Tuberculosis - an old disease

Tuberculosis exists probably ever since pre-historic times. The existence of mycobacteria in the environment indicates, that these germs are able to survive in the environment and also in animals and human beings since long ago.

There is proof of humans being afflicted by the disease from a time 4000 years ago. Skeletal remains of pre-historic humans from that time revealed signs of the disease. Tuberculosis destruction was also revealed in the bones of Egyptian mummies of 3000-2400 B.C. Even in India and America, there are indications of the occurrence of tuberculosis around 2000 B.C. Around 460 B.C., Hippocrates identified „Phthisi" (Greek for wastage) as the most widespread disease of all times, which almost always resulted in death.

Tuberculosis in Europe

Tuberculosis generated public interest in the 19th and early 20 th Century. The disease raged among the urban poor of the Industrial Revolution. The people in confined mass accommodation with poor nutrition were as easy prey as the inhabitants of slums in the mega-cities of Asia, Africa and Latin America today.

In 1815 in England, tuberculosis was the cause of every fourth death. In the year 1850, tuberculosis caused about 500 cases of death per 100,000 inhabitants in Europe. In France, every sixth person died of tuberculosis even in the year 1918.

Tuberculosis Sanatoria

The first tuberculosis sanatorium was opened in Poland in 1859. Thereafter, the concept of treatment at a sanatorium for tuberculosis became popular rapidly, predominantly for the prosperous classes of society.

It was recognised that good food, balanced physical activity and healthy climate helped in overcoming the disease. Nonetheless, up to half of all patients continued to die from the disease.The life in a sanatorium attained literary fame in the novel „Der Zauberberg“ („The Magic Mountain“) by Thomas Mann.

The fight against Tuberculosis

After the recognition of the disease as a contagious disease, tuberculosis was declared a notifiable disease in most European countries from about 1880 onwards.

The isolation of the patients and the avoidance of infectious sputum was recognised as a means of preventing the spread of the disease.

There were campaigns for the avoidance of spitting at public places and the infected poor were encouraged to enter sanatoria, which were more like prisons.

Since the beginning of the 20 th Century, it has been possible to suppress tuberculosis in the developed countries. Even before the deployment of the first antibiotic against tuberculosis, streptomycin (1956), the frequency of the disease had been reduced to one-third of the original cases. This decline can be essentially ascribed to socio-economic development with the improvement of living conditions, hygiene and nutrition.

A Virus, a disease

Because of the multiplicity of its symptoms, the disease was not recognised as a consistent disease right up to early 19 th century.

In the year 1839, the doctor, Johann Lukas Schonlein, named the disease "tuberculosis", namely on the basis of specific changes, which could be observed regularly on the tissue of dead tuberculosis patients. Robert Koch in Berlin described the mycobacterium tuberculosis on 24 th March 1882. He received the Nobel Prize in Physiology and Medicine for this discovery. Koch did not believe that tuberculosis of the cow (bovine TB) and that of humans were similar, which impeded the identification of infected milk as a source of the disease to begin with. Later, this source of infection was recognised, and the method of "pasteurisation" (sterilisation by heating) of milk also enabled the containment of tuberculosis of the intestine. Koch developed in 1890 a glycerine extract of the tubercle bacilli as an adjuvant for recognising tuberculosis, and named it "tuberculin". This adjuvant was, in fact, inappropriate for a vaccination, yet, even today, it serves as a test of the existence of an immunological reaction of the human organism to tuberculosis.

Vaccination against Tuberculosis

Albert Calmette and Camille Guerin achieved the first success in the immunisation against tuberculosis in 1906 with their "BCG" vaccination. This was used for the first time on humans on 18 th July 1921 in France. Nationalistic waves prevented a worldwide usage up to the end of the Second World War. Even today, this vaccine is the only one against tuberculosis.

Antibiotics against Tuberculosis

In 1946, with the development of the antibiotic "streptomycin", active treatment also became possible beside prevention. Before this, only surgical treatment and isolation and cure in a sanatorium were known. In consequence, further antibiotics were developed rapidly.

Thus, it became possible that a treatment of isolation lasting many years was reduced to an ambulant therapy lasting six to eight months.

The last sanatoria were shut down in Europe in the 60s.