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Tuberculosis (TB) is an ancient disease that first came about around 150 million years ago from the genus Mycobacterium. TB can be caused in animals and humans by Mycobacterium Bovis. Mycobacterium Tuberculosis (MT) only causes the disease in humans, shown above. Modern strains of TB are thought to have arisen from a common ancestor that appeared in East Africa around 15,000-20,000 years ago. MT is believed to have infected those in East Africa.
(NCBI)
(CDC)
(Picture of MT)

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Scientists have found evidence of TB infections in Egyptian mummies from 2400BC. These mummies had skeletal deformities that were characteristic of TB.  The mummy pictured above had evidence of TB in lungs and gallbladder tissue samples. The image above shows the dimensions of that mummy, it was the first mummy to have an autopsy. Treatments for lung ailments were found on Ancient Egypt papyrus, such as the Ebers papyrus, and scholars say the detail is very similar to TB.
TB was also found in Peruvian mummies, which illustrated that the disease was prevalent in South American before European colonization.
(NCBI)
(Museum of healthcare)
(NCBI ²)

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TB was common in Ancient Greece; It was known as “Phtisis" due to the medical writing of Hippocrates. Hippocrates wrote about the disease and identified its characteristic “tubercular lung lesions.” He also recognized it as a potentially fatal condition. Galen went on to describe the symptoms of the disease as "fever, sweating, coughing and blood stained sputum".
(NCBI)
(Picture of Hippocrates)

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Many Roman authors described tuberculosis in literature of the time. TB infections had become extensive across Europe after the fall of the Roman Empire. The characteristics of the Roman Empire made it very easy for TB to travel. Trade and military battles helped facilitate the spread of the disease to the regions in which the Romans conquered. Also, Roman urbanization and increase in population is thought to be a reason why TB became very prevalent during and after the glory days of the Roman Empire.
(NCBI)
(Science Direct)

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Avicenna, a notable physician for his time, from the Arabic Empire characterized TB as contagious. Avicenna wrote the The Canon, a book containing vast medical knowledge, pictured above. It was published in 1025 and is still used in medical teachings today. He devoted two chapters of this medical text to TB.
(NCBI ³)
(Research Gate)
(NCBI)

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In the medical writings of Europe through the Middle Ages and well into the industrial age, tuberculosis was referred to as phthisis, the “white plague,” or consumption—all in reference to the progressive wasting of the victim’s health and vitality as the disease took its inexorable course. The cause was assumed to be mainly constitutional, either the result of an inherited disposition or of unhealthy or dissolute living. (Britannica)

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In the Middle Ages, a new form of the disease was noted (above). Scrofula, was a disease affecting cervical lymph nodes, and was described as a new clinical form of TB.  Caused by Mycobacterium bovis, the illness was known in England and France as "king's evil", and it was widely believed that persons affected could heal after a Royal Touch.

The practice of the king's touch established by English and French kings continued for several years. Queen Anne was the last English monarch to use this practice (1712), George I put an end to it in 1714, while in France it continued up to 1825. (NCBI)

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Girolamo Fracastoro becomes the first person to propose, in his work De contagione (above) in 1546, that phthisis was transmitted by an invisible virus. (NCBI)

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In 1679, Francis Sylvius anatomically and pathologically described Tuberculosis in his journal titled Opera Medica (above) (NCBI). He describes the tubercles, their progression to abscesses, cavities and empyema in the lungs and in other sites of consumptive patients.

He recognized that the skin ulcers caused by scrofula resembled tubercles seen in phthisis, noting that "phthisis is the scrofula of the lung".

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Leading Cause of Death in 17th to 19th Centuries

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Leading Cause of Death in 17th to 19th Centuries

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Although Tuberculosis was present in Europe in the middle Ages, it was in the 17th century that the disease reached astounding epidemic proportions. By the mid seventeenth century it was recorded in the London Bills of Mortality that one in five of the deaths in the city was due to consumption. From the seventeenth to the nineteenth century in England, like the other great towns and cities of Europe and America, it swept on in a continuing epidemic of such monstrous proportion, the disease was called the White Plague of Europe. But the history of TB is that in the later part of the 17th century Tuberculosis mortality slowly decreased. (TBFacts)

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In 1699, Italian health law officially referenced TB as infectious.

Later in 1735, the Health Board of the Republic declared that anyone infected must be kept away from the public and be put in places specifically designed to treat TB patients. (NCBI)

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In 1700 John Manget was carrying out such an autopsy when he observed tubercles so small as to resemble "millet seed" present in all parts of the body. These tubercles can be seen in the scans above. This type of disseminated disease is now called "miliary" tuberculosis. (TBFacts)

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In 1720, Benjamin Martin, an English physician, first hypothesized TB's infectious origin in his work "A New Theory of Consumption." (NCBI)

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Tuberculosis mortality probably peaked in England in 1780, at a death rate of 1,120/100,000 people each year. This means that close to 1.25% of England's entire population died of the disease each year. (TBFacts) This high death rate caused the outbreak to become an epidemic known as "The Robber of Youth." (NCBI)

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In 1803, a French doctor Rene Laennec announced that he had found tubercles in all organs of the body, with muscle and body included. Some doctors believed at this time that phthisis corresponded to at least six independent diseases. (TBFacts)

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There was much debate during the beginning of the 19th century about how one contracted tuberculosis. Theories differed across Europe. In Northern Europe, TB was believed to be hereditary; whereas in Southern Europe, TB was thought to be infectious. Some people also hypothesized that TB was another form of cancer. (NCBI)

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Throughout the 1800s, many physicians and surgeons characterized a variety of clinical effects of the disease. They found that it affected many different parts of the body. However, the disease is most known for affecting the respiratory tract. French physician Gaspard-Laurent Bayle of Vernet noted that TB patients had a bad cough and difficulty breathing. Theophile Laennac noted other serious respiratory problems in TB patients including pleurisy, pulmonary cavitation (as seen in the image above), and consolidation. (NCBI)

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In 1842, a German physician by the name of Philipp Fredrich Hermann Klencke successfully reproduced the human and bovine forms of TB (shown in the image above). He took material from a tubercle in the lung and inoculated it into the liver and lungs of rabbits, successfully inducing TB. (NCBI)

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While many treatments have been proposed throughout history, the first truly successful treatment was created by Hermann Brehmer. He established the first sanatorium in Germany, pictured above, after traveling to the Himalayan Mountains with TB and being healed after he returned, believing that fresh air played a role. From then on, many sanatoria were  established in various locations that would allow patients to get lots of fresh air and proper nutrition. (NCBI)

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In 1865, French military surgeon Jean-Antoine Villemin performed experiments to confidently prove TB’s infectious nature after observing TB infections in soldiers and conducting autopsies on rabbits inoculated with the bacteria. He later noted how TB was more prevalent in urban, crowded areas. (NCBI)

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In 1867, Theodor Albrecht Edwin Klebs made the first attempts to isolate the TB bacteria. However, Robert Koch, pictured above, was able to more efficiently isolate tubercle bacillus in March 1882. He isolated the bacteria, cultivated it in animal serum, and inoculated the bacteria into animals to reproduce the disease. His work proved that the cause of TB was infection by tubercle bacillus. Koch’s work was extremely important in the battle against TB. It allowed skin tests, vaccines, and anti-TB drugs to be developed. In 1905, Koch ended up winning the Nobel prize for Medicine. (NCBI)

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The 20th century marked change for TB. Death rates within the United States were approximately 190 to 200 deaths per 100,000 for white Americans and rates among black Americans was significantly higher as it was approximately 400 deaths per 100,000 in the early years of the century. Very few treatments were available at this time but new development was underway that would change the way TB was treated.  (TBFacts)

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In the late 1800's Koch experimented with Tuberculin as a way to cure and prevent TB. However, the treatment was ineffective and at times fatal. The treatment was quickly discredited but experimentation with Tuberculin began again around 1908. It did not serve as a good treatment for the disease but served as an excellent way to diagnose. (TBFacts)

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The Mantoux Test was a common intradermal method of performing a tuberculosis test that was developed in 1912 by French physician Charles Mantoux (pictured above). Typically, five tuberculin units (0.1ml) is injected intradermally and is read between 48 and 72 hours later. If a person was previously exposed to the bacteria, he/she will amount an immune response in the skin that contains the bacterial proteins (NCBI).

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Today's Tuberculosis test is essentially the same as the Mantoux Test but it is often referred to as a PPD (Purified Protein Derivative) Test. Today, almost all those employed in a hospital or healthcare setting are asked to be tested for TB. Some healthcare providers may even request an individual to be tested twice within a 3 week period if it is their first time being tested as this helps catch latent TB (TB Testing)

*Pictured above is an individual receiving a PPD Test*

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The global community has made remarkable progress in the fight against tuberculosis. However, approximately 1.6 million people die each year of the disease. With the onset of Covid, our progress has backtracked in the fight against TB. Based on the number of people diagnosed and treated, the impacts of Covid have set progress back approximately 12 years. TB treatments, vaccines and medications have made very little advancements in the last 100 years, but the Covid-19 vaccine could be released in less than 1 year. More work and awareness surrounding TB is necessary to develop a more responsive public health outreach (Global TB Overview and 12 Months of Covid-19)

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Tuberculosis is a very relevant disease that has quite an expansive history. It is a highly contagious and can be found in every country of the world. It still remains to be one of the leading infectious causes of death worldwide. This disease is curable and can be prevented. As future healthcare workers and global citizens, awareness is key. By recognizing symptoms, preventing the spread of the bacterium and helping patients complete treatments, future devastation can be prevented.

Through this presentation, we would like to remember those directly effected by TB. Countless lives have been lost to the disease, many are infected and continue to live with it, and our beloved healthcare workers, many of which treated TB positive patients with no protection. Whether one passed from TB, contracted TB, or provided and cared for those infected, these individuals made sacrifices and should be remebered.

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The following sources were used to create this memorial and can be viewed to learn more!
The History of Tuberculosis: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5432783/
TB Testing: https://www.healthline.com/health/what-does-a-positive-tb-test-look-like#identifying-infection
How TB relates to COVID: http://www.stoptb.org/news/stories/2021/ns21_011.html
Basic Facts about TB with links to more pages: https://www.cdc.gov/tb/topic/basics/default.htm
TB is a Global Pandemic:
https://www.tballiance.org/why-new-tb-drugs/global-pandemic
History of Tuberculosis- World history, start of TB, then through the Centuries:
https://tbfacts.org/history-tb/
Mycobacterium bovis Fact Sheet: https://www.cdc.gov/tb/publications/factsheets/general/mbovis.htm
TB and Ancient Egypt: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2842630/#:~:text=Tuberculosis%20has%20long%20been%20recognized,New%20Kingdoms%20(Nerlich%20et%20al.
TB Throughout the Ages: https://www.museumofhealthcare.ca/explore/exhibits/breath/tuberculosis-through-the-ages.html
Spread of TB in Ancient Rome: https://www.sciencedirect.com/science/article/pii/S1472979215000062
TB in Iran: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7263069/
Global TB Overview:
https://www.cdc.gov/globalhivtb/who-we-are/about-us/globaltb/globaltb.html