In the mid-1700s, tuberculosis (TB) was thought, by some, to be caused by vampires, the energy of successive family members draining away after the first one got sick.
Its toll peaked in the 1800s, when 25% of deaths in Europe were caused by TB.
In the early 1900s 110,000 died a year in the U.S.
Improved public health conditions, better hygiene and access to clean water, as well as isolation of those infected with TB in sanatoriums, where the primary treatment was bed rest and open air, and a public health campaign to stop public spitting and the use of spittoons, drove down the rates of TB after the 1800s.
Its cure was not discovered until 1943.
Streptomycin was discovered on October 19, 1943, when Albert Schatz, then a year into his graduate studies and two years from his Ph.D. at Rutgers, isolated it in the laboratory, under the supervision of Selman Waksman, whose lab discovered more than ten antibiotic compounds from soil over a twelve-year period.
A microbiologist, Schatz was looking for a soil-born microorganism that would kill penicillin-resistant bacteria, such as the one that caused tuberculosis.
His discovery, streptomycin, was the first antibiotic to cure tuberculosis (TB).
The Mayo Clinic conducted animal trials and early clinical trials.
By 1944, trials conducted by Merck confirmed streptomycin’s effectiveness against a number of penicillin-resistant diseases, including the bubonic plague, cholera, and typhoid fever.
Although there are now other, more expensive drugs available to combat TB, streptomycin is still used where cost is a significant factor.
Other uses include as an antibiotic for large animals, like horses, cattle and sheep, as a pesticide for some fruits and vegetables and to control algae in ponds.
But, it was the laboratory’s head, Selman Waksman, who claimed credit and got Schatz to sign over his patent rights, which Schatz and Waksman filed jointly as inventors, to the Rutgers Research and Endowment Foundation, Schatz thinking it was for the good of mankind.
It wasn’t until later that Schatz found out that Waksman was earning royalties from the Foundation while he was not.
And, it was Waksman who was awarded the 1952 Nobel Prize for Physiology or Medicine, though Schatz had successfully sued the Rutgers Foundation for credit two years before and Waksman had admitted Schatz was the scientific and legal discoverer in the resolution of the lawsuit.
Schatz was eventually awarded Rutger’s highest honor, the Rutgers University Medal.
Tuberculosis is believed to have started in humans 40,000 years ago, eventually spreading to animals.
Evidence of TB has been found in human remains 9,000 years old.
Its chief symptom is wasting away, or losing weight to dangerously low levels, formally called cachexia, informally consumption, as well as a cough, often with blood, and fever.
The Egyptian queen, Nefertiti (1370BC – 1330 BC), who ruled just before King Tut, is believed to have died of TB.
Hippocrates (460 BC – 370 BC) said it was the most common illness of his time and almost always fatal. He thought it might be hereditary.
Aristotle thought it might be contagious.
It was the primary cause of death in 1650 in Europe, during a 200-year epidemic known as the Great White Plague.
Descriptions of the symptoms are found in early works in China, India and South America.
The incidence of tuberculosis peaked between 1700 and 1800, displacing leprosy.
Chopin, the Brontë sisters, Chekhov and Kafka all died of TB.
The poor, starving heroine in Les Miserables had it. It was portrayed in the operas La Traviata and La bohème.
By the 1800s, the medical community had come to understand that it was probably contagious and occurred more frequently in poor areas of cities, so they had issued public health recommendations:
- No spitting in the streets
- Quarantine sick members of a family from well members.
By 1869, scientist Jean Antoine Villemin had proved it was contagious, infecting rabbits with the disease from infected human bodies.
In 1882, a Prussian doctor, Robert Koch, discovered the bacteria causing TB and named it tuberculosis bacillus, publicizing his discovery in a lecture on March 24, 1882, saying:
“If the importance of a disease for mankind is measured from the number of fatalities which are due to it, then tuberculosis must be considered much more important than those most feared infectious diseases, plague, cholera, and the like. Statistics have shown that 1/7 of all humans die of tuberculosis.”
Koch’s discovery proved useful for diagnosis, but not for treatment.
In 1895, Wilhelm Roentgen discovered the x-ray, which could be used to track progress of the disease.
In the late 1800s, sanatoriums began to spring up to care for TB patients. Their record ranged from zero patients who survived to as many as 10 percent.
In 1902, an International Conference on Tuberculosis was convened in Berlin. A Parisian physician suggested the double-barred Cross of Lorraine to signify the fight against TB.
This eventually became the symbol of the Christmas Seals campaign to raise funds to fight TB and became the symbol of the National Tuberculosis Association, now the American Lung Association.
A vaccine was developed in France in 1921, and spread to the U.S., Great Britain and Germany after World War II.
With the 1943 isolation of streptomycin, incidents of TB plummeted. Wiping it out, however, turned out to be trickier, as drug-resistant strains developed in the 1980s.
Great Britain, which had 117,000 cases in 1913, had 5,000 by 1987, but they were back up to 7,600 cases in 2005.
In 2010, there were 8.8 million new cases of TB worldwide, with 1.5 million deaths. TB is the second highest cause of death, after HIV, of a single infectious agent, worldwide.
In 2010, there were 569 deaths in the U.S. from TB, compared to 776 deaths in 2000.
In the U.S., there were 9,951 new cases of TB in 2012, compared to the 84,304 cases in the U.S. in 1953.
Of the 2012 cases in the U.S, 83 were multi-drug resistant cases.
U.S. incidents of TB in 2010 concentrated in Florida, Georgia, Texas, Louisiana, Mississippi, California, Nevada, Arizona, New York, New Jersey, Maryland, Alaska, and Hawaii.
The U.S. does not recommend the TB vaccine for all children.
Rather, it suggests vaccination only for children at risk, either because they are chronically exposed to someone with TB, or have been exposed to someone with drug resistant TB, and they do not test positive for TB.
TB is curable and preventable, but access to sustained medical care is critical.
A short-course therapy developed in the 1980s is estimated to have saved an additional 7 million lives over the previous strategy, but it still requires a daily pill for six to nine months under a health care worker’s supervision.
TB is still a leading cause of death worldwide, according to the Bill and Melinda Gates Foundation. They are working to develop better vaccines, shorter treatment regimens, and point-of-care diagnostic tools that do not require a distant lab.
TB, while not the scourge of the 1800s, also has not gone away.
Do you remember Christmas Seals?
Carol Covin, Granny-Guru