Did you know tuberculosis helped New Mexico become a state? After New Mexico became a territory in 1848, its request to become a state was constantly rejected because the majority of its citizens were Indians or spoke Spanish as their first language. Despite the fact New Mexico had the institutions needed for statehood, a large enough population, and large majority of that population sought statehood, the racist U.S. Congress repeatedly turned down New Mexico's attempts to fully enter the Union.

In order to please Congress, New Mexico officials realized that they needed to recruit a larger white and English-speaking population, and thus began New Mexico's quest to woo consumptives (people infected with TB) from the American Northeast and South with the promise of desert air, open skies and world class consumption care. That plan worked - by 1910, around 10% (!!) of all of New Mexicans were tuberculosis patients, and with these new white residents, the U.S. Congress finally acquiesced and New Mexico became the 47th state in 1912.

Did you remember that the assassination of the Archduke Ferdinand was the official trigger for WWI? The assassin who shot him was a Serb nationalist name Gavrilo Princip. Princip had tuberculosis, and had been given just 6 months to live. So he didn't care if he got caught. There were actually two other assassins in the plot with Princip - they were also diagnosed with tuberculosis (there was no cure in those days). The first guy threw a bomb at the Archduke's car, but missed. But rather than return to safety, one of the Archduke's companions convinced them to continue the tour of Sarajevo by saying: "do you think Sarajevo is full of assassins?"

The driver of the Archduke's car was unfamiliar with the city and took a wrong turn into a dead end. He had to stop the car to put it in reverse - the driver stopped the car right in front of Princip, who just happened to be standing in the wrong spot off of the parade route. Princip shot and killed the Archduke and his wife right there. Princip then took a cyanide pill to kill himself, but there wasn't enough cyanide in the capsule to kill him, so he was captured and sent to prison, where he died of tuberculosis.

Before modern medicine (ie: vaccines), half of every human born died before the age of five. There was a real bathtub curve - get to age six, and you had a good chance of making it to age 50 or 60. Life expectancy was only 30 years, but that was because half of the population was dying as toddlers. But tuberculosis was the anomalous killer - it struck people in their primes - ages 20 to 45.

In London in the 18th century, 15% of the population died from TB. But in the early 19th century, as industrialization caused people to pour into the city and crowd together, 30% of deaths were due to TB, because having people living in packed quarters made it easier to transmit the disease by airborne particles. Indeed, the death rate in London was GREATER than the birth rate, and yet the city continued to grow rapidly due to the influx of new people pouring in (aristocrats were forcing people off of their lands in order to switch from feudal farming to large pastures to raise sheep.)

In the 19th century, it was thought that TB gave people a look of beauty as they got closer and closer to God as they wasted away. Thus, pale white skin (the skin gets whiter due to deoxygenation, a consumptive's lungs are unable to process enough oxygen), the cheeks and lips take on a feverish red hue, the eyes and cheekbones appear more prominent as the flesh dissolves away in the emaciated sick person - think about our standards of beauty even today: White skin, big eyes, ruby lips and prominent rosy cheeks and the ultrathin body of a supermodel.

In 1882, a German doctor named Robert Koch discovered that tuberculosis was caused by a bacteria. TB was not inherited, it had nothing to do with becoming closer to God as you wasted away here on Earth. Tuberculosis was a disease caused by an infectious bug.

Knowing that TB was caused by bacteria cause a lot of behavior changes: Hemlines were shortened, because they thought long dresses might stir up infected dust. People stopped spitting, especially indoors (really? They USED to spit indoors??). There are still laws in some US cities against spitting in the streets. People thought houseflies could transport the disease, so they started putting screens on their windows (houseflies can carry diseases, but not tuberculosis). It was thought that beards could carry the TB germs, so men went clean-shaven. Tuberculosis also infects cows, you could catch bovine tuberculosis from drinking contaminated milk, so they started Pasteurizing milk. And, most importantly, people started to cover their nose and mouth when they sneezed or coughed, everyone started carrying handkerchiefs.

Green finished his book by talking about Virtuous Cycles vs Vicious Cycles, and wondered which one humanity will pursue.

In the Virtuous Cycle path, we provide wealth, drugs and expertise to the poor nations like Sierre Leone in West Africa which struggle with TB infections. In the long run, this would help the first world as well, because many poverty stricken tuberculosis patients cannot complete the long rigorous antibiotic treatment regimen. Treatment requires that a patient take a bunch of pills every day for 6 to 9 months to kill off TB entirely. But if someone is too hungry, then the TB pills make you sick if there is no food in your stomach. And so many people never complete their treatment, and thus there are a lot of drug resistant TB infections. And naturally the more infections, the more chances that a completely drug-resistant form of TB mutates into something super infectious and lethal that would threaten the rest of the world. So stopping TB is in our best interests.

In the Vicious Cycle, we continue to ignore West Africa, keeping the price of drugs high (Johnson and Johnson tried to extend its TB drug patents so it could continue to maximize profits, but eventually its arguments lost in court). Despite the patents expiring, it turns out that none of the generic drug companies had a generic version ready to go, they were unaware that there was a market for those drugs. 1.25 million people die a year of TB, but the generic drug makers were unaware that these drugs were needed??

Which cycle will we choose?

Who are we kidding?

The Vicious Cycle, of course. Everything is Tuberculosis was published in 2025, which means it went to press in 2024 - before Trump and company killed USAID and other foreign assistance, thereby condemning millions to death. Trump is also hacking away at funding for PEPFAR, the anti-AIDS/HIV global relief initiative started by George W Bush. Surprisingly (sarcasm alert) there hasn't been a peep of protest by the pro-life Republican party.

This is an interesting book to read, even though the fact that the first world continues to ignore the plight of TB sufferers in the third world is disturbing to read.