Riding the waves: optimism and realism in the treatment of TB

The history of treatment for pulmonary tuberculosis can be divided into two eras: before and after the advent of antibiotics. What had been treated but had proven incurable for millennia became curable in the early 1950s, when the combination of streptomycin, para-aminosalicylic acid (PAS), and isoniazid effectively cleansed the body of invading mycobacteria. Subsequently more easily administered, better-tolerated drugs advanced treatment protocols and brought greater benefits. It would be wrong to suggest that drugs were the only solution; education, screening, vaccination, and prevention measures were essential. But the ability to cure transformed the experience and meaning of tuberculosis. What then could these two eras have in common? It turns out that those tasked with caring for the tuberculous needed, and continue to need, the ability to ride out the waves of optimism and realism, even hubris and despair, associated with this ancient enemy, described by the French pathological anatomist G L Bayle (1774—1816) as the “longest and most dangerous of all chronic diseases”.