John Green 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.

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

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.

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

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.

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.

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

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.

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

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.

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.

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.

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 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.

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.

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.

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.

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 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.

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. —

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.

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.

I would never accept a world where Hank might be told: “I’m sorry, but while your cancer has a 92% cure rate when treated properly, there just aren’t adequate resources in the world to make that treatment available to you.” That world would be so obviously and unacceptably unjust. So how can I live in a world where Henry and his family are told that? 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?

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.

Like tuberculosis,* malaria, and many other infectious diseases, cholera is only successful in the twenty-first century because the rich world doesn’t feel threatened by it. As Tina Rosenberg has written, “Probably the worst thing that ever happened to malaria in poor nations was its eradication in rich ones.

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.

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.

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.