On a cold winter night thousands of years ago, people were sitting in the caves of Africa to warm them. The plumes of smoke lingered above the flames, and coughs came from time to time among the crowd. A microorganism that usually lives in the soil sneaks into people's inflamed respiratory tract. Biologists at the University of New South Wales in Australia believe that this may be the origin of the oldest human disease, tuberculosis.
Tuberculosis was once called the "head of death" in the West, and it is even said in China that "ten to nine deaths." Until the treatment of Mycobacterium tuberculosis in 1882 and the isolation of streptomycin in 1944, with the advent of antibiotics, BCG and chemotherapy drugs, tuberculosis finally no longer had the same name as death.
Humans have not been able to completely defeat it to this day, but the significance of civilization is that we recognize infectious diseases and accept that human life will always be necessary to fight against viruses.
TB history is almost as long as human history
The British used to believe that tuberculosis was transmitted from Rome to the British Isles. Until Simon, a British archaeologist, discovered that tuberculosis existed in remote British villages 2300 years ago.
Archaeologists have researched ancient human remains and found that as early as the Heidelberg Stone Age in Germany, humans had typical tuberculous lesions in the fourth and fifth thoracic spine. This indicates that tuberculosis is already present 7000 years ago.
Tuberculous lesions were also found on the spine of the mummy in the excavated ancient Egyptian tomb. Nubian mummy had five cases of spinal tuberculosis, and the fifth Dynasty mummy of 2500 BC had bone and joint tuberculosis. A corpse of calcification of tuberculosis was found in the left lung of a female corpse 2100 years ago unearthed from the Han Tomb No. 1 at Mawangdui, China.
Unlike most other infectious epidemics, most of them are transmitted from animals to humans. The latest scientific hypothesis believes that tuberculosis appears to be a human disease at first, and then transmitted from humans to other animals. Tuberculosis pathogens have been found in the remains of African elephants 4,000 years ago. Towards the end of the last ice age, giant mastodons died of tuberculosis.
Tuberculosis in Chinese and Western Classics: Consumption
"Consumption" is a name for early tuberculosis. Consumption literally translates "consumption", which means that this disease will slowly exhaust life, which corresponds to the ancient Chinese name of "pulmonary dysentery".
In the Song Dynasty, the names of tuberculosis infectious diseases were cadaver, laborer, wormworm, and cadaver. According to the characteristics of the symptoms, the names include pulmonary fistula, labor cough, and acute dysentery. In the Song Dynasty, rickets (rickets) were used instead of other names. In the late Qing Dynasty, traditional Chinese medicine called tuberculosis tuberculosis.
The earliest record of tuberculosis in ancient China can be seen from the "Huang Di Nei Jing Su Wen" more than 2,000 years ago. The description of "five deficiency and five labor" is in line with the obvious characteristics of tuberculosis. The same symptoms are also recorded in Zhang Zhongjing's "A Brief Guide to the Golden Depression" in the Eastern Han Dynasty and Hua Jing's "The Book of Tibet".
Pulmonary tuberculosis was considered to belong to the category of wasting disease before the Han Dynasty. In the Song Dynasty, Chen Yan put forward the theory that rickets originated from "maggots" in "Three Causes and One Disease Syndrome", and gradually began to realize the contagious nature of tuberculosis.
"10 deaths and 9 deaths" is not an exaggeration
Human beings have long been unknown about TB and have not hindered its development at all. The West later referred to tuberculosis as "the leading cause of human death", and at some point in history it became the disease with the highest mortality rate.
In the 17th century, tuberculosis was rare in rural England, and limited human interaction isolated the development of the virus. With the advent of the industrial revolution in the eighteenth century, the development of cities brought frequent population movements, and a large number of laborers flocked from rural to urban areas. The cold and humid industrial plants, the poor living conditions in the slums, coupled with heavy physical labor and severe malnutrition, gave the best opportunity for survival and transmission of tuberculosis bacteria.
A full-scale outbreak in Britain began, with 1 in 799 deaths from tuberculosis in 1799. Viruses are trapped throughout Europe, and a quarter of Europeans are killed by tuberculosis. In the nineteenth century, tuberculosis began to ravage the United States, with 400 deaths per 100,000 people.
In the first half of the twentieth century, tuberculosis began to spread in China. Until 1949, there were still 27 million tuberculosis patients nationwide, and more than 1.38 million people died of tuberculosis each year. The annual mortality rate is 307 / 100,000, and the number of people infected with tuberculosis over 18 years of age is as high as 90%. "Of the people born before 1921, few people have no tuberculosis bacteria."
When Aunt Hua in Lu Xun's novel "Medicine" heard the word "cricket", her face changed. Hua Xiaoshuan ate the blood hoe of the person who healed, and did not save his life. Lu Xun eventually died of dysentery.
Prior to the discovery of streptomycin, tuberculosis in China was in a state of no cure. Even if streptomycin is later applied to the clinic, the average patient still cannot consume it. "10 deaths and 9 deaths" was not an exaggerated statement at the time.
From blond hungry therapy to cottage healing
In medieval England and France, tuberculosis was called "the king's evil", and the answer was "the king's touch." It is believed that the king will be cured by touching the lymphatic tuberculosis with his hand. In the 14th century, Philip VI of France touched a total of 1,500 patients during a ceremony. This treatment continued in Britain until the eighteenth century, and in France until the nineteenth century.
Early medicine also sought to stop the development of the disease through bloodletting and starvation. In the 19th century, after the English poet Keats became ill, he received doctors' bloodletting treatments and hunger therapy with a small piece of bread and a small fish every day. He was only 25 years old when he died.
In the 1840s, the living environment and living conditions were considered to be helpful for the rehabilitation of the disease, and the treatment of tuberculosis gradually entered the era of nursing homes.
In 1841, the British established Brompton Hospital, becoming the earliest specialized tuberculosis hospital. In 1854, Bremer established a social undertaking for the treatment of tuberculosis in the mountains of Germany. By 1859, it had become a professional tuberculosis nursing home. He emphasized the improvement of the circulatory system through exercise, fresh air, hydrotherapy and rest, pushing TB into the sanatorium era.
In 1884, Trudeau, an American doctor with tuberculosis, was inspired by Bremer and founded the first TB sanatorium in the United States, a "Cottage Sanatorium", on the shores of Lake Salanak. He also later created a "tuberculosis university", and many of his physical and psychological care methods are still in use today.
The ongoing threat of drug-resistant tuberculosis
Whether it is bloodletting therapy, collapse therapy or self-healing, it means that humans have not actually faced the pathogen.
In 1882, German scientist Robert Koch studied the lungs of tuberculosis patients. After repeated experiments, it was found that the bacteria were transparent but could not be observed with a microscope. Using methylene blue to stain lung tissue, Koch finally found thin rod-shaped tuberculosis bacteria.
On March 24, 1882, Koch announced at the Physiological Society of Berlin that the Mycobacterium tuberculosis pathogen was discovered. This is the first time that humans have found the cause of tuberculosis. In 1905, Koch received the Nobel Prize in Physiology or Medicine.
In 1921, French bacteriologist Carmel and Jie Lin invented the BCG vaccine and successfully inoculated the infants to prevent tuberculosis. In 1944, American scientists isolated streptomycin, the first antibiotic to be effective against Mycobacterium tuberculosis. The same year streptomycin was used in the clinic, marking the beginning of the era of tuberculosis chemotherapy.
In 1951, several pharmaceutical companies including Bayer, Bristol-Myers Squibb and Roche discovered another tuberculosis treatment drug, isoniazid, at the same time. Isoniazid is more potent and less toxic, and is not expensive because there is no patent dispute.
Subsequently, isoniazid, streptomycin, and sodium p-aminosalicylate were combined into a standard chemotherapy regimen (long-term therapy), and drugs such as ramifen, rifampicin, ethambutol were also synthesized in succession.
People finally understand the cause and transmission mechanism, and they have spread a lot about the prevention and treatment of tuberculosis. The incidence and mortality of tuberculosis are also gradually decreasing. However, the life cycle evolution of pathogens is much faster than that of humans, and Mycobacterium tuberculosis is an organism that easily develops resistance.
The "2017 Global TB Report" states that TB is the ninth leading cause of death worldwide, even higher than AIDS, and AIDS will aggravate TB.
Drug-resistant tuberculosis is an ongoing threat, and humans have not fully conquered it. Looking back at the struggle between humans and tuberculosis, we may be able to re-understand the medicine of infectious diseases. There is no doomsday rhetoric and it is not inspiring. It is just that "the virus brings us death and pain, and it also brings us life and future."
West China Metropolis Daily-Cover News reporter Xue Weirui
【references】
Carl Zimmer: The Viral Planet, translated by Liu Ye, Guilin: Guangxi Normal University Press, 2019
Susan Sontag: Metaphors of Diseases, translated by Cheng Wei, Shanghai: Shanghai Translation Publishing House, 2018
Richard Barnett: Sick Rose, translated by Guo Tengjie, Taiwan: Maitian Press, 2015
Wei Jian: Twenty Plagues That Changed Human Society, Beijing: Economic Daily Press, 2003
Xiao Shuiquan, Liu Aizhong: The History of the Plague, Changsha: Hunan Science and Technology Press, 2004
Shi Junshi, Zhang Huimin, Xu Bo, Xiao Yuhuan, Shi Lianke: "History of the Discovery of Tuberculosis Patients", China Tropical Medicine, 2008
Ed Yong, Translated by Ye Ya, Tuberculosis Born in Fire
Dr. Why, From "The King's Evil" to "White Plague"
World Health Organization, Global TB Report 2017