Tuberculosis, commonly known as TB, is one of the oldest known infectious diseases, having been found in Egyptian mummies from 3000 BC.

            In 17th and 18th century Europe it was known as “consumption,” and was commonly depicted in literature and opera. Marguerite, the heroine of the novel The Lady of the Camelias and the opera La Traviata dies of TB, as do Fantine in Les Misérables and Mimi in La Boheme.

            Only in 1882 did Robert Koch discover Mycobacterium tuberculosis, the bacterium that causes TB.

            While TB was widespread in the US until well into the early 20th century, cases are now much less common. TB is very much a disease of poverty and crowding, and economically advanced countries see much less of it.

            In the last few years, cases have been rising. There were about 8200 reported cases of TB in the US in 2022, 9600 in 2023 and 10,300 in 2024. Most of these occurred in immigrants, and most represented reactivation of old infections when the person’s immunity dropped.

            Worldwide it is a different story. TB is the most common infectious cause of death in the world. In 2023, an estimated 11 million people fell ill with TB and 1.3 million died. TB is very common in southern Africa and central Asia and is a major health problem in India and China.

            The best preventive measure, as with most infectious diseases, is vaccination. BCG vaccine (Bacillus Calmette-Guerin) was developed in 1921 and is particularly helpful for children, preventing the worst forms of TB. It is less effective in preventing pulmonary (lung) infection, which is by far the most common form of TB.

            Once given universally, BCG vaccine is now routinely used only in Ireland and Portugal among affluent countries and is not commercially available in the US or most western countries. It is routinely given to newborns in much of Asia, southern Africa and South America.

            You can still get TB, a highly transmissible illness from someone who has it in their lungs and is coughing. While you are unlikely to catch it in normal tourist sites even in high-incidence countries, it does happen.

            Fortunately, active TB is usually easy to diagnose from a standard chest X-ray. Treatment is usually effective, though drug-resistant TB is not rare.

            So, forgotten but not gone. As the cuts in USAID funds for disease prevention take hold, there will be a lot more TB, and some of it will hit our shores.

            Edward Hoffer MD is Associate Professor of Medicine, part-time, at Harvard.

What Does The Doctor Say?

By Dr. Edward Hoffer

As many lawns begin to fry, there isn’t much you can do to reverse it so take time out to think about what is really important in our communion with nature. Is it just about having a lush green lawn and perfectly balanced borders? We all seek perfection, but the bigger picture deserves consideration.

            This column is not so much about achieving perfection as it is about working in concert with nature and considering what truly matters in our garden endeavors. With Earth facing rapid loss of species and biologists warning about a “Sixth Extinction,” we tenants of the land should think how we might make a difference.

            We can contribute to a healthier global ecosystem by reducing chemical usage and allowing for natural biodiversity in our garden. This means tolerating “scruffy” elements like lichen, moss, and toadstools, which are often seen as undesirable but contribute to ecological health. By shifting away from a focus on perfect lawns and towards a more naturalistic approach, homeowners can create habitats that support a wider range of species and reduce their environmental footprint.

            Extinction rates are up due to human behavior that has spilled over into changes in atmospheric conditions, habitat fragmentation, pollution, overfishing and overhunting, according to conservationists. So how can the average homeowner/gardener modify his behavior toward a healthy global ecosystem?

            While the big agribusinesses and over development are culpable, we gardeners share in some of the blame, turning our lawns into monocultures, applying chemicals to repel weeds and being fussbudgets about overall tidiness.

            We’re appalled too often by things that are normal out there: lichen and moss, toadstools and anything that is suggestive of “unkempt.”

            But scruffy can be beautiful. Recent walks in Paris’ Tuileries Garden and London’s Hyde Park, seeing areas left au naturel enlightened me about how I might proceed toward a more bio-conservative mode of gardening back home. There are large tracts of lawn left unmown, intentionally to encourage wildlife and diversity at many levels.

            So how does the average home gardener adapt this practice to their own plot? I’m going to hand down some advice from the late Nigel Colborn, garden writer and a former presenter on BBC’s Gardeners World. It was his belief that the beauty and ease of a more hands-off garden is the preferred way. Here are 10 of his suggestions for making your garden naturally diverse but still beautiful:

            1. Cut your hedges only between August and February to reduce disturbance to nesting birds.

            2. Adjoining gardens make wildlife corridors, but only if creatures have easy access. Alter fencing so hedgehogs and other animals can move freely.

            3. Weed free, fertilized lawns are sterile monocultures. So, tolerate daisies and make part of your lawn a flower meadow (see plantwild.co.uk).

            4. Water features enhance wildlife. Even a tiny pond benefits amphibians, bees, mammals and birds, as well as aquatic life.

            5. Dense undergrowth has wildlife value. Thickly planted perennials, heathers or drought-resistant shrubs such as artemisias and santolinas also create refuges.

            6. Grow pollinator plants for all seasons. Include crocuses and snowdrops for late winter; primulas and wallflowers for spring; lavenders, verbena, buddleia for summer; and penstemons, perennial asters and single-flowered dahlias for autumn.

            7. Provide nesting habitats. Nest boxes are great, but thick hedges, ivy-clad tree trunks or log piles are just as good.

            8. Is your house bird-friendly? Swallows, swifts and other birds love to nest in eaves and roof cavities, but habitats can disappear, especially after repairs or insulation. Explore bird-friendly roofing at green-ecology.co.uk.

            9. Make your parking space dual purpose. Vegetation attracts other life, so floor your parking area with porous material or gravel and plant up the parts where wheels won’t squash. Tire resilient greenery cools in summer and can look more attractive than bare paving.

            10. Above all, never despise a scruffy garden. Tolerate uninvited plants and encourage alchemilla, violets and sedums to grow in paving cracks. Destroy the worst weeds: bindweed, docks, ground elder. Smile on scarlet pimpernel, cuckoo flower, field poppy or wild cranesbills.

            I’ve never been one for the perfectly manicured exhibition-style garden. Right now, it’s a little too Miss Havisham for me, having not really spent much time in it due to being away this summer. Which led to the comment of one visitor: “You do realize it’s organized chaos.” To her I say, “thank you,” and I hear the reverberating echo from the natural world.

            “A lawn is nature under totalitarian rule.” – Michael Pollan.

The Seaside Gardener

By Laura McLean