Tuberculosis has been with human kind since ancient times. There is much evidence of this bacterium throughout history. Many bodies have been found with traces of the disease from all over the world, from Greece to South America. The strand has evolved and grown with humans to continue to threaten us, and will continue to do so. However lately with recent findings and aid from technology we have almost removed the threat entirely.
Tuberculosis has haunted humanity since its very beginning. The earliest known finding of tuberculosis is from a specimen found in a 500,000 year old homo-erectus. In earlier times tuberculosis affected many people, and has recently dwindled in numbers. This used to be a major part of deaths up until the twentieth century, which is when the United States started coming out with vaccines and other forms of treatment and cures for tuberculosis. Tuberculosis is still a major disease in the rest of the world, with a third of the world's population expected to be infected with the disease (Robert M. Jasmer). This is largely in third world countries where they do not have access to the modern cures and treatments for the disease. Every year, there is an average of nine million cases of tuberculosis worldwide (Elimination). This disease still plagues the modern world today with over 12,000 cases reported in the United States in 2008 (Elimination).
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Tuberculosis is a disease caused by mycobacterium, which is a genus of bacteria known to cause many infectious diseases such as tuberculosis and leprosy (Kumar).The specific name for tuberculosis is mycobacterium tuberculosis. It is unknown as to how the disease carried over to humans; however there are cases of humans having evidence of tuberculosis up to 9,000 years ago. Tuberculosis starts out with symptoms somewhat like the flu. These include coughing, sneezing, and a fever, as it advances blood begins to show up in the phlegm that is expelled from the lungs, which is the classic sign of tuberculosis. Tuberculosis can also move into other major organs such as the kidneys, liver, and spine. Once infected with tuberculosis there is a fifty percent death risk if one does not seek treatment, however if one does then there is a very high chance of survival and the disease will be cured.
There are two main classifications for tuberculosis. The first of which is latent tuberculosis infection. A person with this is basically a "carrier" of the disease, they show no symptoms, and the bacteria cannot be spread to others. However, those with the latent infection have a risk of eventually developing the tuberculosis disease. These carriers will test positive if tested for tuberculosis and if given treatment their infection will not advance to tuberculosis. In order to be infected with latent tuberculosis one is suspect to the same thing that would infect them with the tuberculosis disease; direct contact with someone that is infected. The reason this becomes a latent infection instead of tuberculosis disease is due to our immune system's ability to battle the bacteria and it will prevent the bacteria from growing (Elimination).
The tuberculosis disease is the second classification, which is the disease that is in direct relation to tuberculosis. This is the disease which consists of coughing up blood and a high death rate as explained before. Tuberculosis can be attained through direct contact with the disease, or if latent tuberculosis infection was already present and the immune system was weakened from some other cause. People infected with tuberculosis can spread the disease to others which may infect them with the disease or only the latent infection until they receive treatment or the bacteria start to multiply and it becomes a disease. Tuberculosis disease is now just commonly known as tuberculosis, even though this can be attributed to two different classifications.
The exact origin of tuberculosis is still unknown however it is known that it branches from the genus Mycobacterium. The earliest finding of tuberculosis was discovered recently in a Homo erectus fossil found in Turkey.
"Although most scientists believe tuberculosis emerged only several thousand years ago, new research from The University of Texas at Austin reveals the most ancient evidence of the disease has been found in a 500,000-year-old human fossil from Turkey." (Most Ancient Case of Tuberculosis Found)Photo by Marsha Miller
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"View of the inside of a plaster cast of the skull of the newly discovered young male Homo erectus from western Turkey. The stylus points to tiny lesions 1-2 mm in size found along the rim of bone just behind the right eye orbit. The lesions were formed by a type of tuberculosis that infects the brain and, at 500,000 years in age, represents the most ancient case of tuberculosis known in humans." (Most Ancient Case of Tuberculosis Found)
This recent find has increased the origin of tuberculosis' date greatly. Earlier it was thought that the earliest evidence of tuberculosis was found in a Neolithic settlement in the Eastern Mediterranean which dated back to about 9000 years ago (Hershkovitz). There have also been discoveries in Egypt of mummies that have evidence of mycobacterium tuberculosis, which date back to 4000 years ago (Zink).
Early Greek literature was when evidence is first discovered of the recognition of tuberculosis as a disease. The Greeks started to call is phthisis which means consumption. The term consumption was used to describe this disease for thousands of years beyond that time. Consumption was used to illustrate this disease because from the observer, it seems as if the victim was being eaten from the inside out. This observation was due to coughing up blood and the poor health of anyone infected, it also described the high death rate of those who had fallen victim to "consumption". Hippocrates, a highly renowned philosopher and writer of the time, also observed the disease. "Around 460 BCE, Hippocrates identified phthisis as the most widespread disease of the times, and noted that it was almost always fatal" (Center). As time goes on more evidence is found of tuberculosis being noted by writers, most famous of them all being Shakespeare. In Much Ado About Nothing Shakespeare brings up consumption and he refers to tuberculosis as scrofula in his play Macbeth. This was due to the widespread infection of peoples in Europe in Shakespeare's time.
Although knowledge of tuberculosis, or at that time "consumption", was known, it wasn't until the seventeenth century that scientific descriptions of the disease began to form. "In his Opera Medica of 1679, Sylvius was the first to identify actual tubercles as a consistent and characteristic change in the lungs and other areas of consumptive patients" (Center). However, the biggest early breakthrough of tuberculosis was by English physician Benjamin Marten. In A New Theory of Consumption he wrote that tuberculosis was caused by tiny creatures that, once in the body, could create abscesses and cause the other symptoms. Even with these breakthroughs in understanding the disease, scientists and doctors at the time were not able to find a proper cure or prevention for tuberculosis.
Robert Koch is considered one of the founders of microbiology, the study of microorganisms. He was also the first to discover tubercle bacillus, the bacterium that causes tuberculosis, in 1882, which later gained the name of mycobacterium tuberculosis (Brock). In his work he was the first to stain the bacteria to be able to view them under a microscope. This was a difficult task due to tubercle bacillus having a waxy outer shell that would not allow simple dyes of the time to stick to is and therefore could not be seen under a microscope. Koch's work was quickly accepted throughout the world, contrary to his beliefs that it would take time for it to be generally accepted.
Koch then moved onto a new project, a cure for tuberculosis. He began his work in late 1889 and in 1890 he announced that he had found a cure, what he called tuberculin (Brock). This sparked a huge flock of European tuberculosis patients to Berlin, where Koch had made the tuberculin. This cure had worked in the guinea pigs he tried it on, or so he thought. Tuberculin seemed to work on humans, for when it was injected in the affected reason, the area would react, and then the tubercular tissue would begin to be destroyed. However, this was not a cure, it only decreased the tissue for a certain amount of time, and it did not destroy the bacterium that caused the disease. Koch was disappointed in this discovery, but did not put all the blame on himself. He did not intend on his work being released as early as it did, but he was pressured to do so, and was unable to conclude his research before it was being widely used on humans. Although Koch's remedy was not as successful as he wished it to be it still held great value in the medical world. It later became a test to find if someone had tuberculosis and was one of the most reliable tests to date (Brock).
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Sanatoriums were the first major movement in attempting to help the victims of tuberculosis. Hermann Brehmer was the first to have the idea of putting those infected into sanitary conditions with good nutrition and clean air and did so in Gorbersdorf (Center). This idea was formed when he isolated himself after having tuberculosis himself. He went to an area with a healthy climate and eventually was cleared of the disease. The same idea was carried out in sanatoriums; infected patients would be put in a place with clean air, and a good diet, in order for their body to become healthy and battle the infection on its own, which was currently the only way to cure tuberculosis. With no antibiotics or current cures for the disease, the only way to rid oneself of tuberculosis was time and good health.
In 1884 the first sanatorium was built in America; it was the Adirondack Cottage Sanatorium, and was located in Saranac Lake, New York. This became a trend and soon sanatoriums were popping up everywhere. Many big cities had at least one sanatorium or a specialized tuberculosis center. Sanatoriums were in heavy use from the early 1900's until the middle of the century. They were not a "cure" for tuberculosis; however it isolated individuals with the disease which decreased the spread, and also put them in a healthy environment which aided in their immune systems to be able to fight the disease. In 1948 antimicrobials were introduced, which was accompanied by a cure for tuberculosis, and a severe drop in the need for sanatoriums.
Before the introduction of antimicrobials the first vaccine for tuberculosis was created; called Bacillus Calmette-Guérin. Since this was a vaccine, it was not effective on those who were already infected by the disease. This vaccine was created by a bacteriologist and a veterinarian, Albert Calmette and Camille Guérin respectively. Their work consisted of finding a non-virulent bacillus to use as the vaccine. They eventually found a strain and began human use in 1921 (World Health Organization). Although the first vaccines carried a lot of risk, it was effective in many studies. Bacillus Calmette-Guérin was widely used in Eastern Europe after World War II and successfully vaccinated millions of babies. This vaccination was used against tuberculosis until recently when advances in medicine gave way to much more efficient vaccines.
In 1943 the first cure for tuberculosis was introduced. Streptomycin was created by Dr. Waksman at Rutgers University (Wallgren). This was also the first human-safe antibiotic to ever be created, in fact Dr. Waksman introduced the word. This antibiotic successfully healed an average of 80% of all tuberculosis patients (Wallgren). Recently, there has been debate on whether Dr. Waksman deserves the credit that he has been given, including the Nobel Prize. One of his assistants, Albert Schatz, challenged Dr. Waksman's credit to the entire discovery of the drug. After a legal battle over streptomycin, Schatz was recognized as streptomycin's co-discoverer and has received his share of rewards and benefits in this matter (Wainwright). Although this antibiotic was not a cure for all tuberculosis patients, it was a major step in the eradication of the disease.
Current drugs that will treat and cure tuberculosis have stemmed from the first antibiotic previously mentioned, streptomycin. There are ten drugs that are approved by the Federal Drug Administration to treat tuberculosis (Elimination). The most important of these drugs is the "first-line" anti-tuberculosis agents. These antibiotics are the marines in the tuberculosis war. They go in and destroy all visible signs of mycobacterium tuberculosis, and after this treatment, an after-treatment is administered to prevent any return of the bacteria and eliminate any leftover bacterium. This fleet of antibiotics has proven to be very effective in treating tuberculosis.
Recently, tuberculosis has been on the rise yet again in the United States. Strains of drug-resistant tuberculosis have been surfacing which make it difficult to find the right cure. These strains occur due to evolution of the strain if it is able to live through a treatment. This can happen if a tuberculosis patient does not complete their full treatment, misuse the drugs, or use damaged drugs (Elimination). Along with drug-resistant tuberculosis is also extensive drug-resistant tuberculosis. Unlike normal drug-resistant tuberculosis which is only resistant to one type of first-line antibiotic, extensive drug-resistant tuberculosis is resistant to almost all drugs used to treat the disease (Elimination). This is a major problem because treating a patient with extensive drug-resistant tuberculosis becomes almost impossible, and it is very difficult to find a drug that will work since using the wrong drug could prove to worsen the problem or even be fatal.
Tuberculosis originated 500,000 years ago in Homo Erectus, before the modern human had even walked the earth. Up until recently, it has been a major cause of death in Europe and the surrounding area. Luckily, it never got a full foot into the United States and it was largely avoided here, although there are still many cases reported every year. A cure for the disease was not created until merely 60 years ago by Albert Schatz and Dr. Waksman. Currently there are ten drugs on the market used to treat and cure tuberculosis; however that is only available in the United States and other major countries. Third world countries like those in Africa and Asia still suffer greatly from this disease and it is thought that nearly one third of the entire world population is infected with some form of tuberculosis. This disease has haunted humanity since our very beginning and will continue to be with us for a while until, if at all possibly, eradication is acquired.
Although I have not had any direct exposure to tuberculosis, I have been lucky enough to visit a sanatorium near my home. Henryton State Hospital is located about 20 minutes from my house in a slightly remote area of Carrol County. This hospital was originally created as a tuberculosis center for African Americans in 1922 by the Maryland Board of Mental Hygine (SaveHenryton). This area is composed of many buildings, all of which are abandoned and beginning to fall apart. There is little distinction in the buildings from the outside, but upon exploring the internal areas of Henryton it is quite simple to find what areas were for what purpose. What I have found and distinguished are the nursing dormitories, what seems to be a classroom building, a hospitalization building, a power plant/boiler room, and a cafeteria and auditorium. It is an amazing area to explore and to be able to reach into the past of how things were. Just as any abandoned place, Henryton State Hospital is filled with mystery and possible cover-ups. There are little to no records on this hospital, especially once it was transformed into a mental institution. Recently records of a nearby mental institution Rosewood Center have been discovered to show that the mental institutions in Maryland showed below minimal standards in treatment of the patients. Henryton is one of many sanatoriums that show the past of what tuberculosis used to be.
- Brock, Thomas D. Robert Koch: A Life in Medicine and Bacteriology. Washington, DC: American Society for Microbiology, 1999.
- Center, National Tuberculosis. Brief History of Tuberculosis. 26 July 1996. 15 December 2009 <http://www.umdnj.edu/~ntbcweb/history.htm>.
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- Kumar, Vinay. Robbins Basic Pathology. Philadelphia: Saunders/Elsevier, 2007.
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- "Most Ancient Case of Tuberculosis Found." The University of Texas at Austin (2007).
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- Save Henryton. 2008. 15 December 2009 <http://savehenryton.com/>.
- Wallgren, Professor A. "Presentation Speech." Nobel Prize in Physiology or Medicine 1952. Stockholm: The Nobel Foundation, 1952.
- World Health Organization. 2009. 15 December 2009 <http://www.who.int/tb/en/>.
- Zink, Albert R. "Characterization of Mycobacterium tuberculosis Complex DNAs from Egyptian Mummies by Spoligotyping." American Society for Microbiology (2003).