THE BERT AND PEGGY DUPONT LECTURE: TUBERCULOSIS AND THE BUILDING OF THE AMERICAN WEST.

More than any infectious disease in the past century, COVID-19 has had a profound impact on society.Even as life has returned largely to normal and the death rate has dropped, there have been persistent changes in many aspects of life.Remote work for many has become the norm rather than the exception.Masking is now accepted and even required in some communities.And people with immunocompromising conditions lead lives of constant consideration, weighing the risks and benefits of everyday activities.Of course, this is not the first outbreak of an infection that has changed how people live.The original SARS epidemic produced lockdowns across much of Asia and restricted travel even from less affected areas such as North America (1).Ebola not only devastated a set of West African countries during the largest outbreak in 2014-2015, but also led to large-scale social measures to avoid infection (2).During a large Dengue outbreak in Cuba, neighborhoods were organized to search for mosquito breeding areas (3), while, when Zika spread widely through Latin America, many people, particularly pregnant women, took substantial measures to avoid insect bites (4).However substantial were the changes brought about by these epidemics, from a historical perspective, all were relatively brief.We have recently seen more sustained epidemics, such as the continuing spread of HIV, which brought about enormous changes in medical practice and sexual behavior that have persisted, particularly among the most affected communities.But the few decades that HIV has circulated pale in comparison to tuberculosis, a disease that dominated societies for centuries.Although there is pathologic evidence of tuberculosis in antiquity, the first recorded evidence of epidemic spread was in Europe in the late fifteenth and early sixteenth centuries.In fact, within the span of a decade, tuberculosis rose to be the leading cause of death on the