Manchester Royal Infirmary

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• Manchester Royal Infirmary
• Postgraduate Education Centre
• 20th November 2008
• Dr C C Evans MD. FRCP. FRCPI.
• The History of Tuberculosis Treatment

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• TB Early Management Time Line
• Hammurabi 1900 BC
• Sanskrit 1500 BC
• Asklepius 1250 BC
• Hippocrates 400 BC
• Aristotle 350 BC
• Pliny 50 AD
• Galen 131 AD
• Dark Ages
• Villanova 1280 AD
• Edward 1st / Charles 2nd
• Benjamin Marten 1720
• Virchov 1850
• Koch 1882
• Rontgen 1896

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Hammurabi CodeNo 148 If a man takes a wife
and she becomes afflicted with disease, and if he
set his face to take another he may. His wife,
who is afflicted with the disease, he shall not
put away. She shall remain in the house which
she has built and he shall maintain her as long
as she lives
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• NAPT 1898
• AIR CROWDING
• BAD FOOD OVER WORK
• DRINK STRAIN

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Chemotherapy
Streptomycin (S) Waksman 1944 PAS (PAS) Lehmann
1946 Isoniazid (H) Selikoff 1952 Pyrazinamide (Z)
1954 Ethambutol (E) 1962 Rifampicin (R) 19
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MRC Crofton RCT
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• Evidence Based Medicine Hierarchy
• Highest Level META Analysis of good quality
  RCTGood Quality RCTsModerate / Poor RCTsGood
  Quality Cohort StudyPoor Quality Cohort
  StudyCase Control StudyCase SeriesCase
  ReportsExpert Opinion
• Lowest Level

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