12 Facts About Tuberculosis, the Victorian “Robber of Youth”

Since January 2024, 67 cases of tuberculosis (with two fatal) have been found in and around Kansas City, Kansas. Public health officials reported another 79 latent cases, in which people carried the bacterium that causes the disease but did not get sick or become infectious. No one is sure why cases are occurring in this area—and why now.

Tuberculosis may seem like a historic disease: A scourge of overcrowded, unsanitary European cities of the 19th century, a plot point in La Bohème or Jane Eyre, and an inspiration for mournful paintings by Edvard Munch and Claude Monet. But TB is the world’s deadliest infectious disease (after it was briefly displaced by COVID-19). According to the World Health Organization, 1.25 million people died from TB in 2023 and another 10.8 million were infected. 

Now might be a good time to brush up on 12 key facts about tuberculosis.

1. Tuberculosis is caused by a persistent bacterium.
2. Tuberculosis may be as old, or older, than humans.
3. It spreads only through air.
4. Tuberculosis primarily attacks the lungs.
5. Most cases are latent.
6. Tuberculosis is documented in ancient evidence from around the world.
7. Its spread accelerated after the Industrial Revolution. 
8. It was called “the robber of youth”—and inspired works of art.
9. TB patients tried to regain their health at sanitariums.
10. Antibiotics truly ended the age of widespread tuberculosis.
11. Many TB strains are becoming antibiotic-resistant. 

Tuberculosis is caused by a persistent bacterium.

Tuberculosis is caused by the bacterium Mycobacterium tuberculosis, which divides every 18 to 24 hours. This is slow for bacteria, but what it lacks in speed it makes up for in durability. The cell wall of M. tuberculosis is thick with lipids, which give it a waxy coat that allows it to withstand dry conditions and some mild disinfectants.

Tuberculosis may be as old, or older, than humans.

With a few exceptions, humans and other primates are the only animals susceptible to TB, indicating that M. tuberculosis evolved with humans. Some genetic evidence indicates that a bacterium that could be an ancestor to M. tuberculosis infected our hominin ancestors three million years ago. 

Evolutionary biologists think that, in a Darwinian escalation, the hominins that survived the tuberculosis bacterium probably passed on genes that were more resistant to it, but the bacterium adapted to spread among those more-resistant humans.

It spreads only through air.

Tuberculosis spreads when an infected person coughs, speaks, or sings, releasing germs that someone else inhales. That is the only known mode of transmission. TB germs are not spread by shaking hands, sharing food, touching the linens and clothes of an infected person, or even through kissing.

Tuberculosis primarily attacks the lungs.

Tuberculosis mainly affects the lungs, where it can trigger coughing, chest pain, and buildups of blood and phlegm. The disease can also impact the brain, spine, and larynx, as well as lymph nodes and kidneys. Other symptoms might include fatigue, weight loss, chills, fever, headache, back pain, hoarseness, sweating at night, and swelling beneath the skin.

Most cases are latent.

After a few million years of adapting to M. tuberculosis, most people who encounter the bacterium do not get sick; their immune system fights it off before it takes root. By some estimates, 25 percent of the world population has latent tuberculosis infection. Latent TB is also not contagious.

Immunocompromised people are especially at risk for developing active tuberculosis. According to a World Health Organization report, tuberculosis is a factor in 30 percent of the world’s AIDS-related deaths.

Tuberculosis is documented in ancient evidence from around the world.

Ancient artifacts show that no part of the globe has ever been free of tuberculosis. Egyptian mummies from 2400 BCE have skeletal deformities typical of the disease. Peruvian mummies indicate it was in the Americas before the arrival of Europeans. Descriptions of a TB-like disease have been found in 3300-year-old documents from China and 2300-year-old papers from India. 

In the King James Bible, “consumption” is listed among the manifestations of God’s retribution against the Egyptians. It is a translation of the Hebrew word schachepheth, a “wasting disease” that was probably TB.

In ancient Greece, Hippocrates described phthisis, a fatal disease among young adults, defined by lung lesions. The philosopher Isocrates was among the first to theorize it was contagious.

In the Middle Ages, Europe was afflicted by scrofula, a strain of tuberculosis that affects the cervical lymph nodes. In France and England, it was widely believed that a king’s touch could heal it; in 1712, Queen Anne was the last English monarch to offer this service. Charles X, one of the post-Revolution exiled kings of France, attempted to revive the practice.

Its spread accelerated after the Industrial Revolution. 

For reasons that are obvious in retrospect, the industrial revolution accelerated the spread of tuberculosis, then often called the “white plague,” as populations crammed into cities to work in poorly ventilated plants and factories.

In some parts of Western Europe in the 18th century, the TB mortality rate was 900 deaths per 100,000 inhabitants per year. An outbreak in the late 1830s killed one in three English tradespeople, according to the 1952 account The White Plague: Tuberculosis, Man, and Society. Upper-class Britons died of a rate of about one in six. 

In 1793, the Scottish pathologist Matthew Baille described the lung abscesses of the disease as “tubercles,” from the Latin word tuberculum, meaning “small swelling.” Forty years later, German physician Johann Lukas Schönlein wrote of tuberculosis, creating the common name for the disease.

It was called “the robber of youth”—and inspired works of art.

During the peak of tuberculosis in Western Europe, its fatalities tended to be young. Older people were mostly exempt from the back-breaking factory labor and cramped working peoples’ tenements that acted as breeding grounds for TB, and those who survived into old age then tended to have healthier immune systems.

For these reasons, TB was also called “the robber of youth,” a sentiment that spilled into the work of artists and writers. Edvard Munch suffered from the disease as a child and his sister, Johanne Sophie, died of it at age 15, inspiring his painting The Sick Child. Claude Monet painted his wife and muse, Camille, on her deathbed from TB at age 32. Edgar Allan Poe’s mother and wife both died of TB in their twenties, which probably determined his whole vibe. Percy Bysshe Shelley, Robert Louis Stevenson, and John Keats (the last of whom died of TB at age 25) all wrote about the ubiquitous disease. By the end of the 19th century, tuberculosis even had a gothic, Romantic quality because of its association with virginal youth and with artists.

TB patients tried to regain their health at sanitariums.

In 1854, botany student Hermann Brehmer published a doctoral dissertation asserting that “tuberculosis is a curable disease.” He wrote about how his symptoms improved after travelling through the Himalayan Mountains.

This was one instigator of the sanitarium movement, founded on a belief that sunlight, bed rest, nutrition, and the fresh air of high altitudes—the opposite of cramped, smoky factories—could treat, and maybe cure, tuberculosis. Country houses and work hospitals across the U.S. and Europe were repurposed. In the 1920s, architects began designing specialty buildings with large open windows and plentiful balcony and porch space to increase exposure to sunlight and fresh air. These institutions had the added desired effect of quarantining tuberculosis patients away from the general population.

In the U.S., sanitariums sprouted up at a brisk pace. In 1904, there were 115 TB sanitariums with about 8000 beds. By 1923, there were 656 institutions with upwards of 66,000 beds and, by 1953, the number had grown to 839 with 136,000 beds.

The more luxurious sanitariums catered to wealthier clients and the poor and middle class crowded into shabbier ones. Some patients were shipped there for the rest of their lives, while others demonstrated their recovery through sometimes grueling exercise regimens and eventually returned to regular society.

Antibiotics truly ended the age of widespread tuberculosis.

Public health initiatives and improved socioeconomic conditions decreased deaths from tuberculosis in the early 20th century. In 1900, the TB death rate in the U.S. was 194 per 100,000 persons. By 1945, the rate had decreased to 40 per 100,000 persons. 

But nothing did more to diminish the threat of TB than antibiotics. Penicillin was discovered in 1928 and refined and mass-produced over the next decades. In 1945, the drug streptomycin was first used to treat TB, followed by isoniazid, ethambutol, and rifampin.

By the 1980s, tuberculosis was measured in new cases, not deaths. The rate of new diagnoses in the U.S. was just 9.4 per 100,000 people in 1984, with similar rates across Europe and more modest, but still substantial, decreases in developing countries.

Today, tuberculosis is most common in countries with underdeveloped medical infrastructure. North Korea, Mongolia, Myanmar, Indonesia, the Philippines, Papua New Guinea, several sub-Saharan African countries, and a few Pacific Island nations are the only places with case rates of more than 300 per 100,000 people.

Many TB strains are becoming antibiotic-resistant. 

Public health officials hoped that antibiotics would eradicate tuberculosis. However, true to its evolutionary tenacity, the disease has mutated into strains of drug-resistant TB, defined as infections that persists after treatment by at least one common antibiotic. 

The Centers for Disease Control and Prevention reported that, in 2023, 8.5 percent of cases of TB in the U.S. were resistant to the medication isoniazid and 1.4 percent were resistant to multiple drugs.

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