CDC History of Tuberculosis Control - Medical and Public Health ...

was clearly evident in the literature of the time
in the writings of John Keats (1795-1821) in
the Ode to a Nightingale, of John Bunyan
(1628-1688) in The Life and Death of Mr.
Badman, of Charles Dickens (1812-1870) in
Nicholas Nickleby, and of other famous writers
of the time.
In 1720, in his publication, A New Theory of
Consumption, the English physician Benjamin
Marten was the first to conjecture that TB
could be caused by “wonderfully minute living
creatures,” which, once they had gained a
foothold in the body, could generate the
lesions and symptoms of the disease. He
continued that “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 the Lungs, a consumption
may be caught by a sound person . . . I
imagine that slightly conversing with consumptive
patients is seldom or never sufficient
to catch the disease.” For a physician living in
such an early era, Dr. Marten showed much
medical insight.
In 1882, at a time when
TB was raging through
Europe and the Americas,
killing one in seven
people, a German biologist
by the name of
Robert Koch presented
to the scientific community
his discovery of the
organism that caused
Robert Koch
TB. It was called a
tubercle bacillus because small rounded bodies
(tubercles) occurred in the diseased tissue and
were characteristic of the disease. Through his
many experiments with the organism, Dr.
Koch worked on developing a cure for TB.
Koch was able to isolate a protein from the
tubercle bacillus that he tried as an immunizing
agent and later as a treatment for TB; in
both cases it failed. However, the substance,
TB Control at the Millennium
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now called “old tuberculin,” was to be later
used as the screening tool (tuberculin skin
tests) for identifying people and animals
infected with tubercle bacilli.
A further significant advance came in 1895
when Wilhelm Konrad von Roentgen discovered
the radiation that bears his name. This
allowed the progress and severity of a patient’s
disease to be accurately followed and
reviewed.
Another important development was provided
by the French bacteriologist Calmette. Together
with Guerin, he used specific culture
media to lower the virulence of the bovine TB
bacterium, thus creating the basis for the BCG
vaccine still in widespread use today.
TB in America during the colonial period was
accepted as a scourge of humanity that was
common to the poor and rich alike. The first
available mortality figures from Massachusetts
in 1786 indicated 300 deaths per 100,000
population. The peak mortality figure reached
in New England was 1,600 per 100,000 in
1800. With the industrial development, the
epidemic traveled to the Midwest in 1840 and
to the West in 1880. Though the disease
occurred in blacks at a lower rate than in
whites before the Civil War, the increase was
massive among blacks after the war, when
emancipation and urbanization created an
ideal atmosphere for transmission of TB. The
American Indians and Alaskans were the last
American populations to become affected by
the TB epidemic.
At the turn of the century it was estimated
that 10% of all deaths in the United States
were due to TB. By 1904 the TB death rate
for the United States was 188, by 1920 the rate
was 100 per 100,000, and by 1955 the rate had
decreased to less than 10 per 100,000 people
per year.
The TB sanatorium movement, which was
started in Germany by Dr. Hermann