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by
John Green
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November 13 - November 14, 2025
We are powerful enough to light the world at night, to artificially refrigerate food, to leave Earth’s atmosphere and orbit it from outer space. But we cannot save those we love from suffering.
The world we share is a product of all the worlds we used to share.
Of course, tuberculosis doesn’t know what it’s doing, but for centuries, the disease has used social forces and prejudice to thrive wherever power systems devalue human lives—an
an experience that, back in Sierra Leone, Henry and his mother, Isatu, knew all too well.
Henry was not viewed as an infectious case to be feared, but as a human child to be healed.
When I was initially diagnosed with an anxiety disorder in the late 1980s, the first SSRI medications were very new. Pathological anxiety was not seen primarily—at least among my peers and caregivers—as a biomedical phenomenon, but instead as an overdeveloped personality trait. It was as likely to be healed by faith as by science. (In fact, I found great relief from my anxiety through religion and ritual.) Today, in my community, anxiety is more likely to be imagined as an illness to be treated through the healthcare system. I would argue this shift happened largely because the healthcare
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“Death is natural. Children dying is natural. None of us actually wants to live in a natural world.”
Treating disease—whether through herbs or magic or drugs—is unnatural.
That said, it’s important to note that the idealization of the small body did not mean the end of consumptive stigmatization. Once again, we see the commingling of romance and stigma in the way women’s bodies are imagined, sometimes within a single sentence, as when one eighteenth-century magazine extolled the virtues of a consumptive body type: “The beauty of women is greatly owing to their delicacy, or weakness.” One romantic word to describe the beauty standard—delicacy—followed by a stigmatizing one—weakness.
The idea of becoming sick in order to look healthy or beautiful speaks to how profoundly consumptive beauty ideals still shape the world we share.
But as pervasive as these beauty standards are, we must remember that they aren’t universal.
The Ladies’ Toilette tells us, “Whiteness is one of the qualities which it is requisite for the skin to possess before it can be called beautiful.” The 1837 book Female Beauty lays it out plainly: “Whiteness is the most essential quality of the skin.”
it, a disease of civilization.
Everyone knew that rural communities were less vulnerable to consumption. “Fond as I am of London,” one mother wrote after both she and her daughter became ill, “there seems a fatality against my living in it.” But in a highly racialized social order, conceiving of phthisis as a “civilized” disease also meant that it could not be a disease of uncivilized people, which furthered the racialization of consumption.
“The White Man’s Plague.” One American doctor, for instance, called it, “a disease of the master race not of the slave race.”
our understandings of tuberculosis are shaped by social forces—which in turn shape how and where tuberculosis is able to thrive.
Acknowledging that consumption was common among enslaved, colonized, and marginalized people would have undermined not just a theory of disease, but also the project of colonialism itself.
“Phthisis is scarce in these climates and is regarded as contagious.” But of course phthisis was scarce in those climates precisely because it was regarded as contagious.
process, romanticization of the disease was abandoned. The decline happened in part because, as quality of life rose for the wealthy and the emerging middle class, they were less likely to live or work in crowded spaces where consumption can flourish.
Tuberculosis was there, breeding suffering and misery without romance.”
And so TB revealed itself to be not a disease of civilization, but a disease of industrialization; of crowding and intermingling in huge cities with packed tenements and factories where coughed-up particles could linger in the stale air.
“hereditary disposition, unfavorable climate…deficiency of light,
and depressing emotions.”
they were more susceptible to tuberculosis because of racism.
Because of racism, Black Americans were more likely to experience intense stress, and they were less likely to be able to access healthcare.
But then as now, tuberculosis does not travel primarily through paths forged by race, except insofar as human power structures force it to.
it just too often went unheard.
“almost as if the prime conditions for the outbreak of epidemics had been deliberately caused.” The death rate from TB in Canada’s residential schools appears genuinely unprecedented in human history.
meaning that 8 percent of all kids confined in these schools died of tuberculosis each year.
Genocide
today, Inuit people are over 400 times more likely to contract tuberculosis than white Canadians.
but as the result of deliberate neglect and mistreatment on the part of the architects of the residential-school system.”
Framing illness as even involving morality seems to me a mistake, because of course cancer does not give a shit whether you are a good person. Biology has no moral compass. It does not punish the evil and reward the good. It doesn’t even know about evil and good.
Diseases and death are natural. Fighting and curing isnt
In addition to living with the physical and psychological challenges of illness, there is the additional challenge of having one’s humanity discounted.
fighting the stigma of their communities is even harder.
Chronic illnesses are more likely to be stigmatized than acute ones, for instance, as are illnesses with high levels of perceived peril.
If an illness is seen to be a result of choice, it is more likely to be stigmatized. Mental illness is often viewed as a choice or a moral weakness, as are some kinds of heart disease and cancers. And even when there’s no evidence of a clear link between character and illness, we will invent one: It was long believed, for example, that cancer resulted from social isolation, or from bottling up one’s feelings. Even when these explanations are cruel and dehumanizing, we embrace them—because tiger got to sleep, and bird got to land, and man got to tell himself he understand.
We all engage in the punitive act of giving a disease a meaning.
Do we do this with all death and tragedy?
But he also saw the hope that accompanies better understanding.
Conan Doyle went home to England and within a decade published his first Sherlock Holmes story, all about a detective who uses reasoning and evidence to reach rigorous conclusions about causes of death, meaning that Holmes’s work was not so distant from that of his author.
public health efforts
Did TB start the concept and idea of public health and call to actions for heath reasons? Or is this just a famous example
flies became hated and feared,
This again changed fashion, grooming, and social habits.
“The Revolt against the Whisker,” ushering in an era of clean shaves.
For women, hemlines grew shorter as anxiety rose that floor-length dresses might pick up TB germs off dirty floors.
This speaks so much to me about the psychosocial components of living with tuberculosis. Patients were told that good moral and physical hygiene could save them.
But patients like Gale knew this was a lie.
That discordance makes it even more difficult to “keep a positive attitude,” which was enshrined as a treatment strategy for TB, just as it is now enshrined as a treatment strategy for diseases that are sometimes survivable but often aren’t, like cancer.
But I can’t very well blame others for not finishing their antibiotics when I know how often I’ve failed to finish my own.
were both funded primarily by public money. —
absolute control over the price.
