Five Things I Learned From Reading Everything is Tuberculosis

One of the things I love about reading science non-fiction books is that it’s never “just about the science.”  Rather, it’s about how science has shaped the world and how what was happening in the world shaped research, treatments, and the way we as a society think about disease and health.

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I just finished reading Everything is Tuberculosis by John Green, which captures the history of tuberculosis (TB) and how the treatment and attitude towards the disease was influenced by society. It’s the story of how tuberculosis in the 21st century isn’t just caused by bacteria, but rather it’s largely driven by social and economic inequality. The book follows Green’s encounters with Henry, a TB patient in Sierra Leone, with bits of history and science intertwined in this story.

Here’s five things I learned from Everything is Tuberculosis:

#1 TB can spread from the lungs to the bones. Skeletal TB accounts for ~2-5% of TB cases in Europe and the U.S. In fact, you can find evidence of this in mummies dating to about five thousand years ago where the disease had left holes in the skeleton. This type of tuberculosis occurs when the bacterium travels through the blood to the lymph nodes, bones, and joints.

#2 The outcomes of Mycobacterium tuberculosis infection are highly variable. About 20-25% of people recover from active TB without treatment. It’s also possible for TB to lie dormant for decades or for an entire lifetime. This type of TB is known as latent TB. When latent TB turns into active disease is unpredictable, but once it does, it can be deadly within months or not at all. Yet, just between 5-10% of people with latent TB develop active disease during their lifetime.

#3 TB was romanticized in the 1800s. The disease was linked to beauty, creativity, and artistic genius. Many artists, poets, and authors died of TB during this period and the disease became linked to the professions (but really, a lot of people died of TB at the time). The disease gave its victims a certain aesthetic: pale skin, rosy cheeks, sunken eyes, and reduced body weight from the lack of appetite. This appearance gave rise to what some have called a “tuberculosis chic” or “consumption chic” aesthetic. To achieve the consumption look, women at the time used makeup that contained toxic ingredients (you can read more about this in this ASM article),

#4 White doctors blamed emancipation for an increase in tuberculosis. Some white doctors, drawing on racist pseudoscience, claimed that the end of slavery caused an increase in TB in Black Americans because it was rare before emancipation. A doctor even claimed that returning to slavery could “restore” Black people’s health, showing how deeply racism distorted the medical practice. The reality, however, was that tuberculosis had gone largely undiagnosed before emancipation because enslaved people were denied medical care and formal diagnoses.

#5 Sir Arthur Conan Doyle (yes, the author behind Sherlock Holmes) had an early, but significant, role in what would become the TB skin test. The microbiologist Robert Koch had discovered M. tuberculosis as the cause of TB in 1882.  He was inspired by Pasteur’s vaccinations for anthrax and cholera, which were based on killed bacteria. Koch created a similar serum based on killed M. tuberculosis (tuberculin) and injected it into four subjects (including himself) which made all of them sick in a few hours. By the next day, he appeared to get better and he thought it cured the infection. Koch saw that when injected into patients with tuberculosis, the serum caused affected tissues to die off and claimed that the serum could both prevent and cure the disease. This is when Doyle, who was also a physician in addition to being a writer, took notice of Koch’s work. He noticed that the serum didn’t cure infection and that while it killed the infected tissue, it didn’t kill the bacteria. Doyle also noticed that tuberculin caused an immune response in people who had TB, even if they didn’t have symptoms. There was no response in people who did not have TB. He realized that this could be used for diagnosing TB cases, which is the basis for the TB skin test.

Overall, I thought this was a great read and super accessible. I liked that it balanced the history of TB in society and TB as a bacterium and that Green did all think while telling Henry’s story.

Find the book here: Everything is Tuberculosis

If you’re looking for even more microbiology books, check out my microbiology reading list and my thoughts about other microbiology books.

Featured image: The Sick Child (1885–1886) by Edvard Munch, whose sister and mother died of tuberculosis. Source.