Call it phthisis, consumption, TB or something else, it is still a nasty disease — and one that most of my readers will have avoided. Not all: I have a relative with a scar the size of a five cent coin on one lung that was the result of a close contact.

In the 19th century, it was a common way to go. but presumably many of the weakest humans succumbed, and many of the strongest bacteria killed too quickly. We have the image of TB as a slow disease, because it was the slow versions that had the best chance to kill. Evolution, we call it — by no means enough to make a new species, but enough to change both the human species and the bacterial species.

It isn't limited to us or bacteria: the virus that caused myxomatosis also evolved, and so did Australia's rabbit population, which is why myxo is no longer useful against rabbits.

The treatments that were offered for TB were peculiar, to say the least. One way to treat the night sweats that were common was to oil the person all over with olive oil, so as to seal the pores — that was mentioned in 'Scientific American' in early 1859, just about the time people began to realise that there were things called bacteria that caused diseases, and the best cure was to wipe out the bacteria.

Some of the 19th century TB infections were in odd places as well — W. E. Henley, a passable poet and Robert Louis Stevenson's editor, lost a foot to TB and inspired RLS to invent Long John Silver. I think there was also a naïve Inuit population who were infected in the head, rather than in the lungs.

Still, TB is a thing of the past, isn't it?

Not any more. In the past ten years, one of the scourges that we saw off with antibiotics is back — in large part because we squandered those special tools. For many diseases, there is only vancomycin left, but in America, idiot poultry farmers use a close analogue, avoparcin, to make their chooks grow faster. About five years ago, the first vancomycin-resistant infection occurred in a fork-lift driver who worked in the US poultry industry.

As an undergraduate, I learned about how bacteria were able to transfer genes, forty years ago. Now, we are beginning to pay the price. XDRTB or extreme drug-resistant tuberculosis, has entered the lexicon. And it has entered the population, in a return of fast TB.

In people with a compromised immune system, such as HIV-positive people, XDRTB is killing in around 25 days. A paper that appeared yesterday in the British Medical Journal said that among 536 cases of tuberculosis confirmed at a rural hospital in South Africa earlier this year, 41% were multi-drug resistant and of those, 24% met the exact definition of being extensively drug resistant tuberculosis (also referred to as XDR tuberculosis). Such tuberculosis, said the journal, is almost untreatable.

All patients in this outbreak who were tested were HIV positive and 52 of the 53 died after an average of 25 days. Worse, strains of extensively drug resistant tuberculosis have also been noted in Europe, Asia and North and South America. It appears that there are several strains of this tuberculosis.

This is how the world ends — not with a bang, with a whimper.