So far as our information goes, pulmonary tuberculosis has always existed. It is, as Professor Hirsch remarks, "A disease of all times, all countries, and all races. No climate, no latitude, no occupation, forms a safeguard against the onset of tuberculosis, however such conditions may mitigate its ravages or retard its progress. Consumption dogs the steps of man wherever he may be found, and claims its victims among every age, class and race."

Hippocrates, the most celebrated physician of antiquity (460-377 B. C.), and the true father of scientific medicine, gives a description of pulmonary tuberculosis, ascribing it to a suppuration of the lungs, which may arise in various ways, and declares it a disease most difficult to treat, proving fatal to the greatest number.

Isocrates, also a Greek physician and contemporary of Hippocrates, was the first to write of tuberculosis as a disease transmissible through contagion.

Aretaeus Cappadox (50 A. D.) describes tuberculosis as a special pathological process. His clinical picture is considered one of the best in literature.

Galen (131-201 A. D.) did not get much beyond Hippocrates in the study of tuberculosis, but was very specific in his recommendation of a milk diet and dry climate. He held it dangerous to pass an entire day in the company of a tuberculous patient.

During the next fifteen centuries, a period known as the Dark Ages and characterized by most intense intellectual stagnation, little was added to the knowledge of pulmonary tuberculosis. In the seventeenth century Franciscus Sylvius brought out the relationship between phthisis and nodules in the lymphatic glands. This was the first step toward accurate knowledge of the pathology of tuberculosis.

Richard Morton, an English physician, wrote, in 1689, of the wide prevalence of pulmonary tuberculosis, and recognized the two types of fever: the acute inflammatory at the beginning, and the hectic at the end. He also recognized the contagious nature of the disease and recommended fresh air treatment. He believed the disease curable in the early stages, but warned us of its liability to recur. Morton taught that the tubercle was the pathological evidence of the disease.

In 1690, Leeuwenhoek, a Dutch lens maker, started the making of short range glasses which resulted later in the modern microscope, making possible the establishment of the germ theory of disease, including the establishment of that theory for tuberculosis.

Starck, whose observations and writings were published in 1785 (fifteen years after his death), gave a more accurate description of tubercles than had ever been given before, and showed how cavities were formed from them.

Leopold Auenbrugger introduced into medicine the method of recognizing diseases of the chest by percussion, tapping directly upon the chest with the tips of his fingers. The results of his investigations were published in a pamphlet in 1761. This new practice was ignored at first, but after the work of Auenbrugger was translated he attained a European reputation and a revolution in the knowledge of diseases of the chest followed.

Boyle recognized in miliary tubercle, as it was afterwards called by him, the anatomical basis of tuberculosis as a general disease, and, in 1810, published the results of one of the most complete researches in pathology. He described the stages in the development of the disease, using miliary tubercle as its starting point. He opposed the theory that inflammation caused tuberculosis and declared hemorrhage a result and not a cause of consumption.

Laennec discovered one of the most important, perhaps, of all methods of medical diagnosis—that of auscultation. By means of the stethoscope, which he invented in 1819, he recognized the physical signs and made the first careful study of the healing of tuberculosis; he gave also one of the best accounts of the sputum of the consumptive. He believed that every manifestation of the disease in man or animals was due to one and the same cause.

Up to this time the views which were held concerning the infectious nature of tuberculosis were not based upon direct experiment, but in 1843 Klenke produced artificial tuberculosis by inoculation. He injected tuberculous matter into the jugular vein of a rabbit, and six months later found tuberculosis of the liver and lungs. He did not continue, however, his researches; so they were soon forgotten.

To Villemin, a French physician, belongs the immortal fame of being the first to show the essential distinction in tuberculosis between the virus causing the disease and the lesion produced by it. By inoculating animals, he demonstrated that tuberculosis is a specific disease caused by a specific agent. His paper presented in 1865 before the Academy of Medicine in France contained a detailed account of his experimental investigations. This was a most remarkable contribution to scientific medicine.

It remained for Robert Koch in 1882, after years of painstaking investigation, to announce to the world the discovery of a definite bacillus as the causative agent in all forms of tuberculous lesions. Koch isolated, cultivated outside the body, described and differentiated the infective organism of tuberculosis and proved that it could continue to produce the same lesions indefinitely. He showed the presence of the bacilli in all known tuberculous lesions and in tuberculous expectoration, and demonstrated the virulence in sputum which had been dried for eight weeks.

Following directly upon the knowledge of the cause of tuberculosis came the recognition of its curability, and the proper means of its prevention. Although good food and fresh air have always been considered of importance in the treatment of the disease, it was not until the middle of the nineteenth century that anything like systematic treatment was undertaken.

Dr. George Bodingon of Sutton Coldfield, England, wrote an essay in 1840 advocating fresh air treatment. He denounced the common hospital in large towns as a most unfit place for consumptive patients, and established a home for their care, but met with so much opposition that it was soon closed.

In 1856, Hermann Brehmer wrote a thesis on the subject which has been the foundation of our modern treatment. He opened a small sanatorium in 1864. Five years later he established the sanatorium at Goerbersdorf, in Silesia, which eventually became the largest in the world. He advocated life in the open air, abundant dietary and constant medical supervision. He believed that the heart of the large majority of consumptives is small and undeveloped, and that this predisposes them to the disease. In accordance with this theory he put a great deal of emphasis on exercise in the treatment of his patients. He built walks of various grades on the grounds of his sanatorium and installed a system of walking exercise. Patients began with the lowest grade, gradually accustoming themselves to ascend to the highest. Brehmer was himself a consumptive, and was cured by the method he so firmly believed in.

Dr. Dettweiler, who opened the second sanatorium in Germany, at Falkenstein, near Frankfort, was also a consumptive, having developed tuberculosis during the arduous campaign in the Franco-Prussian War in 1871. He entered the Goerbersdorf Sanatorium as a patient, becoming later an assistant of Brehmer. Dr. Dettweiler laid great emphasis upon rest in treatment.

In 1888, Dr. Otto Walther opened his famous sanatorium at Nordrach in the Black Forest, in Germany.

The first sanatorium for the care of the consumptive in the United States was opened at Saranac Lake by Dr. Edward L. Trudeau in 1884. He was the pioneer of the sanatorium treatment in this country, and an example of what a man, although tuberculous himself, can do for his fellow men. In 1874, a seemingly helpless invalid, he made his home in the Adirondack Mountains. A little more than twenty-five years ago he became the founder of a village now crowded with tuberculous patients. The Saranac Lake institution, which began with one small cottage, has since developed into the best known sanatorium in this country.

In 1891, Dr. Herman Biggs posted the first anti-spitting ordinance in the street railway cars of New York.

Dr. Lawrence Flick brought about the formation of the first anti-tuberculosis society in 1892, and in 1894 the City of New York adopted a law to enforce notification and registration.

Dr. Philip of Edinburgh was the first to systematically and completely organize the anti-tuberculosis campaign. In 1887 he inaugurated that new institution, the anti-tuberculosis dispensary, which has since rendered such inestimable service. The fundamental principle of the Edinburgh system is that the disease should be sought out in its haunts.

The first dispensary in the United States was opened in New York in 1904, modeled after the Edinburgh system. About the same time came the Open Air Schools—Charlottenburg establishing one in 1904 and Providence, R. I., following in 1908. The first Day Camp in the United States was opened in 1905 in Boston. New Jersey established the first Preventorium for Children at Farmingdale in 1909. All this naturally led to better provision for advanced cases; sanatoria for hopeful cases at small cost; factory inspection; and, in some countries, industrial colonies for arrested cases.

The tuberculosis patient of today presents a hopefulness previously undreamt of. The outlook is brighter with promise than ever before, and we have every reason to look forward to a steady reduction in the mortality rate from this dread disease; but the extinction of tuberculosis will be achieved only when the social and economic problems have been solved.