Everything is Tuberculosis: Book Review

Every is Tuberculosis: The History and Persistence of Our Deadliest Infection, John Green, 2025. I had no idea how deadly tuberculosis was.

Introduction. The book starts with James Watt, maker of steam engines, whose daughter and son both died of tuberculosis (called phthisis or consumption), with classic symptoms of cough, sweats, fever, and a wasting body because it was difficult to eat. Over the last 200 years, over a billion people died of TB. It has been curable since the mid-1950s. The cure is expensive, and TB is more likely in poverty-stricken places, when treatment tends to be inadequate. It’s caused by an airborne bacterium. An infection can last a lifetime and stay dormant, with some percentage becoming active. Ten million people got sick of TB in 2023, half of whom were malnourished.

Chapter 1: Lakka. Green spent a lot of time in Lakka, Sierra Leone on the West Coast of Africa, where conditions are poor and people often malnourished. He focused on a single kid called Henry who was there for treatment.

Chapter 2: Cowboys and Assassins. Hatmaker John Stetson, who had TB, was advised to go west for the dry air. He made it as far as Missouri and noticed that the hats, like insect-plagued coonskins, were horrible. He felt better, returned east and developed the Stetson cowboy hat and made a fortune.

New Mexico, in an attempt to attract more people, started wooing TB people and about 10% of the population were TB patients. Then New Mexico became a state. Franz Ferdinand of the Austro-Hungarian Empire was shot by a Serbian TB patient who figured he had nothing to lose. That started WW1.

Chapter 3: Look at Our Railroads. The British Empire built infrastructure like railroads to exploit colonies and export minerals and more (resource extraction). That was the story of Sierra Leone, where Freetown was a port for the slave trade.

Chapter 4: The Wealth Never Warded Off. Before Columbus, TB was in both the Old and New Worlds, probably a disease of hominids and is considered the oldest contagious disease. It has been basically untreatable.

Famous patients included Jay Gould, Henry VII, Franz Kafka, Louis XIII, John Keats, and the Bronte sisters.

TB is caused by Mycobacterium tuberculosis. It grows slowly and has fatty thick cell walls which make it difficult for white blood cells to fight. When the immune system fails TB grows. Some 117 billion people have lived, over 100 billion since 1804.

Chapter 5: Whipped Away. Back to Henry. Both he and his sister got sick and treated with old drugs.

Chapter 6: Many people die of disease, perhaps 90%. Historically TB kills the most age 20-45. That included both Keats and Shelley. Generally, they drown in blood and puss that fill their lungs.

Chapter 7: The Flattering Malady. “Our understanding of tuberculosis are shaped by social forces—which in turn shape how and where tuberculosis is able to thrive. In India … there was always extensive illness and death from consumption in colonial India; it just went largely undetected and uncounted by colonial authorities” (p. 74).

Chapter 8: The Bacillus. The bacillus was identified by German doctor Robert Koch in 1882, after he proved anthrax was caused by a bacterium and a chain of transmission. He also developed the use of white mice for experimentation.

Chapter 9: Not a Person. A primary reason for TB spread is poverty, bad housing and sanitation. Indigenous people in North America were more likely to die of TB as were blacks. Now, Inuit people are more likely to get TB. “Biology has no moral compass” (p. 86).

Chapter 10: A Study in Tuberculin. Louis Pasteur studied microorganisms from the 1860s. beginning with wine fermentation. He corroborated Koch’s findings and developed a vaccine for anthrax. Pasteur then developed a vaccine for cholera.

Koch thought he had a cure, “Koch’s Serum,” He injected it in mice and then people. They got violently ill, then fully recovered. Koch claimed it was a cure. Thousands of people were injected around Europe. Dr. Arthur Conan Doyle was skeptical. He saw the serum reaction as an immune response to people who were already infected with TB. Long-term this could cause people to get sicker.

Doyle realized this serum could be a public health tool to diagnose TB infection. A small amount injected under the skin would develop swelling at the site. This is still the test used now. Koch was disgraced. With his strong deductive ability, Doyle went on to write Sherlock Holmes stories.

Chapter 11: Trepidation and Hope. “In the US, entire cities were founded by and for people with tuberculosis, including Pasadena, California, and Colorado Springs, Colorado” (p. 102). Sanatoriums could be horrible places, with workers ordering patients to do specific things, even what to read and write, stand up, or have visitors. Children could be yelled at for crying. Streptomycin was the first TB drug, developed in the 1940s.

Chapter 12: The Cure. X-rays could show evidence of TB. Antiseptics improved the chance of survival after surgery. TB could be spread by cow’s milk until TB testing of cow herds and pasteurization of milk. BCG vaccine was developed in 1921 and this the only vaccine in use, although not particularly effective. TB survivors include George Orwell, Bob Dole, and Ringo Starr. Thomas Wolfe and Vivian Leigh were victims. The antibiotic streptomycin was available in 1944. Combination therapies worked better and eventually RIPE protocol. TB rates dropped in rich countries, but limited in effectiveness in poor countries.

Chapter 13: Where the Cure is Not. Thomas Mann published the TB novel The Magic Mountain in 1920. Patient noncompliance is a factor in antibiotic resistance. This is blamed on the patient, but other factors are involved like family members or travel restrictions. These were factors for Henry in Sierre Leone.

Chapter 14: Marco Polo. Some half-million people become sick with drug-resistant TB. Better drugs and treatments are now available, but limited profit to invest in these expensive drugs. The most effective combo is 5-7 pills a day for 6-9 months, but with possible side effects including liver damage and loss of hearing.

Chapter 15: Dr. Girum. Mobile X-ray machines were used beginning in the 1950s to identify patients early for better outcomes. TB care benefits the economy by making people productive.

Chapter 16. Henry. Chapter 17: Beat Me Later. Still working on Henry.

Chapter 18: Superbug. TB evolution includes drug resistance. TB is rising in the US slowly.

Chapter 19: Vicious Cycles. HIV/AIDS showed up in the 1980s. Treatments were developed, but unaffordable in poor countries until prices were lowered. TB became a disease of poverty.

Chapter 20: Hail Mary. The survival of Henry meant complex drug-resistant TB could be cured in a poor country.

Chapter 21: Like Magic. A new medication regimen had Henry improving. He survived.

Chapter 22: Virtuous Cycles. Peru started TB programs after protests in the 1990s, which proved 85% effective using a DOTS-plus strategy, comprehensive but expensive, then affordable using generic versions of drugs.

Chapter 23: The Cause and the Cure. Poverty proved related to communicable diseases for multiple reasons like proper food, clean water, and education. TB plan was search, treat, prevent.

Postscript. Henry doing great.