Beatrice Mahler, MD,
Associate Professor at the “Carol Davila”
University of Medicine and Pharmacy,
Head of the Pulmonology Clinic I at the “Marius
Nasta” Institute of Pulmonology
The historical positioning of tuberculosis Disease is not a choice; it constitutes, in the life of any human being, a profound state of vulnerability that tests the dignity, resources and social relationships of the affected person. Tuberculosis, in particular, is not only a medical condition — it is also a social and historical phenomenon. Although today we possess extensive knowledge about the etiologic agent and transmission mechanisms, this disease has accompanied humanity for millennia: bone lesions in mummies more than 6,000 years old indicate the presence of a pathology compatible with tuberculosis, a fact that reaffirms its persistent character and the discrepancy between its clinical presence and our medical understanding.
Only about 150 years ago, with Robert Koch’s discovery in 1882, was tuberculosis definitively recognized as an infectious disease. The discovery of the tubercle bacillus marked an epistemological turning point: it transformed the diagnosis and management of this malady, but it did not eliminate the prejudices, ignorance and social stigma that had accompanied it for centuries. The anecdote about the microscope given to Koch underscores the role of scientific instruments in unraveling biological mysteries, but also the fragility of progress: knowledge advances, yet social mentalities often lag far behind in adapting, and I would say they still have not adapted sufficiently.
Perceptions of tuberculosis, especially in nineteenth- and twentieth-century Europe and America, were shaped by cultural context and therapeutic limitations of the time. In the absence of effective therapies, clinical descriptions and literature associated the disease with aesthetic images and myths: pallor, physical frailty and a kind of melancholy were romanticized, and the presence of tuberculosis among certain artists consolidated a misleading image that cloaked suffering in the guise of false glory. At the same time, pseudoscientific explanations — heredity, supposedly “favorable” temperamental types — perpetuated erroneous ideas that survived even after the infectious nature of the disease was established.
The clinical features associated with tuberculosis — cachexia, severe anemia, secondary endocrine disorders — were often reinterpreted as aesthetic traits, amplifying the paradox: the extreme suffering of people was transformed, in cultural discourse, into an aesthetic symbol. This mystification often led to a misapprehension of the disease, and patients became objects of an imaginary that minimized their real therapeutic needs. Social stigma has been and remains one of the most painful consequences of tuberculosis. Isolation, shame and the fear of social exclusion often inhibit seeking medical help, delay diagnosis and compromise adherence to treatment, thereby fueling the cycle of transmission and suffering. Even after the pathogen was identified and treatments became available, socio-economic transformations — industrialization, rapid urbanization, poor working conditions — created contexts favorable to the spread of the disease, relocating it from the “stronghold of artists” to urban working-class environments subjected to adverse living conditions.
Globally, tuberculosis remains a major public health problem: every year millions of people are affected and the loss of human lives continues to be alarming. This reality obliges us, from an ethical and professional standpoint, to engage firmly in prevention, early diagnosis, appropriate treatment and stigma reduction. Moreover, in recent years, victims of tuberculosis have increasingly included people from above-average socio-economic backgrounds who, exhausted by work and disconnected from self-care, experience weakened immunity that allows latent infection to progress to active disease.
The recent history of tuberculosis in Romania
Tuberculosis has been part of Romania’s history, adapting to the country’s socio-economic particularities. The first hospital dedicated to tuberculosis patients was opened in 1906 on Șoseaua Viilor with capacity for 100 patients, and shortly thereafter the first specialized dispensary was established. In the absence of effective pharmacological treatments, interventions focused on removing patients from the environment—primarily to protect healthy people— hypercaloric nutrition and cure by fresh air and sunlight: practices that reflect both the therapeutic limitations of the era and a concern for environmental factors in disease control.
Systematic tuberculosis surveillance in Romania was organized more coherently beginning in the 1970s, and important steps in consolidating complex tuberculosis management were taken at the start of the twenty-first century. In 2002, a dedicated system for multidrug-resistant tuberculosis was implemented for the first time, and these efforts continued and diversified in subsequent decades.
In recent years, the activity of the “Marius Nasta” Institute of Pneumophthisiology, during my managerial mandate that began in 2017, generated projects relevant to improving patient care: multidisciplinary professional training programs; the national tuberculosis screening, which received financial support in 2019 and again with a new project in 2024 from the Ministry of European Funds; as well as projects funded by Norway that allowed the strengthening of laboratory equipment for rapid diagnosis and ensured access to medication for drug-resistant forms of tuberculosis. These interventions, carried out during my mandate, facilitated Romania’s inclusion among countries able to implement shortened regimens for drug-resistant tuberculosis.
Another important initiative was the development of the TBC outpatient service, an initiative through which patients with non-contagious forms or with adequate isolation conditions have been able to receive treatment at home since 2020. It is necessary to note the starting point: until 2020, a compulsory 40-day hospitalization was required for all tuberculosis patients. This measure represented a pragmatic and humane solution for tuberculosis patients, underscored by the context of the recent health crisis, offering a safe alternative that protected both patients and the health system.
Building a healthy, functional and equitable system requires coherence among three fundamental pillars: specialized human resources, adequately equipped infrastructure, and the continuous provision of medicines. In this sense, my involvement in the preliminary stages for the construction of new buildings — Zerlendi — beginning with feasibility studies, design, permits, securing financing and coordinating the works, represents concrete actions to which I contributed. Such steps materialize the hope that initiated programs, which have come to life, will produce tangible benefits for patients and the community.
Public education, community health approaches and social support Combating tuberculosis requires not only medical interventions but also an integrated approach that includes education, community interventions and social policies. Correct information reduces unfounded fears and can foster early diagnosis; stigma, so deeply present in society, can be alleviated through the association of psychosocial support services that mitigate stigmatization’s effects. The empathy of family, community and health professionals is not merely an act of compassion but an essential therapeutic component for recovery and reintegration.
Conclusion
Tuberculosis remains a complex medical and social challenge: a disease with deep historical roots to which science and human solidarity can offer effective responses. It is imperative to combine scientific progress with coherent public policies and a social discourse that eliminates prejudice. Only thus can we transform individual suffering into the story of a community that recognizes, treats and reintegrates those affected with dignity.
