View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by CommonKnowledge Pacific University CommonKnowledge Humanities Capstone Projects College of Arts and Sciences 5-2012 “Half in Love with Easeful Death:” Tuberculosis in Literature Ashley M. Wilsey Pacific University Follow this and additional works at:http://commons.pacificu.edu/cashu Part of theEnglish Language and Literature Commons Recommended Citation Wilsey, Ashley M., "“Half in Love with Easeful Death:” Tuberculosis in Literature" (2012).Humanities Capstone Projects.Paper 11. This Capstone Project is brought to you for free and open access by the College of Arts and Sciences at CommonKnowledge. It has been accepted for inclusion in Humanities Capstone Projects by an authorized administrator of CommonKnowledge. For more information, please contact [email protected]. “Half in Love with Easeful Death:” Tuberculosis in Literature Abstract [From the introduction] Within the history of literature no other disease is as complex and enigmatic as tuberculosis. The disease has known many names, including the Great White Plague, Phthisis, and, most famously, Consumption, before receiving the decidedly unromantic name tuberculosis in the mid-Nineteenth Century (Dubos and Dubos 10). Tuberculosis stands unique within 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 bookThe 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 bookConsumption and Literature: “literature affected consumption’s reality, just as consumption shaped literature to a hitherto unrecognized extent” (190). The literary portrayal of tuberculosis from the early nineteenth to the early twentieth century contrasts with the scientific reality of the disease with the oft-romanticized portrayal in fiction. An examination of a selection of the major works of John Keats, Edgar Allan Poe, Charlotte Brontë, Fyodor Dostoevsky, and Thomas Mann reveals that these writers had firsthand experience with tuberculosis – they either suffered from the disease themselves or were surrounded by those who did. Tuberculosis and the aestheticization of the disease play a major role in many of their works. Document Type Capstone Project Degree Name Bachelor of Arts Department English First Advisor Pauline Beard, PhD Subject Categories Arts and Humanities | English Language and Literature Rights Terms of use for work posted in CommonKnowledge. This capstone project is available at CommonKnowledge:http://commons.pacificu.edu/cashu/11 “Half in Love with Easeful Death:” Tuberculosis in Literature Presented By Ashley M. Wilsey In partial fulfilment for the degree of Bachelor of Arts at Pacific University May 2012 Pauline Beard (Ph.D.) First Reader and Advisor Lorelle Browning (Ph.D.) Department Chair Table of Contents 1. Introduction 1 2. Tuberculosis 2 3. The Aesthetics of Tuberculosis 4 4. Romantic Consumption 9 4.1. John Keats 9 4.2. Keats’s Poetry 12 5. Mid-Nineteenth Century Literature and Tuberculosis 15 5.1. Edgar Allan Poe 15 5.2. Poe’s Romanticized Consumption and “The Masque of the Red Death” 18 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 Wilsey 1 1. Introduction “Yet the captain of all these men of death that came against him to take him away was the consumption, for it was that that brought him down to the grave” John Bunyon, The Life and Death of Mr. Badman, 1680 Within the history of literature no other disease is as complex and enigmatic as tuberculosis. The disease has known many names, including the Great White Plague, Phthisis, and, most famously, Consumption, before receiving the decidedly unromantic name tuberculosis in the mid-Nineteenth Century (Dubos and Dubos 10). Tuberculosis stands unique within 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 consumption shaped literature to a hitherto unrecognized extent” (190). The literary portrayal of tuberculosis from the early nineteenth to the early twentieth century contrasts with the scientific reality of the disease with the oft-romanticized portrayal in fiction. An examination of a selection of the major works of John Keats, Edgar Allan Poe, Charlotte Brontë, Fyodor Dostoevsky, and Thomas Mann reveals that these writers had firsthand Wilsey 2 experience with tuberculosis – they either suffered from the disease themselves or were surrounded by those who did. Tuberculosis and the aestheticization of the disease play a major role in many of their works. 2. Tuberculosis The World Health Organization defines Tuberculosis (or TB) as “an infectious disease caused by the bacillus Mycobacterium tuberculosis” (WHO Report 3). The disease generally affects the lungs (known as pulmonary tuberculosis), but M. tuberculosis can infect any organ within the body (Ringold et al. 464). (Some major forms of non-pulmonary tuberculosis include: “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 associated with bloody sputum” as well as “difficulty breathing or chest pain with breathing” (Ringold et al. 464). According to the World Health Organization’s 2011 report on the disease, TB is “more common among men than women, and affects mostly adults in the economically productive age groups; around two-thirds of cases are estimated to occur among people aged 15– 59 years” (WHO Report 3). Wilsey 3 Treatment for the disease normally requires “a regimen of 3 to 4 antibiotics taken daily for a minimum of 6 to 9 months” (Ringold et al. 464) Treatment takes a long time because the bacteria are difficult to kill – M. tuberculosis bacteria have “hard waxy coats that are difficult to penetrate,” and, while bacteria are “most vulnerable when they are in the act of multiplying…M. tuberculosis multiplies very slowly” (Reichman and Tanne 13). The body responds to an M. Tuberculosis infection in the lungs by forming “a wall of white blood cells, calcium salts, and other fibrous materials around [the bacteria]” (Weeks and Alcamo 433). As all of these materials accumulate, they form a “hard nodule” known as a tubercule (these nodules are visible on x- 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 palaeopathological evidence” that the disease has “been common in human societies for millennia” (Bynum 57). In fact, Thomas Dormandy points out that“characteristic lesions in prehistoric skeletons and in Egyptian Mummies” attributed to tuberculosis (1-2). Historians believe that the human strain of the tuberculosis bacillus “originally spread from animals to humans…it probably leapt from cows to humans about 8,000 to 10,000 years ago” (Reichman Wilsey 4 and Tanne 2002: 11). The ancient Greeks used the term phthisis - which literally translates to “wasting” - to describe the disease (Dormandy 2). The disease was known to Hippocrates and his circle; however, it must be observed that the further one goes back in history, “the more difficult it is to be absolutely certain of the diagnosis, and it is no doubt that many great men have been labeled tuberculous on rather slender grounds” (Wilson 161). It is reasonable to assume that, after the Eighteenth Century, “most cases of ‘phthisis’ would today be diagnosed as tuberculosis” (Bynum 57). Throughout history, tuberculosis was one of the world’s deadliest diseases: in the Nineteenth Century, Tuberculosis was “the leading cause of death throughout 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). 3. The Aesthetics of Tuberculosis 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 experiences that a man [or woman] can undergo” (Wilson 161). The disease affected not just the victims, but the victims’ immediate family, their friends, and their lovers. Tuberculosis also, according to Thomas Dormandy, became for over a century a major influence on nearly all forms of art: “this was not only because the list of tuberculous artists, poets, philosophers and musicians still reads like a roll-call of genius; the disease also imprinted itself on the creations of Wilsey 5 the non-tuberculous majority” (xiii). Though the disease was extremely destructive and painful there emerged in both literature and contemporary medical discourse a belief that the disease could cause one to possess special creative qualities. While medical discourse on tuberculosis in the seventeenth and eighteenth centuries “employed extremely gruesome images of decay, putrefaction, and stinking effluvia.” By the early Eighteenth Century there also existed “alongside the horrible pathology… a tradition of the art of living well with, and dying a good death from, consumption” (Lawlor and Suzuki 463). As the Eighteenth century progressed, having tuberculosis, as well as “being treated for the disease became an experience associated 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: [Tuberculosis] has been associated simultaneously, though not always congruously, with youth and purity, with genius, with heightened sensibility and with increased sexual appetites. The resulting images have become famous textual tropes: the languishing consumptive poet whose thwarted desires and personal frustrations seem to have brought about his illness; the Christlike [sic] innocence of the child who dies because they are too pure for the world; the beautiful but wan and pining girl whose decline owes much to her broken heart…(Byrne 3) Many of these literary tropes existed in literature long before the Eighteenth and Nineteenth centuries. Consumption was considered closely linked to one’s emotions, particularly love and Wilsey 6 desire. As Susan Sontag explains in her essay Illness as Metaphor, the fever associated with tuberculosis was a sign of “inward burning,” and someone with tuberculosis was “‘consumed’ by ardour…leading to the dissolution of the body” (20). Metaphors taken from tuberculosis “to describe love” were the “the image[s] of a diseased love...long antedates the Romantic movement. Starting with the Romantics, the image was inverted, and TB was conceived as a variant of the disease of love” (Sontag 20). Tuberculosis as a disease of love and desire was considered enough of a “literary cliché and a cultural given” in Shakespeare’s time to elicit parody (Lawlor 15). In Much Ado About Nothing, Beatrice claims she is only accepting Benedick’s proposal in order to save him: Benedick: Come, I will have thee, but by this light I take thee for pity. Beatrice: I would not deny you, but by this good day I yield upon great persuasion, and partly to save your life, for I was told you were in a consumption. (V.IV.96-101). According to Lawlor, this exchange “illustrates in comic miniature the logic of consumptive love: pining lovers fall into consumptions which can only be cured by possessing the object of their desire” (15). The belief in tuberculosis as a disease of emotion and aesthetics was not just the opinion of the poets – long before germ theory and antibiotics, medical professionals (along with the public) believed in what Susan Sontag called “a TB character type”: “the TB prone character that haunted imaginations in the Nineteenth Century was an amalgam of two different fantasies: someone both passionate and repressed” (39). According to Sontag, this “melancholy character – or the tubercular – was a superior one: sensitive, creative, a being apart” (32). However, the actual link between tuberculosis and genius is rather tenuous: according to Clark Lawlor, “so many people had consumption that it is statistically likely that many creative people would suffer