"The toll of tuberculosis often surpasses the sacrifices made in wars"

Tuberculosis remains a significant public health challenge worldwide, closely linked to social and economic conditions. Although it primarily affects developing countries, developed and industrialized nations are not entirely spared. In 2022, EU/EEA member states reported 33,676 cases of tuberculosis, with 3,300 deaths attributed to the disease — a reminder that this ancient disease has never been fully vanquished.

Looking back into the past, archaeological evidence suggests that tuberculosis has afflicted populations in Eurasia and Africa since the Neolithic period. During the Middle Ages, the disease had a significant impact on Europe, but in the 18th century it gained momentum and became a real epidemic in many countries, driven by the rapid expansion of industrialization and urbanization. In England and Wales, tuberculosis was responsible for roughly 13% of all deaths between 1851 and 1910.

Tuberculosis in the Transylvanian Press

Late 19th-century articles from the Transylvanian press stressed the alarming virulence of tuberculosis, which had become increasingly widespread, "attacking people when they should be more productive, and valuable to their families and the nation." It was emphasized that tuberculosis mortality in Romania stood at 11.5% and in Hungary at 12.5% of the total number of deaths.

In several Transylvanian newspapers, under the heading "The Ravages of Tuberculosis," tuberculosis mortality data were regularly published. In March 1910 alone, 910 deaths were recorded across Transylvania's counties.

Figure 1

Statistical data on tuberculosis deaths in the counties of Transylvania, March 1910

Source: Brassói Lapok (1910). 16 (228): 3.

The press frequently condemned the habit of spitting on the ground: "Do not spit on the ground, or fight against phthisis." It recommended the use of spittoons or handkerchiefs to be disinfected to prevent the spread of countless microbes present in the sputum of the infected.

Reports on tuberculosis often conveyed an alarming tone: "the toll tuberculosis often surpasses the sacrifices made in wars" (Gazeta Transilvaniei, 1910). Tuberculosis was regarded as "the plague of the age, and there is no man who does not have to mourn the death of a relative who has fallen victim to it."

Medical Imagery and Public Awareness

The press of the time also included medical popularisation columns in which images of a medical nature were published, reflecting the growing concern about tuberculosis and the effort to educate the general public. From microscopic images of Koch's bacilli to illustrations of the progressive destruction of lung tissue, these visual representations served to make the disease tangible and to raise public awareness.

Figure 2

Tuberculosis bacilli viewed under the microscope, rod-shaped, in coagulated sputum

Source: Az Érdekes Ujság (1914) 1 (21): 32–33.

Figure 3

Severe tuberculosis, with bacilli appearing in dense clusters

Source: Az Érdekes Ujság (1914) 1 (21): 32–33.

Figure 4

Diseased lung apex, with purulent cavities where the tissue was completely destroyed

Source: Az Érdekes Ujság (1914) 1 (21): 32–33.

Figure 5

Galloping tuberculosis, with total destruction of the upper third of the lung

Source: Az Érdekes Ujság (1914) 1 (21): 32–33.

Statistical Analysis: The Hungarian Central Reports

During World War I, the Hungarian Central Statistical Office began publishing a report on the devastating impact of tuberculosis, seen as a serious threat to population growth. The study covering 1901 to 1915 revealed that 967,738 people had died from tuberculosis in Hungary — nearly one million deaths. Over this 15-year period, tuberculosis was responsible for 14.4% of all deaths in Hungary, with an even higher rate of 20.3% in Budapest, and 12.7% in Transylvania.

The report also highlighted significant regional differences in tuberculosis mortality, with notable variations between counties and settlements. It drew attention to the high number of deaths among Roman Catholics, Greek Catholics, Orthodox, and Calvinist communities, and emphasized that tuberculosis primarily affected adults in "the most valuable age groups from the point of view of the economy and the maintenance of the species."

Findings from the Historical Population Database of Transylvania (HPDT)

A recent study drawing on data from the Historical Population Database of Transylvania (HPDT) examined tuberculosis-related deaths among adults across 23 localities in six Transylvanian counties (Alba, Cluj, Mureș, Harghita, Hunedoara, and Bistrița-Năsăud) over the period 1850–1914. The findings revealed that tuberculosis accounted for the deaths of 10% of adults in Transylvania, primarily affecting young and middle-aged individuals, with a comparatively lesser impact on older age groups.

The period 1881–1914, characterised by accelerated industrialisation, saw a notable rise in tuberculosis-related mortality. Deaths were less frequent in peripheral localities, pointing to the significant role of environmental conditions and occupational exposures. The disease disproportionately affected semi-skilled and skilled workers, as well as members of the upper-middle class — underscoring that tuberculosis spared no one, irrespective of social standing, power, or wealth. Men and women were equally susceptible to Mycobacterium tuberculosis.

Figure 6

Distribution of deaths by different characteristics — by sex, denomination, locality type, socio-economic category, period, and age group

Source: Holom & Hărăguș (2025)

Tuberculosis mortality was lower among Orthodox communities, which may reflect either a degree of biological or social protection, or disparities in the accuracy of cause-of-death registration. The study confirmed that tuberculosis grew progressively more lethal in Transylvania as the twentieth century approached.