1.2. In the beginning

The reference section of NTI library contains a carefully stacked and faded mimeographed prized document, The Plan Of Operations For The National TB Programme (NTP), India4. This contains exhaustive details of the avowed objectives of the NTI. If one wants to peep into the beginning, uncertainties creep in. When and where was the NTI born? What necessitated its birth? Who or which agencies endeavoured in formulating its ideology? What made the government set it up? The events are as important as their prime movers. There can be several versions, each as important as its narrator. Therefore, any story narrated will have shortcomings.

Obviously, the most dominant reason was the TB disease itself. With its long history across the world, as the captain of all the killers, (white plague, consumption, or phthisis) TB was a major killer threatening the Indian subcontinent too. TB was known in India as kshaya, j` rajrog amOam{J and yakshma `j_m. There are descriptions of a disease closely resembling TB from the Vedic times. The word kshaya means literally wasting away, like consumption, the name given by John Bunyan of England in the 17th century5. Till the middle of the 19th century, the cause was unknown. Hence, virtually any line of treatment was adopted in our country as elsewhere. Noticing multiple cases of pulmonary TB in households, people began to believe that the disease could be hereditary. The disease was feared as much as the taboos woven around it.

Researchers in Europe were the first to act on progressive lines. Rene Theodore Laennec (1781-1826), the inventor of the stethoscope, who himself suffered from consumption, laid the foundations of the knowledge of the etiology of TB6. After a series of experiments, Jean Antonine Villemen (1827-1892) demonstrated in 1868 that TB could be transmitted to rabbits by inoculation of tubercular material from human and bovine sources; the disease could later be passed from animal to animal. He said: "(i) TB is a specific infection; (ii) it is caused by an agent readily inoculable; (iii) inoculation from man to rabbit can be readily performed". Villemen predicted that his work would herald a new era of research that would lead to the prevention and cure of TB. In effect, TB comes from TB! 7

Robert Koch’s (1843-1910) first investigations were on the anthrax bacilli. He observed their development from spores by inventing the ‘hanging drop’ technique. By 1877, he was able to fix smears. He evolved a method for the cultivation of germs on solid media and on coagulated human serum by an astute combination of heat fixing the bacilli to the glass slides and prolonged staining techniques. He, thus, discovered the causative agent of TB. The bacilli appeared brilliant blue and were associated with TB in human and animals. 8