The illness once known as “The Consumption” is the same disease now called Tuberculosis (TB), caused by the bacterium Mycobacterium tuberculosis. For centuries, this infection was a widespread and lethal presence, becoming the leading cause of death in many Western cities during the 18th and 19th centuries. Because it was so pervasive and deadly, it was also called “the white death” or “the captain of all these men of death.” This ancient affliction, traceable to human remains from 2400 B.C. in Egypt, has co-evolved with humanity, marking culture, medicine, and public health.
Why It Was Called The Consumption
The historical name “Consumption” arose directly from the visible effect the disease had on its victims. The term stems from the Latin word consumere, meaning “to eat up” or “to devour.” In the pre-antibiotic era, the slow wasting of the body was the defining characteristic of the illness.
Patients suffered from profound weight loss, known medically as cachexia, appearing to be consumed from within. Persistent, low-grade fevers and chronic fatigue further drained the body’s resources, giving the disease its accurate label. This name remained in common use long after the medical establishment began using the term tuberculosis, coined in the 19th century from the Latin word tuberculum, meaning “small swelling.”
The Symptoms and Progression of the Disease
The initial symptoms of the disease began with a persistent cough, sometimes mistaken for a common cold or bronchitis. This was accompanied by general malaise, a low-grade fever that worsened in the afternoon, and drenching night sweats. These early signs signaled the body’s failing battle against the bacterial invader.
As the infection progressed, the signs became unmistakable. The chronic cough intensified, often producing sputum streaked with blood, a symptom known as hemoptysis. This bleeding resulted from the bacteria destroying lung tissue and forming cavities.
While the lungs were the most common site of infection, the disease did not always stay confined to the respiratory system. The bacteria could travel through the bloodstream or lymphatic system to infect other organs, leading to extrapulmonary TB. This included infections of the spine, known as Pott’s disease, or attacks on the lymph nodes, kidneys, or the brain’s lining.
How the Disease Spread
The true cause of consumption was a mystery for centuries, with theories ranging from a hereditary trait to moral failing or bad air. In 1882, German physician Robert Koch definitively identified the causative agent: the bacterium Mycobacterium tuberculosis (Mtb). This discovery laid the foundation for understanding how the disease propagated.
Transmission occurs through the air when an individual with active pulmonary TB coughs, sneezes, or speaks. These actions release microscopic droplets containing Mtb bacteria, which can then be inhaled by others. The infectious nature of the disease meant that the social conditions of the 18th and 19th centuries were suited for its rampant spread.
Rapid urbanization during the Industrial Revolution created densely packed urban centers. Poor ventilation, malnutrition, and overcrowded housing were commonplace, allowing the airborne bacteria to circulate easily. Koch’s finding shifted the focus from a constitutional weakness to a microbial enemy, making public health measures possible.
From Sanatoriums to Modern Cures
Before the age of antibiotics, managing consumption was largely unsuccessful. Early attempts at treatment included tonics, rest cures, and sea voyages, based on the belief that a change of climate could restore health. The most widespread intervention before the mid-20th century was the sanatorium movement.
Sanatoriums were specialized long-term care facilities, often built in high-altitude, rural areas for fresh air and sunlight. The regimen consisted of strict bed rest, nutritious food, and an open-air environment. These institutions provided supportive care and isolated contagious patients from the general population.
The fate of those diagnosed changed in 1943 with the discovery of streptomycin, the first effective antibiotic against Mtb. This breakthrough transformed the disease from a death sentence into a curable condition. Subsequent research led to the development of other powerful drugs, including isoniazid, rifampin, pyrazinamide, and ethambutol.
Today, active TB is treated with a combination of these antibiotics over several months to ensure the complete elimination of the bacteria. Despite these advances, the emergence of drug-resistant strains of Mtb presents a global challenge. This resistance requires longer, more complex, and more toxic treatment regimens, confirming that this ancient “consumption” remains a persistent threat.