In spite of an array of effective antibiotics, tuberculosis is still very common in developing countries where overcrowding, malnutrition and poor hygienic conditions prevail. Over the past 30 years associated HIV infection has worsened the situation by increasing the infection rate and mortality of tuberculosis. Of those diseases caused by a single organism only HIV causes more deaths internationally than tuberculosis. The tubercle bacillus probably first infected man in Neolithic times, and then via infected cattle, but the causative Mycobacteriacea have been in existence for 300 million years. Droplet infection is the most common way of acquiring tuberculosis, although ingestion (e.g. of infected cows' milk) may occur. Tuberculosis probably originated in Africa. The earliest path gnomonic evidence of human tuberculosis in man was found in osteo-archaeological findings of bone tuberculosis (Pott's disease of the spine) in the skeleton of anEgyptian priest from the 21st Dynasty (approximately 1 000 BC). Suggestive but not conclusiveevidence of tuberculotic lesions had been found in even earlier skeletons from Egypt and Europe. Medical hieroglyphics from ancient Egypt are silent on the disease, which could be tuberculosis,as do early Indian and Chinese writings. The Old Testament refers to the disease schachapeth, translated as phthisis in the Greek Septuagint. Although the Bible is not specific about this condition, tuberculosis is still called schachapeth in modern Hebrew. In pre-Hippocratic Greece Homer did not mention phthisis, a word meaning non-specific wasting of the body. However. Alexander of Tralles (6th century BC) seemed to narrow the concept down to a specific disease, and in the Hippocratic Corpus (5th-4th centuries BC) phthisis can be recognised as tuberculosis. It was predominantly a respiratory disease commonly seen and considered to be caused by an imbalance of bodily humours. It was commonest in autumn, winter and spring, tended to affect groups of people living close together, and young people in particular. Pregnancy exacerbated phthisis which was characterised by a chronic cough (worse at night), prominent sputum, often blood streaked and presumably arising from necrotic lung tissue. The face was typically flushed with sunken cheeks, sharp nose and very bright eyes. There was atrophy of all muscles with prominent (“winged”) shoulder blades, fever and perspiration often associated with shivering. Symptoms were described which would fit in with complicating lung abscess and empyema. Hippocrates also mentions disease entities which would fit in with extra-pulmonary tuberculosis, like Pott's disease of the spine and cervical lymphadenopathy (scrofula), although he did not associate this with phthisis. Minimal specific therapy was prescribed. Subsequent writers in the Hellenistic and Roman eras added little to the classic Hippocratic clinical picture of phthisis, but Celsus (1st century AD) and Galen (2nd century) first suggested that it was a contagious condition. From Themison (1st century BC) onwards, therapeutic regimes became more drastic with the addition of inter alia strict dietary regimes, purges, enemas and venesection. Celsus suggested long sea voyages with ample relaxation and a change of climate. Aretaeus (1st century AD) stressed the importance of not exacerbating the suffering of people with chronic disease by imposing aggressive therapy. Except for the introduction of more drastic therapy the concept of phthisis (tuberculosis) had thus not progressed materially in the course of the millennium between Hippocrates and the end of the Roman era – and it would indeed remain virtually static for the next 1 000 years up to the Renaissance. There is, however, some evidence that the incidence of tuberculosis decreased during the major migration of nations which characterised the late Roman Empire.
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机译：尽管存在多种有效的抗生素，但在拥挤，营养不良和卫生条件差的发展中国家，结核病仍然很普遍。在过去的30年中，相关的HIV感染通过增加结核病的感染率和死亡率使情况恶化。在由单一生物体引起的那些疾病中，只有HIV在国际上比结核病造成更多的死亡。结核杆菌可能首先在新石器时代感染了人类，然后又通过被感染的牛感染，但是致病性分枝杆菌已经存在了3亿年。尽管可能会发生食入（例如感染被感染的牛奶），但液滴感染是获得肺结核的最常见方式。结核病可能起源于非洲。人类结核病的最早途径是在21世纪一位埃及神父的骨骼中（大约公元前10,000年）在一名埃及牧师的骨骼中发现了结核病（脊柱的波特氏病）的骨骼考古发现。甚至在来自埃及和欧洲的早期骨骼中也发现了结核性病变的提示性但非结论性证据。来自古埃及的医学象形文字对这种疾病（可能是结核病）保持沉默，就像印度和中国早期的著作一样。旧约是指沙迦病，在希腊语Septuagint中被翻译为phthisis。尽管圣经没有具体说明这种情况，但在现代希伯来语中，结核病仍被称为沙迦。在希波克拉底前的希腊，荷马没有提到“ phthisis”，这是指身体非特定性的浪费。然而。特拉勒斯（Alexander of Tralles）（公元前6世纪）似乎将概念缩小到特定疾病，在希波克拉底语料库（公元前5至4世纪）中，phthisis被认为是肺结核。它主要是呼吸道疾病，通常被认为是由身体体味失衡引起的。这在秋季，冬季和春季最为普遍，往往会影响到在一起生活的人群，尤其是年轻人。妊娠加重了Phthisis，其特征是慢性咳嗽（夜间更糟），痰液突出，血液经常流血，可能是由坏死的肺组织引起的。脸部通常脸颊凹陷，鼻子尖锐，眼睛非常明亮。所有肌肉均萎缩，肩shoulder骨突出（“有翼”），发烧和出汗通常与发抖有关。症状描述与复杂的肺脓肿和脓胸相吻合。希波克拉底还提到了与肺外结核病相适应的疾病实体，例如脊椎波特病和子宫颈淋巴结病（阴囊），尽管他并未将其与咽部炎相关联。开了最少的特异性疗法。希腊和罗马时代的后来作家几乎没有对希波克拉底的this鱼这种典型临床现象加些什么，但塞尔苏斯（公元1世纪）和盖伦（2世纪）首先提出这是一种传染性疾病。从Themison（公元前1世纪）开始，治疗方案变得更加激烈，尤其是增加了严格的饮食方案，净化，灌肠和穿刺术。塞尔苏斯建议长途航行，要有充分的放松和气候变化。 Aretaeus（公元1世纪）强调了通过采取积极的治疗措施而不加重慢性病患者的痛苦的重要性。因此，除了引入更为激进的疗法外，在希波克拉底和罗马时代结束之间的千年间，Phthisis（结核病）的概念并未取得实质性进展，并且在接下来的一千多年中，它的确将保持不变。到文艺复兴时期。但是，有一些证据表明，在以罗马帝国晚期为特征的国家大规模迁徙期间，结核病的发病率有所下降。
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