differentiating between the various forms of TB (pulmonary, ganglion). He was the first person to recognize that the skin ulcers caused by scrofula resembled tubercles seen in phthisis noting that "phthisis" is the scrofula of the lung" in his book Opera Medica published posthumously in 1679. Benjamin Marten (1720) proposed in A New Theory of Consumptions more Especially of Phthisis or Consumption of the Lungs that the cause of TB was some type of Animacula. The theory was rejected and it took another 162 years before Robert Koch demonstrated, it to be true. Leopold Auenbrugger, (1761) an Austrian physician, developed the percussion method of diagnosing TB, a method rediscovered some years later by John Nicholas of France. Robert Whytt (1768) gave the first clinical description of TB meningitis. Percivall Pott, (1779) an English surgeon, described the vertebral lesions that carry his name. In Systematik de speziellen Pathologie und Therapie, J.