Enrico Pieragnoli and the prevention of tuberculosis: Florence 1906.

Tuberculosis (TBC) is today a health priority in Asia, Africa, and South America and a re-emerging social disease in the Western World. While the pharmacological therapy of TBC is nowadays well established, preventive measures are still under-powered and under-estimated. Current failures in the prevention of tuberculosis are even more surprising considering that, already a century ago a comprehensive preventive of defence against TBC had been designed by clinicians and ante-litteram 'health care managers' such as Enrico Pieragnoli. Pieragnoli was an Italian physician who lived in Florence between the XIX and XX century, and who, after many years of accurate planning, succeeded in 1906 in opening the first Italian tuberculosis preventive centre. Pieragnoli considered it his mission to 'fight' against TBC, a public enemy that was to be defeated using the weapons of global prevention; Pieragnoli had crystal clear concepts of prevention, of the predisposing factors to the disease, and of the need for aggressive treatment. He established his preventive institute with two main aims: the modification of the individual substratum in which the germs grew and the removal of contagion. The prophylactic and diagnostic accuracy of his preventive institute are shown in a number of clinical documents containing objective body measurements (height, weight, thoracic circumference), quantitative clinical comparisons (intra-and inter-subjects) and field epidemiology. We may therefore conclude that the cornerstone of 'evidence-based' prevention of tuberculosis was present in Italy almost a century ago.