Fashionable But Debilitating Diseases: Tuberculosis Past and Present

Abstract

Even today, apparently healthy people might willingly contract a disease to gain benefit in some way, despite painful consequences. People can also experience pain when deliberately enhancing their appearance through plastic surgery, body piercing, or tattooing, and the wish to look attractive has been shown beneficial for employment, a good salary, and in attracting a partner. In considering our ancestors’ health (palaeopathology), how might we explore purposeful pain in relation to health and well-being in distant time periods? Paleopathology provides a longue durée for appreciating how ill health was experienced, and what diseases manifested themselves at what points in history, and why. In understanding illness in societies and treatment of people with them, ranging from actual therapy to attitudes of society towards people with specific diseases, paleopathology provides a window on past disease that cannot be accessed by any other means, especially in the absence of written records. This chapter takes this backdrop as a starting point and explores purposeful pain through the lens of tuberculosis (TB), an infectious disease that was particularly prevalent in the Victorian era in Britain (AD 1837–1901) and classed as fashionable for many reasons. A brief clinical backdrop to TB is described, including signs and symptoms and related pain and distress, showing that the experience of pain can vary between different people. This shows how interpretations of pain based on archaeological skeletons with bone changes of TB (or any other disease) is challenging. A short description of the historical and bioarchaeological evidence for TB is then provided to show that this infection has been around since prehistory, that TB is historically documented for the Victorian period, and that there is some palaeopathological evidence. The relationship between TB and purposeful plain is then explored through known risk factors in relation to TB, and eighteenth and nineteenth century views on fashion and genius. This includes the impact of the competing needs of Victorian women to look beautiful and attractive to the opposite sex, and of their actions to achieve that goal. A tangled web of synergies and relationships are revealed as a means of highlighting TB’s contribution to understanding purposeful pain.