Tuberculosis has been a recurring theme in many literary works. The Magic Mountain, Thomas Mann’s most famous novel, written before Mann came to teach at Princeton University, is set in a Swiss tuberculosis sanatorium. Characters in the Dostoyevsky novels Crime and Punishment and The Idiot are afflicted with TB. In the Puccini opera, La Bohème, the central character, Mimi, dies of tuberculosis.  Coverage of this disease in the medical literature has been extensive.

            With Everything is Tuberculosis: The History and Persistence of our Deadliest Infection, the author, John Green, makes a significant contribution to that otherwise voluminous literature with this highly readable book. This book is not primarily directed to healthcare professionals, and the author is not a healthcare professional. Green is a novelist. He has been very successful in the genre of young adult fiction. And while Everything is Tuberculosis is not a work of fiction, Green brings his creative writing skills to the task of presenting important technical, medical, and sociological information to his readers.

            With a commitment to lifelong learning, Green and his younger brother, Hank, developed and produced the Crash Course series on YouTube, among other educational efforts. For more than 20 years, they have supported the international public health organization Partners in Health, founded by Paul Farmer and Ophelia Dahl, through a community-based health project in Haiti that began in 1987.

Green advances his thesis that “everything is tuberculosis,” using examples some might consider quirky. He acknowledges an increasing obsession with the disease after his return from a trip to Africa, noting that he “simply could not shut up about the disease” and continually identifies intersections of tuberculosis with history and important events. From Green’s description, TB is somewhat like the character Forrest Gump, who always seemed to be present at significant events. In a passing conversation, when someone mentioned New Mexico, he would interject that it had become a state because of TB. The backstory, he explains, is that when the territory was acquired by the United States in 1848, following the Mexican-American War, it was primarily populated by Spanish-speaking and Indigenous people. At a time when it was believed that TB could be treated with dry air, New Mexico sought to attract new white residents to improve its chances of admission to the Union. During conversations about World War I, he would challenge others regarding their awareness of the role of TB in sparking the war. He describes the assassins of Archduke Franz Ferdinand and his wife in 1914 as young men dying of tuberculosis who had nothing left to lose. Adirondack chairs were invented for patients at TB sanatoriums to sit in a reclining position, rest, and breathe the mountain air without having their beds brought outside. Seeing children at Halloween in cowboy costumes, he would exclaim that tuberculosis had given us the cowboy hat. A hatmaker suffering from TB moved from New Jersey to Missouri. Unlike the brimless coonskin hats then commonly worn, the hatmaker developed a wide-brimmed hat that would protect the wearer from the sun, wind, and rain, which came to be known by his family name, Stetson. In a footnote, Green observed that John Stetson made a vast fortune, almost all of which he donated to endow schools, a homeless shelter, and food banks. The need for philanthropic responses permeates the book.

Green weaves the historical, scientific, medical, and cultural information he presents into the story of Henry Reider, a young African with tuberculosis whom Green met in 2019 while visiting Sierra Leone with his wife. Henry Reider's life serves as a prism through which to view developments and shortcomings in the diagnosis and treatment of TB. Green maintained ongoing correspondence and video exchanges with Henry.

            Tuberculosis has been known by various names over time, including phthisis, consumption, and the White Plague, among others. Because an important aspect of TB is weight loss and wasting caused by loss of appetite and severe abdominal pain, the name “consumption,” used until the Twentieth Century, aptly describes a disease that consumes the body. Although it primarily affects the lungs, tuberculosis can also affect other organs. Infection of lymph nodes in the neck – cervical lymphadenitis – was known as scrofula or, more colorfully, as the King’s evil, because it was believed that the royal touch could cure it. In the spine, the disease is called Pott’s disease.

The term “tuberculosis” was first used in 1862 by the German physician Johann Lukas Schoenlein. In 1882, the German physician Robert Koch identified the bacterium that caused the disease. (The date of that discovery – March 24 – has become World Tuberculosis Day.) Although Koch was unable to deliver the promised cure for tuberculosis, his work led to the development of a test that enabled early detection of the disease and permitted treatment at an earlier stage of the infectious process. This objective was further advanced after Roentgen invented X-rays in 1895, when the chest X-ray replaced microscopic examination of sputum for evidence of bacteria, a test that was highly unreliable at the time. However, the lack of X-ray machines in poorer countries and communities hindered the diagnosis of the disease. As Green relates, the lack of effective treatment was even more problematic.

In 1921, the BCG vaccine became available to a limited number of people. The discovery of the antibiotic Streptomycin in 1944 at Rutgers University represented a sea change. (Green does not go into detail concerning the controversy and litigation between Albert Schatz and Selman Waksman that emerged regarding credit for the discovery of Streptomycin, but he does flag the involvement of Elizabeth Bugie, the “invisible woman” in the discovery of Streptomycin.)

The discovery of Streptomycin led to the development of the RIPE combination therapy of Rifampin, Isoniazid, Pyrazinamide, and Ethambutol, which became the standard of care. By 1980, the RIPE treatment protocol had been used for decades in the United States and Western Europe, so that, in combination with efforts at case-finding to identify opportunities for early treatment and preventive measures, the rates of TB had dropped to the point that “tuberculosis felt like what it should have been: history.”

In contrast, in low-income countries, primarily in the Global South – meaning countries that have historically faced colonialism, economic dependency, and developmental challenges – treatment either was not available or reached patients only sporadically. But complete eradication of the disease faces other challenges. According to CDC provisional data released in March 2025, even in the United States, the consistent decline in TB has reversed, with both case counts and rates increasing.

Green explains in detail how the TB bacterium is adept at developing antibiotic resistance and illustrates this with the case of Henry Reider. At age six, Henry began showing signs of the disease. However, his early tests were negative. His treatment with antibiotics was not only delayed but also interrupted by his father, who rejected the medications started at a clinic and instead relied on a local faith healer. This likely led to Henry developing drug-resistant TB. When Green met Henry, he perceived him to be about the same age as his own nine-year-old son, but in fact, Henry was 17. He was small because he had grown up malnourished; he had become emaciated from TB. Despite his difficulties, Henry maintained an optimistic outlook. Green follows the efforts to get Henry the treatment he needed, and indeed, the young man has survived and thrived. He was able to catch up on the schooling he had missed due to prolonged hospitalization and illness, and to attend college.

            Green repeatedly points out that richer countries, such as the United States and much of Europe, have been successful in treating and reducing TB incidence, but the same is not true in other parts of the world, such as Sierra Leone. He emphasizes that allowing a patient with tuberculosis, especially drug-resistant TB, to go untreated makes it more likely that the disease will spread to others. The risks to global health seem readily apparent in the actions of the Trump administration, which has cut foreign aid through the US Agency for International Development (USAID), including programs to fight TB, along with HIV/AIDS and malaria.

Green’s advocacy is apparent throughout his book. In its first chapter, he writes: “We know how to live in a world without tuberculosis. We choose not to live in that world.” Green’s stance is grounded in a rejection of the notion of human interdependence. The inability of physicians to cure TB patients is because “the cure is where the disease is not, and the disease is where the cure is not.” This becomes a leitmotif for the book as Green traces the impact and perception of TB over several centuries. He concludes with a summary of “why we must work together to end tuberculosis and all other diseases of injustice.”