Editing Tuberculosis (section)

== History ==
{{Main|History of tuberculosis}}
[[File:Mummy at British Museum.jpg|thumb|An [[Egyptian mummy]] in the [[British Museum]] – tubercular decay has been found in the spine.]]
<!-- Ancient history -->
Tuberculosis has existed since [[Ancient history|antiquity]].<ref name="Lawn-2011"/> The oldest unambiguously detected ''M. tuberculosis'' gives evidence of the disease in the remains of bison in Wyoming dated to around 17,000 years ago.<ref>{{cite journal | vauthors = Rothschild BM, Martin LD, Lev G, Bercovier H, Bar-Gal GK, Greenblatt C, Donoghue H, Spigelman M, Brittain D | title = Mycobacterium tuberculosis complex DNA from an extinct bison dated 17,000 years before the present | journal = Clinical Infectious Diseases | volume = 33 | issue = 3 | pages = 305–11 | date = August 2001 | pmid = 11438894 | doi = 10.1086/321886 | doi-access = free }}</ref> However, whether tuberculosis originated in bovines, then transferred to humans, or whether both bovine and human tuberculosis diverged from a common ancestor, remains unclear.<ref>{{cite journal | vauthors = Pearce-Duvet JM | title = The origin of human pathogens: evaluating the role of agriculture and domestic animals in the evolution of human disease | journal = Biological Reviews of the Cambridge Philosophical Society | volume = 81 | issue = 3 | pages = 369–82 | date = August 2006 | pmid = 16672105 | doi = 10.1017/S1464793106007020 | s2cid = 6577678 }}</ref> A comparison of the [[gene]]s of [[M. tuberculosis complex]] (MTBC) in humans to MTBC in animals suggests humans did not acquire MTBC from animals during animal domestication, as researchers previously believed. Both strains of the tuberculosis bacteria share a common ancestor, which could have infected humans even before the [[Neolithic Revolution]].<ref>{{cite journal | vauthors = Comas I, Gagneux S | title = The past and future of tuberculosis research | journal = PLOS Pathogens | volume = 5 | issue = 10 | page = e1000600 | date = October 2009 | pmid = 19855821 | pmc = 2745564 | doi = 10.1371/journal.ppat.1000600 | veditors = Manchester M | doi-access = free }}</ref> Skeletal remains show some prehistoric humans (4000 [[Common Era|BC]]) had TB, and researchers have found tubercular decay in the spines of [[Ancient Egypt|Egyptian]] [[mummy|mummies]] dating from 3000 to 2400 BC.<ref>{{cite journal | vauthors = Zink AR, Sola C, Reischl U, Grabner W, Rastogi N, Wolf H, Nerlich AG | title = Characterization of Mycobacterium tuberculosis complex DNAs from Egyptian mummies by spoligotyping | journal = Journal of Clinical Microbiology | volume = 41 | issue = 1 | pages = 359–67 | date = January 2003 | pmid = 12517873 | pmc = 149558 | doi = 10.1128/JCM.41.1.359-367.2003 }}</ref> Genetic studies suggest the presence of TB in [[the Americas]] from about AD 100.<ref>{{cite journal | vauthors = Konomi N, Lebwohl E, Mowbray K, Tattersall I, Zhang D | title = Detection of mycobacterial DNA in Andean mummies | journal = Journal of Clinical Microbiology | volume = 40 | issue = 12 | pages = 4738–40 | date = December 2002 | pmid = 12454182 | pmc = 154635 | doi = 10.1128/JCM.40.12.4738-4740.2002 }}</ref>

=== Identification ===
Although [[Richard Morton (physician)|Richard Morton]] established the pulmonary form associated with [[tubercle (anatomy)|tubercles]] as a pathology in 1689,<ref>{{WhoNamedIt|doctor|2413|Léon Charles Albert Calmette}}</ref><ref>{{cite journal | vauthors = Trail RR | title = Richard Morton (1637–1698) | journal = Medical History | volume = 14 | issue = 2 | pages = 166–74 | date = April 1970 | pmid = 4914685 | pmc = 1034037 | doi = 10.1017/S0025727300015350 }}</ref> due to the variety of its symptoms, TB was not identified as a single disease until the 1820s.  [[Benjamin Marten]] conjectured in 1720 that consumptions were caused by microbes which were spread by people living close to each other.<ref>{{cite book |vauthors=Marten B |title=A New Theory of Consumptions—More Especially a Phthisis or Consumption of the Lungs |date=1720 |publisher=T. Knaplock |location=London, England |url=https://babel.hathitrust.org/cgi/pt?id=ucm.5320214800&view=1up&seq=7 |access-date=8 December 2020 |archive-date=26 March 2023 |archive-url=https://web.archive.org/web/20230326205015/https://babel.hathitrust.org/cgi/pt?id=ucm.5320214800&view=1up&seq=7 |url-status=live }}  P. 51:  "The ''Original'' and ''Essential Cause'' ... may possibly be some certain Species of ''Animalcula'' or wonderfully minute living Creatures, ... "  P. 79:  "It may be therefore very likely, that by an habitual lying in the same Bed with a Consumptive Patient, constantly Eating and Drinking with him, or by very frequently conversing so nearly, as to draw in part of the Breath he emits from his Lungs, a Consumption may be caught by a sound Person; ... "</ref> In 1819, [[René Laennec]] claimed that tubercles were the cause of pulmonary tuberculosis.<ref>{{cite book |vauthors=Laennec RT |title=De l'auscultation médiate ... |date=1819 |publisher=J.-A. Brosson et J.-S Chaudé |location=Paris, France |volume=1 |page=20 |url=https://books.google.com/books?id=LcZEAAAAcAAJ&pg=PA20 |language=fr |access-date=6 December 2020 |archive-date=2 June 2021 |archive-url=https://web.archive.org/web/20210602212549/https://books.google.com/books?id=LcZEAAAAcAAJ&pg=PA20 |url-status=live }}  From p. 20: ''"L'existence des tubercules dans le poumon est la cause et constitue le charactère anatomique propre de la phthisie pulmonaire (a).  (a) ... l'effet dont cette maladie tire son nom, c'est-à-dire, la consumption."'' (The existence of tubercles in the lung is the cause and constitutes the unique anatomical characteristic of pulmonary tuberculosis (a).  (a) ... the effect from which this malady [pulmonary tuberculosis] takes its name, that is, consumption.)</ref> [[Johann Lukas Schönlein|J. L. Schönlein]] first published the name "tuberculosis" (German:  ''Tuberkulose'') in 1832.<ref>{{cite book |vauthors=Schönlein JL |title=Allgemeine und specielle Pathologie und Therapie |trans-title=General and Special Pathology and Therapy |date=1832 |publisher=C. Etlinger |location=Würzburg, (Germany) |volume=3 |page=103 |url=https://books.google.com/books?id=zAtbAAAAcAAJ&pg=PA103 |language=de |access-date=6 December 2020 |archive-date=2 June 2021 |archive-url=https://web.archive.org/web/20210602233224/https://books.google.com/books?id=zAtbAAAAcAAJ&pg=PA103 |url-status=live }}</ref><ref>The word "tuberculosis" first appeared in Schönlein's clinical notes in 1829.  See: {{cite journal | vauthors = Jay SJ, Kırbıyık U, Woods JR, Steele GA, Hoyt GR, Schwengber RB, Gupta P | title = Modern theory of tuberculosis: culturomic analysis of its historical origin in Europe and North America | journal = The International Journal of Tuberculosis and Lung Disease | volume = 22 | issue = 11 | pages = 1249–1257 | date = November 2018 | pmid = 30355403 | doi = 10.5588/ijtld.18.0239 | s2cid = 53027676 }} See especially Appendix, p. iii.</ref>

Between 1838 and 1845, John Croghan, the owner of [[Mammoth Cave]] in Kentucky from 1839 onwards, brought a number of people with tuberculosis into the cave in the hope of curing the disease with the constant temperature and purity of the cave air; each died within a year.<ref>{{cite web | url = http://edition.cnn.com/2004/TRAVEL/DESTINATIONS/02/26/mammoth.cave.ap/index.html | title = Kentucky: Mammoth Cave long on history. | archive-url = https://web.archive.org/web/20060813140746/http://edition.cnn.com/2004/TRAVEL/DESTINATIONS/02/26/mammoth.cave.ap/index.html | archive-date= 13 August 2006| work = [[CNN]] | date = 27 February 2004 | access-date = 8 October 2006 }}</ref> Hermann Brehmer opened the first TB [[sanatorium]] in 1859 in Görbersdorf (now [[Sokołowsko]]) in [[Silesia]].<ref name="McCarthy-2001">{{cite journal | vauthors = McCarthy OR | title = The key to the sanatoria | journal = Journal of the Royal Society of Medicine | volume = 94 | issue = 8 | pages = 413–17 | date = August 2001 | pmid = 11461990 | pmc = 1281640 | url = http://www.jrsm.org/cgi/pmidlookup?view=long&pmid=11461990 | doi = 10.1177/014107680109400813 | access-date = 28 September 2011 | archive-date = 3 August 2012 | archive-url = https://archive.today/20120803180504/http://www.jrsm.org/cgi/pmidlookup?view=long&pmid=11461990 | url-status = live }}</ref> In 1865, [[Jean Antoine Villemin]] demonstrated that tuberculosis could be transmitted, via inoculation, from humans to animals and among animals.<ref>{{cite journal |vauthors=Villemin JA |title=Cause et nature de la tuberculose |journal=Bulletin de l'Académie Impériale de Médecine |date=1865 |volume=31 |pages=211–216 |url=https://babel.hathitrust.org/cgi/pt?id=hvd.32044103060562&view=1up&seq=215 |trans-title=Cause and nature of tuberculosis |language=fr |access-date=6 December 2020 |archive-date=9 December 2021 |archive-url=https://web.archive.org/web/20211209200251/https://babel.hathitrust.org/cgi/pt?id=hvd.32044103060562&view=1up&seq=215 |url-status=live }}

*  See also:  {{cite book |vauthors=Villemin JA |title=Etudes sur la tuberculose: preuves rationnelles et expérimentales de sa spécificité et de son inoculabilité |trans-title=Studies of tuberculosis: rational and experimental evidence of its specificity and inoculability |date=1868 |publisher=J.-B. Baillière et fils |location=Paris, France |url=https://books.google.com/books?id=JFg7AAAAcAAJ&pg=PP7 |language=fr |access-date=6 December 2020 |archive-date=7 February 2024 |archive-url=https://web.archive.org/web/20240207093804/https://books.google.com/books?id=JFg7AAAAcAAJ&pg=PP7#v=onepage&q&f=false |url-status=live }}</ref> (Villemin's findings were confirmed in 1867 and 1868 by [[John Burdon-Sanderson]].<ref>Burdon-Sanderson, John Scott. (1870) "Introductory Report on the Intimate Pathology of Contagion." Appendix to:  Twelfth Report to the Lords of Her Majesty's Most Honourable Privy Council of the Medical Officer of the Privy Council [for the year 1869], Parliamentary Papers (1870), vol. 38, 229–256.</ref>)

[[File:RobertKoch.jpg|upright|thumb|[[Robert Koch]] discovered the tuberculosis bacillus.]]
[[Robert Koch]] identified and described the bacillus causing tuberculosis, ''M. tuberculosis'', on 24 March 1882.<ref>{{cite book | vauthors = Koch R | title = Robert Koch: Zentrale Texte | chapter = Die Ätiologie der Tuberkulose (1882) |series=Klassische Texte der Wissenschaft |date=24 March 1882|trans-title=The Etiology of Tuberculosis| chapter-url = http://edoc.rki.de/docviews/abstract.php?id=610|volume=19|pages=221–30|doi=10.1007/978-3-662-56454-7_4|isbn=978-3-662-56454-7|access-date=15 June 2021|archive-date=6 November 2018|archive-url= https://web.archive.org/web/20181106191545/https://babel.hathitrust.org/cgi/pt?id=mdp.39015020075001;view=1up;seq=235|url-status=live|publisher=Springer Spektrum|location=Berlin, Heidelberg}}</ref><ref>{{cite web|url=https://www.cdc.gov/tb/worldtbday/history.htm|title=History: World TB Day|publisher=[[Centers for Disease Control and Prevention]] (CDC)|url-status=live|access-date=23 March 2019|date=12 December 2016|archive-date=7 December 2018|archive-url=https://web.archive.org/web/20181207112253/https://www.cdc.gov/tb/worldtbday/history.htm}}</ref> In 1905, he was awarded the [[Nobel Prize in Physiology or Medicine]] for this discovery.<ref>{{Cite web|title=The Nobel Prize in Physiology or Medicine 1905|url=https://www.nobelprize.org/prizes/medicine/1905/summary/|access-date=7 October 2006|archive-url=https://web.archive.org/web/20061210184150/http://nobelprize.org/nobel_prizes/medicine/laureates/1905/|archive-date=10 December 2006|url-status=live|website=www.nobelprize.org|language=en-US}}</ref>

=== Development of treatments ===
In Europe, rates of tuberculosis began to rise in the early 1600s to a peak level in the 1800s, when it caused nearly 25% of all deaths.<ref name="Bloom_1994">{{cite book| vauthors = Bloom BR |title= Tuberculosis: pathogenesis, protection, and control|year= 1994|publisher= ASM Press|location= Washington, DC|isbn= 978-1-55581-072-6|url-access= registration|url= https://archive.org/details/tuberculosispath0000unse}}</ref> In the 18th and 19th century, [[History of tuberculosis#Epidemic tuberculosis|tuberculosis had become epidemic in Europe]], showing a seasonal pattern.<ref>{{Cite web| vauthors = Frith J |title=History of Tuberculosis. Part 1 – Phthisis, consumption and the White Plague|url=https://jmvh.org/article/history-of-tuberculosis-part-1-phthisis-consumption-and-the-white-plague/|url-status=live|access-date=26 February 2021|website=Journal of Military and Veterans' Health|archive-date=8 April 2021|archive-url=https://web.archive.org/web/20210408050305/https://jmvh.org/article/history-of-tuberculosis-part-1-phthisis-consumption-and-the-white-plague/}}</ref><ref name="Zürcher_2016">{{cite journal | vauthors = Zürcher K, Zwahlen M, Ballif M, Rieder HL, Egger M, Fenner L | title = Influenza Pandemics and Tuberculosis Mortality in 1889 and 1918: Analysis of Historical Data from Switzerland | journal = PLOS ONE | volume = 11 | issue = 10 | pages = e0162575 | date = 5 October 2016 | pmid = 27706149 | pmc = 5051959 | doi = 10.1371/journal.pone.0162575 | doi-access = free | bibcode = 2016PLoSO..1162575Z }}</ref> Tuberculosis caused widespread public concern in the 19th and early 20th centuries as the disease became common among the urban poor. In 1815, one in four deaths in England was due to "consumption". By 1918, TB still caused one in six deaths in France.{{Citation needed|date=August 2020}}

After TB was determined to be contagious, in the 1880s, it was put on a [[List of notifiable diseases|notifiable-disease]] list in Britain. Campaigns started to stop people from spitting in public places, and the infected poor were "encouraged" to enter [[sanatorium|sanatoria]] that resembled prisons. The sanatoria for the middle and upper classes offered excellent care and constant medical attention.<ref name="McCarthy-2001"/> What later became known as the [[Alexandra Hospital for Children with Hip Disease]] (tuberculous arthritis) was opened in London in 1867.<ref>{{Cite web |title=Lost Hospitals of London |url=https://ezitis.myzen.co.uk/alexandra.html |access-date=2024-06-27 |website=ezitis.myzen.co.uk}}</ref> Whatever the benefits of the "fresh air" and labor in the sanatoria, even under the best conditions, 50% of those who entered died within five years ({{circa}} 1916).<ref name="McCarthy-2001"/>

Robert Koch did not believe the cattle and human tuberculosis diseases were similar, which delayed the recognition of infected milk as a source of infection. During the first half of the 1900s, the risk of transmission from this source was dramatically reduced after the application of the [[pasteurization]] process. Koch announced a [[glycerine]] extract of the tubercle bacilli as a "remedy" for tuberculosis in 1890, calling it "tuberculin". Although it was not effective, it was later successfully adapted as a screening test for the presence of pre-symptomatic tuberculosis.<ref>{{cite journal | vauthors = Waddington K | title = To stamp out 'so terrible a malady': bovine tuberculosis and tuberculin testing in Britain, 1890–1939 | journal = Medical History | volume = 48 | issue = 1 | pages = 29–48 | date = January 2004 | pmid = 14968644 | pmc = 546294 | doi = 10.1017/S0025727300007043 }}</ref> [[World Tuberculosis Day]] is marked on 24 March each year, the anniversary of Koch's original scientific announcement. When the [[Medical Research Council (UK)|Medical Research Council]] formed in Britain in 1913, it initially focused on tuberculosis research.<ref>{{cite book | vauthors = Hannaway C |title= Biomedicine in the twentieth century: practices, policies, and politics|year= 2008|publisher= IOS Press|location= Amsterdam|isbn=978-1-58603-832-8|page= 233|url= https://books.google.com/books?id=o5HBxyg5APIC&pg=PA233|url-status=live|archive-url= https://web.archive.org/web/20150907185226/https://books.google.com/books?id=o5HBxyg5APIC&pg=PA233|archive-date= 7 September 2015}}</ref>

[[Albert Calmette]] and [[Camille Guérin]] achieved the first genuine success in immunization against tuberculosis in 1906, using attenuated bovine-strain tuberculosis. It was called [[BCG vaccine|bacille Calmette–Guérin]] (BCG). The BCG vaccine was first used on humans in 1921 in France,<ref>{{cite journal | vauthors = Bonah C | title = The 'experimental stable' of the BCG vaccine: safety, efficacy, proof, and standards, 1921–1933 | journal = Studies in History and Philosophy of Biological and Biomedical Sciences | volume = 36 | issue = 4 | pages = 696–721 | date = December 2005 | pmid = 16337557 | doi = 10.1016/j.shpsc.2005.09.003 }}</ref> but achieved widespread acceptance in the US, Great Britain, and Germany only after World War II.<ref>{{cite journal | vauthors = Comstock GW | title = The International Tuberculosis Campaign: a pioneering venture in mass vaccination and research | journal = Clinical Infectious Diseases | volume = 19 | issue = 3 | pages = 528–40 | date = September 1994 | pmid = 7811874 | doi = 10.1093/clinids/19.3.528 }}</ref>

In 1946, the development of the antibiotic [[streptomycin]] made effective treatment and cure of TB a reality. Prior to the introduction of this medication, the only treatment was surgical intervention, including the "[[pneumothorax]] technique", which involved collapsing an infected lung to "rest" it and to allow tuberculous lesions to heal.<ref>{{cite book |url=https://books.google.com/books?id=bVEEHmpU-1wC&pg=PA792 |title=General thoracic surgery |vauthors=Shields T |publisher=Wolters Kluwer Health/Lippincott Williams & Wilkins |year=2009 |isbn=978-0-7817-7982-1 |edition=7th |location=Philadelphia |page=792 |archive-url=https://web.archive.org/web/20150906212146/https://books.google.com/books?id=bVEEHmpU-1wC&pg=PA792 |archive-date=6 September 2015 |url-status=live}}</ref>

By the 1950s mortality in Europe had decreased about 90%. Improvements in sanitation, vaccination, and other public-health measures began significantly reducing rates of tuberculosis even before the arrival of streptomycin and other antibiotics, although the disease remained a significant threat.{{Cn|date=March 2025}} 

=== Drug resistant tuberculosis ===
However, a few years after  the first antibiotic [[Tuberculosis management|treatment]] for TB in 1943, some strains of the TB bacteria developed resistance to the standard drugs (streptomycin, [[4-Aminosalicylic acid|para-aminosalicylic acid]], and [[isoniazid]]).<ref name="Keshavjee-2012">{{Cite journal |last1=Keshavjee |first1=Salmaan |last2=Farmer |first2=Paul E. |date=2012-09-06 |title=Tuberculosis, Drug Resistance, and the History of Modern Medicine |url=http://www.nejm.org/doi/10.1056/NEJMra1205429 |journal=New England Journal of Medicine |language=en |volume=367 |issue=10 |pages=931–936 |doi=10.1056/NEJMra1205429 |pmid=22931261 |issn=0028-4793}}</ref> Between 1970 and 1990, there were numerous outbreaks of drug-resistant tuberculosis involving strains resistant to two or more drugs; these strains are called [[Multidrug-resistant tuberculosis|multi-drug resistant TB]] (MDR-TB).<ref name="Keshavjee-2012" /> The resurgence of tuberculosis, caused in part by drug resistance and in part by the [[Epidemiology of HIV/AIDS|HIV pandemic]],  resulted in the declaration of a global health emergency by the World Health Organization (WHO) in 1993.<ref>{{cite journal |vauthors=Chaisson RE, Frick M, Nahid P |date=March 2022 |title=The scientific response to TB - the other deadly global health emergency |journal=The International Journal of Tuberculosis and Lung Disease |volume=26 |issue=3 |pages=186–189 |doi=10.5588/ijtld.21.0734 |pmc=8886961 |pmid=35197158}}</ref><ref>{{Cite journal |date=July–August 1993 |title=Tuberculosis : a global emergency |url=https://iris.who.int/handle/10665/52639 |journal=World Health |volume=46 |issue=4 |pages=3–31}}</ref>

Treatment of MDR-TB requires treatment with [[Tuberculosis management#Second line|second-line drugs]], which in general are less effective, more toxic and more expensive than first-line drugs.<ref>{{Cite journal |last1=Millard |first1=James |last2=Ugarte-Gil |first2=Cesar |last3=Moore |first3=David A. J. |date=2015-02-26 |title=Multidrug resistant tuberculosis |url=http://www.bmj.com/content/350/bmj.h882 |journal=BMJ |volume=350 |pages=h882 |doi=10.1136/bmj.h882 |issn=1756-1833 |pmid=25721508 |s2cid=11683912}}</ref> Treatment regimes can run for two years, compared to the six months of first-line drug treatment.<ref>Kaplan, Jeffrey. 2017. "Tuberculosis" American University. Lecture.</ref><ref name="accessmedicine.mhmedical.com">{{cite book |last1=Adams and Woelke |url=http://accessmedicine.mhmedical.com/content.aspx?bookid=710&Sectionid=46796911 |title=Understanding Global Health. Chapter 10: TB and HIV/AIDS |date=2014 |publisher=McGraw Hill |edition=12th |access-date=9 May 2015}}</ref>