Everything Is Tuberculosis Quotes

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

But as a friend once told me, “Nothing is so privileged as thinking history belongs to the past.

It reminded me, that when we know about suffering, when we are proximal to it, we are capable of extraordinary generosity. 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.

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

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. This is the story of human history as I understand it—the story of an organism that can do so much, but cannot do what it most wants.

And so we have entered a strange era of human history: A preventable, curable infectious disease remains our deadliest. That's the world we are currently choosing.

What's different now from 1804 or 1904 is that tuberculosis is curable, and has been since the mid-1950s. We know how to live in a world without tuberculosis. But we choose not to live in that world.

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

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.

On my first day of training, she told 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.

How can I accept a world where over a million people will die this year for want of a cure that has existed for nearly a century?

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. 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.

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.

We cannot address TB only with vaccines and medications. We cannot address it only with comprehensive STP programs. We must also address the root cause of tuberculosis, which is injustice. 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 idea of becoming sick in order to look healthy or beautiful speaks to how profoundly consumptive beauty ideals still shape the world we share.

I’m a novelist, not a historian of medicine. TB is rare where I live. It doesn’t affect me. And that’s all true. But I hear Shreya, and Henry, and so many others calling to me: Marco. Marco. Marco.

He loved that word. Who wouldn't? "Encouraged." Like courage is something we rouse ourselves and others into.

Where are the drugs? The drugs are where the disease is not, and where is the disease? The disease is where the drugs are not.

We all engage in the punitive act of giving a disease a meaning.

We do not exist primarily to be plugged into cost-benefit analyses. We are here to love and be loved, to understand and be understood.

...somehow, we always seem to blame the patient for noncompliance, rather than blaming the structures of the social order that make compliance more difficult.

But survival is not primarily an act of individual will, of course. It's an act of collective will.

Why must we treat what are obviously systemic problems as failures of individual morality?

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.

But we can choose a different world. In fact, we will choose a different world. The world will be different a generation from now. The question is whether we will look back in gratitude at the virtuous cycles or in horror at the vicious ones.

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

TB in the twenty-first century is not really caused by a bacteria that we know how to kill. TB in the twenty-first century is really caused by those social determinants of health, which at their core are about human-built systems for extracting and allocating resources. The real cause of contemporary tuberculosis, is for lack of a better term, us.

Henry is a human being, just as you are a human being. 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.

I am an author, and I, for one, am deeply offended by the notion that my "waywardness, peevishness, Irascibility, misanthropy, and murky passions" are caused by a "derangement of bodily health," even as I am impressed by a nineteenth-century magazine's ability to absolutely nail my personality.

And so we must remember that illness is not only a biomedical phenomenon, but also a constructed one, and how we imagine leprosy or OCD or tuberculosis matters.

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

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

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.

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.

The world we share is a product of all the worlds we used to share. For me at least, the history and present of tuberculosis reveal the folly and brilliance and cruelty and compassion of humans.

Tuberculosis is so often, and in so many ways, a disease of vicious cycles: It’s an illness of poverty that worsens poverty. It’s an illness that worsens other illnesses—from HIV to diabetes. It’s an illness of weak healthcare systems that weakens healthcare systems. It’s an illness of malnutrition that worsens malnutrition. And it’s an illness of the stigmatized that worsens stigmatization. In the face of all this, it’s easy to despair. TB doesn’t just flow through the meandering river of injustice; TB broadens and deepens that river.

But of course people are not just their economic productivity. We do not exist primarily to be plugged into cost-benefit analyses. We are here to love and be loved, to understand and be understood.

Her optimism flew high, not only for her eventual cure of which she was sure, but for everything that would happen to her henceforth. That too, she knew was a characteristic of the tubercular - the very quality , in fact, which made them such interesting patients.

When we know about suffering, when we are proximal to it, we are capable of extraordinary generosity. We can do 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.

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. This is the story of human history as I understand it- the story of the organism that can do so much, but cannot do what it most wants.

Death is natural. Children dying is natural. None of us actually wants to live in a natural world.

In the U.S., entire cities were founded by and for people with tuberculosis, including Pasadena, California, and Colorado Springs, Colorado.

Education is the most important thing,” he told me once. “Not just for me, you know, but also for the nation.

About half of all humans ever died before the age of five.

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

It's tempting to imagine this romanticization as the opposite as the opposite of stigmatization. Rather than discounting people as stigma does, romanticization lifts them up as paragons of beauty or intellect or some other virtue. But really, I see these as complimentary strategies, used to make "the sick" into an "other," a group of people fundamentally distant and different from the rest of the social order. … Imaging someone as more than human does much the same work as imaging 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.

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.

On the second floor was the office in which Houston pounded an ancient typewriter with two fingers, always setting an example of unceasing hard work for his admiring students. They had no hint of the fact that their hard-driving dean had contracted tuberculosis while serving as a GI in France in Word War I. Houstan always seemed vibrant and impassioned in the chase for justice as he tried to expose his students to everything relating to the law that might give them an advantage. . . . "I never worked hard until I got to the Howard Law School and met Charlie Houston," Marshal told me. "I saw this man's dedication, his vision, his willingness to sacrifice, and I told myself, 'You either shape up or ship out.' When you are being challenged by a great human being, you know that you can't ship out." So Houston rescued Marshall and launched him into a career as one of the greatest lawyers in American history.

Yes, I know, it’s just one patient. There are so many patients, and Henry is just one. Why should we move mountains to save one patient? Because he is one person. A person, you understand? And anyway, what if he can be the first of many?

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.

The consumptive poet cannot be in the snow, only lying in the house in the snow. For me, anyway, this way of understanding chronic illness--as being of the world but also no 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 the difference and loss without othering or romanticizing. It's not trustful or loving or soothing or mild. It's true.

because food was not considered to be an essential aspect of tuberculosis treatment, and so there was no funding for food.

twentieth-century TB survivors include Beatle Ringo Starr (who was institutionalized with TB as a teenager), the novelist George Orwell (who died of TB in 1950,

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.

Tiger got to hunt, Bird got to fly; Man got to sit and wonder, “Why, why, why?” Tiger got to sleep, Bird got to land; Man got to tell himself he understand.

To my brother, Hank, who told me not to let his cancer get in the way of my tuberculosis activism: I love you so much. What a privilege it is to be the tail to your extraordinary comet.

And so here is Shreya, saying “Polo” to me from across the great divide. But she is also saying “Marco.” She is also telling me to hear her voice, and answer her call. People often ask me why I’m obsessed with tuberculosis. I’m a novelist, not a historian of medicine. TB is rare where I live. It doesn’t affect me. And that’s all true. But I hear Shreya, and Henry, and so many others calling to me: Marco. Marco. Marco.

It was an illness of the breath, of the place where the body interacts with the atmosphere, a process so sacred that the Hebrew word ruach, the Chinese word chi, the English word spirit, and the Inuit word sila all derive from words meaning breath or breathing. Breath is liferespiration is the most visible and irrefutable sign that we are still here. To inspire is to breathe in; to expire is to breathe all the way out.

child born in Sierra Leone is over one hundred times as likely to die of tuberculosis than a child born in the United States. This difference, as Dr. Joia Mukherjee writes, is “not caused by genetics, biology, or culture. Health inequities are caused by poverty, racism, lack of medical care, and other social forces.

To me, it was a disease of history—something that killed depressive nineteenth-century poets, not present-tense humans. But as a friend once told me, “Nothing is so privileged as thinking history belongs to the past.

I find it interesting that even here, in the supposedly pure world of science, we feel the weight of historical forces pressing in upon discovery. Our desire to create outsiders, the competition for resources among communities that would be better off cooperating, and our long history of warfare all come together in this moment of discovery.

There’s even emerging evidence that one’s microbiome may have a relationship with thought itself through the gut-brain information axis, meaning that at least some of my thoughts may belong not to me, but to the microorganisms in my digestive tract.

It is a mistake to think of the expatriate as someone who abdicates, who withdraws and humbles himself, resigned to his miseries, his outcast state. On a closer look, he turns out to be ambitious, aggressive in his disappointments, his very acrimony qualified by his belligerence. The more we are dispossessed, the more intense our appetites and illusions become. I even discern some relation between misfortune and megalomania. The man who has lost everything preserves as a last resort the hope of glory, or of literary scandal. He consents to abandon everything, except his name. [ . . . ] Let us say a man writes a novel which makes him, overnight, a celebrity. In it he recounts his sufferings. His compatriots in exile envy him: they too have suffered, perhaps more. And the man without a country becomes—or aspires to become—a novelist. The consequence: an accumulation of confusions, an inflation of horrors, of frissons that date. One cannot keep renewing Hell, whose very characteristic is monotony, or the face of exile either. Nothing in literature exasperates a reader so much as The Terrible; in life, it too is tainted with the obvious to rouse our interest. But our author persists; for the time being he buries his novel in a drawer and awaits his hour. The illusion of surprise, of a renown which eludes his grasp but on which he reckons, sustains him; he lives on unreality. Such, however, is the power of this illusion that if, for instance, he works in some factory, it is with the notion of being freed from it one day or another by a fame as sudden as it is inconceivable. * Equally tragic is the case of the poet. Walled up in his own language, he writes for his friends—for ten, for twenty persons at the most. His longing to be read is no less imperious than that of the impoverished novelist. At least he has the advantage over the latter of being able to get his verses published in the little émigré reviews which appear at the cost of almost indecent sacrifices and renunciations. Let us say such a man becomes—transforms himself—into an editor of such a review; to keep his publication alive he risks hunger, abstains from women, buries himself in a windowless room, imposes privations which confound and appall. Tuberculosis and masturbation, that is his fate. No matter how scanty the number of émigrés, they form groups, not to protect their interests but to get up subscriptions, to bleed each other white in order to publish their regrets, their cries, their echoless appeals. One cannot conceive of a more heart rending form of the gratuitous. That they are as good poets as they are bad prose writers is to be accounted for readily enough. Consider the literary production of any "minor" nation which has not been so childish as to make up a past for itself: the abundance of poetry is its most striking characteristic. Prose requires, for its development, a certain rigor, a differentiated social status, and a tradition: it is deliberate, constructed; poetry wells up: it is direct or else totally fabricated; the prerogative of cave men or aesthetes, it flourishes only on the near or far side of civilization, never at the center. Whereas prose demands a premeditated genius and a crystallized language, poetry is perfectly compatible with a barbarous genius and a formless language. To create a literature is to create a prose.

Covid-19 displaced tuberculosis as the world’s deadliest infectious disease from 2020 through 2022, but in 2023, TB regained the status it has held for most of what we know of human history. Killing 1,250,000 people, TB once again became our deadliest infection.

This year, thousands of doctors will attend to millions of TB patients, and just as my great-grandfather could not save his son, these physicians will be unable to save their patients, because the cure is where the disease is not, and the disease is where the cure is not.

A child born in Sierra Leone is over one hundred times as likely to die of tuberculosis than a child born in the United States. This difference, as Dr. Joia Mukherjee writes, is “not caused by genetics, biology, or culture. Health inequities are caused by poverty, racism, lack of medical care, and other social forces.

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. This is the story of human history as I understand it—the story of an organism that can do so much, but cannot do what it most wants. —

We chose to destroy the human population because it took us less than three seconds to conclude that humanity is a virus that mutates over time and becomes stronger. Many vaccines have come along to try and cure Earth of humanity. Virtuous pandemics: the plague of Athens, the Black Death, smallpox, cholera, Spanish flu, tuberculosis, malaria, yellow fever, Ebola, Zika, and a thousand more. Humanity survives, adapts, grows stronger, multiplies, and continues to wreak havoc on this planet and all other species that inhabit it. Humans are programmed to mate with partners of differing immune systems so that their offspring can be stronger than them. You seek immortality through evolution, yet you annihilate everything in your path. Humanity is cancer, humanity is bacteria, humanity is disease, and you need to be destroyed.

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

The reclining wood-slatted chair known as the Adirondack Chair was invented for TB patients, allowing them to rest outdoors without needing their beds wheeled outside.

While tuberculin cannot treat TB, it can identify TB, because only those who are infected with M. tuberculosis will have an immune response to tuberculin.

The world is inherently more complex than the narratives we impose upon it

The biomedical paradigm has become so powerful in my imagination that it’s easy to forget how inadequate mere medicine can be.

Tiger got to sleep, and bird got to land, and man got to tell himself he understand.

It was as if the cure did not exist—because the disease was where the cure was not, and the cure was where the disease was not.

These illness narratives are often not just a strategy for conceptualizing the pain of others, but also a way of reassuring ourselves that we’ll never feel that pain.

Nothing is so privileged as thinking history belongs in the past.

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

Is it a patient’s fault if their living conditions, or concomitant diagnoses, or drug use disorder, or unmanaged side effects, or societal stigma result in them abandoning treatment?

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.

Everything’s going fine and then, all of a sudden, I’m in despair. As soon as I feel a little joy, something inside me closes up immediately. It’s like an inner flaw; I call it “the survivors’ disease.” It’s not typhus, tuberculosis, or the other diseases that people sometimes caught. It’s a disease that gnaws away at us from within and destroys any feeling of joy. I have been dragging it about with me ever since I spent that time suffering in the camp. This disease never leaves me a moment of joy or carefree happiness; it’s a mood that forever erodes my strength.

Mere despair never tells the whole human story, as much as despair would like to insist otherwise. Hopelessness has the insidious talent of explaining everything: the reason X or Y sucks is that everything sucks, the reason you’re miserable is because misery is the correct response to the world as we find it, and so on. I am prone to despair, and so I know its powerful voice; it just doesn’t happen to be true. Here’s the truth as I see it: Vicious cycles are common. Injustice and unfairness permeate every aspect of human life. But virtuous cycles are also possible.

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 job of the “invalid,” as patients were commonly known, was to improve their health. 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. Even if you convalesced at home, you were still kept from many of the rhythms of daily life.

On my first day of training, she said he told 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.

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. It’s not trustful or loving or soothing or mild. It’s true.

Prevention strategies saw faster progress. The widespread phenomenon of cows infecting humans with tuberculosis decreased with the advent of tuberculin-based testing of cow herds alongside the pasteurization of milk.

It’s worth pausing to consider what it means in the context of American history and our conceptions of freedom that Black people fighting for the British were far more likely to be emancipated than those fighting for an independent U.S.

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. It is a bit like that old children’s pool game Marco Polo, where one person closes their eyes and swims around the pool trying to tag someone else. “Marco,” the person with eyes closed says, and the other pool-goers have to answer, “Polo.” “Marco, Marco, Marco,” cries one kid, and the others reply: “Polo. Polo. Polo.” 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.

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.

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.

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.

There were no reflex hammers, those little tools used to test nerve conduction in the knees and elbows, until 1888. There were no otoscopes, the tool that uses light and magnification to visualize the eardrum, until the 1830s. The first stethoscope, an essential tool for listening to the heart and lungs and GI tract, wasn’t developed until 1816. There were also no X-rays (1895) and no blood pressure cuffs (1881), all of which meant there was really no way to see or understand the inside of a human body while the body was still alive.

It is as if a man whose house was infested with rats were to remove the marks of the creatures every morning and expect in that way to get rid of them,” he wrote. Put another way: Tuberculin was in the business of picking up rat shit, not in the business of killing rats.

Conan Doyle immediately saw what Koch did not: that the serum tuberculin caused a strong immune response in people who’d been infected by TB, but that this immune response did not improve the body’s ability to fight off the disease. As a result, tuberculin often made TB patients more sick, not less.

Something like 90 percent of people die of disease, a phenomenon so entrenched in human life that we attribute most such deaths to “natural causes”. Many of us feel a certain relief when we learn that someone has died “naturally”, especially when the death occurs at what we think of as an appropriate age.

Instead, we could invest more public and philanthropic money into research and development of drugs, vaccines, and treatment distribution systems. We could reimagine the allocation of global healthcare resources to better align them with the burden of global suffering—rewarding treatments that save or improve lives rather than treatments that the rich can afford.

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.” This can become a kind of double burden for the sick: In addition to living with the physical and psychological challenges of illness, there is the additional challenge of having one’s humanity discounted.

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!

But in order for this minor medical intervention to occur, so many systems had to work in my favor: I needed healthcare access, of course—in my case, a health insurance program that pays for basic preventative care like vaccines. I needed to live in a community with twenty-four-hour electricity, so that the tetanus shot could remain cold and not lose its efficacy. I needed a system that could efficiently and reliably transport not just the shot itself, but also the gloves worn by the nurse who did my injection. I needed to live in a community with an education system strong enough to train nurses and doctors. Ultimately, what I needed was not just a tetanus shot but an entire set of robust systems to work perfectly in concert with each other—a phenomenon that ought not be a luxury in our world of abundance, and yet still somehow is.

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. Divorce may be an event, but it almost always results from a lengthy process—and the same could be said for birth, or battle, or infection. Similarly, much of what some imagine as dichotomous turns out to be spectral, from neurodivergence to sexuality, and much of what appears to be the work of individuals turns out to be the work of broad collaborations. 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.

At this time, there was a superstition among upper class women that the blood of young children helped keep the bloom of youth and that young fat helped conserve a young skin. There was also TB raging through the city; at that time, it was a disease that was one hundred percent fatal, as in those years there was no penicillin, but there was a popular belief that ingested human blood soothed and healed tuberculosis. Enriqueta now began kidnapping children of all ages, some for prostitution and some to be killed to create her healing tonics and “facial crèmes.” Everything that she possibly could she used from these children: the blood, bones (that she pounded into powder), and the fat.

I should acknowledge, I guess, that one reason I'm interested in TB is that I have obsessive-compulsive disorder, and my particular obsessive worries tend to circle around microbes and illness. Before the germ theory of disease, we did not know that around half the cells in my body do not, in fact, belong to my body - they are bacteria and other microscopic organisms colonizing me. And to one degree or another, these microorganisms can also control the body - shaping the body's contours by making it gain or lose weight, sickening the body, killing the body. There's even emerging evidence that one's microbiome may have a relationship with thought itself through the gut-brain information axis, meaning that at least some of my thoughts may belong not to me, but to the microorganisms in my digestive tract. 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 am so deeply afraid of microbes.

But it is just as useless for a man to want first of all to decide the externals and after that the fundamentals as it is for a cosmic body, thinking to form itself, first of all to decide the nature of its surface, to what bodies it should turn its light, to which its dark side, without first letting the harmony of centrifugal and centripetal forces realize [*realisere*] its existence [*Existents*] and letting the rest come of itself. One must learn first to know himself before knowing anything else (γνῶθι σε αυτόν). Not until a man has inwardly understood himself and then sees the course he is to take does his life gain peace and meaning; only then is he free of the irksome, sinister traveling companion―that irony of life which manifests itself in the sphere of knowledge and invites true knowing to begin with a not-knowing (Socrates), just as God created the world from nothing. But in the waters of morality it is especially at home to those who still have not entered the tradewinds of virtue. Here it tumbles a person about in a horrible way, for a time lets him feel happy and content in his resolve to go ahead along the right path, then hurls him into the abyss of despair. Often it lulls a man to sleep with the thought, "After all, things cannot be otherwise," only to awaken him suddenly to a rigorous interrogation. Frequently it seems to let a veil of forgetfulness fall over the past, only to make every single trifle appear in a strong light again. When he struggles along the right path, rejoicing in having overcome temptation's power, there may come at almost the same time, right on the heels of perfect victory, an apparently insignificant external circumstance which pushes him down, like Sisyphus, from the height of the crag. Often when a person has concentrated on something, a minor external circumstance arises which destroys everything. (As in the case of a man who, weary of life, is about to throw himself into the Thames and at the crucial moment is halted by the sting of a mosquito). Frequently a person feels his very best when the illness is the worst, as in tuberculosis. In vain he tries to resist it but he has not sufficient strength, and it is no help to him that he has gone through the same thing many times; the kind of practice acquired in this way does not apply here. Just as no one who has been taught a great deal about swimming is able to keep afloat in a storm, but only the man who is intensely convinced and has experiences that he is actually lighter than water, so a person who lacks this inward point of poise is unable to keep afloat in life's storms.―Only when a man has understood himself in this way is he able to maintain an independent existence and thus avoid surrendering his own I. How often we see (in a period when we extol that Greek historian because he knows how to appropriate an unfamiliar style so delusively like the original author's, instead of censuring him, since the first prize always goes to an author for having his own style―that is, a mode of expression and presentation qualified by his own individuality)―how often we see people who either out of mental-spiritual laziness live on the crumbs that fall from another's table or for more egotistical reasons seek to identify themselves with others, until eventually they believe it all, just like the liar through frequent repetition of his stories.

Our historical overview has focused on northern Europe and the U.S., where consumption was considered inherited for most of the nineteenth century, but that certainly wasn’t the case everywhere. 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.

The fact is that what scientists call zoonotic disease was little known in the Americas. By contrast, swine, mainstays of European agriculture, transmit anthrax, brucellosis, leptospirosis, trichinosis, and tuberculosis. Pigs breed exuberantly and can pass diseases to deer and turkeys, which then can infect people. Only a few of De Soto’s pigs would have had to wander off to contaminate the forest. The calamity wreaked by the De Soto expedition, Ramenofsky and Galloway argued, extended across the whole Southeast. The societies of the Caddo, on the Texas-Arkansas border, and the Coosa, in western Georgia, both disintegrated soon after. The Caddo had a taste for monumental architecture: public plazas, ceremonial platforms, mausoleums. After De Soto’s army left the Caddo stopped erecting community centers and began digging community cemeteries. Between the visits of De Soto and La Salle, according to Timothy K. Perttula, an archaeological consultant in Austin, Texas, the Caddoan population fell from about 200,000 to about 8,500—a drop of nearly 96 percent. In the eighteenth century, the tally shrank further, to 1,400. An equivalent loss today would reduce the population of New York City to 56,000, not enough to fill Yankee Stadium. “That’s one reason whites think of Indians as nomadic hunters,” Russell Thornton, an anthropologist at the University of California at Los Angeles, said to me. “Everything else—all the heavily populated urbanized societies—was wiped out.

In the late 1940s, the writer Albert Camus, suffering a bout of tuberculosis, journeyed from war-ravaged Paris to seek warmth and solace in his birthplace of northern Algeria. In a gray, rainy December, he found everything had changed and bitterly recognized the folly of hoping to relive his younger days. And yet he realized that the warm joy of his youth lay still untouched in his memory, writing, “In the depths of winter, I finally learned that within me is an invincible summer.

Creeping Charlie was the real rock star, though, according to Dad. It thrived in the shade on the edge of forests and sometimes on rocky soil, and the world saw it as a greedy invader. They didn't know, Dad said, that creeping Charlie was a jack-of-all-trades. It kept soil from sliding, sure, but also its dry leaves could be made into a tea that was great for colds and coughs. Eaten fresh or boiled, the leaves were a delicious source of vitamin C. But that was just the start. Creeping Charlie, and most ground ivy, was magic. It had strong antibacterial properties, rid the body of excess mucus, was an astringent and diuretic, could be turned into a balm that sped up healing, and treated everything from tuberculosis to tumors to tinnitus.

I am N!ai. When the white people first came, I was already a young woman with breasts. Before the white people came, we did what our hearts wanted. We lived in different places, far apart, and when our hearts wanted to travel, we traveled. We were not poor; we had everything we could carry. No one told us what to do. Now the white people tell us to stay in this place. There are too many people. There’s no food to gather. Game is far away, and people are dying of tuberculosis. But when I was a little girl, we left sickness behind us when we moved.

I am N!ai. When the white people first came, I was already a young woman with breasts. Before the white people came, we did what our hearts wanted. We lived in different places, far apart, and when our hearts wanted to travel, we travelled. We were not poor; we had everything we could carry. No one told us what to do. Now the white people tell us to stay in this place. There are too many people. There’s no food to gather. Game is far away, and people are dying of tuberculosis. But when I was a little girl, we left sickness behind us when we moved.

The next day I was driven down to New York City to take the physical. It was one of the strangest things I’d ever seen. Several hundred young men, maybe even a thousand, in their skivvies, walking around an enormous room, all of us lost, dazed, and confused. Some of these guys had dodged the draft and were there under the watchful eyes of dozens of federal marshals lined up against one of the walls. After eight hours of being poked, prodded, stuck, and poked again, I was given a large red envelope. I had been rejected. I had the respiratory problems of an old man, high blood pressure, partial loss of hearing, very bad teeth, very flat, very wide feet and I tested positive for tuberculosis. “Frankly,” the doctor said, “I don’t know how the hell you’re even standing up,” and that was when the sergeant told me that if they bottled everything that was wrong with me “we could take over the world without a shot.

There I learned that one can forget almost everything in life, beginning with bad smells, and that if there was one thing I aspired to, it was not to die in a place like that. In the low hours—which were most hours—I told myself that if anything was going to get me out of there before an outbreak of tuberculosis did the job, it was literature, and if that pricked anyone’s soul, or their balls, they could scratch them with a brick.

We live in between what we choose and what is chosen for us. from Everything is Tuberculosis, pg 162

We see here that the racist dehumanization of African people is not only part of nineteenth and twentieth century history. Racism continues to distort our policies and practices. And just as with previous examples of racism, it proved to be totally false. In point of fact, a 2007 study found that Africans were more likely to adhere to HIV/AIDS treatment regimens than North Americans.

When we know about suffering, when we are proximal to it, we are capable of extraordinary generosity. We can do and be so much better 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 thee world.

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 an author, and I, for one, am deeply offended by the notion that my "waywardness, peevishness, eracibility, misanthropy, and murky passions" are caused by a "derangement of bodily health," even as I am impressed by a nineteenth-century magazine's ability to absolutely nail my personality.

Why must we treat what are obiously systemic problems as failures of individual morality?

A 2023 paper in the Journal of Benefit-Cost Analysis (there's a journal for everything) calculated an even higher return, finding that every dollar invested in TB yields 46 US dollars in benefits. The report also found that between 2023 and 2050, there could be almost one million averted deaths per year on average. Interventions to address TB represent exceptional value for money. But of course, people are not just their economic productivity. We do not exist primarily to be plugged into cost-benefit analyses. We are here to love and be loved, to understand and be understood. TB intervention is an exceptionally good global health investment. But that is not why I care about TB.

It was impossibly expensive to treat HIV in poor communities until drug companies were pressured to lower prices by 95%, at which point it suddenly became affordable.

Tens of millions of people died of tuberculosis in those years — in fact, between 1985 and 2005, roughly as many people died of tuberculosis as in World Wars I and II combined.

Certain microbiomes are also correlated with the human body craving particular foods—meaning that when you’re hungry for carbs or protein or whatever, it may in fact be your bacteria that are hungry for that food.

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

*1 It’s worth pausing to consider what it means in the context of American history and our conceptions of freedom that Black people fighting for the British were far more likely to be emancipated than those fighting for an independent U.S.

we are capable of extraordinary generosity. 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.

It’s worth trying to imagine how simultaneously thrilling and horrifying the germ theory of disease was when it first emerged. As Louis Pasteur put it, “If 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.” Pasteur acknowledged the terror felt by many—it is truly the stuff of horror movies to learn that unseen organisms are squirming in and on you, replicating in their billions until they take over your body and sicken or kill you. But he also saw the hope that accompanies better understanding. Still, germ theory ushered in a very different world. We had imagined that having minimized deaths from lions, bears, and other predators that we had become “civilized,” a species dramatically above all others, the great power in a world of lesser life. As Conan Doyle would later write of M. tuberculosis, “What an infernal microbe it is!…How absurd that we who can kill the tiger should be defied by this venomous little atom.

It’s hard to overstate how profound the link between consumption and creative genius was in eighteenth- and nineteenth-century Europe and the U.S.[*] 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.

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.” Patients with active tuberculosis typically become pale and thin with rosy cheeks and wide sunken eyes due to the low blood oxygenation and fevers that often accompany the disease, and these all became signals of beauty and value in Europe and the United States. Henry David Thoreau wrote in his journal, “Disease and decay are often beautiful—like the pearly tear of the shellfish or the hectic glow of consumption.” Phthisis was deeply associated with feminine beauty in Northern Europe. Small, waifish bodies can now seem so associated with beauty (and health!) that it can feel innate or instinctual to find smaller bodies more attractive than larger ones. But that’s not inherent to humanity (and indeed was not a significant bias of humanity until relatively recently). 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.

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. But as pervasive as these beauty standards are, we must remember that they aren’t universal. In Sierra Leone, being small and thin like Henry brought to mind not beauty but stunting and unwellness.[*

In Europe and the U.S., most white doctors believed that phthisis—as it was inherited by those with great sensitivity and intelligence—could only affect white people, and it was sometimes known as “The White Man’s Plague.” One American doctor, for instance, called it, “a disease of the master race not of the slave race.” As Snowden writes, “In the United States, the prevailing wisdom was that African Americans contracted a different disease. The disinclination even to give it a name speaks volumes with regard to the prevailing racial hierarchy and the lack of access to medical care by people of color.” This phenomenon extended to all colonial empires. Many European colonialists believed that TB did not exist in South Asia or Africa, even though physicians working in colonized communities knew otherwise.

We see the profound shift from an inherited disease of intellect to a contracted disease of filth in the racialization of tuberculosis. As late as 1880, 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. But after Koch identified Mycobacterium tuberculosis in 1882, all that changed. 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.

The mostly white medical establishment in the U.S., meanwhile, tended to focus on so-called “race susceptibility,” the idea that something inherent in the genetics of Black people caused tuberculosis—a kind of spes phthisica for the infectious age. 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. But Miller instead argued the real cause of the disease was that “even now, after thirty years or more of freedom, he [the Black person] takes but little thought for to-morrow, but to-morrow, nevertheless, comes to him and oftimes finds him wholly unprepared to meet its exacting demands.” Miller argued the only way to restore Black people to health was to return to the institution of slavery.

I found it extremely heartening to see all those donations pour into this young man who has too often been neglected and ignored by society. It reminded me that when we know about suffering, when we are proximal to it, we are capable of extraordinary generosity. We can do 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.

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

For reasons we don’t fully understand, efficacy seems to get worse as one gets closer to the equator.

the cure is where the disease is not, and the disease is where the cure is not

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.

any attempts to essentialize a nation of nine million people amounts to the kind of oversimplification that deceives via distillation. That

yet somehow we always seem to blame the patient for noncompliance, rather than blaming the structures of the social order that make compliance more difficult.

When markets tell companies it’s more valuable to develop drugs that lengthen eyelashes than to develop drugs that treat malaria or tuberculosis, something is clearly wrong with the incentive structure.

But then as now, tuberculosis does not travel primarily through paths forged by race, except insofar as human power structures force it to.

In 2025, microscopy continues to be the leading test for tuberculosis, and continues to be very unreliable.

The global health community loves acronyms so much that they will make up more than one to describe the same thing.

Stetson would go on to live a long life and make a vast fortune, almost all of which he donated to endow schools, homeless shelters, and food banks.

Still, 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.

TB is both a form and expression of injustice. And I learned that how we imagine illness shapes our societies and our priorities.

In Christian Europe, the disfiguring illness leprosy (which is caused by a bacterium similar to M. tuberculosis) was long heavily stigmatized, so much so that lepers were often cast out of society, even as they were also sometimes considered destined for Heaven, since Christ healed lepers.

We know how to live in a world without tuberculosis. But we choose not to live in that world.

tuberculosis has come to be seen as a disease of poverty, an illness that walks the trails of injustice and inequity that we blazed for it.

And so we have entered a strange era of human history: A preventable, curable infectious disease remains our deadliest.

so most kids like Phumeza with drug-resistant tuberculosis could never receive appropriate treatment—not because it was unavailable, but because it wasn’t “cost-effective.

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.

He likes to call me “Dad,” and tells me that in Sierra Leone, Dad is a title you can be born into or one that you can earn.

Shreya’s sister had given her the novel after Shreya became too breathless to leave her bed, the result not only of an infectious TB pathogen but of a society’s unwillingness to help her survive.

I care about TB because of Henry.

And so we have entered a strange era of human history: A preventable, curable infectious disease remains our deadliest. That’s the world we are currently choosing. But we can choose a different world. In fact, we will choose a different world.

As Frank M. Snowden observes in Epidemics and Society, white physicians in Europe and the U.S. generally agreed that consumption was, as some Everyone eighteenth-century observers put 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 "civilized" disease also meant that it could not be a disease of uncivilized people, which furthered the racialization of consumption. In Europe and the U.S., most white doctors believed that phthisis as it was inherited by those with great sensitivity and intelligence could only affect white people, and it was sometimes known as "The White Man's Plague." One American doctor, for instance, called it, "a disease of the master race not of the slave race.

A 2024 study commissioned by the WHO found that every dollar spent on tuberculosis care generates around thirty-nine dollars in benefit by reducing the number (and expense) of future TB cases, and through more people being able to work rather than being chronically ill or caring for their chronically ill loved ones

But randomized control trials have found that directly observed therapy is no more effective than giving patients their pills to take home in two-week or monthlong cycles, provided the patients are adequately supported. DOTS also failed to address the growing crisis of drug-resistant tuberculosis, and failed to identify many cases of TB because smear microscopy is so much less sensitive than chest X-rays. But even in 2025, DOTS remains standard practice in much of the world.

But there’s a problem: 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. In fact, it’s so hard for infection-fighting cells to penetrate the bacteria’s cell wall that, instead, white blood cells usually surround it, creating a ball of calcifying tissue known as a tubercle.[*3] The TB bacteria can survive within these tubercles, replicating very slowly, consuming dead tissue as food. This type of infection, sometimes known as latent tuberculosis, will often last a lifetime without ever making a person sick.

TB in the twenty-first century is really caused by those social determinants of health, which at their core are about human-built systems for extracting and allocating resources. The real cause of contemporary tuberculosis is, for lack of a better term, us.

Many patients have described the experience of receiving their drugs as humiliating—they may be handed their medicine while being told that this only happened because they were unclean or poor or otherwise lesser.[*] This is often not an environment patients are excited to return to—and yet somehow we always seem to blame the patient for noncompliance, rather than blaming the structures of the social order that make compliance more difficult.

There is a benefit to systematizing healthcare, to treating everyone like they are everyone else. But there is also a cost.

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. As Lena Faust and Courtney Heffernan have written, “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.

That mix of trepidation and hope, so deeply felt by all who walk through the valley of serious illness, often sent people traveling in the nineteenth and early twentieth centuries.

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.

There is no way of computing the number of bacteria and noxious germs that may lurk in the Amazonian jungles of a well-whiskered face, but their numbers must be legion,” argued Dr. Edwin F. Bowers in a 1916 magazine article called “The Menace of Whiskers.” 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. For

The English actor Eliza Poe, whose beauty was widely admired, looked stereotypically tubercular—her rosy cheeks, alabaster skin, wide eyes, and tiny body were all the result of consumption, which killed her in 1811, when she was in her early twenties and her son, Edgar, was two. 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.

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.[*]

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.

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.

To cite one story among thousands, Thomas Albert White, a Black veteran of World War I, saw his TB infection turn into active disease after a chemical warfare attack. He returned to the U.S. and was sent by the federal government to a series of TB hospitals throughout the country, all of which denied him entry despite government orders to admit him. White eventually died of his illness without access to care.

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.

The sick were often told to move very little, discouraged even from writing letters or combing their own hair. They were also told not to feel too intensely, drink alcohol, or have sex- all exciting behaviors that could excite the tuberculosis within.

Between 1985 and 2005, roughly as many people died of tuberculosis as in World Wars I and II combined.

And so we have entered a strange era of human history: A preventable, curable infectious disease remains our deadliest. That’s the world we are currently choosing.

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.

Certain microbiomes are also correlated with the human body craving particular foods- meaning that when you’re hungry for carbs or protein or whatever, it may in fact be your bacteria that are hungry for that food.

But I would challenge them to look into Isatu’s eyes and tell her that J&J’s price gouging had nothing to do with a medicine funded primarily by the public being unavailable to the most vulnerable members of that public. In fact, many people have died waiting for bedaquiline.

Even in the 1940s, TB infections and disease remained common—twentieth-century TB survivors include Beatle Ringo Starr (who was institutionalized with TB as a teenager), the novelist George Orwell (who died of TB in 1950, just as curative treatment was becoming available), the writer Thomas Wolfe (who died of tuberculous meningitis in 1938), and the actor Vivian Leigh (who lived with TB for over twenty-five years).

The third patient was a critically ill young Army officer named Bob Dole, who would survive, and go on to become a U.S. senator, Republican nominee for president, and noted Viagra spokesperson.

Jessica uncapped a marker and wrote ILLS at the top of the whiteboard. “Right,” Averman said. “I thought we’d begin with an overview of the problems at hand. This is a brainstorm. There’re no bad suggestions. We’ll prioritize and organize in the second session.” Four men spoke at once and then deferred to Roark. “We’re to list, what? Global pandemics?” “Everything. Like heart disease, for example.” Averman replied. Jessica wrote HEART DISEASE in the top left corner. A voice from the third row. “World hunger?” Jessica wrote WORLD HUNGER. Guy figured he’d come this far. “Jingoism!” JINGOISM. Benatti yelled, “Famine!” “Isn’t that the same as world hunger?” Roark asked. A chorus of assenting murmurs. Wright called up from the second row. “World hunger is a distribution problem. Famine is agricultural.” “Gentlemen.” Averman put his hands up in a conciliatory gesture. “Again, there are no bad suggestions. We’ll sort everything in the second session.” FAMINE. “SIDS!” Mary Ellen yelled. “Malaria!” someone shouted. Momentum gathered: “Alzheimer’s! Influenza! Cerebral palsy! Women’s education! Recidivism! Rising oceans! The migrant crisis! Diabetes! Earthquakes! Wage disparity! Racism! Blindness! Domestic abuse! Nuclear armament! Nuclear stockpiling! Opportunity for the less affluent! Drug patents! Ennui! Urban zoning! High-speed internet access! The Great Barrier Reef! Food deserts! Healthcare reform! Religious extremism! Crohn’s disease! Meningococcemia! Carbon emissions! AIDS! Female genital mutilation! Apathy! Child labor! Deafness! Corporate monopolies! Tax reform! Flesh-eating viruses! Infrastructure! University endowments! River-borne diseases! Mudslides! Marfan syndrome! Wildfires! Sexism! Opioids! Locked-in syndrome! Gambling addiction! Lyme’s! Lack of potable water! Tuberculosis! COPD! Syphilis! Deaths of despair! Mass transportation! High blood pressure! Bee extinction! Monogamy! Pneumonia! Mass incarceration! Mass migration! Pornography! Fibromyalgia! Diarrhea! Cirrhosis! Bacterial infections! Poor hygiene! Illiteracy! E. coli! Car accidents! School shootings! Xenophobia! Holy wars! Preterm birth complications! Sugar! Terrorism! Diabetes! Unemployment! Depression! Norovirus! Fracking! Oxygen depletion in the oceans! Nuclear waste! Mortality! . . .

I am an author, and I for one am deeply offended by the notion that my waywardness, peevishness, irascibility, misanthropy, and murky passions are caused by a derangement of bodily health, even as I am impressed by a nineteenth-century magazine’s ability to absolutely nail my personality.

Johnson & Johnson would later say, “It is false to suggest—as some recently have—that our patents are being used to prevent access to SIRTURO (bedaquiline), our medicine for MDR-TB.” But I would challenge them to look into Isatu’s eyes and tell her that J&J’s price gouging had nothing to do with a medicine funded primarily by the public being unavailable to the most vulnerable members of that public.

It reminded me that when we know about suffering, when we are proximal to it, we are capable of extraordinary generosity. 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 her book An Introduction to Global Healthcare Delivery, Dr. Joia Mukherjee explains how in the years after formerly colonized nations achieved independence, when the recently created World Bank offered loans to poor countries, the Bank’s policies profoundly shaped the healthcare systems in those countries. Restrictions on how much governments could spend and how they could spend it led to tragic underfunding of healthcare and education systems. “By the late 1980s,” Mukherjee tells us, “health budgets in many African and Asian countries were less than $5 per person per year.

And so, as historian Christian McMillen has written, “The terms ‘compliance’ and ‘adherence’ or whatever other term might be deployed are all too confining. What does a national TB program’s inability to keep track of patients on treatment have, necessarily, to do with patient compliance or adherence? When a program loses a large percentage of its patients, is this a compliance problem or a surveillance problem? Is it a patient’s fault when he or she cannot afford the food necessary to ward off the hunger brought on by the drugs?” More broadly, is it a patient’s fault if they are too disabled by depression and isolation to follow through on treatment? Is it a patient’s fault if they or their children become so hungry that they feel obliged to sell their medication for food? Is it a patient’s fault if their living conditions, or concomitant diagnoses, or drug use disorder, or unmanaged side effects, or societal stigma result in them abandoning treatment? Why must we treat what are obviously systemic problems as failures of individual morality? Many patients have described the experience of receiving their drugs as humiliating—they may be handed their medicine while being told that this only happened because they were unclean or poor or otherwise lesser.[*] This is often not an environment patients are excited to return to—and yet somehow we always seem to blame the patient for noncompliance, rather than blaming the structures of the social order that make compliance more difficult.

A physician might conclude, as one German doctor did in the early eighteenth century, that a woman’s life-threatening illness was brought on “by a dog which barked loudly at her.

I found it extremely heartening to see all those donations pour in to this young man who has too often been neglected and ignored by society. It reminded me that when we know about suffering, when we are proximal to it, we are capable of extraordinary generosity. 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.

Lungs are more ethereal than bowels.

...the ill are treated as fundamentally other because the social order is frightened by what their frailty reveals about everyone else's

because the cure is where the disease is not, and the disease is where the cure is not.

Patients with active tuberculosis typically become pale and thin with rosy cheeks and wide sunken eyes due to the low blood oxygenation and fevers that often accompany the disease, and these all became signals of beauty and value in Europe and the United States.

By the time of Eliza’s death, “consumptive chic,” as Carolyn Day termed it, had taken over European beauty standards.

In denying HIV treatment to the poor, the reasons cited—patients couldn’t be trusted to take their medication on time, better to focus on prevention and control—were the same as we’ve seen with TB. In 2001, the head of USAID—the U.S. government’s arm devoted to international aid —had this to say about making antiretroviral treatment accessible to the poor: “If we had [HIV medicines for Africa] today, we could not distribute them. We could not administer the program because we do not have the doctors, we do not have the roads…[Africans] do not know what watches and clocks are. They do not use western means for telling time. They use the sun. These drugs have to be administered during a certain sequence of time during the day and when you say take it at 10:00, people will say, ‘What do you mean by 10:00?’ ” We see here that the racist dehumanization of African people is not only part of nineteenth and twentieth century history. Racism continues to distort our policies and practices. And just as with previous examples of racism, it proved to be totally false. In point of fact, a 2007 study found that Africans were more likely to adhere to HIV/AIDS treatment regimens than North Americans.

And so we must remember that illness is not only a biomedical phenomenon, but also a constructed one, and how we imagine leprosy or OCD or tuberculosis matters. In a place where the formal healthcare system is not particularly effective at treating an illness, it is easy to imagine how more trusted spaces and people—like churches and faith healers—can be a better bet than doctors and hospitals.

Immunosuppressive drugs that treat autoimmune disorders like Ulcerative Colitis can also cause TB infections to become active disease, which is why Americans often hear tuberculosis listed among potential side effects in drug commercials.

Dr. Girum later told me, “Yes, I know, it’s just one patient. There are so many patients, and Henry is just one. Why should we move mountains to save one patient? Because he is one person. A person, you understand?

short, no fashion would suffice unless it was defined as hygienic by the patriarchal medical establishment.

Alan Hart helped pioneer the use of chest X-rays to diagnose tuberculosis. Hart was married to a woman and practicing medicine in San Francisco in 1918 when he was outed as a trans man by a former colleague.