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January 2010 Chirurgeon's Message

Tuberculosis - The White Plague

Tuberculosis has been known under a variety of names during the course of history. It has often been a difficult disease to diagnose and has been confused with many other diseases. The actual name "Tuberculosis" was introduced during the first half of the nineteenth century and it refers to the diseased condition caused by infectious agents known as tuberculosis bacteria or tubercle bacilli. The disease has been also known under other names, such as phthisis, Scrofula, tabes, bronchitis, and inflammation of the lungs, hectic fever, gastric fever, and lupus. It was also known as the great white plague or "consumption".

Tuberculosis (TB) is an infectious disease caused by bacteria whose scientific name is Mycobacterium tuberculosis. TB most commonly affects the lungs but also can involve almost any organ of the body. A person can become infected with tuberculosis bacteria when he or she inhales minute particles of infected sputum from the air. The bacteria get into the air when someone who has a tuberculosis lung infection coughs, sneezes, shouts, or spits (which is common in some cultures).

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 angulation often seen with spinal tuberculosis. Signs of the disease have also been found in Egyptian mummies dated between 3000 and 2400 BCE.

The term phthisis first appeared in Greek literature around 460 BCE. Hippocrates identified phthisis as the most common cause of illness in his time. He stated that it typically affected individuals between 18 and 35 and was nearly always fatal. 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."

The incidence of tuberculosis grew progressively during the Middle Ages and Renaissance, displacing leprosy, and reaching its peak between the eighteenth and nineteenth century as field workers moved into the cities looking for work. The Industrial Revolution coupled with the poverty and squalor created the optimal environment for the propagation of the disease while laying the foundation for an eventual cure.

In 1854, the introduction of the sanatorium cure provided the first big step toward treatment for tuberculosis, a place where patients could get plenty of fresh air and good nutrition. This setup became the blueprint for the subsequent development of sanatoriums.

In 1943, an antibiotic, Streptomycin was first administered to a human and the results were extremely impressive. The disease immediately stopped its progression, the bacteria disappeared from the patient's sputum, and he recovered fully. However the rapid use of anti-TB drugs in the following years cause a surge of resistant mutants to appear within a few months, endangering the success of antibiotic therapy. It was soon proven that using a combination of drugs would solve this problem.

Despite all the drugs available today, tuberculosis is still a problem in many nations. According to World Health Organization (WHO) estimates, each year, 8 million people worldwide develop active tuberculosis and nearly 2 million die.

THL Blase di Angelo
Kingdom Chirurgeon


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