history of tuberculosis history of tuberculosis throughout history, the disease tuberculosis has been variously known as consumption, phthisis, and the white plague. it is generally accepted that the causative agent, mycobacterium tuberculosis originated from other, more primitive organisms of the same genus mycobacterium. in 2014, results of a new dna study of a tuberculosis genome reconstructed from remains in southern peru suggest that human tuberculosis is less than 6,000 years old. even if researchers theorise that humans first acquired it in africa about 5,000 years ago, there is evidence that the first tuberculosis infection happened about 9,000 years ago. it spread to other humans along trade routes. it also spread to domesticated animals in africa, such as goats and cows. seals and sea lions that bred on african beaches are believed to have acquired the disease and carried it across the atlantic to south america. hunters would have been the first humans to contract the disease there. la miseria by cristóbal rojas (1886). rojas had tuberculosis when he painted this. here he depicts the social aspect of the disease, and its relation with living conditions at the close of the 19th century. origins scientific work investigating the evolutionary origins of the mycobacterium tuberculosis complex has concluded that the most recent common ancestor of the complex was a human-specific pathogen, which underwent a population bottleneck. analysis of mycobacterial interspersed repetitive units has allowed dating of the bottleneck to approximately 40,000 years ago, which corresponds to the period subsequent to the expansion of homo sapiens sapiens out of africa. this analysis of mycobacterial interspersed repetitive units also dated the mycobacterium bovis lineage as dispersing approximately 6,000 years ago, which may be linked to animal domestication and early farming. human bones from the neolithic show presence of the bacteria. there has also been a claim of evidence of lesions characteristic of tuberculosis in a 500,000-year-old homo erectus fossil, although this finding is controversial. results of a genome study reported in 2014 suggest that tuberculosis is newer than previously thought. scientists were able to recreate the genome of the bacteria from remains of 1,000-year-old skeletons in southern peru. in dating the dna, they found it was less than 6,000 years old. they also found it related most closely to a tuberculosis strain in seals, and have theorized that these animals were the mode of transmission from africa to south america. the team from university of tübingen believe that humans acquired the disease in africa about 5,000 years ago. their domesticated animals, such as goats and cows, contracted it from them. seals acquired it when coming up on african beaches for breeding, and carried it across the atlantic. in addition, tb spread via humans on the trade routes of the old world. other researchers have argued there is other evidence that suggests the tuberculosis bacteria is older than 6,000 years. this tb strain found in peru is different from that prevalent today in the americas, which is more closely related to a later eurasian strain likely brought by european colonists. however, this result is criticised by other experts from the field, for instance because there is evidence of the presence of mycobacterium tuberculosis in 9,000 year old skeletal remains. although relatively little is known about its frequency before the 19th century, its incidence is thought to have peaked between the end of the 18th century and the end of the 19th century. over time, the various cultures of the world gave the illness different names: phthisis (greek), consumptio (latin), yaksma (india), and chaky oncay (incan), each of which make reference to the "drying" or "consuming" effect of the illness, cachexia. in the 19th century, tb's high mortality rate among young and middle-aged adults and the surge of romanticism, which stressed feeling over reason, caused many to refer to the disease as the "romantic disease". tuberculosis in early civilization external video michael carson persistence of the white plague, tb, uci open, 50 minutes in 2008, evidence for tuberculosis infection was discovered in human remains from the neolithic era dating from 9,000 years ago, in atlit yam, a settlement in the eastern mediterranean. this finding was confirmed by morphological and molecular methods; to date it is the oldest evidence of tuberculosis infection in humans. evidence of the infection in humans was also found in a cemetery near heidelberg, in the neolithic bone remains that show evidence of the type of angulation often seen with spinal tuberculosis. some authors call tuberculosis the first disease known to mankind. signs of the disease have also been found in egyptian mummies dated between 3000 and 2400 bc. the most convincing case was found in the mummy of priest nesperehen, discovered by grebart in 1881, which featured evidence of spinal tuberculosis with the characteristic psoas abscesses. similar features were discovered on other mummies like that of the priest philoc and throughout the cemeteries of thebes. it appears likely that akhenaten and his wife nefertiti both died from tuberculosis, and evidence indicates that hospitals for tuberculosis existed in egypt as early as 1500 bc. the ebers papyrus, an important egyptian medical treatise from around 1550 bc, describes a pulmonary consumption associated with the cervical lymph nodes. it recommended that it be treated with the surgical lancing of the cyst and the application of a ground mixture of acacia seyal, peas, fruits, animal blood, insect blood, honey and salt. the old testament mentions a consumptive illness that would affect the jewish people if they stray from god. it is listed in the section of curses given before they enter the land of canaan. the east ancient india the first references to tuberculosis in non-european civilization is found in the vedas. the oldest of them (rigveda, 1500 bc) calls the disease yaksma. the atharvaveda calls it balasa. it is in the atharvaveda that the first description of scrofula is given. the sushruta samhita, written around 600 bc, recommends that the disease be treated with breast milk, various meats, alcohol and rest. the yajurveda advises affected individuals to move to higher altitudes. ancient china the classical chinese word lào 癆 "consumption; tuberculosis" was the common name in traditional chinese medicine and fèijiéhé 肺結核 (lit. "lung knot kernel") "pulmonary tuberculosis" is the modern medical term. lao is compounded in names like xulao 虛癆 with "empty; void", láobìng 癆病 with "sickness", láozhài 癆瘵 with " sickness", and feilao 肺癆 with "lungs". zhang and unschuld explain that the medical term xulao 虛癆 "depletion exhaustion" includes infectious and consumptive pathologies, such as laozhai 癆瘵 "exhaustion with consumption" or laozhaichong 癆瘵蟲 "exhaustion consumption bugs/worms". they retrospectively identify feilao 肺癆 "lung exhaustion" and infectious feilao chuanshi 肺癆傳尸 "lung exhaustion by corpse transmission as "consumption/tuberculosis". describing foreign loanwords in early medical terminology, zhang and unschuld note the phonetic similarity between chinese feixiao 肺消 (from old chinese **pʰot-ssew) "lung consumption" and ancient greek phthisis "pulmonary tuberculosis". the huangdi neijing classic chinese medical text (c. 400 bce – 260 ce), traditionally attributed to the mythical yellow emperor, describes a disease believed to be tuberculosis, called xulao bing (虛癆病 "weak consumptive disease"), characterized by persistent cough, abnormal appearance, fever, a weak and fast pulse, chest obstructions, and shortness of breath. the huangdi neijing describes an incurable disease called huaifu 壞府 "bad palace", which commentators interpret as tuberculous. "as for a string which is cut, its sound is hoarse. as for wood which has become old, its leaves are shed. as for a disease which is in the depth , the sound it is hiccup. when a man has these three , this is called 'destroyed palace'. toxic drugs do not bring a cure; short needles cannot seize . wang bing's commentary explains that fu 府 "palace" stands for xiong 胸 "chest", and huai "destroy" implies "injure the palace and seize the disease". the huangdi neijing compiler yang shangshan notes, "the proposed here very much resembles tuberculosis ... hence states: poisonous drugs bring no cure; it cannot be seized with short needles." the shennong bencaojing pharmacopeia (c. 200–250 ce), attributed to the legendary inventor of agriculture shennong "divine farmer", also refers to tuberculosis the zhouhou beiji fang 肘后备急方 "handbook of prescriptions for emergencies", attributed to the daoist scholar ge hong (263–420), uses the name of shizhu 尸疰 "corpse disease; tuberculosis" and describes the symptoms and contagion: "this disease has many changing symptoms varying from thirty-six to ninety-nine different kinds. generally it gives rise to a high fever, sweating, asthenia, unlocalised pains, making all positions difficult. gradually, after months and years of suffering, this lingering disease brings about death to the sufferer. afterwards it is transferred to others until the whole family is wiped out." song dynasty (920–1279) daoist priest-doctors first recorded that tuberculosis, called shīzhài 尸瘵 (lit. "corpse disease") "disease which changes a living being into a corpse", was caused by a specific parasite or pathogen, centuries earlier than their contemporaries in other countries. the duanchu shizhai pin 斷除尸瘵品 "on the extermination of the corpse disease" is the 23rd chapter in daoist collection wushang xuanyuan santian yutang dafa 無上玄元三天玉堂大法 "great rites of the jade hall of the three heavens of the supreme mysterious origins" (daozang number 103). the text has a preface dated 1126, written by the song dynasty zhengyi dao master lu shizhong 路時中, who founded the yutang dafa 玉堂大法 tradition, but internal evidence reveals that the text could not have been written before 1158. the disaster of the contagious disease, which changes a living being into a corpse, is caused by the infectious of the nine parasites (ch'ung 蟲). it is also caused by overworking one's mind and exhausting one's energy, injuring one's ch'i and loosening one's sperm—all of which happen to common folk. when the original vitality is being exhausted, the evil aura begins to be transmitted through the affected vital ch'i . ... the aspects of the illness vary, and the causes of contamination are different. rooms and food are capable of gradual contamination, and the clothes worn by the indisposed are twined easily with the infectious ch'i and these two become inseparable. ... the symptoms of the disease: when it begins, the sufferer coughs and pants; he spits blood ; he is emaciated and skinny; cold and fever affect him intermittently, and his dreams are morbid. this is the evidence that this person is suffering from the disease which is also known as wu-ch'uan 屋傳 . ... the disease may be contracted by a healthy person who happens to have slept in the same bed with the patient, or worn his clothes. after the death of the sufferer, the clothes, curtains, bed or couch, vessels and utensils used by him are known to have been contaminated by and saturated with the polluted ch'i in which the noxious ku 蠱 take their abode. stingy people wish to keep them for further use, and the poorer families cannot afford to get rid of them and buy everything anew. isn't this lamentable, since it creates the cause of the great misfortune yet to come! this passage refers to the cause of tb in ancient medical terminology of jiuchong 九蟲 "nine worms" and gu 蠱 "supernatural agents causing disease", and qi. the nine worms generically meant "bodily parasites; intestinal worms" and were associated with the sanshi 三尸 "three corpses" or sanchong 三蟲 "three worms", which were believed to be biospiritual parasites that live in the human body and seek to hasten their host's death. daoist medical texts give different lists and descriptions of the nine worms. the boji fang 博濟方 "prescriptions for universal dispensation", collected by wang gun王袞 (fl. 1041), calls the supposed tb pathogen laochong 癆蟲 "tuberculosis worms". this duanchu shizhai pin chapter (23/7b-8b) explains that the present nine worms does not refer to the intestinal weichong 胃蟲 "stomach worms", huichong 蛔蟲 "coiling worm; roundworm", or cun baichong 寸白蟲 "inch-long white worm; nematode", and says the supposed six tb worms are "six kinds" of parasites, but the next chapter (24/20a-21b) says they are "six stages/generations" of reproduction. daoist priests allegedly cured tuberculosis through drugs, acupuncture, and burning fulu "supernatural talismans/charms". burning magic talismans would cause the tb patient to cough, which was considered an effective treatment. to cure the disease, it is necessary to produce a spout of smoke by burning off thirty-six charms, and instruct the patient to inhale and to swallow