Tuberculosis is a highly contagious disease that is transmitted from microscopic droplets released in the air. It prompts symptoms including pale skin, a high temperature, and the tell-tale sign of coughing up blood. From Hippocrates through to the nineteenth century, the disease was also known as phthisis and consumption. These are terms derived from their Greek and Latin origins, with the former meaning “to waste away.” And ‘waste away’ its sufferers do: without medical intervention tuberculosis is routinely fatal.
It acts by first affecting the air passages of the lungs known as pulmonary alveoli where the bacterium replicates. This causes the symptoms such as weight-loss (cachexia) and labored breathing (dyspnea) to manifest, which weaken the patient and cause their gradual deterioration. Despite the fact that it can now be managed by antibiotics, tuberculosis remains to this date a highly dangerous disease and is listed as the tenth leading cause of death worldwide.
A Disease Since Antiquity
This disease has been present and documented since antiquity but peaked in Western Europe in the early modern period. By the nineteenth century, tuberculosis had become an epidemic in Europe. Between the years of 1851 and 1910 in England and Wales alone, a staggering four million died from tuberculosis, with more than one third of those aged between 15 to 34, and half between 20 to 24. This earned the disease another apt title: “the robber of youth.”
It was not until 1944, when streptomycin, the first antibiotic drug for the disease was founded that it could be managed. This was made possible by the discoveries made in earlier centuries by one of the main founders of modern bacteriology, Robert Koch (1843 – 1910), who in 1882 had successfully discovered and isolated the tubercle bacillus organism that caused the disease.
Inspired By Tuberculosis
Even though tuberculosis is a thoroughly unpleasant disease to be afflicted with, by the 19th century it was frequently perceived and represented in a romantic way. This led to it becoming somewhat of a ‘fashionable’ disease. It imbued the notion of suffering with positive connotations and was a phenomenon paradoxical to traditional discussions centered on disease. This is reflective in the period’s contemporary culture, including fashion, sculpture, literature and fine art. In addition to being romanticized, tuberculosis was also frequently used as a source of inspiration and catharsis, as is demonstrated in the above painting by Edvard Munch, where a grieving mother is shown comforting her dying child. Tuberculosis was a common disease, which Munch himself had nearly died from as a child. He created this image to represent feelings of guilt and despair that he had survived this disease whilst his late sister had not.
Look Good And Die Trying
By the Victorian era, both the disease and its symptoms had been thoroughly romanticized, and for decades many beauty standards emulated the effects of the disease. Flushed cheeks and a skeletal body became revered traits that were considered fulfilling of the contemporary society’s ideals regarding femininity, whereby fragility became inextricably linked with beauty. Corsets, as pictured above were worn to achieve a “‘consumptive aesthetic’ that peaked in the mid-1800s, when corsets and voluminous skirts further emphasized women’s slender figures.”
The idea of the ethereal feminine sufferer can be seen in Dante Gabriel Rossetti’s “Beata Beatrix.” Here, the artist depicts his consumptive wife Elizabeth Siddal as the character of Beatrice Portinari from Dante Alighieri ‘s poem La Vita Nuova right at the moment of her death. Rather than show the grim reality of dying from a chronic disease, Beatrice is instead depicted beautifully posed with eyes peacefully closed. Her flowing red hair drapes beautifully over her back. Here, the disease is highly romanticized through an artistic presentation which shows the consumptive patient as both quietly and beautifully ill.
The idea of being quietly and inoffensively sick further explains why this disease was romanticized. The symptoms of tuberculosis were exponentially preferable to other epidemics and infection which ravaged 19th and 20th century society. The symptoms that other contemporary diseases such as cholera or the plague subjected its sufferers to, such as diarrhea and vomiting, were considered undignified.
Therefore, in a period of extreme sensibility, the consumptive patient’s symptoms were, in contrast, far preferable as the mind and dignity remained intact. The external, visible symptoms that tuberculosis presented, such as weight-loss, pale skin and flushed cheeks were not considered unpleasant in the way that, for example, the bluish-grey skin synonymous with cholera (nicknamed the “the blue death”) were, and instead tapped into Victorian beauty ideals.
The Art Of Dying
That the mind and external body remained mostly intact solidified the idea that this disease and its symptoms allowed its sufferer to die well, and thus enjoy a “good death”. This was an important concept in the early modern period and beyond. The idea of ‘dying well’ is epitomized by the concept of ars moriendi (meaning, “the art of dying”). This stemmed from an early-modern Latin text, which historian Jeffrey Campbell describes as literature that offered its reader “[…] advice on the good death according to Christian precepts of the late middle ages”.
By later centuries, the idea of a good death was broadly defined as a passing which was peaceful and gave sufferers time to settle financial, emotional and religious affairs. Tuberculosis enabled this as it was not an instant killer. A patient could be symptomatic for an extended period of time. A diagnosed patient in the 19th century could expect to live for up to three years after the initial diagnosis. This would have allowed the patient to finalize their wills and settle any last-minute religious affairs. This was incredibly important in post-reformation England where mere praying no longer guaranteed salvation from the deeply feared purgatory.
A Peaceful Passing
The notion of a planned, calm, and peaceful death is epitomized in Robinson’s “Fading Away”. This photo montage illustrates a peaceful, almost romantic vision of death by tuberculosis. Interestingly, the execution of this artwork was calculated and staged to depict a “dying” girl who is being comforted by a grieving mother, sister and fiancé. Much like Rosetti, the artist succeeds in aestheticizing the disease by portraying it as peacefully afflicting the young and beautiful, whilst close friends and family attend to the practical and emotional duties of preparing for her death.
Too Good To Live?
The idea of tuberculosis being depicted as a romanticized illness in 19th century fine art reflects an idea that was further perpetuated by highly esteemed literary figures of the period. Contemporary writers such as John Keats, Percy Shelley, Edgar Allan Poe and Robert Louis Stephenson all wrote about it, with several of them dying from the disease themselves. Their creative contributions regarding the disease consequently helped cement tuberculosis as associated with, and afflicting, the intellectually gifted.
This constructed a stereotype of tuberculosis as affecting the scholarly or artistic person, who upon their death was perceived as robbed of their youth and transformed into something of a martyr. This created what historian Katherine Byrne argues was a “‘too good to live’ cultural stereotype”, which enabled the disease to be perceived as “a spiritual blessing for the afflicted, who possessed mortal strengths to compensate for weakness of the body.”
This was true in the case of John Keats who after coughing up blood as a result of the disease, wrote: “It is arterial blood. I cannot be deceived in that color – that drop of blood is my death warrant – I must die!” This stereotype of the young, gifted creative dying forlornly from a disease associated with the tortured or artistic soul then transferred into art. For example, in the portrait of Keats on his deathbed, he is sketched with his head lying serenely on one side, with eyes closed as though he may be just sleeping. Here, tuberculosis is romanticized not only through the social status of the drawing’s subject, but also the social perception of the disease which the sitter himself had helped establish.