62 pages • 2-hour read
Everything Is Tuberculosis: The History and Persistence of Our Deadliest Infection
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Chapters 6-11Chapter Summaries & Analyses
Chapter 6 Summary: “Tiger Got to Hunt”
Content Warning: This section of the guide includes discussion of illness, death, child death, child abuse, ableism, and racism.
Green suggests that the phrase “natural death” is a misnomer since it implies that natural causes aren’t deterred by “unnatural” systems like healthcare. People accept the idea of a “natural death” because it is a psychological construction; when one is said to have died a natural death, they fulfill parameters that make the death feel more acceptable. Historically, child death was previously considered “natural” because of its frequency prior to modern healthcare. TB is one of the few diseases that killed sick people indiscriminately, no matter what stage of life they were in. This increased the terror around it.
Citing Kurt Vonnegut’s novel Cat’s Cradle, Green explains that the human relationship between understanding and fear is instinctive to humankind. People are driven to understand a disease both to empathize with others and to assure themselves that they are exempt from that pain. This symbolic understanding of disease impacts the human response to the general concept of disease.
TB was initially imagined as a disease that targeted moral failure. This shifted as TB spread, infecting the affluent. During the 18th century, TB was the overwhelming cause of human death. Over the next two centuries, TB was romanticized as an illness of beauty and nobility.
Green argues that romanticization is a complementary strategy for stigmatization since both exclude sick people into a category of “otherness.” He cites the depictions of detectives like Sherlock Holmes and Adrian Monk as examples of characters who romanticize obsessive-compulsive disorder (OCD), which clash with Green’s experience of the OCD.
Nevertheless, TB was reimagined as an inherited disease that afflicted people who were “especially attuned to the fragile and fleeting loveliness of life” (57). The disease was believed to improve the creative powers of artists, which Green finds offensive as an artist. This perspective of TB continued to the 20th century, where sick people were believed to have spes phthisica, a condition in which creative flowering had an inverse relationship with physical well-being. TB was romanticized in literature, from Charles Dickens’s Nicholas Nickleby to Alexandre Dumas’s The Lady of the Camellias. Green describes the life of English poet John Keats, who died from TB-induced asphyxiation.
Green points out that romanticization is not exclusive to TB, citing Vincent van Gogh and his mental health. He adds that this cultural belief was not restricted to the West, as Indian poet Sukanta Bhattacharya was similarly romanticized after his death despite his political writing, which alluded to the injustice that surrounded his death. Green is especially moved by the writing of Japanese haiku poet Masaoka Shiki, who articulated that having TB means a restriction from being “entirely with” the world. This challenges the romanticization of the disease by acknowledging the reality of disability without othering it.
Chapter 7 Summary: “The Flattering Malady”
TB influenced a shift in beauty standards across Europe and the United States, making pale skin, thinness, and wide eyes epitomize feminine good looks. Edgar Allan Poe’s mother, English actor Eliza Poe, possessed looks characteristic of “consumptive chic” and died of TB in 1811.
This shift in beauty standards is visible in the work of European visual artists such as Henry Peach Robinson, whose composite photograph Fading Away depicts a young woman dying of consumption. The elements of the photograph frame the subject as the paragon of beauty, normalizing her death as natural.
In the Victorian era, English women sought advice on how to emulate the physical appearance of consumptive people, such as using belladonna to widen their eyes. By contrast, fashion went against this beauty trend as the patriarchal social order sought to discourage new fashion items like corsets and thin shoes by claiming that they caused TB.
Green suggests that contemporary beauty standards are still influenced by the consumptive ideal of the 19th century. He clarifies that they aren’t universal, however, given that Henry possessed all the characteristics that would have been associated with the romanticization of TB. The difference for Henry is the unspoken beauty standard that relates to whiteness.
In 19th-century European beauty guides, writers extolled the virtues of whiteness as a prerequisite for beauty. TB was further racialized when Western writers described it as a “civilized” disease, implying that it did not affect “uncivilized” communities. Within the United States alone, Black people were diagnosed as having an entirely different disease from TB, which went unnamed due to their lack of access to healthcare. European colonizers likewise argued that TB did not afflict people on Africa and South Asia. By denying that TB affected colonized populations, colonizers could justify neglecting healthcare in these regions while framing disease as a marker of civilization—thereby reinforcing racial hierarchies and tightening control.
Chapter 8 Summary: “The Bacillus”
As the 19th century came to an end, so did the rates of TB infection in Europe and the United States, along with its romanticization. TB was increasingly seen as a disease of the poor as the middle and wealthy classes moved away from the cramped urban spaces of the Industrial Revolution. This led to the present understanding of TB’s surge as a byproduct of industrialization when the infection spread through the crowding of industrial zones throughout the city. This notion would soon be bolstered by the first observation of M. tuberculosis, which would both reshape the imagination around TB and result in its treatment.
Green frames the discovery of M. tuberculosis within the narrative of German doctor Robert Koch, who was part of a wide spectrum of researchers who helped advance the breakthroughs that would lead to the treatment of TB. In the late 19th century, Koch was interested in the study of the unknown organisms that caused wound infections, which he believed he could observe through microscopes. He sought to legitimize his findings through published research, but it wasn’t until 1876 that he announced that he could identify the bacteria that caused anthrax. Koch’s methodology involved isolating the bacteria and replicating the chain of transmission in test rabbits, bringing him fame in medical research circles. Soon after, he completed the same process with M. tuberculosis. The conclusion that TB was transmitted rather than inherited left people shocked. This marked the shift from one way of thinking about TB to another.
Chapter 9 Summary: “Not a Person”
With the discovery of M. tuberculosis, racialized thinking about TB shifted to suggest that the high rates of infection among Black people meant white superiority. Systemic racism, however, increased the risk factor for Black people through low-quality and crowded housing, malnourishment, work-induced stress, and lack of access to healthcare. Black communities pushed back against the racialized view of TB, but their resistance was ignored. The white United States medical industry pushed the view that certain races were more susceptible to TB, including Black, Chinese, and Irish people. Similar violence was committed in Canada, where the placement of Indigenous children in residential schools isolated them from the spread of TB once it entered their communities.
Green argues that stigma is an erroneous way of framing illness as a consequence of morality. The implication of stigma is that the people who get sick “deserve” their pain while those who do not have it do not. This reduces the humanity of the sick in the eyes of those who stigmatize them and contradicts the nature of illness, which does not care for morality. Some TB patients find it more difficult to fight against the stigma because it ostracizes them from their families and their communities. There is a complex hierarchy of stigmatization that categorizes diseases according to their perceived danger, infectiousness, and origin. These stigma structures erupt from the human desire to understand.
Stigma continues to affect people who experience TB in the present, as it does in Sierra Leone. Green recounts stories of people who were shunned by their extended families after they were diagnosed with TB. Others were abandoned at the hospital. In not being abandoned by Isatu, Henry was in the minority.
Chapter 10 Summary: “A Study in Tuberculin”
At the same time that Koch was working on his study of anthrax, the French doctor Louis Pasteur was conducting his study on microorganisms and the fermentation process. Pasteur took Koch’s research a step further by developing the first anthrax vaccine. This invention drove increased competition between the French and German medical research industries—rivals in the wake of the Franco-Prussian War.
When Pasteur announced that he had developed a vaccine for cholera, Koch, at the height of his fame, became desperate to produce a vaccine for TB. Using Pasteur’s methods, Koch injected four subjects with a nonfatal dose of benign tubercles. This had the effect of not only inoculating the subject from TB but also curing them of the illness entirely. The news spread quickly across Europe, drawing the attention of Arthur Conan Doyle, creator of the Sherlock Holmes character.
Green underscores the groundbreaking impact of the germ theory of disease, which finally gave a form to imagine illness. Now that germs can be conceived by the mind, Green is especially conscious of them existing everywhere around him, entering his body and having existential implications on his way of thinking and being.
When Conan Doyle failed to meet with Koch in Berlin, he spent his time roaming around the city to observe the vaccine’s impact. He discovered that Koch misinterpreted the effects of his vaccine, which simply eliminated dead tissue but did not kill M. tuberculosis. He reinterpreted the impact of Koch’s vaccine to show that it simply catalyzed a strong immune response without inoculating the body to TB. Koch was subsequently disgraced, and his vaccine was discredited.
The principles behind the vaccine could still be used for diagnosis since the vaccine catalyzed an immune response, which is only possible when M. tuberculosis is present. This resulted in the development of tuberculin skin tests, which remain useful as screening tests.
Chapter 11 Summary: “Trepidation and Hope”
With the continued study of TB, the United States government began pushing efforts to reduce transmission, such as discouraging people from spitting in public to covering one’s mouth when coughing or sneezing. This led to an increase in public sanitation and drove shifts in style and fashion, as men started shaving facial hair to prevent germs from clinging onto their faces and women started wearing shorter dresses to prevent their hemlines from picking up dust. The latter, however, was once again defined by the social standards of the patriarchy, which also deemed that hemlines could not be too short for fear of catching cold. This demonstrated the moralization of hygiene.
The people of the 19th and early 20th centuries believed that they need not die of TB. Where Henry was administered a regiment of medication pills, the people of the past resorted to travel, particularly to locations where the air was considered “clean.” This qualification left room for ambiguity, which allowed the concept of the sanatorium to develop as the century turned. These dedicated facilities were designed for isolating TB patients outside urban limits to improve their health and limit transmission. The sanatorium became especially popular in the United States, giving rise to cities such as Colorado Springs, Colorado.
In sanatoria, patients were removed from the rhythms of ordinary life since they were discouraged from nearly any form of movement. Green discusses the ableist term “invalid” to describe how TB patients were not seen as being valid in the social order of the everyday world. As a result, many TB patients endured the boredom of life at the sanatorium, an experience that would resonate with Henry’s at Lakka. The supervising physician oversaw every aspect of the patients’ lives, drawing comparisons to incarceration.
Green focuses on the story of a child named Gale Perkins, who contracted bone-involved TB and lived in a sanatorium for 12 years. Gale was terrified upon her arrival—many children wept for their mothers, an act for which they were rebuked since crying was forbidden at sanatoria. In Gale’s case, she was given punishments every time she cried or exhibited distress. These punishments ranged from isolation to the confiscation of her toys.
Gale’s best friend was a second-generation Greek American girl named Angie, who often acted according to the prescribed standards of behavior at the sanatorium. Gale became witness to tragedy when she learned that Angie’s sister, Pauline, had died of TB. The news had been withheld from Angie out of concern for her health, and Angie’s father attempted to hide Pauline’s death by mimicking Pauline’s handwriting in letters to Angie. Soon after, Gale watched Angie being brought to the morgue.
Gale and Angie’s experiences, Green writes, are emblematic of the wrongful framing of TB as a moralistic disease. This underscores the US public healthcare system’s prerogative of “control over care” in the context of TB. While control is helpful in containing an outbreak, care is abandoned when it comes to diagnosed patients, which discourages them from seeing their treatment to completion.
Gale recovered after receiving a treatment of streptomycin, one of the first drug treatments for TB. During her adulthood, she worked as an occupational therapist and devoted herself to cheering up sick children by becoming a clown. Green assesses that while sanatoria decreased transmission rates, it did little to impact recovery rates when compared to home treatment. The decline in transmission was inequitable, however, especially for people of color.
Chapters 6-11 Analysis
In these chapters, Green shows how shifts in the way TB was imagined reflect the class, race, and gender biases of different eras. The fact that these shifts were triggered by scientific discoveries that disproved the underlying assumptions of these biases speaks to the way that bias is primarily a construction. These constructions are not rooted in natural phenomena but in attempts to exploit humanity’s natural inclination for meaning. This gives the challenges around treating TB a base in psychology. Scientific progress, in this view, does not automatically dismantle prejudice—it simply changes the language through which prejudice is justified.
Green suggests that the drive to understand illness is instinctive to human beings, which makes them receptive to the constructed meanings that align with their perspective and experience. Consequently, any perception of illness is prone to constructions that support the imperative for exclusion: “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” (54). This is where Green’s repeated warnings to refrain from reductive thinking become especially relevant. Rather than seeing illness in binary terms such as “natural” and “unnatural,” Green invites the reader to consider illness as a complex spectrum of experiences, which could include pain and suffering. Green’s own experience as a person with OCD falls on that spectrum of experience but cannot be compared to the suffering that people with TB experience. However, his discussion of the romanticization of OCD proves a similar point regarding the dangers of socially positioning illness as indicative of beauty, genius, or other social constructs of identity. By exploring how human thought gives rise to stigmatization, Green frames simplistic thinking and Bias as an Illness of the Spirit. This framing challenges the reader to question the internal narratives that they may unconsciously uphold—stories that render some illnesses tragic and others shameful, drawing false lines between empathy and distance.
Reductive binary thinking is also displayed in Green’s examination of romanticization. He argues that romanticizing disease is just as bad as stigmatizing it. Even if romanticization has a positive connotation, it still places people with illnesses in the category of otherness, separating them from wellness as a category of normalization. In a complex spectral approach to understanding, such categories are rendered moot. There is no “other” in a spectrum, just a broad range of possible human experiences. Green emphasizes that false elevation—casting TB sufferers as beautiful, poetic, or noble—is another form of erasure, one that glosses over real suffering while failing to address the social structures that prolong it.
Green qualifies the effects of bias and reductive thinking by elaborating on its impact in different forms of exploitation. His intersectional approach to studying illness and exploitation strengthens his arguments by showing that the problem is not endemic to a single experience of marginalization. Rather, bias in TB healthcare manifests across multiple dimensions of identity. Even though human society may have pulled itself away from its previous conceptions of TB transmission, some aspects of bias remain in vogue, from the beauty standards associated with TB to the assumption that illness is a consequence of moral failure. Green underscores the latter by bringing the narrative back to Sierra Leone. While Henry had Isatu for company, the same cannot be said for many others, who come to fear healthcare because they are afraid of the stigma attached to it, which often leads to isolation. When Henry’s father pulled him out of treatment, he was acting according to his bias against the healthcare system. This speaks less to the efficacy of the Sierra Leonean healthcare system than it does to Henry’s father’s accepted psychology. Here, Green does not frame Henry’s father as an antagonist but rather as a product of deep structural disillusionment—an embodiment of what happens when systems fail people for too long.
These chapters also show how bias continues to persist even when solutions have been discovered. Prior to the development of the first cures for TB, Western societies turned the prevailing treatment, the sanatorium, into a venue for exclusion and othering. Green shows how the prerogative of “control over care” is counterproductive to the intentions of healthcare treatment. It transforms illness into a moral failing and blames the patient for their inability to abide by the terms of their treatment. In the absence of a clear target to reduce illness, sanatorium workers projected hostility onto patients for having illnesses. Gale Perkins’s experiences resonate deeply with those of Henry’s, even though they lived in radically different times and parts of the world. That resonance only begins with the boredom they experienced while receiving treatment at their respective facilities. Green will later show that this also extends to their social lives in Chapter 16. By tracing the violence of institutional care across generations, Green underscores that control without empathy often results in cruelty disguised as discipline.
Together, Chapters 6-11 expand the thematic architecture of the book, showing how cultural constructions of illness—romanticization, stigma, and scientific triumphalism—intersect with lived experiences of exclusion. In doing so, Green strengthens the case that TB is not merely a medical problem but a reflection of how societies value certain lives over others. These chapters build toward a deeper understanding of The Need for Empathetic Thinking, challenging the reader not only to critique failed systems but also to examine the imaginative biases that shape their own responses to sickness, care, and human vulnerability.
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