Everything is Tuberculosis Book Summary

It is common to say that Sierra Leone is a poor country, but this is not the case. It is an exceptionally rich country with vast wealth in metal ores and especially in diamonds, which during centuries of colonialism encrusted many a British crown. After achieving independence in 1961, the new government struggled to transition away from this extraction-based economy.

The Sierra Leonean physician Dr. Bailor Barrie once told me, "If you want to understand why Sierra Leone is poor, you must look at a map of our railroads." The railroads, built during colonial rule, did not connect people to each other. They connected the mineral-rich areas of Sierra Leone to the coast, where those minerals could be exported. The empire's role in Sierra Leone was primarily to take Sierra Leone's wealth, as quickly and efficiently as possible, out of Sierra Leone.

Section: 1, Chapter: 3

As Frank M. Snowden observes in Epidemics and Society, white physicians in Europe and the U.S. generally agreed that consumption was, as some eighteenth-century observers put it, a disease of civilization. Everyone knew that rural communities were less vulnerable to consumption. But in a highly racialized social order, conceiving of phthisis as a "civilized" disease also meant that it could not be a disease of uncivilized people, which furthered the racialization of consumption.

In Europe and the U.S., most white doctors believed that phthisis—as it was inherited by those with great sensitivity and intelligence—could only affect white people, and it was sometimes known as "The White Man's Plague." One American doctor, for instance, called it, "a disease of the master race not of the slave race." This phenomenon extended to all colonial empires. Many European colonialists believed that TB did not exist in South Asia or Africa, even though physicians working in colonized communities knew otherwise.

Section: 2, Chapter: 7

By the end of the nineteenth century, the replication and acceptance of Robert Koch's research meant that the era of consumption, an inherited condition that grew the soul by shrinking the body, ceased to exist. The era of tuberculosis, an infectious disease of the poor and marginalized, had commenced.

In fact, the way we understood "consumption"—that bright, mild, kind disease that Harriet Beecher Stowe described—was so different from the way we understood "tuberculosis" that even though they are the same disease, one could be forgiven for thinking they were entirely different. Consumption, after all, was a flattering malady, a genetic disorder enriching the soul even as it slowly destroyed the body. Tuberculosis was a horror, an invisible contamination proliferating within you and then spreading to anyone near you.

Section: 3, Chapter: 8

We see the profound shift from an inherited disease of intellect to a contracted disease of filth in the racialization of tuberculosis. As late as 1880, white American physicians still argued that consumption did not occur among Black Americans, who, it was claimed, lacked the intellectual superiority and calm temperament to be affected by the White Plague. But after Koch identified Mycobacterium tuberculosis in 1882, all that changed.

Racialized medicine no longer maintained that high rates of consumption among white people was a sign of white superiority; instead, racialized medicine maintained that high rates of consumption among Black people was a sign of white superiority. One white doctor's 1896 treatise asserted that African Americans were disproportionately dying of tuberculosis due to their smaller chest capacity and increased rate of respiration.

Section: 3, Chapter: 9