Tuesday, July 03, 2012

5000 B.C.- 1750: TB spreads across the world

The 18-year-old Egyptian prince sat on the edge of the bed.  He was fiercely coughing, often bringing up blood which he spat on the ground.  The physician stood alongside him, gently touching the young man's shoulder, chanting an incantation.

He was concerned for his good friend who's skin was drawn taught over his ribs. He seemed to be slowly wasting away.  What the physician offered was the only known remedy for such a condition 2,400 years before the Birth of Christ. Yet his remedy didn't work, and the young prince was mummified.

The bacteria (mycobacterium tuberculosis) that causes tuberculosis (TB) has been around since the beginning of time, although it has evolved during that time too.  At first it may have been a harmless little bacteria, yet it evolved and started causing tuberculosis symptoms in animals.

Then, as humans started cultivating those animals about 8,000 to 5,000 years before Christ, they became exposed to Mycobacterium Bovis, the oldest known species of what is now Mycobacterium Tuberculosis. Evidence of TB was was found by paleopathologists (scientists who study ancient diseases) on human remains dating as far back as 8,000 B.C. (9)

A disease that sounds like tuberculosis was described in writing, etched in stone in cuneiform, by the Babylonian monarch Hammurabi.  He ruled from 1948-1905 B.C.

Some believe it's mentioned in the Bible, which was written in the 1000 year period before the conquests of Alexander the Great, in 327-6 B.C., as shachepeth in Leviticus 26:16 and Deuteronomy 28:22 may be pthisis, which is pulmonary tuberculosis. (11)

Some believe the Bible referenced the condition when Moses said (Leviticus 26: 16, Deuteronomy 28: 22):
Then I will do this to you: I will bring upon you sudden terror, wasting diseases and fever that will destroy your sight and drain away your life. You will plant seed in vain, because your enemies will eat it.
A similar reference was made by Moses in another Biblical book (Deuteronomy 28:22)
"The LORD will strike you with wasting disease, with fever and inflammation, with scorching heat and drought, with blight and mildew, which will plague you until you perish."
However, its difficult to accurately interpret the diseases described in the Bible as knowledge of diseases were scant, which made it difficult to describe them.  Mostly symptoms were listed, which requires the interpreter often to assume what disease is referred to.  Likewise, some symptoms in the Bible may be exaggerated for emphasis of what might happen if a person is evil. (11)

The victims of the bacteria didn't always show symptoms right away.  Sometimes they never did.  Yet the ones who did often developed a strong, harsh cough that was often productive of blood.  They often lost weight, had chills, night sweat and became extremely fatigued.  While some lived to tell about it, most didn't.

The malady was given a name when the Hippocratic (466-377 B.C.) writers referred to it as phthisis in 460 B.C.  Phthisis means wasting away. They described phymata, or tubercles in the tissue of humans and cattle, sheep and pigs. (9)  This is neat because phthisis and pneumonia are the only two lung diseases that were not categorized under the asthma umbrella.  

Hippocrates, the great Greek physician, was the first to write about it as a medical condition, although he acknowledged it had been around for a long time.  He wrote that it was "The greatest and most dangerous disease and one that proved fatal to the greatest number." (1, page 1)

Yet the Hippocratic writers considered it to be a hereditary as opposed to a contagious disease. Aristotle considered it to be contagious, which opposed general consensus at the time.  It was once described as "captain of all these men and death." (10) 

Isocrates is often considered as the greatest rhetoricians' in Ancient Greece.  His intent was to improve the speech and writings of individuals by instilling virtues.  He was born in 436 BC, seven  years before Plato was born.  Both Isocrates and Aristotle also mentioned that phthisis was contagious.  (1) 

Galen wrote about the malady too, and he believed it was an "ulceration of the lungs, thorax or throat, accompanied by a cough, fever, and consumption of the body by pus."  He considered the treatment for the malady to be living at high altitudes, like the top of a mountain.

From about 1066 to 1485, which are considered to be the Medieval or Middle ages in Europe, the condition was referred to as King's Evil "because newly crowned kings (and queens, in England) were alleged to cure scrofula, glandular swellings in the neck associated with TB, with their touch." (2)

Fracastonius of Verona (1478-1553) was the first to use phthisis exclusively for tuberculosis of the lungs.  Franciseus Sylvius (1614-1672) observed tubercles in the lungs of people with pthsisis and is credited with coining the term tubercle.  The tubercle described by the Hippocratic writers now had a name.

After 1492 Europeans started sailing for America.  In America the disease spread too, killing many.  Some believed it was a European disease and the Europeans brought it to America.  Yet evidence of Native American remains show that the disease had made its way to America long before the Europeans. (12, page 13)

So we have a disease that was not prejudiced who it invaded, as the disease was seen all over the world. Most people on the planet had either been inflicted with it, or had seen someone suffer from one or another forms of the disease.  Little was known about it, and there was no cure.  So, for the most part, people saw it as the will of God.  If you didn't catch it, you were lucky.  If you got it, you dealt with it.  If someone you knew got it, you pitied and doted on him.  

The mummy of a 4,412 year old mummy was discovered in a tomb in Egypt.  It was a young prince, perhaps around 18-years-of age.  The mummy was diagnosed by modern experts as having tuberculosis.  This proved the disease has been around for a long, long time.  

By the 17th century the disease was so rampant that that at least one in five death certificates in the city listed consumption as the cause of death.  Yet those statistics would seem small considering what the disease would do to mankind during the following two centuries. (12, page 13)

References:
  1. Norris, Charles Camblos, "Gynecological and Obstetrical Tuberculosis," 1921, New York, London
  2. Koehler, Christopher W., "Consumption, the great killer," http://pubs.acs.org/subscribe/archive/mdd/v05/i02/html/02timeline.html
  3. "History of TB," New Jersey Medical School, Global Tuberculosis Institute, http://www.umdnj.edu/ntbc/tbhistory.htm
  4. Klebs, Arnold Carl, "Tuberculosis," 1909, New York
  5. Morton, Samuel, "Pulmonary Consumption," 1834, Philadelphia
  6. Flenner, Simon, , "Immunity in Tuberculosis," Annual report of the Smithonian Institution, 1907, New York, page 627 
  7. "Captain of the Men of Death," Ulster Med J. 1989; 58(Suppl): 7–9.
  8. Sigeris, Henry E, "A History of Medicine," volume I, "Primitive and Archaic Medicine," Second Edition, 1955, New York, Oxford University Press, page 53
  9. Seth, Vimlesh, SK Kabra, Rachna Seth, "Essentials of Tuberculosis,"  Third ed., Jaypee Brothers Medical Publishing, 2006, page 3-4
  10. Jones, Greta, "Ca;ptain of All These Men of Death," 2001, New York
  11. Prioreschi, Plinio, "A History of Medicine," 1991, volume I, "Primitive and Ancient Medicine," Edwin Mellen Press, Chapter VII, "biblical Medicine," page 514
  12. Landau, Elaine, "Tuberculosis," 1995, New York, Chicago, London, Sydney, Franklin Watts, pages 13-32
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