Introduction

The development of consumption as the “new” disease of tuberculosis after 1882 requires another study…consumption arrived at the point where revelations about its contagious and germ-like nature could cause a shift, however uneven, in its social perception.

Clark Lawlor, Consumption and Literature: the Making of the Romantic Disease

            This study examines the impetus of nation building on the representations of tuberculosis in literature across European traditions and their global influences in the early twentieth century. Literary tuberculosis, or tuberculosis as represented in the literary record, makes manifest the social formulations of tuberculosis as a metaphor for exclusion from the national identity. This time period follows the nineteenth century trope of the tubercular Romantic poet who desired tuberculosis to bestow his writing with qualities of the “sublime.”^[1] This study aims to apply rigorous literary and sociocultural analysis to expose how literary tuberculosis shifted so dramatically from desirable to disposable. As a result, this investigation will demonstrate the gradual introduction of eugenic thought to literary tuberculosis: from characters and family structures, to conceptualizations of time, intersections of identity, and abstract metaphorical structures. As the modern literature gives way to postmodern, symbolic representations, literary tuberculosis consistently engenders the implicit conveyance of eugenic thought to generalized representations of literary disability across national boundaries.

Literature Professor Clark Lawlor has charted the course of literary tuberculosis representations in Britain from the Renaissance into the Victorian era. His observations mark tuberculosis as “the glamorous disease of the beautiful and the genius” because of the perception that writers with tuberculosis had a heightened sensibility (Lawlor 112-3). However, this heightened sensibility typified only the tubercular poet trope, specific to the Romantic Era, on which Lawlor focuses. A second notion of tuberculosis also exists, in which “foreigners and the lower classes could by turns be either more or less susceptible to consumption than the white middle classes, but either way labourers, Jews, the Irish, African-American slaves or Native Americans were depicted as suffering from a different order of consumption from their superiors” (122). Lawlor’s colorful, so to speak, conception of this second notion of tuberculosis confirms that another study, in many ways, must address what tuberculosis conveys after the Romantic era, because “tuberculosis was not, as had been believed, an illness of the rich; it was above all…a disease of the working class” (Herzlich and Pierret 26). It was a condition that affected the masses, implicating the myriad forms of othering that the process of national identity formation would exclude.

            Critical discourse on representations of tuberculosis appears briefly right at the beginning of the twentieth century but then does not reoccur until the 1950s. The most prevalent factor across countries and healthcare systems related to the decline in tuberculosis was the institutionalization, or “segregation,” of those with tuberculosis into hospitals, workhouses, and sanatoria (Wilson 386). However, the success of institutionalization in 1903, according to Dr. H. Timbrell Bulstrode, risked “grave disabilities, such as the weakening of family ties, loss of employment, and the creation of a leper class” for those who were admitted into these medical institutions (Bulstrode in Wilson 380). The so-called disabilities Bulstrode cites here are not biological but social phenomena that cast those people with tuberculosis as an unseen and undesirable social stratum, associated with their low economic status due to the lack of employment. From this “disabled” conception, the public opinion extrapolated a tubercular dependency on social welfare to receive treatment, which connects to eugenic ideologies:

When eugenic sterilization is examined from a social welfare perspective, it appears less like a deliberate plan for genetic improvement than a mundane and all-too-modern tale of fiscal politics, troubled families, and deeply felt cultural attitudes about disability, welfare dependency, sexuality, and gender. (Ladd-Taylor 2)

Identifying those with tuberculosis as a “leper class” due to unemployment serves as an example of eugenic hierarchies that manifested in Europe due to the discovery of peoples in Africa, Asia, and the Americas but developed into an ideology of exclusion on the basis of physical fitness, which includes illness.

            Twentieth century media informing the social perception of tuberculosis, such as information produced by anti-TB campaigns in Great Britain, aimed to incite public support for political endeavors while also reinforcing tuberculosis narratives founded on elaborately layered conceptions of what it meant to have the disease. Nancy Tomes, a Distinguished professor of History at Stony Brook University, examines the extent to which political agendas exploited the paradigm of tuberculosis narratives to call for reforms incurred by modernization: 

[TB] became typecast as a disease of the “other”. Unlike sexually transmitted diseases, which were on the rise and generating considerable concern in this period, the TB problem could be openly discussed in public without offending social mores. Finally, TB served well as a vehicle for pushing a wide range of societal reforms aimed at easing the dislocations of urbanization and industrialization. (Tomes 631)

Tuberculosis therefore signified not only low socioeconomic status but also an exclusion from the collective national self. In line with the reforms urbanization and industrialization necessitated, this tubercular exclusion refers to alienation from the national identities reformulated earlier in the twentieth century.

THEORETICAL FRAMEWORK

Modern and Postmodern Literature

            The ten primary sources that comprise this study fall into both modern and postmodern literature, which is important to understand theoretically as well as historiographically. While Tomes and Wilson investigate the presence of tuberculosis representations from newspaper and political rhetoric in the late twentieth century, this study investigates the sources in literature from the start of the twentieth century to the end of the Second World War. Literature as work generated by the social imagination that is read and re-read across time serves as unchanging artifacts for infinite analysis from different interpretive positions, so that what was once just a plot point can become evidence of social or cultural assumptions about what it means to be human or function as a community.

            With regards to the literary movements of this study, the ten texts consist primarily of modernist movements, as well as postmodernist ones. The generic lines drawn pose no theoretical problem as realism does not transfer over to reality:

Dès lors, ce n’est pas par le biais d’une veritable immersion en son sein que l’auteure étudie la douleur mais au contraire dans une certaine mise à distance, car l’écriture de la douleur ne rime pas nécessairement avec réalisme absolu.

For a long time, it isn’t through the influence of a veritable immersion in pain that the author studies it but on the contrary in a certain distancing, since writing pain does not necessarily translate over to absolute realism. (Atzenhoffer 52, my translation)

If the representation of pain and suffering as conceivably performed through writing illness precludes a text from falling into the modernist literary movement, it blurs the distinctions between Romantic and modern and also between modern and postmodern literary contingencies. As a result, this study may examine the representations without the theoretical divisions that literary movements pose in any significant way as long as the context of each text is taken into account.

            In addition, designating literary movements has lent itself to ideological purposes in the past. The act of carving out different literary movements coincides with tumultuous historical periods, such as the early twentieth century:

Ever since Romanticism, literary historiography has been one of the intellectual genres most actively involved in defining national identity and the communal ‘values’ associated with it, as well as in disseminating the definitions thus formulated, always doing more than simply recovering, compiling, organizing, and assessing literary works. This should come as no surprise given that the majority of such projects were undertaken in times of political and social crisis and therefore have played, to some extent, the role of compensatory fictions. (Goldiş 97-8)

The idea that different literary movements serve a political purpose encourages the transgression in this study of these constructed divisions in literature in order to examine more critically the ideological and political impact that eugenics possessed over literary tuberculosis and its relationship with national identities.

Eugenics, the Nation, and the National Self

            The difficulty of explaining the interrelationship between eugenics and the construction of a national identity comes from their inextricably codependent development. Sharon L. Snyder and David T. Mitchell categorize eugenics as “the hegemonic formation of exclusionary practices based on scientific formulas of deviancy” (Snyder and Mitchell 73).^[2] Of course, what was deemed as science at the time now carries the pseudo-scientific and even sociocultural mode of thinking moniker instead of the institutional authority afforded to the label of science. Deviancy requires a norm against which to compare the Other in order to reject the Other as undesirable from the nation as the unified society with a shared identity that was being formed at the time. This alludes to Orlando Patterson’s notions of intrusive and extrusive rejections of othered subject positions in the construction of the societal self, since 

eugenicists also argued that we should hold no society with the disabled, for they are creatures not of our original, not of our species. Disabilities provide the basis for the designation of species-typical characteristics even as they are identified as most atypical. The disabled Other is always within and without. (98)^[3]

The disabled body, through illness or impairment, becomes the cause for rejection from the societal self on the basis of “fitness” for social inclusion, which at the beginning of the twentieth century could only be a self-contained entity on the national level.

            In the face of urbanization and industrialization, the Western nations faced the problem of incorporating modernity into national identities. In order to do so, nations had to reconcile the self-contained entity with the relocations of populations from diverse origins in addition to resistance against that entity by pre-existing populations which did not meet the homogeneous identity the nation concept contained (Ponting 216-7). The assertion of these new entities

often involved violence, long conflicts, bitter divisions between people, huge numbers of deaths and the uprooting of millions of people to meet the desire for an ethnically and culturally pure nation. In practice none of the new ‘nation-states’ achieved the purity they sought. All were left with minorities of varying sizes who did not share in the majority culture and were excluded and alienated from the state within which they lived. Once national demands had been made and vaguely justified, the process could be extended to other groups almost ad infinitum. (246)

The process of nation building in European states in the wake of urbanization and industrialization drew on eugenic paradigms to effect the mass exclusion or disqualification of people based on pseudo-scientific or sociocultural criteria that delineated national identities.

Snyder and Mitchell see “disability as the master trope of human disqualification in modernity” (Snyder and Mitchell 128). In other words, modern, national selves implemented bodily difference to distinguish those who fulfilled the national identity from those who did not, be it due to health, embodiment, intelligence, ethnicity, religious affiliation, sexuality, gender performance, or some other marked issue that eugenic thought sublimated into the singular category of the foreign.

            The national identity can be tracked through representations of conventional family structures. Georges Simenon, the author of one of the primary texts for this study, wrote that “le couple, la famille se sont soudés à d’autres couples, à d’autres familles, les clans à d’autres clans. La société est née et l’homme peut croire qu’il n’est plus seul / the couple, the family got soldered to other couples, other families, extended families to other extended families. Society is born and man can believe he is no longer alone” (Simenon 1988: 21, my translation). Simenon demonstrates here that the family is the basic anthropological unit of the nation in Europe, since it is through the linkage between multiple families that a society is formed. This study will use this understanding of family structures to investigate the presence of tuberculosis in both family structure and the broader national discourse.

            In addition, the body itself must be studied as a product of national and transnational associations. The human body has minuscule physical differences across the world but is understood through vastly differing sociocultural interpretations:

The body is a globally shared basic condition for different meanings of local identity. Without these meanings, there will be no identity for either culture or individual. But our bodies do not tell us what this meaning is supposed to look like, nor does it place a certain number of possibilities at our disposal, like inflections in a language. For that reason, its meaning has to be constantly confirmed, modified or renewed on particular cultural conditions. (Larsen 194)

This study acts as a renewal of the body’s meaning within the cultural context of the first half of the twentieth century, in that it may seek a slightly altered understanding of the body from the conception that preceded it. In other words, this investigation is as much a cultural analysis as it is a literary one. Literary tuberculosis functions as a cultural phenomenon in the literary record which one can map on the literary bodies that unite them across time, space, and sociocultural differences.

Theories of Illness and Disability

The literary bodies also present illness as a sociocultural phenomenon, which must be understood historically and in the present day to grasp how this study perceives of literary tuberculosis. Sander Gilman contributes to the connection between ethnic identity and illness through the pre-modern and modern scientific paradigms as it related to Jewish identity. In 1882, the tubercle bacillus was discovered as the causal agent of tuberculosis, rendering defunct but not eliminating pre-existing notions of susceptibility to tuberculosis based on ethnicity. Gilman writes that “while the new bacteriology did restructure the image of disease and of the patient, older models of disease were also adapted within the new model, continuing pre-Kochian notions of group predisposition to tuberculosis” (Gilman 1995: 171). The persistence of ethnicity-based susceptibility to tuberculosis in the social perception allowed eugenic thought to pervade the illness’s modern conceptualization.

In large part, this is because of the social constructivist nature of disabled and non-disabled designations. The dialectic between disabled and non-disabled relies on the notion that “ideology obfuscates the ways in which the good health of some persons depends on the ill health of others, or promotes purely political agendas under the guise of passion or concern” (Metzl 9). In other words, what is considered “health” is merely a function of ideological goals to define what constitutes the national identity.

While the social perception of tuberculosis persists, the doctor-patient relationship changes before and after 1882 and its reconceptualization of the condition as a function of power.

The Romantic tuberculosis still reflects the individualizing, even ‘patron-client’ relationship between a wealthy patient and a physician who is unsure both of his science and his social status. Their relationship is not predicated on curing the illness, but on negotiating an acceptable image of it and on working out a way of life that will satisfy the precious and condemned patient. A few decades later, when tuberculosis was seen as a social scourge, the physician appeared as a professional who, assured of his knowledge and his social status, dealt with large numbers of socially inferior patients whom he faced with a scientifically worded diagnosis and etiology. (Herzlich and Pierret 31)

The nature of the doctor-patient relationship diminishes the social status of the disabled. The decline in power and agency that patients had in the modern era produces prejudice, as they were potentially disabled individuals, against a group considered other to the modernizing national self.

The consequential disempowerment of the ill provokes a discussion of the social imagination as the phenomenon that shapes fiction as an ideal future. Sara Hendren, an arts and social change practitioner, identifies both Maxine Green and Jean-Paul Sartre as good starting points for thinking about this phenomenon. Maxine Green saw it as being capable of “thinking as if things could be otherwise,” based on Jean-Paul Sartre’s statement that “it is on the day we can conceive of a different state of affairs that a new light falls on our troubles and that we decide that these are unbearable” (Hendren). The social imagination is theoretically present in all literature. Therefore, the eugenic creation of a tuberculosis-based Other from national identities in literature suggests that the social imagination in this time period condoned the inability of characters with tuberculosis to integrate into the national identity as something that did not need to be reimagined or changed. In other words, writers accepted the eugenic nature of perceiving of illness and disability as disposable.

For this study, it will also be important to be aware of the disability theories of crip time and crip futurity. While many theorists have alluded to crip time or crip futurity, Alison Kafer’s work on the subject best defines it:

Crip time requires reimagining our notions of what can and should happen in time, or recognizing how expectations of ‘how long things take’ are based on very particular minds and bodies. We can then understand the flexibility of crip time as being not only an accommodation to those who need “more” time but also, and perhaps especially, a challenge to normative and normalizing expectations of pace and scheduling. Rather than bend disabled bodies and minds to meet the clock, crip time bends the clock to meet disabled bodies and minds. (Kafer 27)

The notion of a challenge to normative conceptualizations of the passage of time and of the future recurs throughout this study, and so it will be critical to investigate the national construction of time and how the tubercular disabled bodies fail to meet that expectation.

Foucault and the Sanatorium

            Much of the literary tuberculosis exists within spaces of sanatoria, which have also taken on national symbolisms in their institutional nature. As such, the depictions of institutions in this literary corpus must also receive critical attention. Sanatoria were hospitals specifically designated for tuberculosis since the risk of contagion was incredibly high. Michel Foucault’s The Birth of the Clinic serves as an examination of medical institutions and their rise to dominance within the European sociocultural practice. Within this text, Foucault establishes tertiary spatialization as an important theoretical term:

Let us call tertiary spatialization all the gestures by which, in a given society, a disease is circumscribed, medically invested, isolated, divided up into closed privileged regions, or distributed throughout cure centres, arranged in the most favorable way…it brings into play a system of options that reveals the way in which a group, in order to protect itself, practices exclusions, establishes the forms of assistance, and reacts to poverty and to the fear of death. (Foucault 16)

Foucault’s tertiary spatialization refers to institutions such as the sanatorium as a means of protecting society. The repetition of “safety” here, specified with notions of excluding others, and in Simenon’s writing cited previously suggests that the protection of modern, urban life is predicated on the exclusionary practices that constitute eugenics for the purposes of this study. In other words, sanatoria, workhouses, and other medical institutions where those with tuberculosis were treated in reality and in the social imagination not only support the rise of eugenic thought but are an extension of its application in modernized societies.

A Note on Translation

Because this study engages in literary studies across linguistic traditions, questions of translation theory arise. I have worked with the original language text for all French and Spanish language primary sources and provide my own translations. My own translations employ a word-for-word equivalence as long as there is not a cultural meaning lost by a literal translation. This approach avoids for the most part the debate of domestication’s and foreignization’s influences on how an English reader perceives the original text.^[4]

Additionally, this approach to translation for critical analysis engages with anthropological linguistic notions of national identity. Jan Blommaert and Jef Verschueren posit that the national self “appears both as an emotional, irrational matter and as a respectable phenomenon…nationalism is based on the fundamental, natural need for a homogeneous society” (Blommaert and Verschueren 206). Their assertion is with regards to monolingualism in society as an identity. With the above as their conclusion, the role of language in nation building requires a careful attention to the exact words employed in the primary sources in order to have a sense of the relationship between representations of tuberculosis and the national identities under construction in the literature.

For the German and Italian language primary sources, I have worked with English translations with academic authority verified from its source of publication. For example, I analyze the English translation of Sette Piani that appears in The Art of the Tale, a widely used anthology of short stories translated from various linguistic traditions. In addition, for secondary sources in Italian, I have consulted with two native speakers and a long-time student of the language to account for individual biases on cultural connotations of language.

METHODOLOGY

            This study employs close reading analyses of the literary corpus, but it also provides sociocultural context for each text. Plot summaries as well as pertinent biographical information will be provided in each chapter for the corresponding writers analyzed, which will allow the close reading to rely on that biography as well as sociocultural context to emphasize the connections drawn between literary tuberculosis and eugenic thought. The criteria for texts explored in this study were those with explicit or culturally implicit representations of tuberculosis between 1900 and 1950, which allows the texts to lend themselves to direct exploration of themes and tropes associated with tuberculosis in the social imagination of this time period.

            This study investigates literary tuberculosis as opposed to other illness representations because of its continuity in the literary record. This study began with an investigation into representations of the Spanish Flu contemporaneously. However, the nature of the Spanish Flu, decimating populations without a long duration, inhibited writers from capturing a notion of its representation consistently in literature. As a result, only one Danish text, Jørgen Stein, represents the Spanish Flu in this time period, which was insufficient for a literary study of this scale, and the study dedicated itself to literary tuberculosis.

            Chapter one investigates literary tuberculosis in the first decade of the twentieth century. It analyzes Thomas Mann’s short story Tristan (1902), that draws structurally on the archetypal myth of Tristan and Isolde to talk about doomed love with tuberculosis at its center. Also, it explores Mala Hierba, or Weeds (1903), the second novel in Pio Baroja’s trilogy The Fight for Life. The trilogy focuses on Spain’s national identity crisis and suggests in the second novel the heritability and flawed nature of tuberculosis. It will demonstrate the correlation between eugenics and tuberculosis and how the paradigm shifted away from the Romantic conceptions of tuberculosis. 

Chapter two explores notions of the conventional family structure as it relates to the national identity and the rejection of tuberculosis from that structure. It surveys the non-European texts in this study for the European influence on global instances of literary tuberculosis produced during the early twentieth century. For example, Horacio Quiroga’s La gallina degollada, The Beheaded Hen (1918), follows a family whose mother’s tuberculosis is considered to be the main reason four of her children become mentally disabled as infants and the futurity of their family is threatened as a result. In addition, Le Baiser au lépreux, The Leper’s Kiss (1922) by François Mauriac, follows a man whose entire family life has been disrupted by tuberculosis. Third, Miss Sophie’s Diary (1928) by Ding Ling presents Sophie’s account through diary entries of her struggle between traditional and Westernized notions of modern family life for women and how tuberculosis allows her to transgress the available options, placing her outside the nationalistic norm. The intersection of gender and disability emerges quickly between these three texts in order to emphasize the importance of gender roles to the conventional family structure inherent to the national identity, which literary tuberculosis then transgresses to create an Other.

            Chapters three and four explore the World War period. Chapter Three deals specifically with Thomas Mann’s Der Zauberberg, The Magic Mountain (1924), the text that initially inspired this study as a prolific representation of life in the sanatorium as a microcosm of Europe at the onset of the First World War. As a singular text, Der Zauberberg merits its own investigation, particularly along the lines of crip time, a concept in disability studies to account for the change in time perception based on one’s disability, which abounds the protagonist’s experiences at the Berghof. Next, Chapter Four examines the generalization of tubercular disposability in Sette Piani, Seven Floors (1937) a short story by Dino Buzzati, for its representation of a sanatorium on a smaller scale that encounters a dystopian ending that diverges from the modernist realist literary movement. Chapter Four also analyzes Long Cours, Long Road (1936), Georges Simeon’s novel that introduces questions of race and ethnicity into the literary record of the condition. These texts coincide temporally as well as in the initiation of the generalizations that tuberculosis is disposable from the family structure, which is a metaphorical microcosm of the nation, that continue in the final texts of the study. 

Chapter Five concludes the literary analyses with its demonstration of postmodern symbolization of deviance with tuberculosis as the referent. The chapter examines Camilo José Cela’s Pabellón de reposo, Rest Home (1943) which again represents literary tuberculosis in the sanatorium, this time within Franco’s Spain. Cela’s abstraction of tubercular metaphors and allusions to the canonical Spanish text Don Quijote de la Mancha demonstrate that tuberculosis comes to represent more in this time as it generalizes to encompass alterity from the national identity in a disposable, eugenic sense. The literary record of this study concludes with Boris Vian’s L’écume des jours, Froth of Days (1947), which follows a man and his wife as she dies from tuberculosis, although many surrealist events occur along the way that demonstrate the transgression of a literary movement that metaphorizes literary tuberculosis to convey the undesirable Other from the national identity more broadly. The broadening of the eugenic metaphor expands beyond the stricture of tuberculosis and implicates various chronic illnesses that would follow tuberculosis in the literary record, such as HIV/AIDS and cancer, as equally rejected from the national identity.

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^[1] The Romantic sublime invokes the transcendence of awe and terror by experiencing such feelings (Burke). In the Romantic perception, the tubercular poet’s suffering involved terror and as a result influenced the tubercular poet’s writings to transcend the human experience.  

^[2] Snyder and Mitchell explain Gramscian hegemony as “the intersection of contingent social forces that coalesce, for a time, in a unified movement of collective objectives” (Snyder and Mitchell 73). This is the working definition for hegemony here, as Gramsci reappears in the secondary source material for Seven Floors, the Italian primary text of this study, in order to contextualize the author’s political and ideological beliefs. 

^[3] Orlando Patterson formulates two notions of the social death of the enslaved: the intrusive or “permanent enemy on the inside” and the extrusive that transgresses social taboos to the extent where the individual no longer meets the minimum societal expectations for a human and is subjugated into slavery as a result (Patterson 39, 44). The mention of these models of social death do not mean to compare the subjugation to slavery to the ostracism and disposal of tubercular lives but merely to see the similarities in the way the Other is constructed across societies, both intrusively and extrusively.

^[4] Foreignization and domestication are two approaches to translation. As Friedrich Schleiermacher, a German translation theorist from the early nineteenth century, explains, foreignization “insists on breathing into the translated work the spirit of a language foreign to it,” while domestication replaces all cultural concepts with those familiar to the readers in the target language (Schleiermacher 61).