‘At every glass of champagne her cheeks would flush with a feverish colour, and a cough, hardly perceptible at the beginning of supper, became at last so violent that she was obliged to lean her head on the back of her chair and hold her chest in her hands every time that she coughed.
…. Toward the end of supper Marguerite was seized by a more violent fit of coughing than any she had had while I was there. It seemed as if her chest were being torn in two. The poor girl turned crimson, closed her eyes under the pain, and put her napkin to her lips. It was stained with a drop of blood. She rose and ran into her dressing-room.
“What is the matter with Marguerite?” asked Gaston.
“She has been laughing too much, and she is spitting blood. Oh, it is nothing; it happens to her every day. She will be back in a minute. Leave her alone. She prefers it.”
I could not stay still; and, to the consternation of Prudence and Nanine, who called to me to come back, I followed Marguerite.’
According to Arthus Groos, Violetta’s death of pulmonary tuberculosis in Verdi’s La Traviata was the first of its kind in opera. Tuberculosis exerted a similar mythological hold on the cultural imagination in the 19th century as AIDS and cancer exerted over the 20th Susan Sontag suggests in Illness as Metaphor (1979). Around each disease there is cultivated a slew of metaphoric and figurative associations. Sufferers of TB revel in excessive passions, cancer victims repress and the ramifications are internal: malignant vacuous growths. AIDS kills men for who sex is pure pleasure, those thoughtless of mankind’s reproductive future: a death drive fixation.
Groos is keen to suggest, with an example drawn straight from fiction, that contemporary audiences might experience some sort of cognitive dissonance in watching beautiful, paling women die, apparently, of just a bad cough.
‘One of the central events of the film Moonstruck (1987) takes place in a performance of La bohème at the Metropolitan Opera. Loretta (Cher) is puzzled by what seems to be Mimi’s unexpected death (….)
“You know, I didn’t think she was going to die! I knew she was sick!”
“She had TB.”
“I know. I mean she was coughing her brains out. Right? And still she had to keep singing!”
Most of us will smile indulgently at a first-time opera-goer’s ingenuous conflation of character (‘coughing her brains out’) and voice (‘keep singing’)….’
People were always dying of TB in the 19th century literature, like Marguerite in Alexandre Dumas, fils’s La dame aux camellias (1852) – the text that would later be adapted by Verdi to become La Traviata. In his adaptation Marguerite is renamed, becoming Violetta. The tuberculosis epidemic in Europe had reached its peak in the 1850s. By the early eighteen hundreds, ‘TB was the most common cause of death by single disease.’
Yet as the source of the disease was unclear and its manifestations varying there was much speculation as to its causation: probably too much sex, too much drink and precious little moral fibre. As TB is a highly contagious bacterial disease and ventilation in 19th century buildings was extremely poor, entire families often were plagued with the affliction. As a result, doctors concluded, TB was probably hereditary.
As Groos notes, ‘Consumption in the mid-nineteenth century thus signified a particular disease that could be diagnosed but whose origin and cure remained unknown and could be attributed to a wide variety of factors. As a result, the illness -to use Susan Sontag’s phrase -became a metaphor, a means of constructing character.’
Curiously, Groos continues, as the metaphors that proliferated around the disease became cultural short-hand for all sorts of pernicious characters traits, cultural manifestations of TB were also gendered. Whilst dying women became beautiful, pale waifs, who delicately coughed a little blood on a lover’s white handkerchief, men with TB were just extremely creative. Naturally.
 A. Groos, ‘TB Sheets’: Love and Disease in La traviata’, Cambridge Opera Journal, Vol. 7, No. 3 (Nov., 1995), pp. 233-260 (p. 233).