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The TB germ may be as old as the Earth itself - surviving in the primeval mud at the very beginning of time.

Originally by Frederick Marais.

The germ first infected animals - possibly inhaled or ingested from the soil, and it would have been passed on to humans through the animals' flesh and milk. It affects many kinds of animals including cows, birds, fish and reptiles.

The earliest evidence of TB in humans is from a neolithic grave near Heidleberg, Germany, dating back to 5000BC, examinations of the spines of mummies and of tomb paintings from 4000BC confirm TB as a common disease in Egypt, and skeletal remains in Italy from the same date also show TB in the spine.

Around 2500 BC - 1500 BC TB was established in mainland Europe, but the earliest evidence of the disease in Britain comes from graves dating from the Roman occupation (55 BC - 800 AD).

By the mid 17th Century, one in five deaths in London - as recorded in the Bills of Mortality - were due to TB (consumption). TB soon became an epidemic in Britain and major cities in the USA and Europe - becoming known as the "White Plague".

By the turn of the 19th Century, the estimation of world wide TB death rate was 7 million per year and pulmonary TB rate - 50 million per year. London and New York were two of the worst affected cities. This led to the fear that by the end of the 19th Century European civilisation might be destroyed.

In 1882 in Germany, Dr Robert Koch discovered the bacterial cause of TB, and in 1931 in France, Drs Calmette and Guerin discovered Bacillus Calmett-Guerin (BCG) - a 'tamed' living bacterium. However safety problems occurred during the trials and there were many deaths as a result.

In the USA in 1942, Drs Feldman and Hinshaw reported the first drug trial (Promin) in the treatment of TB. Unfortunately this trial was unsuccessful due to significant side effects. In January 1944 Drs Schatz, Bugie and Waksman were able to announce to the world the discovery of a drug called 'Streptomycin' and 'Patricia', a 21 year old woman was the first patient to be successfully treated with the drug.

In 1946 a paper was published by Dr Lehmann concerning the discovery of Para-Amino-Salicylic (PAS) in the treatment of TB and in 1952 at Seaview Hospital, New York, a new wonderdrug called 'Isoniazid' was used to treat TB patients by Drs Robizek and Selikoff.

BCG Vaccination had been introduced in France and Scandinavia following a survey of 50,000 children which showed an 80% reduction in infection rate. Britain adopted a vaccination programme in the 1950's, America however didn't - as their research showed contrary conclusions.

In 1960 Dr John Crofton a TB expert at the University of Edinburgh proposed that a combination of drugs, Streptomycin, PAS and Isoniazid made TB completely curable and he declared "all out war" to conquer the disease. His proposals included the pasteurization of milk, tuberculin testing of cattle, BCG vaccinations of whole populations, mass radiography for the early detection of disease, triple therapy for every infected patient, isolation of the infectious until no longer so and reduction in household overcrowding. All this would hopefully be accompanied by a general improvement in the standard of living.

From the 1950s to 1985 the USA saw a rapid decline in TB disease and deaths, for instance 84,304 contracted the disease in 1953, reducing to 22,201 in 1985, and 19,707 died in 1953 reducing to 1752 in 1985. However since 1985 this decline halted and a progressive rise has been seen. A total increase of about 9% per year.

A survey (1961-1968) in the USA which examined drugs susceptability results among TB hospitalised patients found 3.5% resistance to at least one drug - and the USA reported the first outbreak of drug resistant TB in 1970. From then until 1990 the USA experienced a few outbreaks involving small numbers of Isoniazid-resistant and multi drug resistant TB. In Britain the decline in notifications continued for 40 years, remaining virtually static before rising again and by 1991 an increase of 5% was reported. By now this pattern was being repeated in most of Western Europe.

From 1990 - 1992 the Centers for Disease Control (CDC) in Atlanta USA, investigated outbreaks of multidrug-resistant TB in eight hospitals in Florida, New York and New Jersey. One also occurred in the NY State Correctional System. These outbreaks involved large numbers of cases. TB was found to be transmitted not only from patient to patient, but also from patient to health care worker. Also 80% of cases were HIV positive.

The first report of MDR-TB outbreak at a London hospital HIV Unit occurred in August 1995 - and the second in June 1996.

In 1998 the World Health Organisation (WHO) reports that of all infectious diseases, TB is at present the most lethal one for children and adults and is killing more people than in any other year in history. The global graph of TB suggests that about a third of the world's population is infected with tuberculosis and it is estimated 7-8 million new cases of active TB are occurring each year. TB is now causing 2-3 million deaths each year.

The WHO proposes that the recommended way to cure tuberculosis is by means of Directly Observed Therapy (DOT). The DOT system cures more than 95% of individuals with TB, even in the poorest countries; DOT prevents new infections from appearing and it works to help prevent the development of multidrug-resistant TB (MDR-TB). The World Bank identified DOT as one of the 'most cost effective of all health interventions'

The prospect of new, faster TB drugs is gaining momentum, after a 40-year delay in private sector development.

Dr Jack Chow, Assistant Director-General of the WHO HIV/AIDS, TB and Malaria cluster and Dr Mario Raviglione, Director of Stop TB, threw their support behind this critical goal at a meeting of the Stakeholders of the Global Alliance for TB Drug Development on 30 October 2003 in Paris.

Dr Chow applauded the Stakeholders for embracing a key task that others "would rather walk away from". He added: "The development of new TB drugs will have a profound impact on the way we fight the greatest joint threat now facing us -- the combined TB-HIV epidemic."

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