Tuberculosis (TB) : A Terrible Toll

by National Institute of Health

Tuberculosis (TB) is an old disease but one that still ranks among the foremost killers of the 21st century. Every second of every day, someone is newly infected with the bacterium, Mycobacterium tuberculosis (M. tb ), that causes TB. About one-third of the world's population is infected with M. tb , and as many as two million people die of the disease each year. TB kills more people than any other disease caused by a single infectious agent. Among people with HIV/AIDS, tuberculosis is the leading cause of death. The highest rates of TB are in some of the world's poorest countries, and the economic toll taken by the disease is enormous. Left unchecked, infectious disease can sow the seeds of political upheaval and threatens to reverse progress made by developing countries in recent decades. As for the toll in lives shortened, children orphaned, and communities weakened, the cost is inestimable.

Unprecedented Opportunities

Among the components of the National Institutes of Health (NIH), the National Institute of Allergy and Infectious Diseases (NIAID) is the primary locus of TB research. NIAID has been committed to fighting infectious disease and improving global health throughout its history. From state-of-the art laboratories in the United States to busy clinics in South Africa, scientists supported by NIAID are learning new things about the TB bacterium and developing better ways to fight the diseases.

"Better control and eventual elimination of TB worldwide will require a marriage of modern science, time-tested public health measures, and the strong commitment of the international community," says NIAID Director Anthony S. Fauci, M.D. "History will judge us harshly if we do not capitalize on unprecedented opportunities and act boldly to rid the world of this ancient killer."

Tuberculosis in History

"I Must Die"

Tuberculosis, it seems, has always been with us. Evidence of tubercular decay has been found in the spines of Egyptian mummies thousands of years old, and the disease was common both in ancient Greece and Imperial Rome. While it may have lessened its grip on mankind during some periods of history, TB never completely let go.

Attempts at cures were varied, but uniformly ineffective. Roman physicians recommended bathing in human urine, eating wolf livers, and drinking elephant blood. Fresh milk-human, goat, or camel-figured in many treatment regimens. Depending upon the time and country in which they lived, patients were exhorted to rest or to exercise, to eat or to abstain from food, to travel to the mountains or to live underground.

And yet, tuberculosis continued to claim victims by the millions. When, in 1820, the poet John Keats (who had schooling in medicine) coughed a spot of bright red blood, he told a friend, "It is arterial blood. I cannot be deceived. That drop of blood is my death warrant. I must die." Within a year, at just 25, he did.

Consumed by Love

Other artists and writers who succumbed to tuberculosis in the 19th century included Frederick Chopin, Anton Chekov, Robert Louis Stevenson, and Emily Bronte, while 20th century victims included Franz Kafka, George Orwell, and D.H. Lawrence. Consumption became romanticized in the popular imagination as a disease of the young, pure, and passionate. The heroines of Alexandre Dumas' 1852 novel, Camille, and Giacomo Puccini's 1896 opera, La Boheme, were among the fictional characters whose deaths from tuberculosis were imagined to result from thwarted love affairs.

A Doctor's View

The variable course of TB only served to make it more baffling and terrifying. Physicians could not easily predict whether a consumptive patient would succumb within months, linger for years, or somehow manage to overcome the disease altogether. According to the 19th century American physician William Sweetser, the first stage of consumption was marked by a dry, persistent cough, pains in the chest, and some difficulty breathing, any of which could be symptoms of less dire illnesses.

The second stage brought a cough described by Dr. Sweetser as "severe, frequent, and harassing" as well as a twice-daily "hectic fever," an accelerated pulse, and a deceptively healthy ruddiness in the complexion.

In the final, fatal stage, wrote the doctor, "the emaciation is frightful and the most mournful change is witnessed...the cheeks are hollow ... rendering the expression harsh and painful. The eyes are commonly sunken in their sockets...and often look morbidly bright and staring." At this point, throat ulcers made eating difficult and speech was limited to a hoarse whisper. Once the distinctive "graveyard cough" began, diagnosis was certain and death inevitable. Rarely, wrote Dr. Sweetser, "life, wasted to the most feeble spark, goes out almost insensibly." More typically, severe stomach cramps, excessive sweating, a choking sensation and vomiting of blood preceded the victim's demise.

About the Author

NIH is the nation's medical research agency - making important medical discoveries that improve health and save lives. The National Institutes of Health (NIH), a part of the U.S. Department of Health and Human Services, is the primary Federal agency for conducting and supporting medical research.