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

were sold for a penny each at the post office.
She worked hard to make the campaign a
success, personally presenting the idea to all
sorts of groups and officials, including the
Philadelphia North American newspaper,
emphasizing how buying Christmas seals
would help children and adults with TB. The
idea took hold, and by the end of the holiday
season, $3,000 had been raised — 10 times the
amount she had set out to raise. By 1946 at
least 10 million people were purchasing seals
or giving to the Christmas seal fund. The
Christmas seal campaign was so widely advertised
on buttons, milk caps, postcards, school
booklets, billboards, book marks, rail and bus
passes, etc., that it permeated many aspects of
social life. The National TB Association said
at that time that “No
nationwide program
has rested for so many
years on so broad a
base made up of millions
of small gifts.”
Then, in the middle of
World War II, came
the final breakthrough,
the greatest challenge
to the bacterium that
had threatened humanity
for thousands of years: chemotherapy.
In fact, the chemotherapy of infectious diseases,
using sulfonamide and penicillins, had
been underway for several years, but these
compounds were ineffective against Mycobacterium
tuberculosis. Since 1914, Selman A.
Waksman had been systematically screening
soil bacteria and fungi, and at the University
of California in 1939 had discovered the
marked inhibitory effect of certain fungi,
especially actinomycetes, on bacterial growth.
In 1940, he and his team were able to isolate
an effective anti-TB antibiotic, actinomycin;
however, this proved to be too toxic for use in
humans or animals.
Notable Events in TB Control
5
Success came in 1943. In test animals, streptomycin,
purified from Streptomyces griseus,
combined maximal inhibition of M. tuberculosis
with relatively low toxicity. On November
20, 1944, the antibiotic was administered for
the first time to a critically ill TB patient. The
effect was almost immediate and impressive.
His advanced disease was visibly arrested, the
bacteria disappeared from his sputum, and he
made a rapid recovery. The new drug had side
effects — especially on the inner ear — but the
fact remained, M. tuberculosis was no longer a
bacteriological exception; it could be assailed
and beaten into retreat within the human
body.
A rapid succession of anti-TB drugs appeared
in the following years. These were important
because with streptomycin monotherapy,
resistant mutants began to appear within a few
months, endangering the success of antibiotic
therapy. However, it was soon demonstrated
that this problem could be overcome with the
combination of two or three drugs.
Although there were some attempts at providing
guidance on TB control measures through
publication and conferences, the federal control
of TB did not occur until the mid-1940s,
when the 1944 Public Health Service Act
(Public Law 78-410) authorized the establishment
of a TB control program. On July 6,
1944, the Surgeon General established a Tuberculosis
Control Division in the Bureau of State
Services of the Public Health Service (PHS).
Doctor Herman E. Hilleboe was appointed
medical director of the new division. The
Public Health Service provided supplemental
fiscal support to state and local health departments
for TB control activities through formula
grants and special grants-in-aid. These
grants were to assist states in establishing and
maintaining adequate measures for prevention,
treatment, and control of TB and focused
greater attention on the need for case finding.