A while back, I posted about what might well be a photograph of Doc Holliday taken shortly before his death from tuberculosis. Whoever that poor soul really was, his neck is neatly wrapped in white cloth. It was not a fashion statement; it was a bandage. It covered the kind of open sores that can result from TB-infected glands, but its resemblance to the male neck wear of the Romantic period is not accidental.

It is hard to overestimate the impact of tuberculosis in the 1700-1800s. The disease itself is as old as human history, but it became epidemic in Europe in the 18th century when aristocratic land-grabs, famines in the countryside, war, and the Industrial Revolution brought millions of displaced, impoverished and starving people into crowded cities where they lived in tenements and flop houses. Because it was airborne, TB quickly spread throughout the urban population.

The symptoms were familiar to everyone. Night sweats. A low persistent fever. Pallor. Chest pain. A deep racking cough that simply would not go away. Exhaustion. Lack of appetite. Weight loss. Most frighteningly: hemoptysis – coughing up blood when the lungs themselves began to bleed.

Sometimes the disease was relentless, killing sufferers within months of the onset of symptoms. Sometimes it went into remission, only to come back later when people were weakened by other illnesses or by old age. Sometimes, despite years of exposure to someone with active disease, caretakers would never develop the illness. The disease took fifteen years to kill both Frederic Chopin and Doc Holliday. (In Doc and Epitaph, I used the extensive written record of Chopin’s illness to portray that of John Henry Holliday because they were diagnosed and died at the same ages.) On the other hand, their lovers both lived long lives. George Sand died at 72 and Kate Harony lived almost 90 years.

It was mysterious, terrifying, and baffling, and by the early 1800s tuberculosis was killing one in every four people. It was still statistically more likely to kill anonymous poor people, but it was also affecting famous poor people like poets, novelists, actors, composers, and musicians.

The entire Bronte family died, one after another. So did Elisabeth Barrett Browning, Anton Chekhov, Washington Irving, John Keats, Moliere, Guy de Maupassant. Edgar Allen Poe’s mother and wife died of it. So did Henry David Thoreau, the painter Paul Gauguin, the composer Stephen Foster. The list goes on and on.

These admired public figures made the disease bizarrely fashionable. Servants and laborers continued to work themselves into early graves while those who could employ them could affect languid exhaustion. (In the 1934 movie “The Scarlet Pimpernel,” Leslie Howard gives a wonderful performance of this kind of foppish aristocratic ennui.) Ladies strove for wasp-waisted slenderness, whitened skin and artificially rosy cheeks to mimic the wasting, pallor and “hectic malar flush” of genuine tuberculosis.

Low-cut gowns remained fashionable among the healthy. When a rich woman actually did become ill, she could stay home. Men, however, still had to go out into society. Thus, bandages that covered strumous neck glands became the well known neck wear of the Romantic period.

If you’d like to read more on this topic, check out this this Smithsonian article.