Images of Illness

In Death in Venice passion brings about the collapse of all that has made Gustav von Aschenbach singular—his reason, his inhibitions, his fastidiousness. And disease further reduces him. At the end of the story Aschenbach is just another cholera victim, his last degradation being to succumb to the disease afflicting so many in Venice at that moment. When in The Magic Mountain Hans Castorp is discovered to have tuberculosis, it is a promotion. His illness will make Hans become more singular, become simply more than he was before. In one fiction, disease (cholera) is the penalty for a secret love; in the other, disease (TB) is its expression. Cholera is the kind of fatality that, in retrospect, has simplified a complex self, reducing it to a sick environment. The disease that individualizes, that sets a person in relief against the environment, is tuberculosis.

What made TB seem so “interesting”—or, as it’s usually put, romantic—throughout the last and well into this century also made it a curse and inspired special dread. In contrast to the great epidemic diseases of the past (plague, typhus, cholera), in which each person is stricken as a member of an afflicted community, TB was understood as a disease that isolates one from the community. However steep its incidence in a population, TB—like cancer today—always seemed to be a mysterious illness of individuals, a deadly arrow that could strike anyone, that singled out its victims one by one.

As after a cholera death, for a long time it was common practice to burn the clothes and other effects of someone who died of TB. “Those brutal Italians have nearly finished their monstrous business,” Keats’s companion Joseph Severn wrote from Rome on March 6, 1821, two weeks after Keats died in the little room on the Piazza di Spagna. “They have burned all the furniture—and are now scraping the walls—making new windows—new doors—and even a new floor.” But TB was frightening not only as a contagion, like cholera, but as a seemingly arbitrary, uncommunicable “taint.” And people could believe that TB was inherited (think of the disease’s recurrence in the families of Keats, Trollope, the Brontës, Thoreau) and also believe that it revealed something singular about the person afflicted. In a similar way, the evidence that there are cancer-prone families and, possibly, a hereditary factor in cancer can be acknowledged without disturbing the belief that cancer is a disease that strikes each person, punitively, as an individual.

That consumption is induced by the foul air of houses is now certain,” Florence Nightingale declared in 1861. Yet however much TB was blamed on poverty and unsalubrious surroundings, it was still thought that a certain inner disposition was needed in order to contract the disease. Doctors and laity believed in a TB character type—as now the belief in a cancer-prone character type, far from being confined to the backyard of folk superstition, passes for the most advanced …

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