The South Island of New Zealand saw several major waves of migration in the mid-nineteenth century, predominantly from Europe but also with an ethnically distinct Chinese presence. The rural community of Milton, Otago, was a settler community established primarily by immigrants from the United Kingdom in search of a better quality of life. However, these settlers faced unique challenges related to surviving in an isolated location with very little infrastructure compared to their origin populations. In 2016 excavation was undertaken at St. John's Burial Ground, Milton, with the object of using bioarchaeological methods to elucidate the lived experience of the first organized European settlement of this region, particularly in terms of health and disease. Here we present a case study of Burial 21 (B21), a male individual of known identity and a documented cause of death. We use biochemical and paleopathological methods to ground-truth his written history, which includes a period of invalidism due to tuberculosis, and discuss the implications of our findings for the community, provision of care, and quality of life in rural colonial New Zealand.