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.”

times. He called Lakka “a place where hope and despair intertwined …. I found myself in a world where food was scarce, water was rationed, and clothing was inadequate for the chilly nights.”

on. Looking at history through any single lens creates distortions, because history is too complex for any one way of looking to suffice.

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

Sometimes slave raiders broke into homes in the middle of the night and stole away entire families. Other times, children or young adults were kidnapped while hunting or gathering water. One

It’s possible that young Kaw-we-li lost the memory of whatever name his parents had given him, knowing himself only by the location of his kidnapping.

Henry, the boy I met at Lakka Hospital, had a Krio father—meaning that Henry’s roots in the United States may stretch back much further than my own. (My people have only been in America since the late nineteenth century.)

but I know the joy of feeling woven into the social fabric, feeling a part of the world rather than apart from it, and that’s how Isatu has always described her early years to me. But then the war came.

tuberculosis is listed in Guinness World Records as the oldest contagious disease.

Around a thousand years ago, the Persian scholar and poet Ibn Sina wrote that tuberculosis and other illnesses were caused when the body was “contaminated by tainted foreign organisms that are not visible by naked eye.”

M. tuberculosis grows so slowly because it takes a long time to build its unusually fatty, thick cell wall, which is a formidable enemy to the immune system. White blood cells struggle to penetrate the cell wall and kill the bacteria from within.

All of which is to say that three human lifetimes ago, a trained physician in Germany had no idea that the human body contained a digestive tract.

The classical physician was a kind of detectivefn4 whose job was to listen carefully to a person’s story, pay close attention to their appearance, and then use that information to identify a culprit.

it’s worth noting that all four of them are over fifty years old, and many forms of tuberculosis have developed resistance to one or more of the drugs, a condition known as drug-resistant TB, or DR-TB.

And unlike the medical system, traditional healers treated Henry and his father like people. Henry was not viewed as an infectious case to be feared, but as a human child to be healed.

Sierra Leone was devastated by an outbreak of the hemorrhagic fever Ebola. The already fragile healthcare system completely collapsed. Because most clinics lacked clean water and protective equipment like gloves and masks, many healthcare workers were infected with Ebola. At least 221 Sierra Leonean healthcare workers died of Ebola between 2014 and 2016, including many of the nation’s most experienced physicians, nurses, and community health workers.

Dr. David Morens defines as “a condition believed peculiar to consumptives in which physical wasting led to euphoric flowering of the passionate and creative aspects of the soul.”

Percy Shelley (who also lived with phthisis) wrote to him, “This consumption is a disease particularly fond of people who write such good verses as you have done.”

In Ode to a Nightingale, Keats wrote, “Youth grows pale, and spectre-thin, and dies.” It proved a prophecy.

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.

I am especially haunted by one of his lines, written when he had very little time left to live: “Your pleasure signals our death.”

All I can think of Is that I am lying In a house in the snow.

For me, anyway, this way of understanding chronic illness—as being of the world but also not permitted by circumstances or the social order to be entirely with the world—is a sentiment applied from within rather than from without, a way of thinking about the limits and opportunities of disability that acknowledges difference and loss without othering or romanticizing.

Edgar Allan Poe would go on to describe many of the women in his stories and poems as similarly wispy, pale, and large-eyed before he himself possibly died of tuberculous meningitis.

With step as noiseless as the summer air, Who comes in beautiful decay? Her eyes Dissolving with a feverish glow of light; And on Her cheeks, a rosy tint, as if the tip Of beauty’s finger faintly press’d it there: Alas! Consumption is her name.

Magazines also offered instructions for how to apply red paint to the lips and cheeks to capture the hectic glow of consumptive fevers. I

The insanity of beauty standards and femininity

It’s often been said, for example, that corsets sought to emulate the experience of consumption by being restrictive enough to limit women’s breathing and physical activities, but more recently, historians have found that most corsets were not particularly restrictive and these connections have been overblown.

Instead, fashionable dressing was viewed as a risk factor for consumption in Europe precisely because the patriarchal social order disapproved of it.

He wrote beautiful poems, and his interest in writing blossomed during his illness. He was preternaturally brilliant and deeply sensitive, expressing deep emotions of yearning and love in his memoir and poetry. But of course he did not live in the nineteenth century, and he also wasn’t white.

The 1837 book Female Beauty lays it out plainly: “Whiteness is the most essential quality of the skin.”

After all, the entire premise of colonialism relied on white supremacy, and the entire premise of spes phthisica maintained that only superior and civilized (read: white) people could become consumptive. 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.

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.”

“If the importance of a disease for mankind is measured from the number of fatalities which are due to it, then tuberculosis must be considered much more important than those most feared infectious diseases—plague, cholera, and the like.”

white American physicians still argued that consumption did not occur among Black Americans, who, it was claimed, lacked the intellectual superiority and calm temperament to be affected by the White Plague.

they were more susceptible to tuberculosis because of racism. Because of racism, Black Americans were more likely to live in crowded housing, an important risk factor for TB. Because of racism, Black Americans were more likely to be malnourished, another risk factor. Because of racism, Black Americans were more likely to experience intense stress, and they were less likely to be able to access healthcare.

In truth, the disease was “rare” because enslaved people had no access to diagnosis and lived in a world where white physicians presumed that consumption among Black people was either uncommon or impossible.

“These deaths should not be dismissed as an unavoidable consequence of a long-standing epidemic, but as the result of deliberate neglect and mistreatment on the part of the architects of the residential-school system.”

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 f...

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.

Mom you are special and beautiful You stand closer When everyone ran away Especially my cousin ran away But you stood firm.

it is terrifying to think that life may be at the mercy of the multiplication of those infinitesimally small creatures, it is also consoling to hope that Science will not always remain powerless before such enemies.”

Research indicates that certain gut microbiomes are associated with major depression and anxiety disorders; in fact, it’s possible that my particular microbiome is at least partly responsible for my OCD, meaning that the microbes are the reason I’m so deeply afraid of microbes.fn1

Microbes challenge my very understanding of myself—what am “I,” in the end, if half of me isn’t me, and the half of me that isn’t me dictates some of “my” thinking and feeling? 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!

Fear of TB germs getting caught in beards led to what Harper’s Weekly called “The Revolt against the Whisker,” ushering in an era of clean shaves.

At the height of the sanatorium, there were nearly as many beds to treat tuberculosis patients as there were hospital beds for all other illnesses combined.

The word “invalid,” of course, gets at the core of what it meant to live with chronic illness—you were a person outside of society, invalid in the social order, separated from your family and your community.

They were also told not to feel too intensely, or drink alcohol, or have sex—all exciting behaviors that could excite the tuberculosis within.

One day, young Gale overheard a terrible secret about her best friend Angie: Angie’s sister Pauline, who wrote her weekly, had in fact already died of TB. “But her father didn’t want her to know,” Gale recalled, because it might cause the kind of emotional shock that was deemed dangerous to the TB patient. So to encourage the daughter he still had, this father wrote letters that mimicked the handwriting and style of the daughter he’d lost.