Recently, I’ve been reading a lot of books about the past and, in such books, tuberculosis (TB) often comes up. If you don’t understand what TB is, your enjoyment of books about the olden days might be diminished. I’ve decided to do my part to improve your chances of enjoying reading about the past by demystifying one of the most common old-timey diseases.

TB is a contagious bacterial infection that mainly involves the lungs, but may spread to other organs. You can get it by breathing in air droplets from a cough or sneeze from an infected person. So this is one of several reasons you don’t want someone to cough on you or sneeze into your face when, for example, you’re riding the bus.

When one contracts TB, there aren’t necessarily any symptoms. In fact, there may never be any. According to Wikipedia, “Most infections in humans result in an asymptomatic, latent infection, and about one in ten latent infections eventually progresses to active disease…”

If you’re one of the unlucky ones whose TB progresses, this is how it works – you’re living your life, worrying about what to make for dinner or if you’re going to ever get that raise at work when you develop a cough. Eventually, your cough will produce mucus or blood. Coughing up blood should get your attention, tipping you off to the fact that something is very wrong. You’ll also be tired, sweaty and lose weight effortlessly. Further along, it will be hard to breathe and there may be chest pain, wheezing, fluid around the lungs and crackling sounds when you breathe.

But what’s happening in your lungs? Well, the bacteria sets up shop in the lungs ( these are called tubercles) and your body sends out cells that form granulomas (kind of like lesions) around them to prevent them from spreading further. So if you get an x-ray, they will see these little masses in your lungs. What can happen is that these granulomas  can cause cell death in the tubercles and this stuff, called necrotic material, “has the texture of soft white cheese.” I believe this is the mucus-y stuff you’d be coughing up, and which earned TB the nickname of the White Plague. If the TB bacteria gets into your bloodstream, it can set up shop and form tubercles in other tissues. This seems like a major bummer.

Also, tissue that is ravaged by TB is replaced by scarring and cavities filled with that necrotic stuff – thus greatly reducing lung capacity. In the book I was just reading about the 1920s, a boy with TB had one of his lungs purposely collapsed by getting injections of gas (a thick needle was inserted under his arm and between his ribs!)  that surrounded and collapsed it in the hopes that immobilization of the lung would stop the spread of the disease.

It would be best, at this stage, if you enclosed yourself in your house or went off to live in a tent, so as to avoid infecting other people. Today, treatment involves being on a series of drugs to fight the bacteria. This is why TB was such a huge bummer before antibiotics – there were no drugs to take.

This is a great example of why it’s not such a great idea to romanticize the past. If you got TB in, say,  the 1920s, it was Welcome to Doomsville. “In 1815, one in four deaths in England was of consumption; by 1918 one in six deaths in France were still caused by TB. In the 20th century, tuberculosis killed an estimated 100 million people.” This is why it’s so prevalent in books about, or written in, the past. And it really was a death sentence. You’d go off to the sanitarium in some mountainous setting (they believed cool, thin air was best to slow the disease and “rest, sun and fresh air” were often the only treatments offered), sometimes for years, and lie in your “cure chair” and try to breathe. Even if one managed to recover, the bacteria would still be in one’s lungs, lurking, ready for a recurrence at the most inopportune time, like when one just met the love of one’s life and was going to get married and have a huge family and live on an estate.

Old-timey tip: When reading books about the past, you will often see reference to people dying of “consumption.” This is TB. For years, this confused me when I was reading. They often called TB “consumption” because sufferers wasted away, their bodies seemingly “consumed” by the disease. They also talked believed people became euphoric or experienced a burst of energy just before they died of consumption but this is likely one of those disease myths – women became more beautiful and men more creative. Ha!

So antibiotics have saved us, right? Well, yes and no. Antibiotics were great at first but, as so often happens, the TB bacteria are increasingly resistant to our drugs and have always required a cocktail of drugs. Wiki says, “The proportion of people who become sick with tuberculosis each year is stable or falling worldwide but, because of population growth, the absolute number of new cases is still increasing.” Granted, TB in the U.S. is pretty rare and there is a vaccine, although we don’t use it that much here due to this low rate of incidence.

One thing people can do to keep TB (and other communicable diseases) down is stop coughing and sneezing without covering their mouths – especially at home and work. It’s actually not that common to get TB from a stranger but more common to get it from someone you’re exposed to often. Anyway, one sneeze contains 40,000 droplets of spit… 40,000 little spit daggers loaded with bacteria! Is it really so hard to raise your hand or arm to your mouth to cover it while coughing or sneezing?

Also – stop spitting, people! I was in the park yesterday and some guy spit on the walking path as I walked by. Really? It’s so hard to swallow your spit? Does it hurt your throat? I’ve never understood this compulsion. The other afternoon, while I was enjoying the June weather on my front porch, my neighbor across the street came outside, sat down on his front steps and proceeded to hack and spit about 18 times, spraying his front lawn with mucus-y wads. This is what he needed to do on a gorgeous spring afternoon?

Want to do your part to stop TB? Stop being gross.