The wasting disease known as tuberculosis, or TB, is as old as human history. Caused by the waxy bacillus Mycobacterium tuberculosis, TB remains one of the deadliest infectious diseases in the modern era, killing around 1.5 million people per year worldwide. TB infection is usually initiated when an individual inhales bacteria made airborne through the coughing or sneezing of other infected individuals. The bacteria settle deep into the lungs where they begin a latent infection that, if left untreated, can last a lifetime.

The problem for some people with latent TB is that they do not remain immune-competent and can’t keep latent TB contained. Some individuals develop immune deficiencies, autoimmune diseases, or cancer that render them susceptible to reactivation of bacterial growth. Individuals with AIDS, for example, have lost the helper T cells that are needed to help TB-containing macrophages, and so the HIV/AIDS pandemic was associated with a resurgence in TB worldwide. Modern medicine has increased the number of individuals on immunosuppressive drugs or those able to survive with immune deficiencies, increasing the number of people susceptible to more severe forms of TB. Because of its high prevalence, it’s safe to say that TB will likely never be eradicated.

After an initial infection that could be mistaken for a common cold, progressive TB can result in chronic destruction of lungs, where patients often cough up blood while bacteria spreads to other parts of the body. Chronic TB infections differ within individuals in their level of severity and progression, with disease progressing over a period of a single year to decades. Some develop periodic fevers, extreme fatigue, and excessive production of phlegm and leaking of blood in the lungs. The final stage results in individuals developing a pallid color and an emaciated physique with a loss of muscle tone, sunken cheeks, and hollow eyes. This appearance describes the typical form of late-stage “consumption” as the disease was called in the 18th and 19th centuries, since the disease appeared to consume the body slowly until the skeletal-like victim expired.

Much of the popular mythology of vampires can be traced to beliefs about TB. People with progressive TB often appeared pale and gaunt, with reddish eyes and blood on their lips. Consumptives often exhibited a sensitivity to light, forcing them to stay inside during the day, venturing out only at night. Some thought that blood on their lips wasn’t just suggestive of a loss of blood, but also a thirst for it, giving them an overwhelming urge to bite others. During one such outbreak of TB-related vampire hysteria in Rhode Island in March of 1892, villagers dug up bodies of three suspected vampires, a mother and her two daughters who had died of TB. Participants observed that one of the daughters looked suspiciously well-preserved despite being entombed for several months, with evidence that her hair and nails had grown, and her blood not fully coagulated. A local doctor tried to reason with the mob, explaining that the previous cold winter had likely preserved the young woman’s body. Yet the crowd believed this was indisputable proof of her undead status, resulting in the removal of her heart and burning of it on a rock, thus ‘killing’ the vampire that had caused all of their trouble once and for all. Perhaps coincident to this story, Bram Stoker’s classic vampire novel Dracula was published in 1897. 

Not everyone associated consumption with supernatural beings. Before Robert Koch identified TB as an infectious disease in 1882, it was thought by some to be a spontaneous, predestined disease, an act of fate, one inflamed by emotional trauma and passions, including those of the sexual nature. For the cosmopolitan set, there was no stigma associated with TB. Instead, consumption was celebrated as a sign of creative genius and aesthetic gentility, since many famous artists, authors, and poets like Edgar Allen Poe, the Bronte sisters, Frederic Chopin, Robert Louis Stevenson, and John Keats were known to have suffered from the disease. Thus, the consumptive look became the fashion of the day. Women desired to make themselves more attractive by powdering their faces ghost white, using bright lipstick to mimic blood on their lips, and wearing clothing that accentuated their neck and compacted their waists to appear as thin and consumptive as possible.

Once TB was firmly established to be a contagious infectious disease, this type of behavior disappeared, tuberculosis lost its romanticism, and TB sufferers became shunned from polite society. Frank Snowden painted a vivid picture of the new stigma associated with TB in Epidemics and Society:

American newspapers and magazines reported a rising tide of what they called “phthisiphobia” and “tuberculophobia” that was stoked by the ubiquitous messages that public health authorities disseminated. Pamphlets and posters warned the dangers presented by consumptives, and doctors and nurses reinforced the message during consultations in the clinic. In the new understanding of tuberculosis as contagious, the general public viewed persistent coughers as dangerous and even unpatriotic. Accordingly, tuberculosis sufferers were shunned. They found it difficult to obtain lodgings, employment, or insurance, and their condition was a serious barrier to marriage. Parents of schoolchildren demanded that pupils be tested for fever as they entered school and that any child with a reading above 98.6°F be sent home.

Measures to prevent transmission of TB were often completely irrational and based on hysteria rather than science:

People panicked about the dire consequences of licking postage stamps. In many cities residents viewed library books with suspicion as possibly bearing the lethal tuberculous bacilli from a previous reader. They demanded that all books be fumigated before they were recycled…For the same reason…banks sterilized coins and the Treasury Department retired old bills and issued uncontaminated replacements…Beards and mustaches fell out of favor after being fashionable for most of the second half of the nineteenth century…Indeed, some public health authorities advised that kissing was excessively dangerous and should be avoided altogether.

Finally, some newspapers started to push back against the hysteria:

The New York Tribune…argued in 1901 that things had gone too far: “The American people and their officials, animated with zeal not according to knowledge, are in danger of going to senseless and cruel extremes in hunting down consumptives. There is a tendency on the part of the people who have grasped the idea of infectious nature of this disease to become panic-stricken and act as badly as we from time to time see communities doing when they burn down contagious disease hospitals…In California and Colorado talk of barring invalids from other states has been heard and there is danger that the common and natural anxiety to guard against consumption may be indulged with a heartlessness more characteristic of the Middle Ages.”

In other words, people might have been better off not knowing TB was an infectious and potentially contagious disease, as that knowledge drove an irrational hysteria and an unearned stigmatization of TB sufferers.

Fortunately, like most bacterial infections, with the advent of antibiotics TB became a treatable and curable disease, and as a result progressive TB is now quite rare in the developed world. However, outside of the developed world, the burden of TB remains huge, with over nine million new infections per year and a million and a half deaths. Furthermore, anywhere that economic progress and human rights take a step back, TB is quick to step forward, especially in the wake of wars, famines, natural disasters, and economic collapse. Thus, as long as societies maintain a system of ordered liberty, and encourage economic growth and unlimited human potential, TB will remain kept at bay, much as M. tuberculosis is contained in the lungs by our TB-adapted immune system.