Consumption was understood as a manner of appearing, and that appearance became a staple of nineteenth-century manners. It became rude to eat heartily. 

(Susan Sontag)


In her landmark essay ‘Illness as Metpahor’, Susan Sontag traced the vastly differing places that tuberculosis and cancer occupied in the public imagination, their functions within language, and the vastly different moral and social attachments each disease carried. Whereas cancer was viewed as a battle between self and invasive Other, TB has a long history of being viewed asa demonstration of a Romantic sensibility, an illness produced from within the far-too-sensitive self. In TB, you are eating yourself up, being refined, getting down to the core, the real you. In cancer, non-intelligent (‘primitive’, ‘embryonic’, ‘atavistic’) cells are multiplying, and you are being replaced by the non you. Immunologists class the body’s cancer cells as ‘nonself’ (Sontag). Cancer is written of as a monolithic, amorphous being, which exists outside bodies,  


Twentieth-century women’s fashions (with their cult of thinness) are the last stronghold of the metaphors associated with the romanticising of TB in the late eighteenth and early nineteenth centuries (Sontag). So let’s start from that premise.  


At a certain point in Victorian era Europe, class boundaries began to shift with the rise of the middle class and nouveau riche; the architecture and infrastructure of cities and society itself were also changing, so more and more people were being seen in public. The Victorians—obsessed with class, status, and morality; living in cities with increasing population density—became preoccupied with physical appearance as a measure of character, a way of assessing and assigning persons’ place in a hierarchy: both in clothing choice, and in body and face (phrenology, a false science used to underpin arguments for eugenic, racist and imperialist goals, also became popular in the 1830s). (The existence of an intimate connection between the mind, the individual, and his or her illness had been recognised since the ancient period, although the relationship had been couched in the terminology of the humours and their interaction with an individual’s psyche and soul. Piquant emotions like sadness or excessive joy were thought to trigger illness. By the eighteenth century, a more mechanical approach to the body had replaced humoralism, but the notion that the disease was a product of disruption due to either physical, mental, or emotional stresses remained. (Carolyn Day))And as more and more upper and upper middle class persons fell ill with TB, it became not a marker of contagion, but instead the demonstration of a superior sensibility. For snobs and parvenus and social climbers, TB was one index of being genteel, delicate, sensitive. With the new mobility (social and geographical) made possible in the eighteenth century, worth and station are not given; they must be asserted. They were asserted through new notions about clothes (‘fashion’) and new attitudes toward illness. (Day)


I apologise for the binary categorisation of gender that will now follow, but given the time and place that I am discussing, where the conflation of binary gender and assigned sex was ubiquitous, it is important to consider how different aspects of the disease were folded into ideologies of masculinity (seen as embedded within male subjectivity) and femininity (seen as embedded within female subjectivity). In my wider reading around the subject—such as Carolyn Day’s incredible Tubercular Chic, which I highly recommend despite the cringe-worthy title and cover art—it seems that the particular ways that tuberculosis was held to be a desirable disease differed vastly depending on whether the sufferer was a man or a woman (which were the only real options at the time, with very few incidences of questioning or challenging this imposition). 


Genteel, delicate, sensitive. For the Victorian man, it offered access to a Romantic sensibility: Tuberculosis and its accompanying symptoms were construed as the physical manifestation of an inner passion and drive. It was the outward sign of genius and fervour that literally lit the individual, providing the pallid cheek with a glow. The consumptive’s bright, shining eyes and pink, illuminated cheeks were seen as the outer reflection of the inner soul that was consuming itself, burning hot inside and out. 


Those persons with a refined nature were thin and possessed a matching fineness and superiority in taste. In contrast, plumpness was associated with a lack of intellect, ad the stout and portly were often described as tedious and slow. (Day) 


The association was with passion and burning temperament. The consumptive man was a genius and a poet. 


For women, the tubercular look became more and more based on appearance and the notion of physical weakness. Increasingly, those women who suffered from consumption were lauded for their delicate (almost otherworldly) beauty that was characterised by pallor, slenderness, and transparency. (Day) The tubercular look:

Pale (therefore white)  




A connection was therefore created between the sensibility that caused tuberculosis, and those tendencies explicitly viewed as feminine,, By virtue of this association, Victorian women not only fell prey more easily to illness, but as a quality of feminine sensibility, sickness became an integral part of female identity. (Day)


This is the point: specifically, how tuberculosis contributed massively to the reinforcement of a very specific idea of what it meant to be feminine: and

not only that to be sick was to be feminine, but further, the demand that to be feminine was to be sick. 


The physical symptoms of consumption could now be rationalised as reflecting the victim’s moral virtue, and consumptive women were increasingly presented as too good and beautiful to live. (Sontag)


Sontag’s point that this contributes to the twentieth century’s (and arguably twenty-first century’s) cult of thinness is not simplistic, I do not think, but I also think that this goes back far earlier, and tuberculosis was just one vehicle among many that could be used in the propaganda for enforcing very specific dogma about what constituted femininity as inherently weak. 


It goes back very far, which is perhaps why it is taking so very long to displace, and the overwhelmingly white, young, extremely thin and entirely able-bodied casts of almost all fashion shows until really very recently is testament to how entirely embedded the idea of the thin white female as the paragon of femininity and beauty has taken root in Western imagination. You might at this point begin to think that my introduction of the discourse of models and the fashion industry in general is a trivial argument. But that just also goes to show how embedded the idea that the realm of fashion is the realm of silly little women.

The Oyster Dress from Alexander McQueen Spring Summer 2003 Irere collection 
Chanel Autumn Winter 1995