Tuberculosis, caused by the bacte rium Mycobacterium tuberculosis,
is one of the deadliest infections a human can get. The messed up history of
tuberculosis includes how the deadly disease became fashionable in the
Victorian era and was first treated by sunlight and milk transfusions.
Tuberculosis has been around for as long as recorded human history.
Belonging to the genus, Mycobacterium, which is estimated to have originated
around 150 million years ago, Mycobacterium tuberculosis is
believed to have evolved roughly 3 million years ago, in East Africa.
M. tuberculosis is the main mycobacteria responsible for causing tuberculosis.
However, there are four other mycobacteria that can cause TB;
M. tuberculosis, M. africanum, M. bovis, and M. microti. It's likely that these strains
of mycobacteria shared a common ancestor in Africa between 35,000 and 15,000 years ago.
Modern strains of M. tuberculosis appear to become recognizable between 15,000 to
20,000 years ago. But, according to NPR, some scientists suggest
that modern tuberculosis may be closer to 70,000 years old.
Signs of tuberculosis have been found on mummies from ancient Egypt, dating back almost 6,000
years, and tuberculosis is also described in texts from ancient India and ancient China,
dating back 3,300 years and 2,300 years, respectively.
While M. tuberculosis typically attacks the lungs,
the bacteria has also been known to affect the brain, spine, and kidneys. Without treatment,
TB has a high mortality rate, with at least 70% of people dying within 10 years of diagnosis.
While TB was once thought to be hereditary, in 1882, Robert Koch discovered that TB was
caused by M. tuberculosis. Now it's known that M. tuberculosis is transmitted through the air,
via respiratory droplets expelled during speaking or coughing.
These droplets can stay in the air for hours and, while some diseases like
measles can only be caught once, recovering from TB doesn't give one lasting immunity.
Primary symptoms of TB include pain in the chest, a bad cough lasting over three weeks, and coughing
up sputum or blood. Other symptoms include fever, weakness or fatigue, and weight loss.
For those with TB that is susceptible to treatment with drugs, 85%
recover. With drug-resistant TB, the success rate of recovery falls to 56%, globally.
Evidence of TB has been found in elephants, bison, and birds. There's even a study that
claims that seals are responsible for bringing TB from the African continent to the American
continents. But, while the presence of TB in humans has been studied for hundreds of years,
the study of TB in animals, such as elephants, is relatively recent.
TB can also be found in deer and cattle, though it is caused by M. bovis rather
than M. tuberculosis. However, M. bovis has been known to affect humans as well.
Modern animals aren't the only ones susceptible to tuberculosis. There's
also evidence that prehistoric animals may have suffered from TB as well.
Analysis of rib bone fossil fragments from a marine reptile from the mid-Triassic,
revealed lesions that may have been the result of pneumonia.
In humans, these lesions are only seen in those with TB,
so it's possible that this animal represents one of the earliest cases of TB.
There are additional discrepancies in the animal's vertebrae,
which are consistent with Pott's disease, a form of TB that attacks bones of the spine.
Evidence of tuberculosis has been found in a variety of forms from ancient Egypt. Skeletal
deformities, indicating Pott's disease, have been found on Egyptian mummies from between 2400 and
3400 BCE. Molecular studies also show that TB is present in almost one-third of Egyptian mummies.
One of the most convincing signs of TB was found in an ancient Egyptian mummy, discovered in 1881.
The earliest reference to TB in ancient Egypt comes from a papyrus dating to 1550 BCE.
Known as the Ebers Papyrus, tumors are described to be a result of tuberculosis,
though they were once thought to be describing leprosy.
And, there are also artistic representations of TB from ancient Egypt. People with spinal deformities
are often depicted in Egyptian iconography, which was likely a result of Pott's disease.
Tuberculosis existed in North and South America before Europeans began colonizing the continents,
but it's still unclear when or how the bacteria spread across the Atlantic.
Skeletal remains with lesions resembling TB have been found
in a variety of different sites across the American continents.
The earliest evidence of TB on the American continents was found in mummified remains
recovered from the Atacama desert in Chile, dating back to the first millennium CE.
Notably, however, there have never been any Mayan skeletons found with
signs of tuberculosis. There are a number of thoughts about this,
though it's unclear whether this is a result of a low infection rate or poor bone preservation.
While the written record of TB in the Middle Ages is sparse, there is archeological evidence from
across Europe. In the medical writings that do exist, TB was referred to as the "White Plague,"
consumption, or phthisis, which meant "wasting." The term "consumption" was also
used because the disease gave the impression of consuming its victims as they shed weight.
Also, during this era, it was thought that scrofula was caused by gluttony.
Now known as tuberculous cervical lymphadenitis,
scrofula was once referred to as the "King's Evil" and was treated with the "royal touch."
Monarchs would touch sick people and offer a seemingly painless and instant cure. The practice
was thought to demonstrate the king's divine right to rule. During one Easter Sunday, Louis XIV of
France was said to have once touched about 1600 people. And since scrofula lesions sometimes went
into spontaneous remission, monarchs were credited with providing miracles when this occurred.
The contagious nature of tuberculosis was detected as early as the 16th century,
when Girolamo Tracastoro suggested that clothing and bed sheets might contain contagious particles.
And once the stethoscope was invented in 1816, the pulmonary effects of the disease
were finally identified. The belief that TB was infectious was primarily held in
Southern Europe. In Northern Europe, TB was still considered to be hereditary.
During the 18th century, Western Europe suffered from a TB epidemic
with a mortality rate of 900 people per 100,000 per year. Death rates were higher
among young people, and as a result, TB was called "the robber of youth."
"Mercy!"
During the following century, death rates stayed consistently high across cities,
reaching upwards of 800 to 1,000 per 100,000 people per year. As the
Industrial Revolution progressed, along with it came poorly ventilated housing,
deprived working conditions, and poor sanitation, which allowed for the disease to spread.
Because of the prevalence of tuberculosis,
the appearance of wasting away that it gave people began to be considered fashionable.
The thin, pale face, glossy eyes, and rosy cheeks that were considered beautiful were
actually symptoms of the low-grade fever and loss of appetite caused by tuberculosis. When
Edgar Allan Poe's wife Virginia coughed up blood while playing the harp, Poe reportedly said,
"[Her sickness is] a strange additional charm,
which rendered more ethereal her chalky pallor and her haunted, liquid eyes."
Even though tuberculosis affected all types of people, it was especially associated
with so-called "respectable women," and was considered an elegant and aristocratic disease.
Science Museum reports that Lord Byron wished that he could die of consumption so that the ladies
could, quote, "see that poor Byron — how interesting he looks in dying."
Women would even effectively poison themselves in an attempt to get that oh-so-chic deathly pallor,
using arsenic to lighten their skin. Dresses and corsets also
tended to emphasize the emaciated bodies that tubercular victims had.
Tuberculosis is featured and romanticized in countless works of art. Emily Brontë,
who died of tuberculosis herself in 1848 at the age of 30, included several tubercular
characters in her work. In Wuthering Heights, Cathy is described as, quote,
"rather thin, but young and fresh complexioned and her eyes sparkled as bright as diamonds."
The character Smike in Charles Dickens' Nicholas Nickleby also succumbs to tuberculosis.
And although authors avoided using the word "consumption," descriptions
of pale heroines in decline became more and more common.
TB also appears throughout La Bohème, an opera by Giacomo Puccini, and is responsible for the
death of Mimi. TB is also featured in The Magic Mountain by Thomas Mann, which is set
in a Swiss sanatorium. Nuances such as a flask for coughing up sputum, called the Blue Henry,
are mentioned in Mann's novel, demonstrating a cultural awareness of the specifics of TB illness.
Tuberculosis was also depicted in visual artworks such as 1858's "Fading Away" by
Henry Peach Robinson and 1907's "The Sick Child" by Edvard Munch. Many artists and
writers themselves succumbed to tuberculosis, which solidified its association with the arts.
TB wasn't effectively treated until streptomycin and para-aminosalicylic acid, or P.A.S.,
started being used in 1944. Up until that point, people with TB were subjected to a
variety of treatments. These included dietary changes, herbal concoctions, bleeding,
sunlight therapy, and resting in sanatoriums. Mountain climbing and horseback riding were
also recommended as therapeutic. Even electric shock was used as a treatment.
In "A Doctor's Dilemma" by George Bernard Shaw, one of the characters describes the treatment
of TB as, quote, "a huge commercial system of quackery and poison."
This certainly applies to the experiments of Dr. Joseph Howe of New York City.
In 1873, Dr. Howe tried injecting 1.5 ounces of goat's milk into the veins of
a person infected with TB. During the late 1800s,
milk transfusions were frequently attempted, and often had disastrous and deadly effects.
Once Robert Koch attributed TB to bacteria in 1882, sanatoriums were increasingly used
for TB treatment. Sanatoriums were used to isolate people with tuberculosis but
they were also intended to provide a nicer environment for treatment. This was because
lifestyle adjustments were believed to help people infected with TB manage their diseases better.
The North American continent was wracked with repeated TB epidemics. By the 19th century,
TB was responsible for killing one in seven people that had ever lived. Between 1810 and 1815,
TB accounted for over one-fourth of the deaths in New York City alone. By 1900,
TB was the second-leading cause of death, after influenza with associated pneumonia.
By the time the American Sanatorium Association was founded in 1905,
there were over 100 sanatoriums with over 9,000 beds for people with TB in the United States.
Within 50 years, there were over 100,000 beds allocated for the treatment of TB.
Despite the prevalence of the epidemics between 1900 and 1930, the TB mortality rate in the
United States fell by more than 60%. This drop was likely due to the public health campaign
against TB that was led by medical professionals as well as laypeople. This campaign was almost
entirely funded through Christmas Seals, which also went towards funding sanatoriums.
In 1900, French bacteriologists Albert Calmette and Camille Guérin began researching a vaccine
for TB at the Pasteur Institute in Lille. While they were ready to start a vaccination trial
in cattle in 1913, their experiments were interrupted by the start of World War I.
They managed to keep working, despite the German occupation,
and by 1919, they had finalized their TB vaccine.
The first human trials for the vaccine occurred in 1921 and resulted in few
adverse side effects. The BCG vaccine was then sent to various laboratories around the world,
where regional variations were then developed. Unfortunately,
due to this variability, not all vaccine variants ended up being equally effective.
Today most countries require the vaccine to be given while a person is young, since it is less
effective on adults. And while the vaccine's effectiveness can last upwards of 40 years,
it's mostly effective against miliary and meningeal TB, rather than pulmonary TB.
In 1930, a tragedy befell Lübeck, Germany that undermined the integrity of the BCG vaccine.
After an attempt to vaccinate a large number of infants between 1929 and 1930,
almost 83% ended up becoming infected with TB. Out of 252 vaccinated, 72 infants died from TB
and another 135 were infected, but were able to recover. This became known as the Lübeck disaster.
An inquiry, led by Professor Bruno Lange of the Robert Koch Institute,
was promptly set up by the German government to find out if the vaccine itself was at fault.
After 20 months of investigations, their report determined that the
BCG vaccine itself wasn't at fault. The infections had been due to contamination.
The contamination was found to have occurred in the Lübeck tuberculosis laboratory. As a result,
two vaccine scientists were convicted and imprisoned. Although they hadn't been directly
responsible for the error, they came under a great deal of fire, and confidence in the vaccine sank.
Although the BCG vaccine is only 70-80% effective against some forms of TB,
it was invaluable towards slowing the spread. Then in 1943,
Selman Waksman discovered streptomycin to be the first effective treatment of TB.
The first person cured of TB was in November 1949, but subsequent people ended up requiring
P.A.S. in addition to the streptomycin, since the tubercle bacillus had become resistant.
Despite new developments in drugs, TB continues to build its resistance.
Over one million people die every year from TB, with upwards of 10 million people falling ill
from the disease annually. More than 20% of TB cases are due to multidrug-resistant TB,
which may require over two years of treatment.
Despite the global knowledge of how to treat TB,
almost a third of people with TB don't have access to quality care. There continues to be a worldwide
effort towards eradicating TB but, from 2016 to 2017, the mortality rate only declined by 3.9%.
From 2017 to 2018, TB-related deaths only dropped from 1.6 million deaths to 1.5 million.
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