Consumptive Chic: When Tuberculosis was the Height of Fashion
During the late 18th century the physical effects of tuberculosis became the ideals of beauty for the fashionable woman.
The idea of disease as fashionable, or at least as something to be emulated, remains a familiar one: think of the heroin chic of the 1990s or the underground Pro Ana movement, which glorifies anorexia. The idea, however, that tuberculosis – a disease characterised by wasting, diarrhoea, coughing and the spitting of blood – could enhance its victim’s beauty is less relatable. Yet, during the late 18th and early 19th centuries, cultural ideas about beauty intertwined with the reality of tuberculosis (known as consumption or phthisis), allowing the ravages of the illness to be seen as markers of beauty. Tuberculosis became the site of a battle between professional and popular ideologies of disease – a conflict that played out both in beauty practices and dress.During the 18th century, diseases such as melancholia, gout and tuberculosis became associated with the upper echelons of society. Physicians argued that there was a relationship between certain illnesses and the sensibilities of the fashionable elite. The middle and upper classes were believed to have more highly refined nervous systems and, as a consequence, a greater share of sensibility (the ability of the nervous system to accept sensations and convey the body’s will). This made them susceptible to certain illnesses and there was a growing concern that the lifestyles and nervous systems of these groups were creating a scourge of ill health among them. As one physician suggested, the ‘great and opulent’ were subject to the whims of fashion ‘in their choice of diseases’. The statesman and essayist Sir William Temple lamented the faddish nature of certain diseases in 1809, likening the trends for illness and their treatments as being ‘very much seen or heard of at one season, disappearing in another’. Others complained of the growing popularity of nervous disorders, dubbed in 1799 ‘a modern invention’.If diseases could be fashionable, then they could become targets for emulation. The Scottish doctor James Adair carped in 1790 that ‘people of no rank and slender means’ attempted to transgress social boundaries by ‘fashionably ruining themselves’. More significantly, he pointed to ‘the pale of distinction’ as the mark to be copied by those seeking to become ‘people of fashion’. This connection between the ‘pale of distinction’ and fashionable illness was especially apt, as tuberculosis was distinguished by a translucent complexion. Its allure lay in its symptoms, which coincided with contemporary ideals of attractiveness: rosy cheeks and lips coupled with pale skin were considered beautiful. Tuberculosis brought about a consumptive pallor accompanied by a hectic flush (the product of a constant fever). Charlotte Brontë acknowledged the phenomenon in 1849: ‘Consumption, I am aware, is a flattering malady.’A victim enhancedDuring the 19th century, tuberculosis supplanted the great epidemics (such as plague or smallpox) in the public’s imagination. Depictions of tuberculosis diverged from those of other diseases such as smallpox, cholera and typhoid. Tuberculosis found its distinction in two key differences: the way the illness manifested itself in the body and its social distribution. Although it physically altered the sufferer, it was not disfiguring in the way that smallpox or cholera were. Instead, with its wasting and pallor, the disease seemed to enhance its victim by amplifying those qualities already seen as attractive. Tuberculosis was also different from other illnesses due to its chronic nature and constant presence. Unlike sudden, acute maladies that manifested in sweeping epidemics, tuberculosis was ever-present, in all classes, at all times, seemingly indiscriminate in the way it claimed its victims, afflicting the denizens of mansions as well as tenements. The disease was rampant in urban centres, though not limited to the city, and showed little respect for gender, status, age or occupation.By the 19th century, tuberculosis had almost become two distinct and seemingly unrelated afflictions, as victims from the more prosperous classes were lauded while poorer victims were stigmatised. There was a connection between the disease and the unhealthy living conditions of the urban environment, such as smoke, dust, dirt and damp. Among the lower classes tuberculosis was seen as the result of poor air quality, drunkenness or material deprivation, hallmarks of their lifestyles, which in turn fostered a negative perception of the illness in this group. Members of the lower orders were presented, by social reformers and medical investigators, as the architects of their own demise and so tuberculosis was never presented as an attractive disease in the poor.On the other hand, there was an equally strong tradition that associated the disease with the best and brightest members of society, those intelligent and beautiful individuals who seemed so prominent in the ranks of its victims. In the more prosperous classes, then, consumption was viewed primarily as the consequence of a hereditary defect, one complicated by ‘exciting’ causes, and the association between the illness and the sophisticated lifestyle of the beau monde was widely accepted. This benign view of the disease only offered the affluent victim limited control over the circumstances that provoked the illness. As a consequence, representations of tuberculosis in the middle and upper classes were remarkably positive, ignoring the unpleasant realities, in part, because beauty was thought to be one of the significant signs of a predisposition to the illness.Medical references to symptoms repeatedly describe the consumptive body as slight, thin, delicate and slender in make, with a narrow chest, projecting clavicles and shoulder blades that gave the appearance of wings. The complexion was fine and delicate, criss-crossed by blue veins, with clear, smooth and nearly transparent skin of an almost brilliant whiteness, only relieved by the ‘bloom of the rose’ – the flush of the fever. As descriptions of the ideal feminine form in the 19th century tended to bear a striking similarity to those provided for consumption, the accounts of these symptoms show how the disease beautified as it destroyed. As one medical treatise asserted of the disease in 1842: ‘Death seems to array his victim for the tomb with all the attributes of physical loveliness.’Sense and sentimentalismEarly Victorian ideas of beauty were heavily influenced by sentimentalism, which believed that emotional authenticity was revealed not through overt demonstration but through subtle exterior signs and subdued behaviour. The ideology of sentimentalism defined not only personal feelings and emotions but also the physical manifestations of those sentiments. Sentimentalism provided one avenue for escaping difficult social realities, concealing reality through a refusal to acknowledge the harsher aspects of a situation. This permitted the further elevation of consumption as an ideal of beauty. Sentimentalism emerged as an influential force in middle-class culture in the 1830s and elevated the notion that the exterior revealed the character beneath, making beauty a signifier of moral virtue. These notions were reinforced by medical investigators who held that: ‘Goodness and beauty in woman will accordingly be found to bear a strict relation to each other; and the latter will be seen always to be the external sign of the former.’ The physical symptoms of consumption could now be rationalised as reflecting the victim’s moral virtue. Consumptive women were increasingly presented as too good and too beautiful to live.The face, considered the most transparent part of the body, permitted access to a woman’s feelings, as revealed in her smile, her complexion and her eyes. Since, in the sentimental tradition, the eyes were styled ‘windows of the soul’ and were thought to ‘speak’ because they revealed the emotions and were ‘the seat … of intellect and love’, they also enhanced the beauty of the consumptive. Large pupils, in particular, were both a ‘mark of beauty’ and a sign of disease. One work, detailing the markers for the tubercular constitution, stated that the most consistent indicator was ‘that the pupils of the eyes are uncommonly large and … the eye-lashes are long and glossy’. The author of this medical treatise then advocated a method of achieving this look, suggesting the use of belladonna to dilate the eyes.Popular works of advice also promoted an endless list of cosmetics to darken the lashes and even the draw on the blue veins, which were so prominent in those suffering from tuberculosis. The whiteness of the complexion was enhanced by the contrast of the veins, the ‘faint tinge of blue’ thought to give ‘delicacy to the white, and mingles with the … carnation’. Fashionable women often used cosmetic enhancements to achieve this look, although The Mirror of the Graces, by ‘A Lady of Distinction’, railed against the practice in 1830, arguing that women were drawing ‘the meandering vein through the fictitious alabaster with as fictitious a dye’.The limitations of cosmetics – that they could not create what was not already present but could ‘only assist nature’ – were also an issue. The use of paints seems to have raised the most ire, as the application of metallic oxides, advertised as ‘pearl white’, were roundly condemned. Such cosmetics were, however, also thought to bring about the consumptive illness that naturally provided the fair pallor. The Art of Beauty argued that white paints, made from extracts of bismuth, lead or tin, were capable of penetrating ‘through the pores of the skin, acting, by degrees, on the … lungs, and inducing diseases’. A Treatise on Pulmonary Consumption vehemently asserted, meanwhile, that ‘the chemicals of the toilet … very materially assist the messenger of death’. Despite these complaints, cosmetics remained an important – but controversial – element of the lady’s toilette.In addition, the outcry against the overt use of cosmetics was also tied the notion that beauty was something natural to a woman of virtue. As a result, tuberculosis, with its ability to enhance female beauty without deception, became a way of manifesting a virtuous character, while naturally achieving beauty.Dropping the shoulderThe tradition of sentimental beauty went beyond the face and took the appearance of the woman as a whole to be an expression of her character. The fashions of the period, therefore, emulated the consumptive build. The bodice was ornamented to heighten the appearance of length: decorative elements were applied to highlight and narrow the shoulders and emphasise and elongate the pointed waist; the heavy corseting made the upper body appear delicate, thin and weak, in a manner reminiscent of the consumptive torso. Bodices were close-fitting and their armholes were set very low off the shoulders, with tight-fitting sleeves, cut on the cross, which prohibited the wearer from lifting her arms above a right angle. The drop-shouldered style also forced a round-shouldered posture, which emulated the bowed silhouette of the consumptive.In sentimental dress, the waist – and, indeed, the torso as a whole – was narrower than it had been in the previous decade. As a result, the corset remained an indispensable component of style. In the ideals laid down in the literature of conduct and beauty, it was clear what was expected of middle- and upper-class women: softness, delicacy, weakness and modesty, combined with a small waist and curving shoulders – all features which matched the debilitating effects of tuberculosis.As with make-up, however, sentimental fashions were also believed not just to emulate but to produce tuberculosis in those who wore them. This was particularly true of the physical distortion caused by corseting, as ‘deformities of the chest’ were ‘commonly ranked among the exciting causes of consumption’. Yet, despite voluminous writings against the ruinous use of the corset, young women continued to wear them, much to the frustration of one physician, who complained bitterly in 1842 that it was ‘vain to expect, that the warning voice of the physician will be listened to in preference to the dictates of fashion’. Health Made Easy for Young People (1845) asserted that consumption would be the inevitable result for those women whose chests were bound up ‘to make them look pretty’ and considered the practice ‘Monstrous!’Stooping, too, was presented as both the architect and indicator of tuberculosis. Young women were warned ‘that an inactive sedentary mode of life appears to dispose to the formation of tubercles … by the habit of stooping, hurting the lungs in the same manner with malformation of the chest’. Cold and Consumption in 1847 located the fault in women’s education: ‘The sickly school girl, with her pallid countenance and stooping gait, would seem to predict her fate – pulmonary disease.’ Middle- and upper-class women were considered more susceptible to tuberculosis than men due to their upbringing. Some doctors, such as John Tricker Conquest, expressed their disgust over the type of ‘lady-like’ upbringing that guaranteed the illness, writing: ‘That horrid word “lady-like”, haunts the poor girls of the middle and higher classes through years which should be devoted to physical education, and leaves them, at last, the prey of deformity and disease … Fashion is the war cry of tyranny.’When the idea of illness as character-illuminating is combined with sentimental culture as a whole, it is easy to see how consumption could invade the popular ideals of beauty and fashion.Tuberculosis would gradually lose its positive associations, however. The proliferation of the disease in the slums of industrial England, the growing awareness of this circumstance and the flourishing of works that identified the disease with moral transgressions all helped alter the ideology surrounding tuberculosis. Once these associations were established, the disease could no longer be rationalised as acceptable for respectable women. By the end of the 1840s tuberculosis had become tainted by poverty and promiscuity, connections that continued through the end of the century and beyond.During the second half of the 19th century, then, the notions that dominated the lower-class perception of the disease – the ones that saw tuberculosis as the result of moral and hygienic shortcomings, complicated by filthy and crowded living and working conditions – gained purchase and were increasingly applied at all levels of society. This gradually became the dominant image of the illness, particularly with the growing focus on public health in the middle of the 19th century. The introduction and eventual acceptance of the germ theory of disease would make this hygienic model, with its moral undertones, the sole explanation for tuberculosis. Health became a desirable goal in the face of fears over biological degeneracy, leading to a stigmatisation of tuberculosis and a change in the coping strategies employed by society at large.Carolyn A. Day is Associate Professor at Furman University, South Carolina and the author of Consumptive Chic: A History of Beauty, Fashion and Disease (Bloomsbury, 2017).