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

Author: John Green

Completed: May 2025 (Full list of books)

Overview: I’ve been listening to John Green talk about AFC Wimbledon for year and thoroughly enjoyed reading The Anthropocene Reviewed audiobook a few years ago. I also enjoyed reading Rabid so this seemed like my type of book. It’s fascinating to think of a disease that feels so old fashioned still infects so many people around the world and kills over a million people each year (see the third bullet point below). I’m grateful that John is highlighting what we aren’t doing but could/should be to help eliminate deaths from this terrible illness… while telling great stories.

Highlights:

• over a million people died of tuberculosis in 2023. That year, in fact, more people died of TB than died of malaria, typhoid, and war combined.
• One estimate, from Frank Ryan’s Tuberculosis: The Greatest Story Never Told, maintains that TB has killed around one in seven people who’ve ever lived.
• Anyone can get tuberculosis—in fact, between one-quarter and one-third of all living humans have been infected with it. In most people, the infection will lie dormant for a lifetime. But up to 10 percent of the infected will eventually become sick, a phenomenon we call “active TB.”
• For reasons we still don’t fully understand, between 20 and 25 percent of people recover from active TB illness without treatment,
• Vaughan points out that in precolonial Africa, leprosy was not especially feared or stigmatized, and certainly was not seen as a cause for removal from the social order.
• One analysis quoted in Vidya Krishnan’s Phantom Plague found that “roughly 15% of all deaths in London before 1730 were due to the disease, a percentage that nearly doubled [by] the early 1800s.” When almost a third of all people shared the same fate, it became impossible to construct consumption as merely a disease of the drunk or demon-possessed. There were simply too many cases for consumption to be understood as a disease caused by immorality or weakness.
• Fading Away, a combination print by Henry Peach Robinson, 1858. Around the time of this photograph, some women applied belladonna to their eyelids, albeit in minimally toxic amounts, to dilate their pupils so they’d have that wide-eyed consumptive look. Magazines also offered instructions for how to apply red paint to the lips and cheeks to capture the hectic glow of consumptive fevers. I probably do not need to point out that these standards of beauty are still informing what is considered to be feminine beauty in much of the world.
• I came across a comment on a video about tuberculosis recently in which a woman named Jil wrote, “As a fat person, I used to wish for a wasting disease like tuberculosis. It’s…it’s messed up.” Dozens of people replied to that comment with their own experiences of being complimented for weight loss associated with life-threatening illness, or their fantasies of tapeworms and other illnesses that would shrink their bodies. 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.
• 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.
• Rates of phthisis appear to have been lower, for example, in China, where Daoist physicians argued the disease was infectious beginning in the twelfth century CE. Consumption was rarer in southern Europe as well, where the illness was also understood to be infectious. As the writer George Sand tried to find a place for consumptive Frédéric Chopin to stay in Spain, Sand wrote a friend, “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. “We went to take residence in the disaffected monastery of Valdemosa,” Sand goes on, “…but could not secure any servants, as no one wants to work for a phthisie…. We begged of our acquaintances that they give us some help…a carriage to take us to Palma from where we wanted to take a ship back home. But even this was refused us, although our friends all had carriages and wealth.”
• “TB’s parallel journey with capital,” as the investigative journalist Vidya Krishnan put it, appears in outbreak after outbreak. And so TB revealed itself to be not a disease of civilization, but a disease of industrialization;
• Racialized medicine no longer maintained that high rates of consumption among white people was a sign of white superiority; instead, racialized medicine maintained that high rates of consumption among Black people was a sign of white superiority. One white doctor’s 1896 treatise asserted that African Americans were disproportionately dying of tuberculosis due to their smaller chest capacity and increased rate of respiration, for example. None of this was true, of course. Black people were not more susceptible to TB because of factors inherent to race; 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.
• Some white doctors even argued that the “susceptibility” was caused by the end of slavery in the U.S. In his famous 1896 essay “The Effects of Emancipation upon the Mental and Physical Health of the Negro of the South,” Dr. J. F. Miller argued (falsely) that tuberculosis was a “rare” disease “among the negroes of the South prior to emancipation.”
• Some white doctors even argued that the “susceptibility” was caused by the end of slavery in the U.S. In his famous 1896 essay “The Effects of Emancipation upon the Mental and Physical Health of the Negro of the South,” Dr. J. F. Miller argued (falsely) that tuberculosis was a “rare” disease “among the negroes of the South prior to emancipation.” 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.
• The Canadian Public Health Association has estimated that in First Nations communities, around 700 of every 100,000 people died annually of tuberculosis in the 1930s and 1940s. Indigenous people were more than ten times as likely to die of TB than white Canadians. But in residential schools, the rate was 8,000 per 100,000—meaning that 8 percent of all kids confined in these schools died of tuberculosis each year. And these inequities persist—today, Inuit people are over 400 times more likely to contract tuberculosis than white Canadians.
• “By 1900, 34 sanatoriums with 4,485 beds had been opened in the United States. Twenty-five years later, there were 536 sanatoriums with 673,338 beds.” 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.
• In the U.S., entire cities were founded by and for people with tuberculosis, including Pasadena, California, and Colorado Springs, Colorado. Southern California came to be known as especially salubrious, and tens of thousands of people relocated there—a movement of people rivaling the Gold Rush. These “lungers,” as they were known, settled in western towns and the sanatoria that sprung up within them. If patients survived, they often stayed in their new hometowns and began families, reshaping the geography of the United States.
• The biomedical paradigm has become so powerful in my imagination that it’s easy to forget how inadequate mere medicine can be. Yes, illness is a breakdown, failure, or invasion of the body treated by medical professionals with drugs, surgeries, and other interventions. But it is also a breakdown and failure of our social order, an invasion of injustice. The “social determinants of health”—food insecurity, systemic marginalization based on race or other identities, unequal access to education, inadequate supplies of clean water, and so on—cannot be viewed independently of the “healthcare system,” because they are essential facets of healthcare. When someone living in Haiti contracts cholera, is the resulting illness really caused by a bacteria called Vibrio cholerae, or is it also caused by dirty water, by poverty, and by the reintroduction of cholera to the nation by aid workers after a 2010 earthquake? We cannot view “health” absent the “social determinants of health,” or else we end up in situations seen all the time with TB, wherein people are, to cite just one example, unable to take their medicine because they don’t have enough food in their stomach.