Tuberculosis Considered As Dating Strategy

Against some evopsych

Sometimes I see people say something like: “men evolved to be into healthy, fertile women who would bear them healthy offspring. They like symmetrical faces, because symmetrical faces are indicative of good health in childhood. They like unblemished skin because blemishes are a sign of disease. They like a 0.7 waist to hip ratio, because women with that waist to hip ratio tend to be healthier and to conceive more easily. They like big perky boobs because uh something something youth something.”

All of that is true, as far as it goes. But if that’s true, then why were tuberculosis patients sexy?

It is difficult to overstate the strength of the boner 19th century elites had for tuberculosis patients. To quote John Green’s excellent Everything Is Tuberculosis, women with tuberculosis were considered "beautiful, ethereal, and wondrously pure.” He elaborates:

Patients with active tuberculosis typically become pale and thin with rosy cheeks and wide sunken eyes due to the low blood oxygenation and fevers that often accompany the disease, and these all became signals of beauty and value in Europe and the United States. Henry David Thoreau wrote in his journal, "Disease and decay are often beautiful-- like the pearly tear of the shellfish or the hectic glow of consumption."

The ideal feminine body was delicate, weak, and waifish. Women avoided exercise and time in the sun so as not to be too energetic or tan. One author wrote of a dead consumptive woman that "the glow of her face made it look like 'she had died of beauty.'" A medical treatise on consumption (i.e. tuberculosis) included a literal poem describing the beauty of female consumptives. Women applied belladonna to dilate their pupils so they'd look more like they had tuberculosis.

Today, the average man prefers his women tanned and blonde. But the distinctive look of, say, Dita von Teese—thin, delicate, pale, with pink cheeks and blood-red lips—is just what (white) tuberculosis patients look like.

See page for author, CC BY 4.0, via Wikimedia Commons

There is no conceivable way it is adaptive to be into tuberculosis patients. Set aside the obvious facts that any communicable illness is a sign of a poor immune system or that sick women are more likely to face pregnancy complications and might pass the disease on to her children. Most people with tuberculosis have inactive tuberculosis, which means that they don’t have any symptoms. Active tuberculosis occurs when the immune system can no longer keep tuberculosis under control: for example, if the patient is immunosuppressed, malnourished, chronically ill with something like diabetes, or under stress. In short, selecting for women with active tuberculosis is specifically selecting for unhealthy partners, even within the category of people who have tuberculosis.

On the other hand, having tuberculosis was high-status. Tuberculosis was extraordinarily common: in 19th century London, every year, 1% of people died from tuberculosis. To be clear, that’s not 1% of all deaths, that’s 1% of all people. And unlike other diseases—which killed the very young or very old—tuberculosis took people in the prime of their lives. Naturally, people reached for a way to make this all okay. They concluded that people with tuberculosis were Too Good For This Sinful Earth [cw: TVTropes]. Men with tuberculosis were artistic, sensitive, emotional, and pure. People compiled lists of geniuses who died young of tuberculosis to prove that tuberculosis was inextricably linked with genius (never mind that if 1% of Londoners die of tuberculosis each year, you’ll have as many tuberculous artists as you can stand). And women with tuberculosis were considered beautiful.