In a “Remember When” column written a few months ago, Kristina Smiley described an event that occurred 50 years ago pertaining to required tuberculosis (TB) testing in Warsaw Community Schools.

At that time, following the discovery of a single case, letters were sent to the parents of all students who were considered to have come into contact with that student. Tine tests were administered to 178 students and were negative except for one individual.

Such testing is not routinely done today and the disease does not receive much attention in the United States. It is considered an ancient disease by most of us. However, it is the leading cause of infectious disease and continues to be a major challenge to global health.

According to the National Institutes of Health, each day roughly 5,000 people die of TB disease, resulting in nearly 2 million deaths in 2016 alone. Surprisingly, more than 1 billion people died of TB during the last 200 years, more deaths than from malaria, influenza, smallpox, HIV/AIDS, cholera and plague combined.

Tuberculosis is caused by a bacterium called Mycobacterium tuberculosis. The bacteria usually attack the lungs, but TB bacteria can attack any part of the body such as the kidney, spine and brain. Not everyone infected with TB bacteria becomes sick. As a result, two TB-related conditions exist: latent TB infection (LTBI) and TB disease. If not treated properly, TB disease can be fatal.

Tuberculosis bacilli are among the oldest and most widespread on Earth, and the liability to tubercular infection long antedated the emergence of humanity itself. Stone Age and Egyptian Old Kingdom skeletons have been diagnosed as exhibiting signs of tubercular damage.

It has been hypothesized that the genus Mycobacterium originated more than 150 million years ago. In the middle ages, scrofula, a disease of the cervical lymph nodes, was described as a new clinical form of TB. The illness was known in England and France as "king's evil," and it was widely believed that persons affected could heal after a royal touch.

In 1720, for the first time, the infectious origin of TB was conjectured by the English physician Benjamin Marten, while the first remedy against TB was the introduction of the sanitarium cure. The famous scientist Robert Koch was able to isolate the tubercle bacillus and presented his result to the Society of Physiology in Berlin on March 24, 1882. In the decades following this discovery, tuberculin skin tests, two partially effective vaccines, and anti-tuberculous drugs were developed.

“Tuberculosis” is an easy shorthand for pulmonary tuberculosis, from which most of the tuberculous suffer, although the disease is horribly ubiquitous. In addition to the lungs, it destroys the tissues of most of the body’s systems — central nervous, circulatory, lymphatic, gastrointestinal, genitourinary, as well as the bones, joints and skin. Something of an oddity among the infectious diseases, tuberculosis has an undefined incubation period (from contact to symptoms), and a typically chronic course.

TB once killed more people than any other single disease; the danger of death from consumption, as pulmonary tuberculosis was commonly called, tracked the footsteps of young men and women and loomed over courting couples for as long as they lived. Contracted in childhood or adolescence, tuberculosis left its victims more vulnerable to chronic or wasting illness in later years.

In the middle of the 19th century, diseases of the lung caused up to 25 percent of all deaths reported, and early in the 20th century, when Americans were generally healthier, tuberculosis continued to head the list of fatal contagious diseases, al-though though it resulted in fewer deaths. Even when tuberculosis had slipped to seventh place in the roster of fatal diseases by 1930, it remained terribly destructive — the most frequent cause of death or disability during the critical ages of 15 through 45.

During that time, the uncertainties of treatment also magnified the public's fear of contagion. When a man was found to have tuberculosis, he received a notice to quit his job and schoolchildren with the disease were ordered to stay home indefinitely.

Unfortunately, due to its infectious nature, chronic progression and the need for long-term care, TB continues to be a worldwide health problem. In more recent years, the appearance of multi-drug resistance and the current human immunodeficiency virus (HIV) epidemic have presented additional challenges in designing therapy. (HIV weakens the immune system, increasing the risk of TB in patients with HIV.)

Multi-drug resistance has been a global problem and it threatens the inhabitants of countries in Europe, Asia, Africa and the Americas. An effort is being made by the World Health Organization and the U.S. government to address fundamental TB research and to stimulate applied efforts to develop new diagnostic and therapeutic treatment methods.

Max Sherman is a medical writer and pharmacist retired from the medical device industry. He has taught college courses on regulatory and compliance issues at Ivy Tech, Grace College and Butler University. Sherman has an unquenchable thirst for knowledge on all levels. Eclectic Science, the title of his column, will touch on famed doctors and scientists, human senses, aging, various diseases, and little-known facts about many species, including their contributions to scientific research. He can be reached by email at maxsherman339@gmail.com.