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Think of the pale and fragile Camille ensconced on a chaise in a Victorian parlor, daintily coughing a small spot of blood onto her white lace pillow. Before "con" referred to politics, it described a syndrome of cough, fever, malaise and weight loss. (The body was being consumed, hence the word consumption.) Marked by long periods of suffering, slow deaths and occasional spontaneous remissions, with no apparent cause or cure, the disease was an ideal metaphor.

Personality traits were ascribed to sufferers, both in getting the illness and as a result of the illness. A certain languid artistic sensibility was considered a predisposition. Will, morality and virtue were considered methods of resistance. Folk cures were everywhere, though I confess to a lack of expertise in Hemingway's particular remedy. (It does sound like a great first date line in the days before consumption was known to be contagious. Now such a thought would be the kiss of death.)

Initially the syndrome was non-specific and included a variety of similar-appearing pulmonary disorders such as "miner's lung" (silicosis) and stonecutter's phthisis. In 1868 the organism mycobacterium tuberculosis was isolated and shown to be the underlying cause of most cases of consumption. Despite studies clearly demonstrating the ability to transfer the disease via blood and sputum from infected patients to rabbits, acceptance of the infectious nature of tuberculosis took more than another 14 years. Meanwhile, many physicians continued to preach that consumption was caused by breathing unhealthy air (miasmas), by bad living habits, even by moral turpitude. (Sound suspiciously like the early days of AIDS?)

In the pre-antibiotic era, treatment was symptomatic. Sanitarium rest cures became the standard. Drastic surgical procedures were developed, such as lung collapse/inserting talcum powder into the chest cavity to restrict lung movement. In the early '60s more powerful antibiotics became available. For the first time, TB seemed under control, destined for ancient history. As evidence of this, the TB ward I worked on during my internship in 1966 was closed in the early '70s. (No such decline occurred in third-world countries. The disease continued to flourish among the poor and malnourished.)

By 1985 the incidence of TB was on the rise. According to the Centers for Disease Control and Prevention in Atlanta, worldwide there are 8 million new cases and 3 million deaths annually. In 2000, the CDC estimates, the annual new infection rate will be 10 million. Tuberculosis is the leading cause of death attributable to a single infectious organism and the fourth largest overall cause of death worldwide. Presently 10 to 15 million people in America are infected, mainly in such high-risk populations as nursing homes, AIDS hospices, homeless shelters and prisons. Much of this increase has been a direct result of the worldwide AIDS epidemic, because it both increases susceptibility to new disease and allows for the reactivation of the latent form of TB (rejuvenation of dormant bacteria from a previously controlled infection). Decreased cellular immunity is the primary culprit.

People with normal immune systems have a much better chance of controlling and/or limiting their infection. The combination of M. tuberculosis and HIV infection is catastrophic, associated with higher death rates for each disease, a problem compounded by the emergence of single- and multi-drug resistant strains. While the number of new cases of tuberculosis for the United States is again on the decline, largely as a result of strenuous public health control measures, the numbers continue to rise in several states and the District of Columbia, where the disease remains at near epidemic levels.

Ask Dr. Bob Dr. Robert Burton, who is a neurologist and novelist, answers health questions every Monday in Salon Health & Body. Please e-mail your queries to him at AskDrBob@ salon.com.

The problem is compounded by shifts in world population. Forty percent of new TB cases in the United States last year occurred in foreign-born patients, up from 16 percent in 1982, according to the New York Times. Numbers are similar in most developed countries. World travel means world spread, including resistant organisms.

Sound scary? You bet. So, just how contagious is tuberculosis? An informed guess is that you have a 50 percent chance of contracting the disease from someone with active TB if you spend two months, 24 hours a day in close proximity or six months of eight-hour-a-day contact. A single casual exposure has a low risk. In a Washington University School of Medicine study of 5,000 medical school employees, there was an approximate 3 percent rate of infection (skin test conversion) annually. Yet researchers estimate that each person with active TB will go on to infect between nine and 12 others. In TB-ravaged Russia, it is estimated that a minimum of 3.5 million new drug-resistant cases will occur in the next year.

The point: TB is very definitely contagious. Reasonable precautions should be taken. As individuals we can observe good hygiene and "just say no." The single most preventable risk factor for TB is HIV disease. But the problem is more than personal hygiene. TB is a worldwide catastrophe and a serious comment on our times. We do not need to be rocket scientists to understand the following ingenious experiment; 130 years later, this study still says it all:

In 1870, shortly after the discovery of the tubercle bacillus, Edward Trudeau, a young New York physician suffering from advanced pulmonary tuberculosis, performed the following experiment: He infected groups of rabbits with tubercle bacilli and then housed them under different living conditions. A group of animals was infected with tubercle bacilli and kept in a dark, crowded box in an unheated cellar. As controls, a group of uninfected rabbits was also placed in a damp, dark pit with only minimal food and water. A third group was infected and released on a small island where they had plenty of food and exposure to fresh air and sunlight. When Trudeau examined his three groups of rabbits several months later, the results were indisputable. The infected rabbits that he kept in the cellar were all dead from TB. The uninfected rabbits living under the same conditions were emaciated but otherwise alive and well. Of the infected rabbits released to roam Rabbit Island, one died, but the other four were alive and with no autopsy evidence of active TB. His conclusion? Progress of a tuberculous infection could be arrested, even reversed, by a regimen of rest, good food, sunlight and fresh air. Trudeau established that poor housing and malnutrition were not, per se, a cause of tuberculosis, but provided a fertile breeding ground.

Sound familiar? Sound like the infectious disease version of the rat overcrowding experiments? With the recent politicization of debate on national health care, it is impossible not to wonder about priorities.

The metaphor has shifted -- TB is no longer about spiritual inadequacies leading to sighs and swoons and the slow ravages of consumption. The new metaphor is obvious; medicine may advance, but the bugs will continue to outsmart us. And maybe it is the bugs who are the reminders of virtue and morality. After all, TB's persistence is a measure of how we feel about the impoverishment of others. Remember the rabbit experiments.

Suggested reading: Mycobacterial Pathogenesis: A Historical Perspective by Frank M. Collins.

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