Where does that come from? A regular column that examines the history and origins of a particular medical topic.

Tuberculosis (TB)
This disease has seen a renaissance in recent years in concert with the HIV infection, creating a dangerous synergy where each makes the other more deadly. It is thought that currently one-third of the world's population is latently affected by TB and two million people die of it each year, mainly in Africa where both afflictions are rampant.

Due to its characteristic loss of weight, before the 20th century it was commonly known as ‘consumption' or ‘phthisis' (from the Greek phthinein, meaning to waste away). Bones from the Palaeolithic and Neolithic era have shown evidence of such a disease and its contagious character was first described by the Arabic physician, Avicenna (AD 980-1037).

Its bacterial cause was first isolated by the German bacteriologist, Robert Koch, in 1882. The first definitive treatment emerged in 1944 when the Russian, Selman Waksman, discovered Streptomycin.

Malaria
Carried by mosquitoes, this is the commonest ailment (after dental caries) in the world. In Africa alone it kills about one million people a year; world-wide it affects 200 to 300 million people, mainly in tropical and subtropical countries. Up to the 1920s it occurred sporadically in Western Europe.

During the Roman Empire the marshes near Rome were a breeding ground for mosquitoes, and the Empire's decline is regarded in part to have been due to infection from a virulent form when the drainage system fell into disrepair. Thousands died and the mental and physical condition of the population was undermined. The Mayans in Mexico and the temple builders of Cambodia disastrously fell victim to the malady. Oliver Cromwell died in England of ‘the ague' (its then name) in 1658

A fanciful story about the discovery of cinchona bark, the first treatment, tells that early in the 17th century the Countess of Chinchon (sic), wife of the Viceroy of Peru, was miraculously cured of the ague by powder prepared from the bark of a tree. The tree became known as the cinchona and its by-product, quinine, or Countess's Powder. As a thanksgiving she distributed large quantities to the citizens of Lima and later introduced it to Spain. Unfortunately for the legend, 60 years ago it was shown that the Viceroy's first wife never went to Peru and his second led a remarkably healthy life.

The French physician, Charles Laveran, found the parasite responsible for malaria in 1880, and in 1897 the British epidemiologist Ronald Ross discovered the link between mosquitoes and malaria. Both received the Nobel Prize for their work.

Yellow fever
Also referred to as Yellow Jack, this is a mosquito borne disease and was very common in West Africa and South America. It is said to have wiped out most of the sailors from Columbus's ship the Santa Maria and the population of the second largest island in the West Indies, Hispaniola (formerly Santo Domingo) which he discovered in 1492.

Philadelphia with its swamps, stagnant water and solitary sewer was a likely candidate for an epidemic and, sure enough, in 1793 the city was devastated.

The accompanying jaundice gave the malady its name and ‘yellow fever' was first used in 1750. In 1881, Carlos Findley from Cuba was the first to believe it was transmitted by mosquitoes. Proof came in 1900 through a US Army Commission under Walter Reed. He famously allowed James Carroll and Jesse Lazear to be bitten by infected insects. Both contracted the disease: Carroll recovered, but Lazear died 12 days later. The connection between vector and disease was proved.

During the construction of the Panama Canal in the 1880s the death rate from yellow fever and malaria was 176 per 1000 but, because of sanitation brigades organised by William Gorgas, by 1906 it was reduced to nil.

Smallpox
Evidence of this disease has been found in Egyptian mummies. This was exclusively a human disease, with a fatality rate of 25 percent. It was eradicated in South America in 1970, India in 1975 and Africa (Somalia) in 1977. The WHO declared total eradication in 1979. In passing, ‘greatpox' was syphilis.

Many of those who survived were pock marked for life and commonly rendered partially or totally blind. Inoculation was practised in ancient China when dry powdered pox crusts were blown into the nose. Not until Edward Jenner introduced ‘vaccination' with the fluid from cowpox in 1796 was a prophylaxis made available.

Abraham Lincoln contracted a mild dose of smallpox at Gettysburg after giving his famous address in 1863. In 1562 the badly affected Queen Elizabeth I was given up for lost but recovered, though losing much of her hair. William III's wife Queen Mary died of smallpox in 1694, and the only surviving child (out of 17) of her sister, Queen Anne, succumbed at the age of 11, thus bringing to an end the Stuart dynasty in England.

Typhoid
Mortality for this water and food borne disease is about 10 percent, but two percent of those who recover become permanent carriers, most by the lodging of the organism in their gallbladder and being excreted in their faeces.

Poor sanitation and the burgeoning of cities in the early 19th century saw the condition at its most rampant. The bacillus was first identified in 1880 by Edwin Klebs and by 1900 a vaccine had been developed.

During the American Civil War and the Boer War, deaths from this disease easily outstripped war casualties. Prince Albert, consort of Queen Victoria, died of it and 20 years later hope was abandoned for Edward, Prince of Wales; he survived. As recently as 1931 the novelist Arnold Bennett died of typhoid, said to have been contracted after drinking the tap water in Paris.

Typhus
Also called ‘spotted fever', this disease is unusual in that it is transmitted by the human body louse. Case fatality varies between five to 40 percent; one attack usually confers life-long immunity. The louse is happiest in a warm, unwashed environment, so occurs chiefly in times of social dislocation such as war and mass migration.

The first clear description was given by Fracastorius in 1528 when he observed typhus rash and fever among French troops besieging Naples. With no knowledge of bacteria, he rightly ascribed infection to direct contact with lice. It dogged Napoleon's army during the Russian campaign and ravaged Ireland during the Great Famine of the 1840s.

Although the method of transmission had been suspected for years, it was not proved until 1906. The causative bacterium was isolated in 1910; the researcher died of the disease shortly after.

In Serbia during WWI it killed 150,000 people and continued to smoulder among returning Russian troops leading to an epidemic which engulfed the country between 1918 and 1922. An estimated 30 percent of the population was infected and 2.5 million people died, leading Lenin to remark, ‘Either the louse will defeat socialism, or socialism will defeat the louse.'

ACSM #47