The Consumptive Revolution: How Tuberculosis Shaped Our World
There's a certain irony in how death begets life, how suffering creates beauty, how disease—of all things—can spark innovation. You might know John Green for his infamous novel, "The Fault in Our Stars," but I know John Green for his nuance and hopeful look at the world. In his new book, "Everything is Tuberculosis," Green dives into one of his specialized interests: the deep and complex roots of tuberculosis as a disease, a result of systemic sociological factors, and a consequence of the rich getting richer and the poor getting poorer.
Though the history of what was once known as consumption is grim, and its present, though curable, still ill-fated, the book explores an arc of hope in which humanity goes through vicious cycles of loss and growth. I commend Green for his hopeful outlook on life because—if we have no hope, what have we?
The book, just under 200 pages, is a recommended read, but if you'd rather get a quick summation of things influenced by tuberculosis, here is the list for you.
A Brief History of the White Plague
Tuberculosis has been with us longer than civilization itself. Traces of TB have been found in the remains of bison from 17,000 years ago, and signs of the disease appear in human remains dating back to prehistoric times. The ancient Egyptians documented what appears to be tuberculosis in their medical papyri. Hippocrates described it in ancient Greece as "phthisis" (wasting away), while the Romans called it "tabes" (decay).
By the 17th century, the disease had earned its poetic moniker "consumption" for the way it seemed to consume its victims from within. The 19th century saw TB reach epidemic proportions in Europe, killing one in seven people. The disease knew no boundaries of class or status, yet its brutal efficiency in spreading through overcrowded tenements made it primarily a disease of poverty.
Today, we have antibiotics and vaccines, yet tuberculosis stubbornly persists. Why? The answer lies in the same inequities that have always fueled its spread: poverty, inadequate healthcare access, and neglect. In wealthy nations, TB has retreated to the shadows, while in many developing countries, it continues its deadly work largely unabated—a curable disease that kills 1.5 million people annually.
This millennia-old disease, for all its grim efficiency at claiming lives, has paradoxically spawned a legacy of innovation that reaches far beyond the realm of medicine into the very fabric of our society. From the chairs we lounge in at sunset to the architecture of our most cherished spaces, tuberculosis has left its consumptive fingerprints on art, fashion, literature, and cultural touchstones we encounter daily without recognizing their origins in suffering. Here is a list of tuberculosis-influenced creations—by no means exhaustive—that reveals how deeply this disease has shaped our world, a testament to humanity's peculiar ability to transform tragedy into lasting beauty.
*In no particular order, as disease respects no hierarchy...*
1. Adirondack Chairs
Those comfortable, sloped-back wooden chairs you see outside Home Depot and at your grandpa's lake house? They began as "cure chairs" designed for tuberculosis patients to recline while taking their prescribed fresh air and sunlight therapies. The wide armrests weren't just for comfort—they provided space for drinks, medicines, and books during long hours of outdoor recuperation. What once was medical necessity has become synonymous with summer leisure.
2. Consumption Towns
Places like Pasadena, California; Phoenix, Arizona; and Colorado Springs weren't just founded by chance—they were established or grew substantially as havens for tuberculosis sufferers seeking healing climates. The medical theory of the time held that dry, elevated air was therapeutic. These "lunger colonies" transformed into thriving communities that still stand today, their origins in disease forgotten by most who walk their streets
2. The Cowboy Hat
When doctors prescribed the dry, clean air of the American West as a remedy for consumption, thousands of pale Easterners donned wide-brimmed hats to shield themselves from the harsh desert sun. These "lungers," as TB patients were sometimes cruelly called, helped popularize what would become the iconic cowboy hat. Disease drove them west; fashion followed.
4. Consumption Chic (The Tim Burton Look)
Before heroin chic or the waif look, there was "consumptive chic"—the romanticized aesthetic of the TB sufferer: pale skin, hollow cheeks, bright feverish eyes, and an ethereal thinness. This look influenced fashion, art, and beauty standards for generations. The disease's wasting effects were perversely idealized as a form of tragic beauty. Even corset designs shifted, sometimes becoming looser around the chest (at doctors' recommendations) while still emphasizing the slim waist that mirrored the TB-ravaged figure.
5. Spes Phthisica: The Creative Death Rattle
Perhaps most bizarre was "spes phthisica," the feverish creative energy that supposedly overtook tuberculosis patients in their final stages. This phenomenon gave us the tragic archetype of the dying artist creating their masterpiece with their last breaths. The list of creators who died from TB while producing remarkable work is staggering: Keats, Chopin, the Brontë sisters, Chekhov, Kafka, and countless others whose creative flames burned brightest just before being extinguished by the disease. Society has long romanticized suffering as a subconscious coping mechanism against its devastation—we see this same pattern today in our fascination with troubled artists battling mental health issues or addiction, as if creativity requires a toll paid in personal anguish. This troubling tendency to aestheticize illness speaks to our deep discomfort with mortality and our desperate need to find meaning in suffering, even when that meaning is largely constructed.
6. The Rise of the Health Movement
Today's wellness culture—with its emphasis on clean living and natural remedies—has roots in the anti-tuberculosis campaigns of the early 20th century. Fresh air, sunlight, exercise, and nutritious food were prescribed as both prevention and treatment. The disease that killed millions inadvertently sparked a revolution in how we approach health and self-care.
7. Handkerchief Culture
The elegant gesture of coughing delicately into a handkerchief—a staple of period dramas—was codified as part of TB prevention. In literature and opera, the bloodstained handkerchief became the universal foreshadowing of death. From Mimi in "La Bohème" to Satine in "Moulin Rouge," that crimson-spotted cloth signaled the beginning of the end, a symbol so powerful it remains with us long after spitting into handkerchiefs has (thankfully) gone out of fashion.
8. Sanatorium Architecture
The architecture of healing transformed our built environment. Sanatoriums, with their emphasis on light, air, and cleanliness, influenced modernist architecture's clean lines and functional spaces. The minimalist aesthetic—those bright, uncluttered spaces we now associate with contemporary design—evolved partly from medical necessity. When your spaces might harbor deadly bacteria, ornate Victorian clutter suddenly seems less appealing.
9. The Romanticization of Illness in Literature
Thomas Mann's "The Magic Mountain," set in a tuberculosis sanatorium, is just one example of how TB became literary shorthand for tragic beauty and profound suffering. Consumption didn't just kill characters; it transformed them into symbols. Mimì in "La Bohème," Fantine in "Les Misérables," and countless heroines wasted beautifully away, their deaths rendered not as the messy, painful reality of TB but as aesthetic moments of transcendence.
10. Gothic & Victorian Death Aesthetic
The Victorian obsession with death—elaborate mourning rituals, post-mortem photography, and memento mori jewelry containing locks of the deceased's hair—developed during tuberculosis's peak years. When death from consumption was commonplace, cultures developed elaborate ways to process grief and remember the lost.
11. Porch Culture & Sleeping Porches
The screened sleeping porch, a fixture of early 20th-century American homes, emerged from tuberculosis treatment protocols emphasizing fresh air, even during sleep. Families built these extensions so TB patients could benefit from outdoor air while remaining protected from insects and weather. The American front porch itself gained popularity partly as a tuberculosis prevention measure—a space between the private home and public street where families could enjoy fresh air without exposure to potentially infected passersby.
12. X-Rays
While Wilhelm Röntgen discovered X-rays in 1895, their widespread medical adoption was driven largely by tuberculosis. The ability to see inside the chest, to detect TB before symptoms became severe, revolutionized diagnosis. Those illuminating rays, first used to hunt the shadows of consumption in lungs, paved the way for modern medical imaging.
13. Milk Pasteurization
Before pasteurization became standard, tuberculosis commonly spread through contaminated milk. Louis Pasteur's process, which kills TB bacteria without significantly altering milk's taste, became widespread largely due to anti-tuberculosis public health campaigns. Every time you pour milk without fear of deadly disease, you can thank the fight against TB.
14. White as a Symbol of Cleanliness
The crisp white doctor's coat, the nurse's uniform, the sterile white hospital room—our association of white with medical purity stems largely from tuberculosis sanitation efforts. White clothing showed dirt clearly, making it easier to maintain hygiene standards in TB wards. What began as practical became symbolic, and that symbolism remains with us today.
The Persistent Plague
Despite having the medical knowledge to prevent and cure tuberculosis, the disease kills someone every 20 seconds worldwide. Why? The answer is painfully simple: resources and will. TB thrives where healthcare systems are weak, where poverty concentrates people in unsanitary conditions, where HIV/AIDS undermines immune systems.
The tools exist to end tuberculosis entirely. The missing ingredient is the global commitment to use those tools where they're most needed—often in communities without political power or economic leverage.
Perhaps that's the most important lesson from tuberculosis's long shadow: disease isn't just biological; it's political and social. The same inequities that allowed consumption to flourish in Victorian tenements still enable its modern spread. The innovations sparked by tuberculosis—from art to architecture—show humanity's remarkable creativity in the face of suffering. But they also remind us of our selective attention, our capacity to transform some aspects of life while leaving fundamental inequities untouched.
John Green's hopeful outlook reminds us that even in cycles of suffering, beauty and innovation emerge. The challenge is to extend that hope beyond aesthetics and consumer products to the systems that determine who lives and who dies from a preventable, curable disease.
After all, if we have no hope for that kind of change—what have we?
