<P> The first genuine success in immunizing against tuberculosis was developed from attenuated bovine - strain tuberculosis by Albert Calmette and Camille Guérin in 1906 . It was called "BCG" (Bacille Calmette - Guérin). The BCG vaccine was first used on humans in 1921 in France, but it was not until after World War II that BCG received widespread acceptance in Great Britain, and Germany . In the early days of the British National Health Service X-ray examination for TB increased dramatically but rates of vaccination were initially very low . In 1953 it was agreed that secondary school pupils should be vaccinated, but by the end of 1954 only 250,000 people had been vaccinated . By 1956 this had risen to 600,000, about half being school children . </P> <P> As the century progressed, some surgical interventions, including the pneumothorax or plombage technique--collapsing an infected lung to "rest" it and allow the lesions to heal--were used to treat tuberculosis . Pneumothorax was not a new technique by any means . In 1696, Giorgio Baglivi reported a general improvement in tuberculosis sufferers after they received sword wounds to the chest . F.H. Ramadge induced the first successful therapeutic pneumothorax in 1834, and reported subsequently the patient was cured . It was in the 20th century, however, that scientists sought to rigorously investigate the effectiveness of such procedures . In 1939, the British Journal of Tuberculosis published a study by Oli Hjaltested and Kjeld Törning on 191 patients undergoing the procedure between 1925 and 1931; in 1951, Roger Mitchell published several articles on the therapeutic outcomes of 557 patients treated between 1930 and 1939 at Trudeau Sanatorium in Saranac Lake . The search for a medicinal cure, however, continued in earnest . </P> <P> In 1944 Albert Schatz, Elizabeth Bugie, and Selman Waksman isolated streptomycin produced by a bacterial strain Streptomyces griseus . Streptomycin was the first effective antibiotic against M. tuberculosis . This discovery is generally considered the beginning of the modern era of tuberculosis, although the true revolution began some years later, in 1952, with the development of isoniazid, the first oral mycobactericidal drug . The advent of rifampin in the 1970s hastened recovery times, and significantly reduced the number of tuberculosis cases until the 1980s . </P> <P> The British epidemiologist Thomas McKeown had shown that' treatment by streptomycin reduced the number of deaths since it was introduced (1948 - 71) by 51 per cent ...' . However, he also showed that the mortality from TB in England and Wales had already declined by 90 to 95% before streptomycin and BCG - vaccination were widely available, and that the contribution of antibiotics to the decline of mortality from TB was actually very small:'...for the total period since cause of death was first recorded (1848--71) the reduction was 3.2 per cent' . These figures have since been confirmed for all western countries (see for example the decline in TB mortality in the USA) and for all then known infectious diseases . McKeown explained the decline in mortality from infectious diseases by an improved standard of living, particularly by better nutrition, and by better hygiene, and less by medical intervention . McKeown, who is considered as the father of social medicine, has advocated for many years, that with drugs and vaccines we may win the battle but will lose the war against Diseases of Poverty . Thereto, efforts and resources should be primarily directed toward improving the standard of living of people in low resource countries, and toward improving their environment by providing clean water, sanitation, better housing, education, safety and justice, and access to medical care . Particularly the work of Noble laureates Robert W. Fogel (1993) and Angus Deaton (2015) have greatly contributed to the recent reappreciation of the McKeown thesis . A negative confirmation of the McKeown thesis was that increased pressure on wages by IMF loans to post-communist Eastern European were strongly associated with a rise in TB incidence, prevalence and mortality . </P>

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