Everything Is Tuberculosis

Despite its great influence on history, people rarely think of disease as being as significant as love and war. Green posits that this is caused by the silence of pain and illness, as it only exists within a body and historians often have little record of it. We do know TB has been around since the times of ancient Egypt at the very least, but evidence suggests it’s been around for much longer. TB has been referred to by many names in many languages, though all its titles refer to a major symptom of the disease: extreme weight loss.

TB, unlike other illnesses, was indiscriminate in its ability to infect both the poor and the wealthy; many famed thinkers and artists died of the disease, such as Charles Dickens, Eleanor Roosevelt, and Jay Gould. It also differs from other illnesses because of its slow rate of infection and death. It did not spread quickly, but it was in fact contagious, so becoming ill with TB was often unpredictable. These differences led to varied understandings of the disease, with some classical thinkers believing lifestyle choices could worsen one’s condition and others thinking, long before the use of microscopy, it may be caused by germs. Still, there were no effective treatments for the disease.

Even still, in the times of modern science, TB is incredibly unpredictable. TB can lie dormant or inactive for an entire lifetime, or it can kill somebody within a few months. This is caused by the microorganism Mycobacterium tuberculosis. Over two billion people have been infected with it, but it is also very slow growing. White blood cells struggle to penetrate M. tuberculosis’s thick cell wall, so they calcify around it, creating a ball of tissue called a tubercle. While the TB bacteria survive, it is contained, meaning a person will never get sick. In some cases, however, there aren’t enough white blood cells to create tubercles, leading to illness and death. Active TB can be caused in part by a compromised immune system. After it becomes active, it is still unpredictable, with some patients surviving a lifetime and others dying within months.

While the 19th century does not seem so far in the past, medicine was not at all comparable to what it is today. Medical tools such as X-rays and blood pressure cuffs were not invented until the end of the century, meaning that there were few ways to understand internal bodily functions. It was assumed that illness was caused by an imbalance in the “four humours” (blood, phlegm, yellow bile, and black bile), but diagnoses were largely made by simple observation. Since TB was so widespread, its telltale symptoms (sweating or coughing up blood, for example) were closely and universally connected to the disease. Even now, society at large still associates coughing up blood with TB. These symptoms are, most often, related to TB of the lungs, but the disease can infect other parts of the body.