of Bachelor of Arts at Pacific University

May 2012

Pauline Beard (Ph.D.)

1. Introduction 1

2. Tuberculosis 2

3. The Aesthetics of Tuberculosis 4

5.3. Death by TB: Jane Eyre and Crime and Punishment 22

6. Science Marches On 28

6.1. Robert Koch and Literary Response to the Discovery of the TB Bacillus 28

6.2. The Magic Mountain 29

7. Conclusion 32

7.1. Modern Tuberculosis 32

7.2. “Half in Love with Easeful Death” 33

Bibliography 35

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“Yet the captain of all these men of death that came against him to take him away was the

realm of literature against other diseases due mainly to its commonality: the disease was, and

remains today, one of the most prolific killers of human beings all over the globe. In his book

The White Death: A History of Tuberculosis, Thomas Dormandy writes that, unlike other plagues

such as scarlet fever or measles, tuberculosis “transformed the lives as well as causing the deaths

of its victims” (xiii). For centuries, tuberculosis was a disease that was believed to be linked with

special poetic and aesthetic qualities, and these beliefs were reflected not just in literature, but in

medicine as well. As science progressed, so did the literature of tuberculosis – the disease

changed in literature and in medicine from something romantic and mysterious but a disease

caused by an agent (the tuberculosis bacillus) which could be conquered. As Clark Lawlor points

out in his book Consumption and Literature: “literature affected consumption’s reality, just as

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surrounded by those who did. Tuberculosis and the aestheticization of the disease play a major

2. Tuberculosis

“tuberculosis of the bones and joints, the lymph nodes… the abdomen, the meninges and central

nervous system, and the skin”) (Bryder 3). Pulmonary TB is the most common form of the

disease, with 80-85% of all deaths from TB in the twentieth century caused by the pulmonary TB

(3). TB is an airborne disease, and when those with an active TB infection “cough, sneeze, talk

or spit, they propel [TB bacilli in water droplets] into the air. A person needs only to inhale a

small number of these to be infected.” If left untreated someone with an active TB disease will

infect “between 10 and 15 people every year.” However, only 5-10% of those infected with the

TB bacilli will develop an active infection – the immune system “walls off” the bacteria, which

can lay dormant for years (“Tuberculosis”). Symptoms of an active pulmonary tuberculosis

infection include fever, night sweats, weight loss, fatigue, and a “persistent cough that may be

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for a minimum of 6 to 9 months” (Ringold et al. 464) Treatment takes a long time because the

rays). While M. Tuberculosis itself does not produce any known toxins, these tubercule growths

are “so unrelenting that the tissues [surrounding the tubercules] are literally consumed” – this

“consuming” action, along with those suffering from TB appearing to waste away is what gave

rise to the disease’s most common nickname: “consumption” (433). The cavities resulting from

the consumed lung tissue cause one of TB’s most iconic symptoms: haemoptysis, or coughing up

blood. This usually occurs only with advanced pulmonary TB and is “usually mild. The typical

presentation is blood-streaked sputum.” Massive, fatal hemorrhages are rare, but when they do

occur it is usually due to “erosion into a bronchial artery or [of a] rupture of an

aneurysm…within the TB cavity” (Hoffmann and Churchyard 338).

Historically, tuberculosis is one of the oldest diseases known to man, as there “is good

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“wasting” - to describe the disease (Dormandy 2). The disease was known to Hippocrates and his

Europe” (Bynum 56). From the seventeenth century through the Nineteenth Century tuberculosis

“killed as many as one in four people in Western Europe and America” (Lawlor 5). On the east

coast of the United States, the estimated annual tuberculosis rate was “as high as 400 per 100,000

population” (Carpenter 60). Between 1838 and 1843 the disease killed more than 60,000 people

in Britain and “ultimately wiped out more Britons in the 1800s than did smallpox, measles,

typhus, whooping cough, and scarlet fever all combined” (Pool 247).

In literature as well as life tuberculosis became more than just a disease: it became an art. In

his 1966 article “Tuberculosis and the Creative Writer” John Wilson argues that “all art is forged

out of human experience, and pulmonary tuberculosis is one of the deepest and most testing

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there emerged in both literature and contemporary medical discourse a belief that the disease

with refined cultural values and aesthetic pleasures” (475). The Nineteenth Century “developed

and transformed, rather than denied, the culture of aestheticized consumption” that developed in

the previous century (462).

The aesthecization of tuberculosis can be seen in all forms of art, but it is especially present

in literature. In her book Tuberculosis and the Victorian Literary Imagination, Katherine Byrne

describes the numerous subject types that tuberculosis became associated with in literature:

appetites. The resulting images have become famous textual tropes: the languishing

consumptive poet whose thwarted desires and personal frustrations seem to have brought

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disease of the heart…the lungs appear to be fairly sound” (Dormandy 19). Reflecting the popular

and discovered that he was still alive (Dormandy 20). Keats died on February 23, 1821, just a

few months after his twenty-fifth birthday. Joseph Severn, writing to John Taylor in March of

1821 wrote “Dr. Clark and Dr. Luby with an Italian Surgeon opened [Keats’s] body. They

thought it the worst possible Consumption. The lungs were entirely destroyed. The cells were

quite gone” (Scott 511). They wondered at how Keats managed to survive the past few months

(Dubos and Dubos 17). Dr. Clark would later “return to London…to become a royal physician”

and would “end his long life a baronet” (Dormandy 19)

4.2 Keats’s Poetry

Keats’s experience with his illness had a profound effect on his writings – many of his

poems reference death or dying young. Each of Keats’s odes, including “On a Grecian Urn,” “On

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feeling is the singing of the nightingale “in full-throated ease.” The narrator wishes to escape into

annihilation that becomes temptingly explicit in stanza six” (90-91). In Stanza VI the narrator

conceives of death as an “eternal present” and the “prolongation of the ecstatic moment” (Sperry

265):

Darkling I listen; and, for many a time

I have been half in love with easeful Death,

Call’d him soft names in many a mused rhyme

To take into the air my quiet breath;

Now more than ever seems it rich to die,

To cease upon the midnight with no pain,

While thou art pouring forth thy soul abroad

In such an ecstasy!

Still wouldst thou sing, and I have ears in vain –

To thy high requiem become a sod.

The narrator, “half in love” with the notion of the “easeful” painless death, associates it with the

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emphasize the gap between them” (265).

have Fears that I may cease to be” written in either 1817 or 1818, Keats writes of his fear of

death – especially that he will die before he may be able to write and publish the poems in his

head. “When I have fears that I may cease to be” is far less complex than “Ode to a Nightingale”

in its exploration of death and though it has no explicit references to tuberculosis, it does provide

some insight to Keats’s thoughts on dying:

When I have fears that I may cease to be

Before my pencil has gleaned my teeming brain,

Before high piled books, in charact'ry,

Hold like rich garners the full-ripen'd grain;

When I behold, upon the night's starr'd face,

Huge cloudy symbols of a high romance,

And think that I may never live to trace

Their shadows, with the magic hand of chance;

And when I feel, fair creature of an hour,

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the loss of both being the primary fear. The action of tracing the shadows of the “huge cloudy

he will never again “relish” in “unreflecting” (meaning without thought or reflection) love. The

narrator continues to think of death, until both love and fame “to Nothingness do sink” – the

continual thought of death causing both to become meaningless. Throughout the sonnet the word

“when” is repeated several times, along with the word “never” –stressing both the inevitability

and finality of death.

It is nearly impossible to view a sonnet such as “When I have Fears that I may cease to

be” or the reflections on dying in “Ode to a Nightingale” without the knowledge that Keats

himself died so young of a disease that decimated his lungs, in a land far away from his family

and friends. Nearly every trope associated with the sickly poet is exemplified in Keats’s

biography – many of the tropes began with him. The disease which killed Keats’s mother,

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tragic as Edgar Allan Poe. Perhaps best known for his tales of mystery, horror and the macabre,

Virginia Clemm, from tuberculosis. Poe was, by all accounts, devoted to Virginia, and her illness

influenced his moods and his ability to write (Harris 869). It was not just Virginia’s death that

influenced Poe – the disease that killed her, tuberculosis, is also frequently seen and referenced

in Poe’s works. The disease figures prominently in a great deal of Poe’s works, often referred to

by name: other times its presence is alluded to, such as in the short story “The Masque of the Red

Death.” In stories such as “Metzengerstein” the disease is heavily romanticized – it is portrayed

as an easy and glorious death that the narrator wishes all his friends to experience (Poe 97). “The

Masque of the Red Death,” however, presents a different image – an image of a terrifying and

painful disease. While his wife’s illness had a profound effect on Poe’s life and work, his

portrayal of the disease often wavers between the image of a romantic death, and an image of

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disliked it so he “got himself court-martialed and expelled” (Fisher 3). Poe then went to New

actually consummated (Galloway 32). Poe “characteristically regarded his relationships with his

chosen women as ideal or spiritual in temper...[and] we can only speculate that physical intimacy

with his child bride, if it occurred at all, came at a subsequent date” (Ackroyd 62).

In January of 1842, Virginia Poe suffered a pulmonary hemorrhage while singing, and

spent weeks in bed afterwards (Ackroyd 81). Friends noted that Poe would “hover about his

wife’s bed, alert to every tremor and cough” (81-82) and “would not allow a word about the

danger of her dying – the mention of it drove him wild” (Thomas and Jackson 358). Virginia’s

illness “waxed and waned until her death in 1847” (Harris 869). In an 1848 letter to George

Eveleth, Poe described how Virginia’s illness affected him:

Six years ago a wife, whom I loved as no man ever loved before, ruptured a blood-vessel

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oscillation between hope and despair” (Harris 868). During the last months of Virginia’s life,

grade of deterioration, checked now and again before its approaching dissolution to turn

and attempt a struggle back to sanity and health, yet never quite succeeding. (394-5)

Poe died two years after Virginia, under mysterious circumstances in Baltimore on October 7,

1849. The precise cause of his death has never been determined (Fisher 10).

In his works Poe, more often than not, portrays consumption as “the disease of an easy

and beautiful death. In the Romantic formulation, consumption was aestheticised in a positive

manner as a sign of passion, spirituality and genius” (Lawlor 1-2). However, it can easily be

seen that Poe’s romanticization of the disease stems not from ignorance, but rather that, as

Beddoes comments, suits his narrative. Poe may have witnessed first-hand his wife’s slow and

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consumption:

While “Metzengerstein” was originally published in 1831, Poe made several changes to the story

over the years: The passage concerning the nature of Lady Mary’s death and the narrator’s

wishing all he loved to perish from the disease was “preserved as far as the edition of 1840” but

was “afterwards omitted” (Quinn 193).

The mention of the “gorgeous autumnal leaves” in the paragraph about Lady Mary

solidifies the romantic image of consumption: “autumn was traditionally the time for

consumptive death but also the most visually poetic of seasons” (Lawlor 2). The image of falling

leaves was, according to Dormandy, a metaphor in tuberculosis literature for “failing hopes [and]

the destruction of young lives” (85). Poe, like many of his contemporaries, reveled in “the

terrible beauty of consumption” despite being frequently exposed to the devastating reality of the

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he wrote in the wake of [Virginia’s] haemorrhaging,” one of which is entitled “The Mask of the

profuse bleeding at the pores with dissolution. The scarlet stains upon the body and

especially upon the face of the victim, were the pest ban which shut him out from the aid

and from the sympathy of his fellow-men. And the whole seizure, progress and

termination of the disease, were the incidents of half an hour. (442)

One can easily draw a parallel between the mysterious “Red Death” and tuberculosis –

Silverman even refers to the Red Death as a “Virginia-like pestilence” (180). However, Poe

obviously took creative liberties in the creation of his disease: tuberculosis does not cause blood

to seep out of the pores, nor does it kill in only half an hour, but one can see similarities between

tuberculosis (such as the blood upon the face, the pain and dizziness that comes with not being

able to breathe) and the Red Death. However, Poe has put his own spin upon it. In the story, the

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the grave” wearing a mask designed to resemble that of the face of a victim of the Red Death

dominion over all” (446).

“The Masque of the Red Death” can be seen as an allegory for the desire to escape death,

particularly death at the hands of the Red Death – i.e. tuberculosis. While Poe “professed a

dislike for allegory” “The Masque of the Red Death” is steeped in “allegorical imagery and leads

readers something very much like a moral about the inevitability of death” (Peeples 104).

Prospero wishes to escape death by hiding away – yet the Red Death, comes for him anyway,

and despite Prospero’s attempt to corner and attack it, he dies nevertheless. “The Masque of the

Red Death” was first published in May of 1842 – just months after Virginia Poe suffered her first

hemorrhage while singing. Just as Poe wished to avoid hearing of the fatality of tuberculosis,

Prospero shuts himself away from the disease that is ravaging the land, and tries to ignore it,

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sank back into unconsciousness again, but this time it did not last long. Her pale, yellow, wasted

spiritual state is one of suffering – not the glorious, pious suffering seen in Jane Eyre, but

suffering brought on by both moral and financial poverty.

The first nail in the coffin of the notion of romantic consumption came in 1882 when

German bacteriologist Robert Koch isolated and identified the causative agent of tuberculosis:

the Mycobacterium tuberculosis. Following this discovery it was proven that “tuberculosis was

not hereditary as formerly believed but an infectious disease caused by the tubercle bacillus”

(Bryder 3). Koch’s work “produced such a phenomenal sensation among the lay public and in

medical circles that it was immediately regarded as...heralding a new era in the study and control

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met with some resistance – some refused to believe Koch entirely, and set out to prove him

tuberculosis continued to persist even after Koch – but portrayals of an idealized, romantic

consumption began to wane and all but disappeared by the mid-twentieth century. The

mythology of the disease, as Clark Lawlor points out, began at this point in history to “shift” –

old genres, such as consumptive poetry disappeared completely. “The praise of the spiritualised

the 1880s.” Literature, as the Nineteenth century turned to the Twentieth, “embraced illness as a

sign of the outsider.” Tuberculosis was no longer “a disease of the Self, but a disease of the

Other” (Lawlor 189).

Thomas Mann’s magnum opus The Magic Mountain, though more a novel of philosophy

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Mann’s novel “generated a particular hothouse culture of refined decadence…this was a more

realistic representation and conformity to popular misconceptions. In this, according to Wil

Gesler in his article “Hans Castorp’s journey-to-knowledge of disease and health in Thomas

Mann’s The Magic Mountain”, Mann plays with the “dual nature of disease. On the one hand,

diseases are brute realities; the body suffers physical decline and dies.” As the humanist

Settembrini reminds Hans Castorp, “there is little evidence that the patients at the Berghof are

ennobled or spiritualized by their illness; in fact, they are often depicted as frivolous and vain.

And yet, paradoxically, Mann shows that disease and death may have positive spiritual values.”

(Gesler 129).

Two contrasting points of view on tuberculosis in The Magic Mountain exist in the

opinion of the constant talker, Sttembrini, and of the romantic Dr. Krokowski. Settembrini fully

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sick man was, as it were, a well man who had to bear the agonies of a sick one – than

taking it a good deal too seriously. (451)

Opposite Settembrini, Mann also gives a great deal of credence to the belief that illness is a result

of repressed emotions. According to Dan Latimer in his article “Erotic Susceptibility and

Tuberculosis: Literary Images of a Pathology,” Hans Castorp’s disease “manifests itself at the

same time that some long-buried memories of a boyhood attachment to Pribislav Hippe return

during a strenuous walk” (1019). When Hans Castorp returns from this walk, suffering from a

massive nosebleed, “he is in a state of nervous prostration and…spattered in his own blood. He

sinks into a chair just in time to hear Dr. Krokowski explain to a roomful of shouldering female

patients that the power of repressed desire always returns in the form of a disease” (1019). In his

lecture, Dr. Krokowski argues that suppressed love lives on in the form of illness:

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transformed. (128)

writes: “the continued mental strain had so combined to aggravate [Naphta’s] hereditary

complaint…” (Mann 446). Mann was influenced by the German romantics and he, according to

Wil Gesler, “repudiates, through Hans, the notion of disease and death as primarily ennobling.

Thus, Mann seems to say, disease and death are both noble and ignoble” (129). These paradoxes

present in The Magic Mountain represent the turning point in fictional portrayals of tuberculosis

in literature. The disease can no longer be represented as purely aesthetic – science has long

since shown tuberculosis to be otherwise. Yet the belief lingers that disease can set one apart,

and have positive qualities. In The Magic Mountain, Mann attempts to paint tuberculosis as

being both a disease of science and a disease of art and intelligence. However, writing the latter

convincingly was becoming increasingly difficult by this time. As the twentieth century

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effective in killing M.tuberculosis, romantic consumption was a thing of the past. The modern

system – such as those with HIV/AIDS – are less capable of walling off the bacteria, and are

more likely to develop an active tuberculosis infection. “People living with HIV and infected

with TB are 21 to 34 times more likely to develop active TB disease than people without HIV”

(“Tuberculosis”). Though tuberculosis is no longer a famous literary disease, it is still a global

health issue – in 2010 alone “8.8 million people fell ill with TB and 1.4 million died from TB”

(“Tuberculosis”)

Thomas Dormandy observes that “[i]llnesses have their personalities in much the same

way as nationalities and historic periods, impossible to define, but, once experienced, instantly

recognizable” (392). Of all diseases portrayed in literature, tuberculosis has perhaps the most

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the most brilliant writers known to literature, many of whom had firsthand experience with the

seem as though he or she possess special creative qualities. The modern victim of tuberculosis is

merely diseased.

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