Tuberculosis (TB), also known as consumption, is a deadly bacterium that attacks people’s lungs. It’s passed through sneezing, coughing or coming into contact with an infected person’s saliva, and at the turn of the 19^th century it was the deadliest disease in history, having killed one in every seven people who had ever lived. While a vaccine was first used on humans in 1921, it wasn’t widely spread until after World War II. It’s still a disease that ravishes poorer parts of the world, where people can’t afford and/or don’t have access to treatment.

For centuries TB was a terrifying disease, not just because of how deadly it was but because anyone, of any race, gender, age and status could catch it seemingly out of nowhere. When someone did catch it they lost weight and suffered from fever, aches, pains and serious fits of coughing. It would sometimes take painful decades for people to die. People worldwide were terrified of TB, and as a result new inventions and trends emerged that changed the world.

10. Shorter Skirts

Before the discovery of germs and bacteria, people spit everywhere. And since women wore long skirts that dragged along the ground, their dress could pick up spit and possible TB bacteria as they walked. If the woman was a mother with small children, she could easily infect them because children have a tendency to hang onto their mother’s skirts. The longer the skirts, the more dangerous the health risk. Women started to hem their skirts so that they didn’t drag on the ground, so if you enjoy short skirts you can thank your ancestors for spitting.

9. Grooming of Beards

Prior to learning that TB was spread via sneezes and coughs, men often had long beards, quite possibly for health benefits. Some people thought that beards worked as a respirator and protected against diseases of the mouth, throat and lungs. Plus, it protected men’s faces from the cold. But that all changed when it was discovered that TB can stay contagious in saliva for up to a day. If spittle got caught in a man’s beard it made the man, and anyone he touched, susceptible to TB.

Health officials instilled the fear that the beard could pass on the horrible disease if they were to kiss their wife or children and encouraged men to start shaving. The campaign made facial hair styles change drastically — if a man had a beard it was neatly trimmed, otherwise most men were clean-shaven or had small mustaches. Since beards were associated with the transmission of TB, well-kept facial hair (or none at all) made men look healthier, cleaner and ultimately more attractive.

8. Reclining Chairs

Is there anything better than coming home after a long day, sitting down in your favorite recliner, and putting your feet up? That small luxury of everyday life actually has its roots in TB treatment. When someone was suffering from TB, they were often bed ridden for years. Reclining chairs were invented to help with treatment.

American doctor Edward Livingston Trudeau, a pivotal figure in the study of TB, opened up a cottage sanatorium that treated TB patients. An early idea of Dr. Trudeau was that sufferers of TB could be helped with enough bed rest. As a result, they developed reclining chairs called “Cure Chairs.” The chairs would reduce movement from a bed to a chair and allow people to get the optimal amount of rest. The design of these chairs would go on to influence day beds, recliners and loungers — all the chairs we now love lazing on.

7. Waffle Cone

A popular treat in 1890 was ice cream served as “penny licks.” Ice cream vendors would sell small amounts of ice cream for a penny in glass cups that were about the size of a shot glass. People would buy the penny lick, lick the ice cream out and give the glass back to the vendor, who would fill it again and sell it to the next customer without washing out the glass. People just didn’t know that that was how diseases were spread.

By 1899 penny licks were banned in places like London, because they were pretty sure they helped spread TB. By 1900, ice cream started to be served in a pastry in New York. Then at the 1904 St. Louis World Fair the waffle cone that we know and love was introduced to help serve and transport single servings of ice cream, making the snack even more delicious.

6. Front Porches

One of the earliest theories for treating TB, dating all the way back to the ancient Greeks, was getting fresh air, a treatment sometimes called the “wilderness cure.” At one of the first treatment centers for TB in the United States, the Adirondack Cottage Sanitarium at Saranac Lake, New York, they built giant front porches where patients would rest and sleep in any season.

Since Adirondack was one of the leading authorities on the disease, many people tried to emulate it and added front porches, sometimes referred to as sleeping porches, to their homes. Since there were so many sufferers, front decks became more popular around the turn of the 20^th century.

It was eventually proven that fresh air wasn’t the cure for TB, but people did start to see the benefit of outdoor living. Instead of fighting TB, porches and sunrooms helped people stay cool and enjoy the outdoors without dealing too much with the elements.

5. Disposable, Single Use Items

As we’ve already noted, before the evolution of germ theory people often didn’t mind eating or drinking from items covered in other people’s saliva. After the health hazards of that practice came to light, innovations were needed. It was during this time that two famous everyday products started to flourish. The first is the Dixie Cup, which was invented in 1912 to replace “tin dippers,” communal cups that people used to drink from free water sources.

In 1907, Bostonian Lawrence Luellen started working on a design for a one-time-use disposable paper cup. By 1908 he had not only the cup but a partner, Hugh Moore, who made vending machines that would dispense water for a penny. They even called the disposable cup the Health Cup. It became Dixie Cup in 1919, after a popular doll at the time to set them apart from their competition. The invention of the soda fountain ensured that Dixie Cups became a mainstay around the world.

Then, in 1924, the Kleenex Company started manufacturing the first facial tissues in the Western world. Originally advertised as a way to remove makeup and cold cream, Kleenex didn’t advertise that they were a way to stop the spread of disease because people still predominately used handkerchiefs. However, Kleenex saw an opportunity after a health campaign said that if you had to spit, it was best to do it into a tissue or newspaper and then burn it. Since then, Kleenex and other facial tissues have become an excellent way to combat TB and other contagious diseases. Both of these inventions showed that there was a market and a need for one-time disposable items like razors, pens and bottles of water.

4. More Parks

As mentioned earlier, people used to believe that fresh air in a natural setting would help prevent people from catching TB and aid those who suffered from it. But how do people who live in cities and don’t have easy access to transportation to rural areas enjoy nature? The answer was to develop more parks within city limits.

The parks weren’t just used to help more people get fresh air — at times they were used to quarantine people with TB. One example is Maybury State Park in Michigan, which used to house a sanatorium for TB treatment. By 1975 the sanatorium was torn down, and it’s now a beautiful state park with paths for biking, hiking and walking. Public parks were created throughout the world simply because they thought it would help combat TB.

3. No More Spitting

In contemporary culture, someone spitting in a public place is considered quite crass. But it wasn’t always that way — before the scientific community and the general public accepted the theory of germs and bacteria, they thought that illness happened because something was wrong with a person’s level of bodily fluids. So spitting in public wasn’t a big deal. And since it wasn’t a big deal, people would spit everywhere — the roads, theaters, public transportation, shops and taverns, everywhere.

That all changed after it was discovered that spitting is an excellent way to spread TB. There was a huge public health campaign to stop spitting in public. In the United States, the National Association for the Study and Prevention of Tuberculosis (which later became the American Lung Association) shamed the act of spitting, calling it a “filthy habit.” Their message was simple — stop spitting or you may condemn someone to a horrible death. And it worked! After the campaign, they noticed that TB levels dropped dramatically.

2. Migration to the Southwestern United States

Contracting TB could mean a long and painful death sentence. People would do anything to cure it, including gambling on unorthodox treatment methods. Capitalizing on this trend, cities in the southwestern United States looking to grow advertised to people with TB, claiming that they could live a healthier life if they moved out to where the weather was warmer. This is how cities like Denver, Albuquerque and Los Angeles grew. Other times, people with TB would move and set up settlements. For example, Pasadena, California started as a settlement of people from Indiana infected with TB.

While the climate did help people with ailments, it wasn’t a cure. And the more populated these cities got with people with TB, the faster the disease spread across the country.

1. Generations of People With Better Hygiene

One of the most terrifying aspects of TB was the fact that it could infect children just as easily as it could infect an adult. In fact, for a long time people thought that it was hereditary. When the truth was discovered, there was a drastic change in how and what children were taught about hygiene and healthcare.

A campaign called the Modern Health Crusade encouraged children to perform 11 daily tasks, which included washing their hands before every meal and brushing their teeth twice a day. To make it more interesting for children, the National Association for the Study and Prevention of Tuberculosis gave them stamps which would allow them to rise through the ranks of the crusaders — for example, enough stamps would promote you in rank from sage to knight. The revolutionary campaign, which launched in 1915, reached seven million children. These children developed lifelong habits which have been passed on for generations, and those 11 daily tasks created the standard for healthy hygiene that we follow today.

Robert Grimminck is a Canadian crime-fiction writer. You can follow him on Facebook on Twitter, or visit his website.

Alongside diseases like cholera and smallpox, tuberculosis was one of the world’s biggest killers during the 19th century. Anyone unfortunate enough to contract the illness often didn’t survive it. Also known as “Consumption” or the “White Plague,” its symptoms made it easy to spot anyone afflicted by it. Extreme weight loss, a pale and fragile appearance, and the coughing up of blood all added to the strangely romanticized “tubercular aesthetic” that had a huge influence over the Victorians.

Here are ten of the ways in which the debilitating disease shaped Victorian society.

10 High Death Rates

The most obvious way in which tuberculosis affected Victorian society was, of course, the number of lives it took. It’s even believed to be the leading cause of death by any microbial pathogen in history. At the turn of the 19th century, around 50 million people worldwide were openly infected with it. What the Victorians didn’t know for a long time is that the disease, which attacks the lungs and damages various organs, is highly infectious. The poor sanitation and hygiene standards of the time created the perfect breeding ground for its proliferation.

Two of the worst affected places were the cities of London and New York. In Victorian England, it claimed around one in five lives of the entire population, with similar numbers in the United States. As one of the leading causes of death during the 19th century, it’s little wonder tuberculosis affected so many areas of society.^[1]

9 Beauty and Aesthetics

When tuberculosis was at its peak during the early to mid-19th century, it was heavily glamorized, despite it causing around 25% of deaths in Europe. Some of the physically apparent symptoms of the disease, such as emaciation and wasting away, were aligned with existing Victorian ideas of attractiveness. Subsequently, tuberculosis quickly became associated with beauty. Sufferers usually had a thin, fragile frame, pale skin with rosy cheeks, red lips, and sparkling eyes. These features were the ideal beauty standard of the time, which left many wishing to imitate it through the use of makeup.

Among the upper class of Victorian society, it was generally believed that a woman’s level of attractiveness could determine how likely she was to suffer from tuberculosis. The disease simply enhanced features considered beautiful in women. Since makeup was usually associated with prostitutes and actresses, however, most upper-class ladies actually hoped to contract the disease!^[2]

8 The Fashion

With the disease and its effects having become entwined with the ideals of beauty, tuberculosis soon played a role in the nature of 19th-century fashion. During the first half of the 1800s, consumption was believed to be caused by “bad airs” in the environment, as well as the result of a hereditary predisposition. At this time, when admiration for the pale, wasting appearance was at its peak, fashion trends tended to emulate and highlight symptoms of the disease. Pointed corsets were worn by women to emphasize tiny waists and were paired with huge, voluminous skirts to further show off the waifish look.

When tuberculosis came to be recognized as a bacterial disease during the second half of the 19th century, it still continued to have a huge influence over fashion. Large-scale public health campaigns were implemented in an effort to prevent the spread, and doctors claimed that large skirts could sweep up germs from the street and bring them into the home. Corsets were also criticized for limiting blood circulation and the movement of the lungs, which was quickly reconsidered to exacerbate tuberculosis. Even men’s fashion came under attack. Extravagant, bushy beards, sideburns, and mustaches that were at the height of fashion at the beginning of the century, were deemed too dangerous. The clean-shaven look was initially adopted primarily by physicians and surgeons, but the rest of male society soon followed.^[3]

7 Literature

The prevalence of tuberculosis within 19th-century European society led to its depiction in the various celebrated literary works of the time. These works certainly helped to shape the romantic image that the Victorians held of the disease. Tragic fictional icons who fell to the disease were common in 19th-century literature, including Katerina Ivanova in Dostoevsky’s Crime and Punishment and Fantine from Victor Hugo’s Les Misérables.

A strange belief about tuberculosis also surrounded celebrated writers of the time. The prevalence of the disease meant that numerous individuals of extraordinary talent were also among its victims. This led to the notion that there was a link between tuberculosis and creative genius. Some notable writers among the mass of sufferers included Robert Louis Stevenson, John Keats, and Emily Brontë. All were said to have improved creative power as their physical conditions deteriorated. Unsurprisingly, this caused many literary and artistic types of the time to wish to contract tuberculosis.^[4]

6 Entertainment

The “tragic beauty” associated with tuberculosis also worked its way into the sphere of 19th-century entertainment. The upper crust of Victorian society would often frequent the opera, where heart-breaking stories of the beautiful victims of consumption would be portrayed. Two popular operas that explored the themes of the disease included La Traviata and Giacomo Puccini’s La Boheme.

Based on a novel, the tragic story of La Traviata is a particularly romantic representation of tuberculosis. It follows the tale of two lovers: the young and beautiful courtesan Violetta and her secret admirer Alfredo. The story’s themes of love, joy, youth, and beauty are accompanied by the looming threat of disease and death, with Violetta’s consumption playing an increasingly large role as the tale progresses. Given that tuberculosis was so often represented within romantic contexts in the arts, it’s little wonder that the Victorians came to view it as a romantic disease.^[5]

5 Art

As with other areas of the creative sphere, the imagery depicted in many artworks produced by 19th-century artists was influenced by their own experiences of tuberculosis. Works of the 19th-century artist Ferdinand Hodler reflect his tragic childhood encounters with the disease, which had robbed him of his entire family. Some of his most significant works in this respect include “The Convalescent,” “Night Hodler,” and “A Troubled Soul.” It was a similar story for Edvard Munch, which inspired his works such as “The Sick Child” and “Sick Chamber.” Works such as these and others were significant in developing the more morbidly tragic notions that the Victorians associated with the illness.

As with literary artists, tuberculosis was associated with artistic genius on the canvas too. It was speculated that the low-grade fever accompanying tuberculosis might have been responsible for heightened perception and bursts of inspiration and insight.^[6]

4 An Obsession with Death

Death was a huge part of life for the Victorians, and as such, they were obsessed with it. Given that tuberculosis was one of society’s biggest killers (although, admittedly, there were a few!), the disease likely played a small yet significant role in fueling this obsession. The Victorians were ritualistic in their approach toward death and mourning, and it became a way of life for most.

The deathbed itself became an important focal point around which the departed’s last words were highly valued. In fact, “deathbed watches” and notions of a “good death” often featured prominently in the literature of the time, particularly the works of Charles Dickens. Complex codes of mourning were in place, including the requirement that a grieving woman must only wear black for exactly twelve months and a day. Jewelry created from the locks of the deceased’s hair was also produced, along with other mementos, such as death masks and portraits, which were given a place of pride around the home. In Victorian society, death, loss, and grief were simply seen as an inevitable and integral part of life.^[7]

3 Science

Although tuberculosis has been around for thousands of years, it wasn’t until the mid-19th century that scientists began to recognize that its transmission wasn’t simply the result of “bad airs” or genetic predisposition. It was the likes of the French chemist Louis Pasteur and the British surgeon Joseph Lister who developed germ theory around this time. However, while they were key figures in determining that germs cause disease, it was the German physician Robert Koch who first linked specific bacteria to certain diseases.

It was in 1882 that Koch announced his discovery that Tubercle bacillus caused tuberculosis. His experiments involving culturing and inoculating animals with the bacilli completely revolutionized the understanding of the disease and others like it. He also found that a mixture of saliva and mucus coughed up from the respiratory tract was the main way of spreading the disease. This led to huge changes in scientific understanding and the fields of medicine, hygiene, and sanitation in Victorian society.^[8]

2 Medicine and Hygiene

Koch’s discovery meant that Victorian society became acutely aware of the fact that tuberculosis was not only contagious but also very much tied to personal and public standards of hygiene. This meant the previous reliance on treatments such as a “change of air” and bloodletting would no longer cut it. Instead, public health measures were put in place to stop the spread of tuberculosis and other contagious diseases. These included the provision of clean water, waste removal, and separate sewage systems. New legislation was also implemented for improved housing to reduce overcrowding.

Within the medical field, improvements took place very rapidly. Technological equipment was developed to detect and treat diseases, and sterilization and antiseptic surgical procedures started to take place. In addition, specialized surgical instruments and techniques began to be developed. Ultimately, Koch’s discoveries started a chain reaction that led to a complete overhaul of the Victorian medical profession and the growth of the medical industry.^[9]

1 Social Reform

With growing awareness of the importance of hygiene and decent sanitation to prevent the spread of tuberculosis, it quickly became apparent that the poorer classes were the most at risk. Although concerns surrounding the living and working conditions of the poor were by no means initiated by Koch’s discovery, it certainly emphasized the importance of the matter. Fifty new statutes on housing were, therefore, put into place during the second half of the 19th century. The main target was to reduce overcrowding and improve the overall standard of living for the poorest members of society.

Various measures, reforms, and legislation were also put into place or updated to help the working class. Penny savings banks were established, early forms of insurance policies were offered, and communal resources were made available to assist the poorest members of Victorian society. Their vulnerability to tuberculosis and other diseases had further highlighted a burgeoning need to improve their living standards.^[10]