History of Tuberculosis - Seventeenth and Eighteenth Centuries

Seventeenth and Eighteenth Centuries

Franciscus Sylvius began differentiating between the various forms of tuberculosis (pulmonary, ganglion). He was the first person to recognize that the skin ulcers caused by scrofula resembled tubercles seen in phthisis, noting that "phthisis is the scrofula of the lung" in his book Opera Medica published posthumously in 1679. Around the same time, Thomas Willis concluded that all diseases of the chest must ultimately lead to consumption. Willis did not know the exact cause of the disease but he blamed it on sugar or an acidity of the blood. Richard Morton published Phthisiologia, seu exercitationes de Phthisi tribus libris comprehensae in 1689, in which he emphasized the tubercle as the true cause of the disease. So common was the disease at the time that Morton is quoted as saying "I cannot sufficiently admire that anyone, at least after he comes to the flower of his youth, can dye without a touch of consumption."

In 1720, Benjamin Marten proposed in A New Theory of Consumptions more Especially of Phthisis or Consumption of the Lungs that the cause of tuberculosis was some type of animacula—microscopic living beings that are able to survive in a new body (similar to the ones described by Anton van Leeuwenhoek in 1695). The theory was roundly rejected and it took another 162 years before Robert Koch demonstrated it to be true.

In 1768, Robert Whytt gave the first clinical description of tuberculosis meningitis and in 1779, Percivall Pott, an English surgeon, described the vertebral lesions that carry his name. In 1761, Leopold Auenbrugger, an Austrian physician, developed the percussion method of diagnosing tuberculosis, a method rediscovered some years later in 1797 by Jean-Nicolas Corvisart of France. After finding it useful, Corvisart made it readily available to the academic community by translating it into French.

William Stark proposed that ordinary lung tubercles could eventually evolve into ulcers and cavities, believing that the different forms of tuberculosis were simply different manifestations of the same disease. Unfortunately, Stark died at the age of thirty (while studying scurvy) and his observations were discounted. In his Systematik de speziellen Pathologie und Therapie, J. L. Schönlein, Professor of Medicine in Zurich, proposed that the word "tuberculosis" be used to describe the affliction of tubercles.

The incidence of tuberculosis grew progressively during the Middle Ages and Renaissance, displacing leprosy, peaking between the 18th and 19th century as field workers moved to the cities looking for work. When he released his study in 1808, William Woolcombe was astonished at the prevalence of tuberculosis in 18th century England. Of the 1,571 deaths in the English city of Bristol between 1790 and 1796, 683 were due to tuberculosis. Remote towns, initially isolated from the disease, slowly succumbed. The consumption deaths in the village of Holycross in Shropshire between 1750 and 1759 were one in six (1:6); ten years later, 1:3. In the metropolis of London, 1:7 died from consumption at the dawn of the 18th century, by 1750 that proportion grew to 1:5.25 and surged to 1:4.2 by around the start of the 19th century. The Industrial Revolution coupled with poverty and squalor created the optimal environment for the propagation of the disease.