Chapter 4 opens with an extended quotation from Oliver Goldsmith’s 1773’s play She Stoops to Conquer. In it, a wife and husband are speaking about the wife’s child by a previous marriage. The boy has a terrible cough and is generally weak. The wife, Mrs. Hardcastle, begins by blaming herself for the boy’s perpetual sickly state and wonders if shielding him from the world is the cause of his illness. Sontag uses this exchange to show the received ideas about TB (who is to blame, sources of shame, etc.) already at work in the 18th-century English culture.

With the advent of social mobility in the late 18th and early 19th century, TB became a marker of one’s appearance. The poet Byron Shelley, a tubercular, noted that the sickness colored his outward appearance. Oddly, in the 19th century, it became uncouth to eat heartily or act in a libertine manner, as more and more people aspired to a sickly, wan appearance that was brought on by sicknesses like TB. The co-opting of the look of TB victims by artists and aristocrats led to the look becoming something aspirational and of “a mark of distinction” (29). Sontag even relates the 20th-century look of high-fashion (thinness) with the last vestiges of a romanticization of the TB look.