Tuberculosis, an infectious disease caused by the bacterium Mycobacterium tuberculosis, has shadowed humanity for millennia. Before modern medicine, it was a relentless and often fatal illness, earning it the ominous title of the “white plague” for its visible and devastating effects on victims.
The Origins of the Name
The term “white plague” emerged in the 1700s to describe the stark appearance of those afflicted with tuberculosis. A primary symptom was a profound pallor, an unnatural paleness of the skin caused by anemia and the wasting effect of the long-term infection. The name created a stark contrast with other major epidemics like the bubonic plague, which was known as the Black Death.
Before it was called the white plague, tuberculosis was widely known as “consumption.” This name described how the disease appeared to consume a person from within, causing dramatic weight loss, fever, and a persistent cough that often produced blood. The slow wasting process and ghostly pallor created a powerful and frightening image of the disease.
Ancient Greeks called it “phthisis,” and it was also known as the “king’s evil” in the Middle Ages, a reference to scrofula, a form of tuberculosis affecting the lymph nodes. In 1834, Johann Schönlein coined the term “tuberculosis,” based on the presence of characteristic nodules called tubercles found in the lungs.
Historical Impact and Cultural Perception
During the 18th and 19th centuries, tuberculosis reached epidemic proportions in Europe and North America, becoming a leading cause of death. The Industrial Revolution was a catalyst for its spread, as rapidly growing cities with overcrowded and poorly ventilated housing created ideal conditions for airborne transmission. The disease thrived in these dense urban environments, disproportionately affecting the working poor.
Despite its devastating reality, tuberculosis was paradoxically romanticized in art and literature. The consumptive’s pale and languid appearance was sometimes viewed as a mark of heightened sensitivity and creativity. This perception was reinforced as the disease afflicted people across all social classes, including prominent artists and writers, contributing to its mystique as an “artist’s disease.”
The primary response to the epidemic before antibiotics was the sanatorium movement, which began in the mid-19th century. Believing the disease could be managed with rest, nutritious food, and fresh air, specialized hospitals called sanatoriums were established in remote locations. Patients would spend months or even years in these institutions, following a strict routine that included many hours outdoors.
The Shift to Modern Treatment
The scientific understanding of tuberculosis changed on March 24, 1882, when German physician Robert Koch announced he had identified the bacterium responsible for the disease, Mycobacterium tuberculosis. Before Koch’s work, many believed the disease was an inherited condition. By isolating the bacillus and demonstrating its role in causing the illness, Koch proved its infectious nature, laying the groundwork for developing targeted treatments.
This breakthrough marked a turning point, but an effective medical treatment remained elusive for several more decades. The next major leap forward came in the 1940s with the discovery of antibiotics. In 1943, a research program led by Selman Waksman resulted in the isolation of streptomycin from a soil bacterium. Clinical trials confirmed its effectiveness against Mycobacterium tuberculosis, showing it could halt the disease’s progression.
The introduction of streptomycin revolutionized tuberculosis care, making a cure possible and leading to a dramatic decline in mortality rates. The success of antibiotic therapy gradually rendered the sanatorium model obsolete, and these institutions closed. It was also discovered that using a combination of several antibiotics was more effective and helped prevent the development of drug resistance.
Tuberculosis in the 21st Century
Tuberculosis is far from a vanquished disease and remains a significant global public health problem. In 2021, an estimated 10.6 million people fell ill and 1.6 million died. While its prevalence has decreased in industrialized nations, it continues to be a major cause of death and disability in many developing countries, particularly in sub-Saharan Africa and Asia.
A formidable challenge in the modern fight against tuberculosis is the emergence and spread of drug-resistant strains. Multidrug-resistant TB (MDR-TB) is a form of the disease that does not respond to the two most powerful first-line antibiotic drugs, isoniazid and rifampicin. Extensively drug-resistant TB (XDR-TB) is even more dangerous, showing resistance to additional second-line drugs, leaving patients with fewer and often more toxic treatment options.
Modern preventative strategies include the Bacille Calmette-Guérin (BCG) vaccine, which has been in use for a century. The BCG vaccine is given to infants and young children in countries with a high prevalence of TB and is effective at preventing severe forms of the disease in this age group. Today’s standard treatment for drug-susceptible TB involves a six-month course of four different antibiotics, a regimen that is highly effective when completed.