Two of humankind's most socially and psychologically devastating diseases, tuberculosis and leprosy, have been the subject of intensive paleopathological research due to their antiquity, a presumed association with human settlement and subsistence patterns, and their propensity to leave characteristic lesions on skeletal and mummified remains. Despite a long history of medical research and the development of effective chemotherapy, these diseases remain global health threats even in the 21st century, and as such, their causative agents Mycobacterium tuberculosis and M. leprae, respectively, have recently been the subject of molecular genetics research. The new genome-level data for several mycobacterial species have informed extensive phylogenetic analyses that call into question previously accepted theories concerning the origins and antiquity of these diseases. Of special note is the fact that all new models are in broad agreement that human TB predated that in other animals, including cattle and other domesticates, and that this disease originated at least 35,000 years ago and probably closer to 2.6 million years ago. In this work, we review current phylogenetic and biogeographic models derived from molecular biology and explore their implications for the global development of TB and leprosy, past and present. In so doing, we also briefly review the skeletal evidence for TB and leprosy, explore the current status of these pathogens, critically consider current methods for identifying ancient mycobacterial DNA, and evaluate coevolutionary models. Yrbk Phys At the close of the first decade of the 21st century, a number of factors converge to make a review of mycobacterial disease timely. The first of these is the re-emergence of human tuberculosis (TB) in epidemic proportions on a global scale. As emphasized in the section on Mycobacterial diseases: The Historical, Epidemiological, and Ecological Context Section, by the mid-point of the 20th century the disease was thought to be conquerable and by the 1980s, conquered. How wrong these predictions were! TB, termed ''the white plague'' during the 19th century, has a very long history as a health burden to humankind, which continues today. A thorough knowledge of the coevolution of humans and pathogenic mycobacteria may inform development of treatment and prevention methods.A second important factor making a review of mycobacterial disease timely involves the emergence of new techniques in molecular biology. The development of the polymerase chain reaction (PCR) method for amplifying DNA, advancements in sequencing technology, as well as the availability of mycobacterial genome sequences have revolutionized our knowledge of contemporary mycobacterial genetic variation. These advances permit scientists not only to explore global patterning within species, but also to make phylogenetic inferences and understand the evolutionary relationships between mycobacterial strains. In turn, molecular biologists and anthropologists have used this technology to identify...