Everything Is Tuberculosis: The History and Persistence of Our Deadliest Infection

by John Green

“Nothing is so privileged as thinking history belongs to the past.”

In general, colonial infrastructure was not built to strengthen communities; it was built to deplete them.

As Barbara Duden has written, “Pain is in the body. It leaves no trace for the historian, unless complaints about it are recorded.” But I wonder if we also ignore illness because of our bias toward agency and control.

But history, alas, is not merely a record of what we do, but also a record of what is done to us.

We pay a lot of attention to how we treat illness, and much less to the critical question of how we imagine illness.

When I was twenty-one, I worked for several months as a student chaplain at a children’s hospital. My supervisor was a Presbyterian pastor with the soulful eyes and calm voice her job demanded. On my first day of training, she said to me, “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. No other animals do it, at least not with anything approaching our sophistication. Hospitals are unnatural, as are novels and saxophones. None of us actually wants to live in a natural world.

Owen’s idea that cancer is obscene is also a construction, as is our current idea that for a life to be truly good, it must end in old age, and probably asleep. Our understandings of good illnesses, and good deaths, are perpetually shifting.

I want to pause here to note a defining feature of humans, which is that we like to know why things happen, especially why really bad things happen. And if a reason is not immediately apparent, we will find one.

Imagining someone as more than human does much the same work as imagining them as less than human: Either way, the ill are treated as fundamentally other because the social order is frightened by what their frailty reveals about everyone else’s.

Female artists were occasionally mentioned in analyses of how the disease quickened genius—the Brontë sisters, after all, died of TB, and Elizabeth Barrett Browning likely did as well—but the focus was on men and how TB enhanced their talents. It is said that Victor Hugo’s friends joked with him that he could’ve been a truly great novelist…if only he’d contracted consumption.

When TB rates declined in the U.S. toward the end of the nineteenth century, some physicians worried it would harm the quality of American literature, with one writing, “By way of compensation for good health we may lack certain cultural joys.”

This concept of the body being refined of its grosser aspect, of the mind flowering as the body wilts, continues to reverberate, of course—both because the sick are still sometimes viewed as unusually proximal to the divine and sacred, and because those with smaller bodies are often treated as more valuable or beautiful by the social order.

Of course, romanticizing the troubled young artist isn’t unique to tuberculosis—I think of the way people talked about Billie Holiday’s substance abuse disorder, or Vincent van Gogh’s mental illness. There’s something about the candle snuffed out prematurely that captures our imagination—it is the thought, perhaps, of the books and paintings and songs that might’ve been, or the idea that artists simply burn too bright for this world.

Women were also believed to be elevated by their illness, sometimes in their artistic gifts, but most obviously in their physical beauty. Women with consumption were believed to become more beautiful, ethereal, and wondrously pure. As Charlotte Brontë put it in a letter she wrote as her sister was dying of the disease, “Consumption, I am aware, is a flattering malady.”

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.

History is often imagined as a series of events, unfolding one after the other like a sequence of falling dominoes. But most human experiences are processes, not events.

We love a narrative of the great individual whose life is shot through with major events and who turns out to be either a villain or a hero, but the world is inherently more complex than the narratives we impose upon it, just as the reality of experience is inherently more complex than the language we use to describe that reality.

Consumption, after all, was a flattering malady, a genetic disorder enriching the soul even as it slowly destroyed the body. Tuberculosis was a horror, an invisible contamination proliferating within you and then spreading to anyone near you.

People who are treated as less than fully human by the social order are more susceptible to tuberculosis. But it’s not because of their moral codes or choices or genetics; it’s because they are treated as less than fully human by the social order.

Biology has no moral compass. It does not punish the evil and reward the good. It doesn’t even know about evil and good.

Stigma is a way of saying, “You deserved to have this happen,” but implied within the stigma is also, “And I don’t deserve it, so I don’t need to worry about it happening to me.”

What does it mean to be a person whose consciousness, whose love and longing and fear, can be snuffed out by an overgrowth of bacteria that neither love nor long nor fear? How absurd that I can be murdered by that venomous little atom!

In all the heartbreaks of reading about tuberculosis, perhaps none has stayed with me quite like the image of a father trying to write in his dead daughter’s handwriting to his living daughter, in the hopes that she wouldn’t be crushed by the truth.

When you write a novel, you are alone in it. I wrote that book alone, sitting in airports and coffee shops and lying in bed. But when writing, there is always for me a hope that one day I will not be alone—not in this work and not in this world.

” Writing is like that for me, like I’m typing “Marco, Marco, Marco” for years, and then finally the work is finished and someone reads it and says, “Polo.”

We live in between what we choose and what is chosen for us.

Vicious cycles are common. Injustice and unfairness permeate every aspect of human life. But virtuous cycles are also possible.

And so we must fight not just for reform within the system but also for better systems that understand human health not primarily as a market, but primarily as a shared priority for our species.

We can do and be so much for each other—but only when we see one another in our full humanity, not as statistics or problems, but as people who deserve to be alive in the world.

In a world where everyone can eat, and access healthcare, and be treated humanely, tuberculosis has no chance. Ultimately, we are the cause. We must also be the cure.

The problem with statistics is that I cannot take in what it means to lose 1,250,000 people each year to a curable illness. That’s more than a hundred thousand people a month. But how do I conceptualize such statistics? I’ve been in a stadium with a hundred thousand people, but I didn’t know each of their families. I didn’t know about the people they’ve loved, the heartbreaks they’ve endured, their constraints and encouragements, their frailty and resilience. I simply cannot fathom what 1,250,000 means.

Consider yourself for a moment—everything you’ve overcome, everything you’ve survived. Think of the people who loved you up into your now. Think of how hard school is or was, how you were lucky or blessed to meet people you could love and who could love you. Think about how rare and precious humans are, and how many of them you get to worry for and care about. Then, if you can, find a way to multiply that times 1,250,000. That is why we must work together to end tuberculosis and all other diseases of injustice.