Tuberculosis and Cancer in European and North American Literature

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Writing Illness: Tuberculosis and Cancer in European and North American Literature

DISSERTATION

Presented in Partial Fulfillment for the Degree of Doctor of Philosophy in the Graduate School of The Ohio State University

Kristen M. Hetrick, B.A., M.A.

Graduate Program in Germanic Languages and Literatures

The Ohio State University

2012

Committee Members: Helen Fehervary, Advisor Barbara Becker-Cantarino Gregor Hens

Kristen M. Hetrick

2012

Abstract

This dissertation addresses the use of two of the great scourges in world history, tuberculosis and cancer, in the literary texts of North America and Europe. The focus of this work is on these two diseases due to their prominent status in the western world over the last several centuries. They also possess several significant commonalities: each has held the distinction of being one of the most feared diseases, each has been responsible for the deaths of countless people, and each has had a significant literary presence in

Europe and North America. I first provide a chapter on each disease detailing its biological, medical, and social histories. Each chapter on the literary texts then includes discussions of noteworthy examples from a wide range of cultures in this investigation of each disease’s three primary manifestations in literature. The longer focused analyses of each paradigm concentrate on works from Germany and North America, as these literary traditions have produced particularly compelling works concerning tuberculosis and cancer. These focused analyses concern use of tuberculosis in the texts of Erich Maria

Remarque, Eugene O’Neill, and Thomas Mann, and the use of cancer in the works of

Brigitte Reimann, Maxie Wander, Audre Lorde, Reynolds Price, Thomas Mann,

Margaret Atwood, Margaret Edson, and Christa Wolf.

My readings of literary texts, both fictional and experiential, examine in part the effects of these illnesses on the perception of self and place in society. These analyses

rely to some extent on the scholarly literature that has already investigated problems of identity produced by illness in general, both in culture and in literature. What these scholars have not done is examine these themes of identity and the self in society as they relate to specific diseases in literary texts, and I will therefore investigate and expand on them in their manifestations in works concerning tuberculosis and cancer. My readings therefore in part discuss how the unique physical manifestations and cultural realities of cancer and tuberculosis affect the identities and the narratives of their fictional and non- fictional sufferers. I also address how these themes are used in texts in which the author has sought to highlight social or ethical conditions using either of these diseases.

Literary portrayals of tuberculosis and cancer are informed by the medical and social facts of each disease. I therefore investigate how authors may alter, expand, or even distort these medical and social facts in their texts so as to achieve their respective intentions. In doing so, authors can reinforce commonly held perceptions or misperceptions of the disease. They may also create new perceptions or associations as they depict the disease in a novel manner. I discuss the ways in which authors within each paradigm either use or go against the medical and social facts of each disease and the effect this then has on the themes the author presents. I also explore why these diseases lend themselves to the particular paradigms authors have traditionally favored for each, and discuss the historical progression of those paradigms.

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This dissertation is dedicated to B. Gene Corley, Steven Dettinger, and Mary Jo Hyatt, whose lives continue to inspire my own.

Acknowledgements

It is my pleasure to acknowledge the long list of individuals who have offered the guidance and support that has made it possible to complete a project of this magnitude.

First and foremost, I would like to express my gratitude to my advisor, Helen Fehervary, for her support, direction, and dedication throughout the completion of this project. At every stage of the process, she offered insightful and helpful feedback and sincere encouragement. My dissertation is immeasurably better due to her suggestions. I would also like to thank my committee members, Gregor Hens and Barbara Becker-Cantarino, for their willingness to serve on this committee and offer astute comments. I would especially like to acknowledge Barbara Becker-Cantarino for agreeing to join my committee late in the project, which enabled me to complete this dissertation when I have.

I would like to thank my colleagues and dear friends from the Department of

Germanic Languages and Literatures at The Ohio State University, in particular Alex

Brewer, Kristopher Fromm, Lizzie Gordon, Berit Jany, Jaclyn Kurash, Sara Luly,

Jennifer Magro Algarotti, Wonneken Wanske, and Jesse Wood, for all of the great conversations, emotional support, and most of all, for the fun of working together daily. I welcome the opportunity for us to meet again as colleagues and as friends throughout the years to come.

I also owe a debt of gratitude to the leaders and members of the ABD group at the

Younkin Success Center. Danielle Langfield, Christopher Smith, and Shannon Thomas in particular have contributed many hours of understanding and encouragement, and I treasure the friendships we have developed through the trials and tribulations of the dissertation process.

The friendships of Stephanie Baer; the Denny family; Anthony D’Orazio; Bregtje

Hartendorf; Gwynne Junkin; Jessica Kistler; Diana Klingelhafer, Mike and Fran

Klingelhafer; Anjana Modi; Missy Redding; Danielle Romanetti; Charles Ruggiero;

Mike Shaughnessy; Tina Tuminella; Erick Urbaniak; Hannah Washington; and Melissa and Charlotte Wood have also proven to be invaluable to me in the untold and unique ways each has contributed to my completion of this degree.

I would not have ever started down the path to a doctorate without the encouragement of Jenny Kline, Carolyn Kyler, Victoria List, and Greg Redding at my undergraduate college. I thank them for their unwavering belief in me as a scholar and for their guidance throughout my education. I am proud to join them in the professorate of liberal arts colleges. As for my current colleagues and the administration at Doane

College, I thank them for their understanding, help, and support during my first year as I learn ever more about this college and find my place among the fine educators that comprise its faculty.

Finally, I would like to thank to my family, especially my parents, William and

Patti Hetrick; my sisters, Susan Rihn and Bethany Hetrick; my brother-in-law

Christopher Rihn; my nephew and niece, Benjamin and Maria Rihn; and my brother,

Bryan Hetrick. They have supported me in every way imaginable, and I could not have achieved this degree without their willingness to stand behind me and to help me accomplish everything I have. I was also blessed with four grandparents, Olive and

Walter Bryan, and Anna and Jack Hetrick, who instilled in me the value of an education and fostered my love of learning. I am only the latest in a long tradition of educators on both sides of my family, and I aim to continue this legacy to the best of my ability. Most importantly, however, my family has served as a constant reminder of what is truly meaningful in life.

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Vita

December 27, 1978 ...... Born-Pittsburgh, PA

2001 ...... B.A. in German, mathematics minor, summa cum laude Washington & Jefferson College, Washington, PA

2001-2...... Max Kade Fellowship Recipient University of Cincinnati, Cincinnati, OH

2001-3...... Teaching Assistant University of Cincinnati, Cincinnati, OH

2003 ...... M.A. in German Studies University of Cincinnati, Cincinnati, OH

2003-4...... Foreign Language Teaching Assistant Fulbright Commission Grantee in Jena, Germany

2004-5...... Adjunct Instructor of German Washington & Jefferson College, Washington, PA

2005-6...... University Fellowship Recipient The Ohio State University, Columbus, OH

2006-11...... Graduate Teaching Associate The Ohio State University, Columbus, OH

Fall 2007 ...... Adjunct Instructor of German Washington & Jefferson College, Washington, PA

Summer 2010 ...... Instructor of German Middlebury Language Schools, Middlebury, VT

2011-present ...... Assistant Professor of German Doane College, Crete, NE

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Field of Study

Major Field: Germanic Languages & Literatures

Table of Contents

Abstract ...... ii

Dedication ...... iv

Acknowledgements ...... v

Vita ...... viii

Introduction ...... 1

Chapter 1: The History of Tuberculosis ...... 12

Chapter 2: Depictions of the Sentimentalized Consumptive ...... 57

Chapter 3: Naturalist Depictions of Tuberculosis ...... 78

Chapter 4: Tuberculosis and Bourgeois Culture ...... 99

Chapter 5: The History of Cancer ...... 150

Chapter 6: The Autopathography Model of Cancer Texts ...... 184

Chapter 7: Representations of Cancer as a Transformative Experience in Fiction ...... 233

Chapter 8: Representations of Cancer Linked to Social or Ethical Concerns ...... 289

Conclusion ...... 319

Bibliography ...... 329

Introduction

Illness has been a topic of literature for as long as literature has existed. In

Homer’s Iliad, Apollo sends a plague to cripple the Greek army, and the Bible presents numerous accounts of sickness. Indeed, the figure of Job, with his affliction of skin sores, appears in both the Bible and the Koran. In Hartmann von Aue’s narrative poem

Der arme Heinrich (1190/95), the titular figure is suffering from leprosy, and

Shakespeare’s eponymous figure in Julius Caesar (ca. 1599) suffers from seizures.

Serious illness is nearly always unexpected and thrusts a person into a position where he must confront several weighty issues: his own mortality, the potential end of his life, and the way he is living his current life. Often, a newly diagnosed patient must do this while in the midst of facing a previously unknown world of caretakers, treatments, and consequences of the sickness. This has led to a rich tradition of literature about illness, and indeed one can find either fictional or personal accounts of nearly every affliction imaginable. My analysis will concern literary texts involving two of the great scourges in world history, tuberculosis and cancer, as they appear primarily in European and North

American literary works.

Themes Common to Literary Texts about Illness

There are a few common themes around which accounts of illness revolve, and those that arise in autobiographically written experiential accounts, also referred to as autopathographies, are similar to those that appear in fictional accounts. The ill are frequently defined by their opposition to the healthy, and due to this, one who has a malady is often assigned an outsider status. This is in some measure the result of the physical and emotional consequences of disease. David B. Morris has argued in Illness and Culture in the Postmodern Age (1998) that “[i]llness is, in short, never wholly personal, subjective, and idiosyncratic, nor is disease wholly objective, factual and universal, but both take on their specific, malleable, historical shapes through the mediations of culture” (Morris 41-2). In connection to this, my readings of literary texts, both fictional and experiential, examine in part the effects of illness on the perception of self and place in society as they pertain to tuberculosis and cancer. The scholarly literature has already investigated these problems of identity produced by illness in general, both in culture and in literature. My readings rely to some extent on these general assertions about illness, but I will investigate and expand on them in their specific manifestations in literary works concerning tuberculosis and cancer. I will briefly summarize below the themes that I reference in my discussions.

As Sidonie Smith has argued in her 1993 monograph Subjectivity, Identity and the

Body: Women’s Autobiographical Practices in the Twentieth Century , bodies are rendered either as “normalized” or as “culturally abnormal, even grotesque” through discursive systems (S. Smith 129). A diseased body is perceived as outside of the realm

of normalcy, and as such it is regarded with wariness by others and even by the sufferer himself. This leads to a general sense of alienation of the ill person from those around him. Further, a seriously ill person is often unable to work or participate in daily life, and thus is physically separated from those who are perceived as healthy. This separation is exacerbated when one is in a residential treatment facility because the separation is constant. The clinical experience then heightens this sense of alienation. Michel

Foucault has argued in The Birth of the Clinic: An Archeology of Medical Perception

(1963) that: “The clinical gaze is a gaze that burns things to their furthest truth” as it seeks to establish the nature of the disease (Foucault 120). In doing so, however, the person who houses the disease is also filtered out, leaving the patient as a human to be essentially disregarded. Laura Tanner has then asserted in Lost Bodies: Inhabiting the

Borders of Life and Death (2006) that this disregard for the human side of the patient is also present in friends and family members who cannot see past the disease, leading to a further emotional isolation as intimate relationships become strained or compromised due to this unease (Tanner 22). At the same time, the ill person may also feel alienated from his own body, since it now harbors a foreign entity set on destroying it, thus making the body an enemy of the soul within (Tanner 27-9). This sense isolation from mainstream society is compounded by the fact that, as Thomas Anz has explained in Gesund oder krank?: Medizin, Moral und Ästhetik in der deutschen Gegenwartsliteratur (1989), fictional portrayals of illness have historically presented the sufferers as outsider figures

(Anz 186). This literary trope adds to the general perception of the ill person as a being set apart from the healthy.

The reaction of a sick person to this newfound outsider status is then a significant theme within fictional and experiential works concerning illness. Claudine Herzlich and

Janine Pierret have posited in Illness and Self in Society (1984) that the patient must confront this problematic by accepting his illness, redefining his identity, and presenting this identity to those around him; indeed, as they argue, a significant benefit can be found in having this time of illness that is free from societal demands made on the healthy. It can allow one the opportunity to reconsider one’s life trajectory, and may be the opening to a new type of existence (Herzlich and Pierret 53-4, 182). The process of identity reformation and the resulting change in a person’s life and self-image are a principle theme in both fictional and experiential works as the protagonist seeks to come to terms with his disease and the loss of his former self-conception. Howard Brody has theorized in

Stories of Sickness (2003) that telling one’s story and thereby reclaiming one’s own identity, rather than accepting the one assigned by others, is a means of healing. The act of narration allows the patient to bring order and meaning to an experience that at first may feel uncontrollable and arbitrary (Brody 13). The retelling of an illness often takes on a positive tone; the illness itself has been difficult to endure, but the resulting life changes have been beneficial. Arthur Frank has offered an argument similar to Brody’s in The Wounded Storyteller: Body, Illness and Ethics (1995), but Frank has included the assertion that illness narrations are a way for the sick person, be he fictional or non- fictional, to attempt to restore a narrative flow to a life story that has been fragmented, or, at the very least, interrupted by the illness. By altering one’s identity to include the experience of being sick, one restores a continuity to the narrative (Frank, Wounded 56). 1

1 The importance of writing in processing one’s illness experience that has been elucidated by such scholars 4

In works in which an illness bears a psychosomatic element, this issue of identity and identity formation is no less integral to the story. As G. Thomas Couser has succinctly explained this phenomenon in Recovering Bodies: Illness, Disability and Life

Writing (1997), “[…] generally, […] life writing about illness and disability promises to illuminate the relations among body, mind and soul” (Couser 12). This statement refers both to the origins of an illness and the way in which one conceives of and integrates the body into the sense of identity; the breakdown of a body can be the impetus for reflection on a potential psychological cause as well as for a consideration of how one’s physical condition alters one’s sense of self. The latter arises as a frequent narrative strain in fictional and experiential illness works as the body’s new appearance and level of dysfunction affect the patient’s psychological state and ability to cope with the illness.

David T. Mitchell has written in “Narrative Prosthesis and the Materiality of

Metaphor” (2000) that a disability in literature, which includes illness, is often a

“metaphoric signifier of social and individual collapse” (Mitchell 16), and therefore in such texts, the issue of examining one’s identity and reworking it bears a significance beyond just the illness itself. An autopathographer may expressly link his illness to a psychological condition or to a stressor he believes is at its root. In doing so, the author may implicitly or explicitly criticize the source of this psychological condition or the agents related to it, be they his own behavior or those of outside forces. As Lilian Furst has asserted in Idioms of Distress: Psychosomatic Disorders in Medical and Imaginative

as Herzlich, Pierret, Brody, and Frank elucidate bears a connection to psychoanalysis and the talking cure. Although the talking cure was initially used by Austrian physician Josef Breuer in the late nineteenth century, this therapeutic method was extensively developed and popularized by Sigmund Freud in the early twentieth century. The act of talking—or in the case of the works I discuss, writing—about significant events in one’s life can enable one to come to terms with them or even to overcome them. 5

Literature (2003), fictional works are particularly suited to this treatment of an illness because the link between the malady and the sufferer’s psyche can be made more clearly and deliberately than in an experientially-based work (Furst 60-1). As such, authors may use a particular illness to elucidate and also often to criticize other seemingly non-related issues, such as political or social situations.

The intersection of an ill person with the medical community and medical institutions is also central to many of these works. Here again, one is relegated to becoming an outsider in a previously unfamiliar arena and consequently often experiences a sense of frustration and alienation. Being asked to place one’s full trust in caretakers rather than being a part of the decision-making team is both difficult and trying for many patients, especially in instances where the patient wants to have full knowledge of his condition and agency in its treatment. Hans-Georg Gadamer has argued in The

Enigma of Health: The Art of Healing (1993) that physicians embody a combination of the scientist and the artist. The art consists in part of knowing when and how to stand back from a person as a case and view him instead as a complete whole—as a person with an illness, rather than as merely a vessel for the disease (Gadamer 40-3). Gadamer has explained that the solution to the initial inequality inherent in the relationship between patient and caretaker is the establishment of a personal relationship between doctor and patient wherein they discuss the illness at hand (Gadamer 110-112). This theme arises particularly frequently in experiential works as the patients seek to understand their condition, the treatment plan, and the prognosis, although it is present in fictional works as well.

What these scholars have not done in these works is investigate these themes as they relate to specific diseases in literary texts. My readings therefore in part examine how the unique physical manifestations and cultural realities of cancer and tuberculosis affect the identities and the narratives of their fictional and non-fictional sufferers. I also consider how these themes are used in texts in which the author has sought to highlight social or ethical conditions using either tuberculosis or cancer.

Focus on Tuberculosis and Cancer

I have chosen to focus on tuberculosis and cancer due to their prominent status in the western world over the last several centuries. They also possess several significant commonalities: each has held the distinction of being one of the most feared diseases, each has been responsible for the deaths of countless people, and each has had a significant literary presence in Europe and North America. In my investigation of each disease’s three primary literary manifestations, I provide brief discussions of noteworthy literary examples from a wide range of cultures. My longer focused analyses of each paradigm then concentrate on works from Germany and North America, as each of these literary traditions has produced particularly compelling works concerning tuberculosis and cancer.

Following the mid-twentieth century discovery of antibiotics that are effective against tuberculosis, the disease lost much of the associated dread in Europe and North

America. It has regained a measure of public attention and fear due to the recent rise in multidrug resistant strains increasingly affecting sufferers in Europe and North America.

The unparalleled ubiquity of untreatable tuberculosis infections in the eighteenth, nineteenth, and early twentieth centuries caused it to be a primary concern of governments and people alike during these years. The inclusion of tuberculosis in literary works of this time reflects its widespread nature and its status as an incurable disease with an undeniably dramatic course that, once progressed to its secondary infection, leads to death. The establishment of the sanatorium as a locus of treatment also lent tuberculosis a unique literary value, as this allowed for the condemned tubercular patients to be confined together in one space. Sanatoria offered authors a place for characters who logically may not have otherwise met to come together. They could then be forced to confront both one another and themselves apart from their families, friends, or other influences.

Cancer assumed a position of particular prominence in the twentieth century.

Although the disease has a history reaching back thousands of years, medical research in the twentieth century allowed all forms of cancer to be diagnosed. Prior to these advances, cancer was only able to be confirmed when it was a visible tumor either close to or on the surface of the skin, such as with breast cancer or melanoma. Further, as scientific developments have led to cures or vaccines for many of the previously rampant infectious diseases, cancer has assumed a position of particular prominence in the western world. Cancer awareness campaigns and federally sponsored research funding have also been twentieth-century phenomena. As the silence surrounding the disease has been broken as a result of these efforts, the societal view of cancer as the fault of the diseased individual has been challenged and, for the most part, overcome. The literary

manifestations of cancer have therefore emerged as predominant since the second half of the twentieth century. Texts involving figures with cancer have now become as popular as those with tuberculosis prior to its cure.

Literary portrayals of tuberculosis and cancer are informed by the medical and social facts of each disease. It is then the task of the literary scholar to ask how authors may alter, expand, or even distort these medical and social facts in their texts so as to achieve their respective intentions. In doing so, authors can reinforce commonly held perceptions or misperceptions of the disease. They may also create new perceptions or associations as they depict the disease in a novel manner. In the case of tuberculosis, for example, it was primarily a disease of the poor, due to the unhealthy living conditions that promoted the spread of disease. This led to a plethora of literary characters who were in some way disadvantaged, such as the orphan Smike in Charles Dickens’ 1838-39 novel The Life and Adventures of Nicholas Nickleby . Smike’s lack of means is consistent with a vulnerability to the disease. Dickens then combines the social disadvantage associated with the contraction of tuberculosis with the positive traits in Smike to create a wholly sympathetic character. This usage of the disease is seen, with some variation of the scenario, throughout much of the literature involving tubercular or consumptive characters, despite the fact that merely having tuberculosis confers no special status of goodness or virtue.

Cancer has a similar set of responses to its own realities. The painful and disfiguring treatments generally required to combat cancer are the topic of works such as

Alexandr Solzhenistyn’s 1967 novel Cancer Ward. In this case, the presentation of such

treaments reinforces the veracity of cancer as a disease associated with agonizing, demoralizing, and sometimes embarrassing consequences of attempts to cure it. This has since become a frequently portrayed aspect of all types of cancer works, be they fictional or experiential.

The literature I discuss is categorized in each case, tuberculosis and cancer, into the three most prevalent paradigms in which it appears in literary texts. Each paradigm is examined in a separate chapter. For tuberculosis, these are the sentimentalized depictions, the naturalist depictions, and the uses of tuberculosis in critiquing bourgeois culture. For cancer, these are the autopathographical depictions, the transformative depictions, and the linkage of cancer to social or ethical concerns. The authopathographical portrayals are diary entries, letters and memoirs that cancer patients have written about their own experience. While these are of course not fictional accounts, they nonetheless contain their own presentation of the author’s view of the disease and the impact it has on him or on the world around him. These works therefore provide an important avenue of investigation in my study of cancer’s literary depictions and usages.

I discuss the ways in which authors within each paradigm either use or go against the medical and social facts of each disease and the effect this then has on the themes the author presents. I also explore why these diseases lend themselves to the particular paradigms authors have traditionally favored for each. In the conclusion, I discuss the historical progression of these paradigms, which in tuberculosis texts is far clearer than in those concerning cancer.

My analysis of the two diseases and their literary impacts is divided into four chapters on each, Chapters 1-4 concerning tuberculosis and Chapters 5-8 concerning cancer. Chapter 1 contains the history of tuberculosis and Chapter 5 the history of cancer. Each of these chapters includes the origins and development of the disease as well as the history of treatments. I provide the current statistical prevalence of the disease and a brief history of the research and awareness campaigns in the United States and Germany. In Chapter 5, I include the statistics and information about cancer research and awareness for Canada as well, as one of the works I discuss in detail concerns a

Canadian woman. In Chapter 1, I present a discussion of prominent authors who have had tuberculosis, but I do not include a similar section in Chapter 5. This is because many of the writers who have faced cancer have subsequently written about it, and this forms the basis of a later chapter.

The tuberculosis section presents one focused analysis of a particular work per chapter, in addition to a less extensive presentation of other works using the disease in a similar manner. I structure the cancer section similarly, but I have chosen to closely analyze multiple works in Chapter 6: The Autopathography Model of Cancer Texts, and

Chapter 7: Representations of Cancer as a Transformative Experience in Fiction. This allows for a more complete demonstration of the distinct possibilities within these usages of the disease. The primary portrayals of tuberculosis are more uniform in their manifestations, and so one focused analysis suffices as an illustration of each paradigm.

At the conclusion of Chapters 4 and 8, the final chapters on the respective diseases, I have included a brief discussion of gender and sexuality in portrayals of each disease.

Chapter 1: The History of Tuberculosis

Part I: The Medical and Historical Framework of Tuberculosis

Tuberculosis, also earlier known as consumption or phthisis, is a disease that has existed by many names and with an increasingly specific definition since approximately

4000-1000 BCE. Prior to precise diagnostic techniques, physicians used the terms

“consumption” or “phthisis” to refer to “[…] several varieties of wasting disease that involved weight loss, fever and lung lesions, indicated by coughing and expectoration,” which included tuberculosis (Ott 9). Several other defined conditions were also mistaken for TB. Among these were: silicosis, which is caused by inhalation of silica dust; histoplasmosis, a fungal infection; neurasthenia, a condition with similar symptoms to TB but considered psychological in origin; emphysema; and lung cancer (Ott 3, 72). Lacking an understanding of the cause of consumption until 1882, the illness was accordingly also attributed to a wide range of causes. This list included other maladies of the lungs or chest that converted into tuberculosis, the will of God or gods, “excessive intellectual work, masturbation, germs, disturbed electrical energy, ethnic foods, living on wet soil,

[…] starvation, fatigue, and exposure to unfavorable environmental conditions such as foul air and insufficient light, […] insufficient alimentation, improper clothing or excessively hard work” (Ott 4, 19), all of which we of course now know to be false.

Tuberculosis as it has been defined since Robert Koch isolated the

Mycobacterium tuberculosis in 1882 is a disorder that is primarily caused by one of two related aerobic bacteria, Mycobacterium tuberculosis or Mycobacterium bovis. 2 French physician René Laënnec used post-mortem examinations in 1804 to establish that the disease tuberculosis itself is a single syndrome, even though it may originate from any of these different strains of Mycobacterium . Further, Laënnec found that all primary tuberculosis is initially seated in the lungs, but it may then initiate secondary infection in any other site of the body (Dubos and Dubos 84). 3 Secondary pulmonary tuberculosis, which is the type the western general public most closely associates with the terms

“tuberculosis,” “consumption,” or “phthisis” is chiefly caused by M. tuberculosis . M. bovis generally produces tubercular infection of other regions of the body, the most common of which are the spine, known as Pott’s disease, and the lymph nodes in the neck, known as scrofula. Human infection with M. bovis is relatively rare today. 4

M. bovis originated in cattle, and François Hass and Sheila Sperber Hass have postulated that M. tuberculosis is a mutated form of it. Their hypothesis hinges on the fact that while M. bovis can infect both cattle and humans, M. tuberculosis is found only in humans, thus indicating a more specialized, evolved form of its progenitor (Hass and

2 Three other related bacteria, Mycobacterium africanum, Mycobacterium canetti and Mycobacterium microti , can also cause TB in humans; however, this is a comparatively rare occurrence and the vast majority of cases has been caused by M. tuberculosis or M. bovis. (Soolingen, et al. 1236). 3 Thomas Daniel has noted that tuberculosis can affect nearly any organ or tissue of the body, from the adrenal glands to the inner ear or choroid of the eye, each causing its own set of symptoms and resulting disabilities (Daniel 24). 4 Pott’s disease frequently results in a fusion of the thoracic spinal vertebrae, resulting in a so-called “hunchback.” 13

Hass 3). 5 Hass and Hass have therefore concluded that since M. bovis is conveyed to humans through unpasteurized infected milk, M. tuberculosis likely originated some time after the domestication of cattle in milk-drinking Indo-European nomads, which would place it between 8000 BCE and 4000 BCE (Hass and Hass 3, 8). The earliest actual evidence of tuberculosis in humans has been found in skeletons dating from between

4000 and 1000 BCE. As Thomas Daniel has noted, these were nearly all cases of Pott’s disease, as it is much more likely for the skeletal remains that would contain this form of secondary infection to survive for that length of time. It would be much harder for soft tissue evidence of disease to survive, even if it were originally present at the time of a human’s death (Daniel 11). As a result of Egyptian embalming practices and a climate favorable to preservation, many of the earliest specimens of human tuberculosis infection are from Egypt; 6 however, the geographic distribution extends to Italy, France, Denmark, and Jordan in the European and African realms, as well as Chile and Peru in South

America (Hass and Hass 4; Daniel 11-12).

There is, however, no physical evidence of pulmonary tuberculosis prior to 1000

BCE. 7 The first case was found in an Egyptian boy of approximately five years old whose lungs showed major clinical signs of secondary TB: pleural adhesion, which occurs when fibrous bands form between the two pleural layers; evidence of hemoptysis, the coughing up of blood; and the presence of acid-fast bacilli, indicating either M. bovis

5 Daniel has argued instead that M. bovis and M. tuberculosis have a shared common ancestor (Daniel 15); however, Hass and Hass’s genetic evidence provides more compelling support for their hypothesis. 6 There is also abundant evidence of Pott’s disease in Egyptian art from 3000 BCE onward, largely portrayed through depictions of deformed backs (Daniel 9). 7 Besides a lack of descriptions of illness that fit pulmonary tuberculosis, Hebrews did not have a word for cough, thus indicating they also did not have pulmonary tuberculosis, since it is invariably accompanied by one (Hass and Hass 4). 14

or M. tuberculosis was present (Hass and Hass 5). By the end of the first millennium

BCE, however, pulmonary tuberculosis had been widely recognized in medical writings from Greece to India, with the chief symptoms of coughing, hemoptysis, physical wasting, and expectoration common across the accounts (Hass and Hass 5).

The Diagnosis of Tuberculosis

Diagnosing probable tuberculosis before the late 1800’s was largely based on external physical observations, including weight loss, fever, hemoptysis, palpable enlarged lymph nodes, or persistent coughing. Austrian physician Leopold Auenbrugger prompted a major development in observing the internal working of the body with his development of the art of physical percussion. His work in the mid to late 1700’s on using the sounds the body makes as one taps it in various places allowed doctors to diagnose numerous conditions even without the ability to view the particular organ or region in question. This included the chest, where one could diagnose “abscesses and areas of collapse, air in the pleural cavity […] the filling up of air spaces with inflammatory fluid or pus and the formation of air-filled or partially air-filled cavities”

(Dormandy 27-28). In 1818, René Laënnec then added to this ability to use auditory signals with his invention of the stethoscope. Through mediate auscultation (listening to the body’s sounds through a device rather than directly), it was possible for first Laënnec, and then all physicians, to use the thoracic sounds to more accurately predict when a person had active pulmonary tuberculosis (Dubos and Dubos 87).

Resolving the question of whether TB infection was hereditary or contagious was just as important as determining how best to diagnose it. By the end of the seventeenth century in Europe, a general geographical division had developed around this issue: those living in countries bordering the Mediterranean believed in the contagious nature of the disease, while those living in countries north of the Alps for the most part considered tuberculosis to be the result of hereditary factors (Hass and Hass 11). North Americans tended to side with northern Europe in favoring the hereditary argument (Rothman 55).

French military surgeon Jean-Antoine Villemin settled this debate in 1868 when he demonstrated that the tuberculous material from human lesions could be injected into rabbits and produce subsequent tubercular lesions in the animals (Daniel 72). 8 Robert

Koch then reinforced Villemin’s findings when he presented his discovery of M. tuberculosis on March 24, 1882 (Daniel 80).

This also meant that a tuberculosis diagnosis could now be definitively confirmed by testing either the patient’s sputum or other involved body fluids for presence of the bacillus (Waksman 77). This was by no means a swift process: the fluid was sent to the lab, where it was cultured and injected into guinea pigs. Examination of the guinea pigs six to eight weeks later could definitively confirm or disprove the presence of tuberculosis in the human patient (Dormandy 4). The length of time required for this test meant that it was not used routinely. Tuberculosis diagnosis was then further revolutionized with German physicist Wilhelm Röntgen’s discovery of x-rays in 1895.

X-rays not only allow the detection of tubercular lesions before one even has symptoms,

8 Injecting humans would have provided the most convincing evidence, but it would also have been unethical. This demonstration therefore had to suffice, and indeed succeeded in establishing TB as contagious. 16

but they can also allow one to establish how old the lesions are, how extensively they have spread, and how they change over time (Dubos and Dubos 120-1). Still today, x-ray detection of tuberculosis remains an important means of screening for the disease and tracking its progress. In 1907, Clemens von Pirquet announced his development of a safe, reliable test for tuberculosis based on tuberculin, a substance derived from tubercle bacilli that had first been produced by Robert Koch in 1890. This subcutaneous test, still widely used today, yields a positive result in anyone whose body has either active or latent tuberculosis, thus enabling doctors to treat even those who have never exhibited signs of secondary disease (Dormandy 206).

The Course of Tubercular Infection and the Distribution of the Disease

Increasingly sophisticated scientific techniques also yielded the knowledge that tubercular infection itself is divided into two major phases. The first of these is primary infection, which occurs shortly after one has contracted the bacterium. This phase is invariably pulmonary, and it is characterized by flu-like symptoms that rarely lead to death (Condrau 15). Initial infection does not condemn one to move on to the secondary phase. Rather, only five to eight percent of those whose bodies house the bacterium go on to develop what the general public would identify as tuberculosis (Daniel 111). The

92-95% whose disease does not progress have been protected by their individual immune mechanisms, which in the unfortunate others have ceased to function sufficiently well to ward off the further development of TB. There is a host of potential factors that affect the strength of the immune defenses, among them heredity, nutrition, age, environment,

and overall health (Daniel 111, 127). Although scientists are not absolutely sure which specific influences are the most crucial ones, poor nutrition and an impaired immune system seem to be particularly important in separating those who manifest active, secondary TB and those who do not (F. B. Smith 19). This phase can occur at any time after the primary phase, which could mean years or decades later. If left untreated, the secondary development often leads to death (Condrau 15).

Both primary and secondary tuberculosis were an essentially constant presence in Europe and North America. This is unlike most epidemics which alternate between times of great activity when they sweep through an entire region, and times where they are almost completely dormant (Ott 6). Specific and accurate rates of tuberculosis infection in various times and places are, however, difficult to assess before the twentieth century. This is partly because up until 1882, it was hard to prove conclusively that a person had tuberculosis as opposed to another related disease, thus skewing statistical results. Further, the stigma attached to a tuberculosis diagnosis meant that the infected and their doctors did not always truthfully report cases of TB so as to spare the patient undue hardships (Dormandy 77). Nonetheless, researchers have been able to either find documented rates, although they may still underestimate the true prevalence, or make rough estimates as to the rates of both primary and secondary infection from about the late 1700’s on. Hass and Hass report that TB rates in northern Europe were approximately one in 3.8 at the end of the eighteenth century (Hass and Hass 11), and

Rothman has noted that TB was the listed cause of death in one in five deaths in the

United States between 1800 and 1870 (Rothman 2). Pathologists’ post-mortem findings

in the 1870’s then concluded that nearly every person in the United States living in a city had at least contracted the TB bacterium, even if it had not progressed to secondary infection (Ott 35). Similarly, Matthew Gandy has asserted that rates of those infected with M. bovis or M. tuberculosis neared 100% around 1900 in the quickly expanding

European cities such as Paris and London (Gandy 15). Thomas Dormandy has explained this by writing that tuberculosis was “[…] part of the landscape of the Industrial

Revolution” due to the “explosive increase” in cases between 1790 and 1840 (Dormandy

73). This was partly a result of the shift in population from the country to the city, as this meant that people were living and working in much closer proximity to others, thus enabling a more rapid spread of the disease.

Rates of secondary tuberculosis infection began to fall starting in the late 1800’s in both the United States and in Europe. Condrau has noted that in Germany, the rate of deaths attributed to tuberculosis fell at approximately the same rate as the overall death rate (Condrau 40), which can be extrapolated to likely be true across the western world as well. Dormandy, however, has attributed this trend to the return of TB rates to pre-

Industrial Revolution levels; it was essentially a natural correction after the rapid peak

(Dormandy 73). Both likely played a role in this decline, which continued largely unperturbed until World War I. Dormandy has reported that from 1914-18, the incidence of TB rose in western Europe for the first time since relatively reliable statistics had been kept. While the numbers varied somewhat from country to country, in Germany, the increase was the most dramatic at 62% (Dormandy 224). According to Matthew

Smallman-Raynor and Andrew D. Cliff, the reasons for this reversal of the decline likely

include: the close physical proximity of both the military and civil populations, which eases the aerosol spread of the bacilli; the increase in factory jobs supporting the war, where dusty environments could have eased infection; malnutrition, which has a correlation to the contraction of the bacilli and the emergence or reemergence of latent disease; and physical and mental stress, which are also associated with both primary and secondary infection (Smallman-Raynor and Cliff 74-5). This increase also reinforced the idea that the development of active tuberculosis is closely connected to a worsening standard of living, which indeed happened during wartime in the countries most closely involved in the war (Condrau 40). Following World War I, tuberculosis rates resumed their decline in Europe until World War II, which led Marc Daniels refer to TB as “the major health disaster of the Second World War” (Daniels 201). While this increase was again the most dramatic in the involved European countries, the effect spilled over across the continent. There was no such increase in rates outside of the European theater of war, though; the United States, Australia, and Canada, for example, showed no spike corresponding to these years (Smallman-Raynor and Cliff 82).

In addition to TB’s atypical pattern of occurrence, secondary pulmonary tuberculosis has also had a unique demographic portrait. Unlike most similar infectious diseases that affect the elderly and very young to a greater degree than other age groups, pulmonary TB peaks in the middle age bracket, from 15-60 (Condrau 42). While infants and toddlers were certainly a very vulnerable group, this disease was actually rarely seen from ages 5-15, the so-called “golden age of resistance.” The physiological reasons for this are still unknown, but it is likely that the hormones of adolescence play a vital role

(Dormandy 247). This age group could still suffer from scrofula or Pott’s disease, but these tubercular disorders are much less likely to kill, even though they could cause permanent physical disabilities (F. B. Smith 12).

Rates for males and females remain similar until post-adolescence, when, according to Thorson and Divan’s investigation of epidemiological studies around the world from 1948-51, the number of tubercular infections in males begins to exceed that of women. Possible reasons they have offered for this include either that men at this time generally havd a wider social network after puberty or that there exists a differing reaction in male and female bodies to testing for TB with tuberculin, which could have led to an underdiagnosis in women (Thorson and Divan 59).

In addition to age and gender, TB rates seem to have varied according to one’s economic status as well. As Dormandy has phrased it, “Tuberculosis picked out and killed a few Princes and it carried off more than one bejeweled, tender-hearted courtesan; but it slaughtered the poor by the millions” (Dormandy 73). Smith then notes that “[f]ew escaped exposure [to TB] but the richer people had at every stage of the life cycle better chances than poor people of escaping infection or of enjoying a remission or cure” (F. B.

Smith 10). This is further supported by the evidence that the TB mortality rate in

Hamburg in the late 1800’s showed a strong correlation to the income level to which one belonged; the lower the income, and thus lower standard of living and economic status, the higher the mortality rate (Condrau 54). 9 The exact reasons TB converts from latent to active disease remain unclear, but the compromised immunological resistance that results

9 Condrau has provided the caveat that this could partly be attributed to the fact that having active tuberculosis negatively affected one’s ability to work, thus placing one in the lower bracket (Condrau 54). 21

from poor nutrition in addition to reduced access to medical care, which are both often a part of a life lived in poverty, seem to be major factors in this process (F. B. Smith 19).

Treatment of Consumption and Verified Tuberculosis

For the countless across the centuries who did contract secondary tuberculosis, treatments have varied widely over time, due largely to both the lack of understanding of its cause and the absence of a reliable chemotherapeutic cure before the 1940’s. Where

TB was primarily considered the work of the devil or of a displeased God or gods, treatment often included exorcism or the appeal to a higher power for mercy (Daniel

166). 10 Scrofula sufferers sought the touch of a monarch, which likely began with Clovis of France in 496 CE. These exalted rulers were considered emissaries of God, and therefore able to absolve one of evil, thus curing the disease (Daniel 23-4). A unique means of preventing evil forces from spreading TB infection was commonly carried out in New England during the nineteenth century. Here, bodies of the tubercular dead were exhumed and the hearts burned to prevent them from returning in the form of vampires who would cause further spread of the disease (Daniel 166).

One of the most popular treatment modalities was that of travel to different climates. Dating to at least the ancient Romans, travel was thought to be primarily helpful in cases of pulmonary tuberculosis. The ancient Romans would seek warm, dry climates, such as Sicily or Egypt, and the ancient Greek physician Galen specifically recommended the vicinity of Vesuvius for the same purpose (Waksman 49, 56). This

10 Catholics even had several patron saints to whom they could pray specifically for release from tuberculosis (Waksman 61). 22

idea of therapeutic climate change to warmer regions, be they arid or balmy, persisted into the eighteenth and nineteenth centuries, both in Europe and North America. Favored destinations for Europeans included anywhere along the Mediterranean Riviera and trips to Egypt, which were particularly favored by the Germans and Austrians (Daniel 168,

Dormandy 114).

In the United States, where New England was heavily populated but considered the least advantageous environment for someone with tuberculosis, doctors also recommended trips to the Mediterranean for those with the financial means (Rothman 4,

Daniel 117). 11 Other early, more accessible popular destinations for Americans included

Florida, the Caribbean islands, and mineral spas such as White Sulphur Springs in West

Virginia (Ott 40, Daniel 117). Sea voyages, however, were the most frequently recommended remedy in the United States, be they to a reputedly therapeutic Caribbean destination or simply as a treatment in and of themselves, since the sea air was considered particularly beneficial to the lungs (Rothman 19). 12 These recommendations were intended primarily for men, however; the vast majority of tubercular women did not make these sea voyages or trips south, as the physicians expected women to want to remain within the bosom of their families, either attending to or supervising their household duties (Rothman 23).

11 Barbara Bates has noted that New England and Atlantic shore destinations did become popular sites for tubercular patients in the late eighteen hundreds, among them resort hotels on Block Island, Rhode Island and in Atlantic City, New Jersey (Bates 27). 12 Sea voyages were also recommended as a preventive measure, particularly for those with a family history of tuberculosis. Young men would even sign on as crew in order to ensure a greater choice of destinations (Rothman 19, 38). 23

Beginning in the 1840’s and gaining in popularity from 1870 to 1880, Americans also sought relief from tuberculosis in the western United States, where the mountains, deserts and open air abounded (Rothman 132). 13 The clean, unpolluted air, lack of overcrowding, and rugged outdoor lifestyle fit all of the common climate prescriptions for consumptives. These “open health resorts” favored in the United States “[...] constituted a spectrum of housing and camping options, ranging from boarding houses, hotels and private homes to ranches and camps,” where doctors and institutions were not nearly as important as location (Rothman 160). In California, these resorts frequently arose out of informal tent colonies. A physician who had come west in search of his own health might begin to advise other tubercular or consumptive people, and eventually establish a more formal arrangement (Ott 147). Rothman has described southern

California in the 1880’s as a “‘sanatorium belt,’ dotted with communities, resorts, hotels, and boardinghouses, some more makeshift than others, but all hoping to attract invalids, especially consumptives” (Rothman 146). She goes on to state that by 1900, “fully one- quarter of the migrants to California and one-third of the newcomers to Colorado had come in search of health […] and every western state owed some degree of its growth to these itinerant health seekers” (Rothman 132). Those who came west with insufficient means often ended up carrying out their “open air therapy” by working as hired hands in physically demanding outdoor jobs, while their wealthier counterparts had the option of buying their own orchards or plots of land to cultivate themselves, with some going on to

13 This increase in migration was aided by the expansion of the railroad system, which shortened the trip considerably and also simply made the west more accessible (Ott 40). 24

become rich entrepreneurs (Dormandy 118, 120). 14 Although at first few women ventured west, the eventual formation of towns and settlements made this a much more conducive environment for entire families than the other suggested destinations

(Rothman 167). 15

No records or statistics were kept to attest to the degree to which the westward migration may have been successful in helping the health seekers (Rothman 163). What it did accomplish, however, was to aid in the establishment of an American therapeutic model by the 1880’s that was distinct from the standard European model. This European theory was much more focused on a regimen and physician care, although location was still an important aspect of sanatorium treatment. In the eighteenth and nineteenth centuries, hospitals were places where one went only if one’s illness could be cured. As this was not yet the case with tuberculosis, beginning in the mid-1800’s, sanatoria became the primary option for those in Europe seeking residential care outside of the home (Condrau 65-7). 16 The principles on which the European sanatoria were based were hardly new. Daniel notes that as far back as the ancient Greeks, “[…p]rescriptions commonly included milk, mild exercise and warm climates” (Daniel 167). 17 Although climate change, nutrition and physical activity had then become consistent themes in

14 Many who went to Pasadena, California, ended up becoming citrus farmers and remained there for life (Rothman 163). 15 Pasadena was originally settled by families from Indiana seeking a western cure for a family member (Rothman 167). 16 Hospitals specifically for tuberculosis care were established later, though, and in 1992 the United States still had four hospitals for tuberculosis with 420 beds (Davis 50). 17 English physician John of Gaddesden’s medical text Rosa Angelica Practica Medicina a Capite ad Pedes, published around 1300, expanded on this idea. He named specific types of milk in a preferential ranking, with the milk of “a young brunette with her first child, which should be a boy” at the top of the list and cow’s milk at the bottom (Daniel 167). 25

tuberculosis treatment throughout the centuries, the institution that would unite these three would be the sanatorium. 18

Around 1840, at approximately the same time Americans began heading west for open air treatment, English doctor George Bodington was earning his place as the

“progenitor and pioneer of modern sanatorium treatment” (Davis 36). Bodington abandoned more complicated medicinal intervention entirely, going against the trend at the time, and instead advocated fresh air, plenty of food, and “graduated exercise,” wherein the patients increased their daily amount of exercise slowly. The only medication Bodington allowed was a dose of opium each night so that the patient might sleep (Dubos and Dubos 174-5). While Bodington’s concept in and of itself was not an entirely new idea, what he added to the treatment was his direct medical supervision over the patients, whom he quartered in a home near his own (Davis 36). This was known as a closed model, because the patients were housed in specific buildings under the care of one specific person, in contrast to the open model favored in the United States.

Bodington soon turned his attentions to other diseases, abandoning his work with tuberculosis as well as this prototypical sanatorium (Condrau 119).

The sanatorium movement truly came into popularity after German physician

Hermann Brehmer opened his sanatorium in Görbersdorf, Germany in 1854. Brehmer believed that TB was invariably curable at its onset given the proper care. He further asserted that consumptives’ small, weak hearts—a consequence of TB that he claimed to

18 Exercise was often prescribed in the form of horseback riding, because English physician Thomas Sydenham’s 1742 writings on TB asserted that this was the best form of exercise to cure it (Daniel 169). Further, nutrition did not necessarily mean a rich diet, as starvation regimes were also in vogue at different times. However, the recommendation of hearty meals was much more prevalent. 26

have observed in autopsies—could also be cured by engaging in vigorous exercise and living above sea level (Dormandy 150). Brehmer chose the mountains of Silesia not only for this reason, but also for two others: the ultimately erroneous arguments of both

Alexander von Humboldt and Brehmer’s teacher, Johann L. Schönlein, that TB did not exist above certain altitudes, in addition to Brehmer’s personal belief that his time in the

Himalayas had cured his own bout of tuberculosis (Dubos and Dubos 175-6, Waksman

63). 19 Brehmer’s sanatorium was initially one house, but by 1859 he had built a Kurhaus with 40 rooms, including entertainment spaces and kitchens (Davis 36). While his basic regimen was not entirely revolutionary, Brehmer did add rain baths and Waldduschen , during which a patient was taken outside and doused with ice cold water for up to thirty seconds. 20 He also added temperature readings every two hours to the traditional recommendations (Davis 36, Kinghorn 195).

Peter Dettweiler, a German physician who was also Brehmer’s former patient and assistant, further developed the sanatorium treatment modalities in both his own

Heilanstalt , which opened in Falkenstein im Taunus in 1876, as well as in the first

Volksheilstätte intended for the poor, which Dettweiler opened in conjunction with the

Frankfurter Verein für Rekonvaleszentenanstalten in 1892 (Condrau 120, 123). 21

Dettweiler’s most significant innovation in sanatorium care was the Liegekur . In opposition to Brehmer’s belief that exercise was imperative, Dettweiler believed that

19 Brehmer is also the reason for the now common benches that line trails and populate parks. He used benches so that his patients could more easily finish the prescribed distances of their walks (Dormandy 151). 20 Bates notes that Brehmer was influenced by the “peasant healer” Vincent Priessnitz’s theory of hydrotherapy, whereby water baths or showers were considered integral to treatment (Bates 30). 21 The German terms Sanatorium and Volksheilstätte generally connote the economic standing of the patients; the Sanatoria were inhabited by patients paying their own way, while the Volksheilstätten were financed by public funds or charities (Condrau 57). 27

intensive rest in the fresh air was the key to recovery. To this end, patients in his sanatoria spent much of their time resting on open-air verandas ( Liegehallen ) that were built in a manner to afford protection from the wind, rain, or snow. The Liegekur took place regardless of the ambient temperature, and patients would recline in special chairs that were designed specifically for use on these verandas (Rothman 195, Condrau 125,

153-4). The Liegehallen facilitated another of Dettweiler’s beliefs, which was the much stricter control of physicians. Since all of the patients were concentrated in these areas, the caretakers could easily keep watch over them, track their progress, and conduct sessions on hygiene and care in preparation for departure from the sanatorium (Rothman

195, Condrau 124). The simplicity of carrying out the methods espoused by Brehmer and

Dettweiler facilitated the widespread establishment of sanatoria, and by 1899 there were

300 in Germany alone (Condrau 128, Davis 37).

There was a European alternative to the strict Brehmer-Dettweiler style that was more of a hybrid of Brehmer-Dettweiler’s model with the American system. This style of sanatorium was primarily associated with Switzerland, and in particular the village of

Davos in the Swiss Alps. Dr. Walter Spengler first recommended this “dingy and sunless little village” in the 1860’s and it then became a prototype of this type of treatment

(Dormandy 153). The care at Davos did not take place in a single sanatorium, however.

Rather, hotels, inns, and boarding houses were either built as individually run sanatoria or converted into them. Treatment included time outdoors and large meals, but unlike the closed Brehmer-Dettweiler model, there were few doctors on staff and little strict medical

supervision or consultation (F. B. Smith 99). 22 Noted personalities such as Sir Arthur

Conan Doyle and Robert Louis Stevenson sought cures there, in addition to many other famous tuberculosis sufferers from all over Europe and the United States (Dubos and

Dubos 176).

In the United States, the first official facility dedicated to the care of people with tuberculosis was the Channing Home, which was founded in 1857. Despite what the name would suggest, it was actually located in the basement of a Boston church (Daniel

179). Edward Livingston Trudeau, however, established the first and most important closed sanatorium in the United States in 1885. Years before this, Trudeau, a physician with tuberculosis, had initially gone in vain to the southern United States to find a cure.

Believing himself to be near death, he retreated to the Adirondack Mountains in New

York, where he had spent many happy days throughout his life, in order to live out his remaining days (Dubos and Dubos 178-9). What he experienced instead of a fatal decline in health, however, was a dramatic improvement. He attributed this to the hunting, wholesome diet, and fresh air that filled his days (Rothman 199). In 1882, upon reading of Brehmer’s sanatorium and therapeutic methods, Trudeau resolved to establish a closed sanatorium in the Adirondacks (Dubos and Dubos 179). Since Trudeau was going against the commonly accepted American practice of focusing on where one was living rather than how one was living, he encountered the problem of attracting patients.

To solve this issue, he resolved to focus on serving the poor by offering them free treatment and housing in exchange for their participation in the testing of his method

22 This is in contrast to Thomas Mann’s portrayal of Davos in Der Zauberberg, where he depicts a single sanatorium that seems to be based more on the Dettweiler method, as it includes long descriptions of the Liegekur and a strict regime prescribed by the physicians on staff. 29

(Rothman 201). In order to fund this charitable endeavor, Trudeau solicited donations from friends and philanthropists. With their donations, he built a community of small cottages that by 1900 would grow to number twenty buildings and include “a large administration building, a library, a chapel and an infirmary” (Rothman 203). 23

Trudeau’s sanatorium was initially called the Adironack Cottage Sanatorium (later renamed the Trudeau Sanatorium), and it was located about one and a half miles from the village of Saranac Lake, New York (Davis 39). His goal was to develop a place of research as well as treatment, and so Trudeau eventually included a laboratory, nurses’ training school, and a school for postgraduate education in tuberculosis on the grounds

(Davis 42). Trudeau’s closed sanatorium system steadily gained in popularity, leading to the founding of the first state-run sanatorium in 1895 in Rutland, Massachusetts (Davis

43). By 1900, there were 34 sanatoria in the United States modeled after Trudeau’s and by 1925, there were 536 with 673,338 beds. By this time, the European closed system had overtaken the American open resort system as the preferred method of treatment in the United States (Rothman 198). 24

A stay in such a sanatorium, either in Europe or in North America, could range from weeks to years. The average, however, was about three to nine months (Ott 148).

For those who were not among the wealthy, the cost of sanatorium treatment was therefore prohibitive unless outside financial support was available. As Dormandy

23 Trudeau proved to be an exceptionally good fundraiser, tailoring his pitch to each particular potential donor’s interests and deciding to erect individual cottages that donors could point to as the result of their contribution (Rothman 203). 24 Rothman has noted, however, that each sanatorium had its own definitions of what constituted a rich diet and in what proportions rest and exercise should be prescribed, so there was no true standardization of care (Rothman 206-7). 30

explains, in the late nineteenth century, “[c]haritable associations, campaigns, societies and leagues dedicated to combating, preventing, treating and eradicating tuberculosis sprang up in five continents. […] The first task of the new charities was […] clear. The benefits of the sanatorium treatment must be available to all“ (Dormandy 298). Although charitable donations were initially largely confined to the offerings of the well-to-do, those less able to contribute significant sums, but who were still interested in helping, soon had their opportunity: special stamps. These were the creation of Danish postal worker Einar Holboell in 1904, and soon the idea that one could raise money either by adding a few cents to a special postage stamp or by issuing special postal seals spread across Europe and the United States, enabling even more charitable care for consumptives (Dormandy 300-1). For those who were rejected from the non-profit sanatoria funded by charities, the only other institutional option was a tax-funded public sanatorium. These institutions were of varying quality and “[…] more likely than charitable institutions to lose sight of their therapeutic mission” (Rothman 207). 25

Physician involvement in most sanatoria, regardless of the funding, was initially limited due to the constraints of treatment options. The doctor on staff, himself often tubercular, would perform an intake physical and then prescribe a regimen to be followed. After this, he followed each patient by tracking temperature readings or weight, but there was little else he could do to cure the TB or to determine a patient’s state of health in the time before the introduction of surgical intervention and x-ray diagnostics (Condrau 223-4). Nurses in sanatoria had an intermediary role between

25 There was a hierarchy of preference among the publicly funded sanatoria in the United States. Rural state sanatoria were the most sought after, while urban municipal sanatoria were the least desirable (Rothman 207). 31

doctor and patient. They were responsible for making sure the doctor’s prescribed regimen was carried out, and they also ensured that the patients behaved according to the sanatorium rules (Condrau 234). 26 The patients, at the lowest rung of the sanatorium hierarchy, also had their own ranking system amongst themselves. Whether it was a sanatorium for the rich or the poor, what mattered most was the stage of disease and stringency of treatment. Those relegated to constant bed rest were of the lowest rank, because they could not take part in any of the social activities. The length of stay also played a role, with those who had been there the longest at the top of the ranking

(Condrau 242).

It was difficult to assess stastistically how effective sanatoria actually were in comparison to home care. As far back as the opening of Brehmer’s sanatorium, attempts were made to follow up on patients’ health. The patients typically reported personally to their sanatorium on their general state of health rather than undergoing any actual medical evaluation, and so these accounts therefore held little if any actual medical data.

Even later, more systematic analyses were neither standardized across the various studies nor compared to a control group that did not receive any treatment (Condrau 255-7). Ott has asserted, however, that even given the shoddy nature of the data available, it can be said that: “Recovery rates for patients were rather dismal. Many consumptives faced periodic readmittance over a four- or five-year period, which finally ended with their death” (Ott 149). Despite the unproven efficacy of sanatoria, they nevertheless remained a popular locus of treatment. This can be explained by their fulfillment of basic

26 A particularly egregious action for which the nurses were constantly on the lookout was the formation of sexual relationships between patients, which was termed “cousining” in the United States (Rothman 236). For more on the role of the nurse in sanatoria, see Bates 197-213. 32

psychological needs: they isolated the sick from the well, thereby granting the uninfected a sense of security, and they allowed the sick to feel as though they were taking some action in order to combat the dreaded disease (Ott 150). With the discovery of chemotherapeutic cures for tuberculosis, sanatoria quickly became obsolete and most of them closed before the end of the 1950’s. 27

While much has been made in both popular culture and research about sanatorium care, the vast majority of tubercular people were never treated there. The principal reasons for this included: the cost of a stay if one could not secure charitable or public support, the attendant loss of wages, and a general lack of open beds (Ott 80, 149). The effects of the closed sanatorium regime could nonetheless be seen even in home care.

Many products were sold to facilitate exposure to the outdoors, such as special awnings that allowed the bed to be enclosed and yet remain attached to an open window, or beds designed to fit partially through windows (Ott 89). Further, home architecture was altered to allow for exposure to fresh air. Sleeping porches and verandas were frequently added to houses, and have since remained important aspects of home building in the

United States (Ott 90).

As science and medicine advanced, the nineteenth and early twentieth centuries proved to be particularly fertile times for developing new medical treatments for this disease in addition to traditional sanatorium or home care. Iodine, for example, was thought to relieve scrofula, and cod liver oil was widely used for all types of TB (F. B.

Smith 41-2). Bleeding was also a commonly used treatment. Doctors would use leeches

27 Some, such as the sanatoria in Davos and Saranac Lake, were converted for new uses. The Davos facilities were transformed into winter skiing resorts and the Trudeau Sanatorium was bought and converted into a conference center (Dormandy 369, F. B. Smith 249) . 33

to relieve scrofulous joint disease and then scalpels to draw blood from those with pulmonary secondary tuberculosis. Blood-letting in pulmonary cases was thought not only to remove the “bad blood” that would further infect the sufferer, but it was also believed to alleviate hemoptysis, the spitting up of blood, because physicians attributed this symptom to an overabundance of blood. The bleeding of patients continued regularly up until the 1860’s, when it fell out of fashion (F. B. Smith 42-3). Physicians also frequently prescribed laudanum, a diluted opium solution, in order to both alleviate the pain that accompanies TB and also to act as a sedative. This would eventually allow a tuberculosis sufferer a more peaceful death (Dormandy 49).

Even after Robert Koch identified the pathogen responsible for tuberculosis, a cure did not immediately come to light. Robert Koch himself, however, announced to great fanfare and excitement in 1890 that he had produced a substance, tuberculin, that could both protect against TB and even cure current cases (Bates 37-8). Sir Arthur

Conan Doyle, a physician as well as a novelist, arrived immediately after the announcement to inspect this new wonder. Unfortunately, what he and others soon found was that tuberculin did more harm than good. It likely killed more patients than it helped due to the immune response it catalyzed (Dubos and Dubos 106). 28 The first truly effective medical treatment for any kind of tuberculosis was the use of ultraviolet light to alleviate secondary tuberculosis of the skin, and this discovery garnered Danish researcher Niels Rybereg Finsen the 1902 Nobel Prize in medicine (Dormandy 157). The

28 This same immune response would prove to be what made tuberculin useful in developing the subcutaneous test for TB (Dormandy 206). The failure of tuberculin to provide a cure for TB was actually a boon to the sanatoria, because hope waned that a medicinal cure would be found (Condrau 122). 34

larger endeavor remained finding a cure for the more widespread forms of the disease, and pulmonary TB in particular.

Various salts and compounds, including copper salts, creosote, and gold salts, had earlier been popular treatments of choice, and this increased in the wake of tuberculin’s failure (Waksman 62-3). Koch had himself tested many substances around 1890 for use as potential cures, and a cyanide-gold preparation demonstrated the ability to kill M. tuberculosis bacilli in petri dishes. However, it did not demonstrate the same efficacy in animals (Benedek 51). Due to the resulting disappointment over tuberculin, this preparation was revisited around 1912 (Benedek 51). This gold therapy was not meant as a total cure, but rather it was intended to reduce the bacteriological load in a person to a point where the body’s own immune system could then eradicate the remaining bacteria

(Benedek 87). This treatment was widely popularized, but as Benedek has explained,

“[e]ventually toxicity was considered to outweigh the alleged therapeutic benefit of all gold compounds,” and this type of therapy was eventually abandoned in favor of surgical interventions (Benedek 50, 89).

The principle behind the primary types of surgery used to treat tuberculosis was the long-held belief that rest was a vital aspect of a cure. This initially meant bed rest, the mainstay of much sanatorium treatment. In the 1920’s and 1930’s, it also commonly came to mean more drastic measures, such as body casts intended to immobilize a particular area of the body, and then surgical treatments to achieve the same end

(Dormandy 251, 262). Collapse therapy became the analogous paradigm for surgical treatment. The fundamental principle behind collapse therapy, the underlying idea of

which has existed since at least 1770, is that if one can deflate affected areas of a lung— or even the entire lung—any cavities within the tissue that had been formed as a result of the tuberculosis collapse as well. The theory was that the aerobic tuberculosis bacilli, now deprived of oxygen, would either die or become dormant (Dormandy 249-52). The artificial pneumothorax and thoracoplasty were the two most widely used surgical options to achieve this collapse. In an artificial pneumothorax, which first came into limited use around 1880, this is achieved by injecting some substance, usually air or nitrogen, into the space between the two layers of the pleural sac that encases the lung. 29

The resulting change in pressure causes the section of the lung to collapse upon itself and become inactive (Ott 95, Dormandy 250-1). The surgeon had to fill the pleural cavity over a period of weeks, and then refill the air periodically to maintain the collapse because the air or nitrogen would gradually be absorbed by the body (Ott 97). The advantage to this procedure was that one could continue a relatively normal daily life. It was not without risk, however, as there were deadly complications, such as an air embolism or the puncture of major organs or veins (Ott 97). By the 1930’s artificial pneumothoraces were all too often being performed by undertrained, inexperienced practitioners or in situations where it was unnecessary, but they nonetheless remained immensely popular with patients themselves. Daniel had noted that while there was much anecdotal evidence of improvement due to this procedure, no comprehensive study was ever conducted to prove its efficacy (Daniel 198-9). Nonetheless, Dormandy has

29 In addition to air or nitrogen, the less commonly used options collectively called “plombage” included oil, “gauze, paraffin, fat and Ping-Pong balls” (Ott 98). Although the artificial pneumothorax steadily gained in popularity in Europe, in the United States, following a brief initial burst of use, it became a relatively rare procedure. This remained the case until the European usage rates and success began to be reported in American medical journals around 1912 (Ott 96). 36

explained the reason behind its popularity: “Almost anything active was better [in the patients’ minds] than just waiting and hoping” (Dormandy 352).

Thoracoplasty, a more permanent means of collapsing a lung, is believed to have been first performed in 1885 by Swiss surgeon De Cérenville (Daniel 200). This operation was based on the same principles as an artificial pneumothorax, but it was a much more involved procedure. It was therefore intended for those patients for whom the less invasive artificial pneumothorax or other remedies with a similar aim, including crushing the nerve controlling the diaphragm, did not suffice. Dormandy has vividly described the thoracoplasty as “[…] major surgery with a vengeance, one of the bloodiest operations in the canon,” due to the fact that it entailed removing both a varying number of ribs and also some amount of muscle from the chest. The weight of the remaining chest tissue, no longer supported by the bone and musculature, would then collapse, mechanically forcing the lung to do so as well (Dormandy 254). Surviving this mutilating operation meant significant subsequent deformity, but socially this disfigurement often became a badge of honor among those who endured the surgery (Ott

153, caption to image on unnumbered page). The more important benefit of a successful thoracoplasty was the dramatically improved survival rate in comparison with those who had not undergone the surgery (Daniel 202).

Following on the heels of the thoracoplasty was the ultimate surgical intervention for pulmonary TB: the removal of lung tissue, ranging from a single lobe up to the entire lung, known as either a lobectomy in the case of a lobe, or a pneumonectomy when the entire lung was removed (Dormandy 359). This was initially very dangerous to attempt,

but by the height of thoracic surgery in the 1940’s, this procedure came to be preferable to the more drastic and deforming thoracoplasty (Dormandy 359). Cases of secondary tuberculosis in other parts of the body were then treated in a similar manner by surgically excising the infected area when it was possible to do so (Dormandy 259).

Artificial pneumothoraces, thoracoplasties, lobectomies, pneumonectomies, and sanatorium stays in general were then all supplanted due to American microbiologist

Selman Waksman’s discovery of the antibiotic streptomycin, a microbe with an ostensibly miraculous ability to kill M. tuberculosis (Waksman 113). 30 Waksman had already been researching various microbes with the ability to inhibit or prevent the growth of other disease-causing microbes when, in August of 1943, a poultry farmer concerned about a sick chicken arrived at an Agricultural Experiment Station. A poultry pathologist cultured the chicken’s throat and then sent the resultant bacteria on to

Waksman’s laboratory at Rutgers University (Waksman 115). Waksman and his graduate students Albert Schatz and Elizabeth Bugie studied the antibiotic activity of this organism, which included in vitro efficacy against M. tuberculosis as well as other pathogenic bacteria. They named the resultant antibiotic streptomycin (Waksman 116,

119). Mayo Clinic researchers H. Corwin Hinshaw and William H. Feldman then conducted experiments with guinea pigs, demonstrating streptomycin’s powerful effect in eliminating M. tuberculosis in vivo as well (Waksman 123-4). 31 The first human to be cured by streptomycin was Patricia T., whose treatment for advanced secondary

30 Removal of the lobe of an affected lung is still occasionally performed today, but only in those rare cases where antibiotics are ineffective (Boyd, et al. 643). 31 Pharmaceutical manufacturer Merck & Company worked in contract with Waksman to produce more streptomycin (Waskman 123). 38

pulmonary tuberculosis began on November 20, 1944. She left her sanatorium on July

13, 1947, with arrested disease and went on to marry, have children, and live a long life

(Daniel 210-11). By 1946, the Mayo Clinic researchers felt they had enough conclusive evidence of streptomycin’s efficacy with pulmonary tuberculosis, as well as most other forms of TB, that they published their findings. Streptomycin became available to the world at large by 1947 (Waksman 129-30, 138).

While streptomycin proved to be the savior of many, it was not without problems.

Some patients experienced toxicity to the drug itself, some had disease that was too advanced to be cured, and about ten percent of patients who had apparently been successfully treated then relapsed (Daniel 216). The largest complication, however, came in the form of the emergence of mutated new strains of tuberculosis that were resistant to streptomycin. Thus, researchers decided that the best course of treatment would involve streptomycin and at least one other drug that could destroy the streptomycin-resistant bacilli. The pharmaceutical companies searched for an effective medication to administer in tandem, and two new medications seemed to be suitable, thioacetazone and paraamniosalicylic acid (PAS). Three pharmaceutical companies, Bayer, Squibb, and

Hoffman-LaRoche, then discovered isoniazid, an even better option, at approximately the same time (Daniel 216-7). Isoniazid quickly became the favored medication, and was given in combination with at least one of the others. A course of 18-24 months on the two medications would cure most patients (Daniel 218).

Once Koch confirmed the infectious nature of tuberculosis, laws were the crafted and enacted in order to prevent—or to attempt to prevent—its spread. In the United

States, tubercular people could be barred from marrying in the state of Washington, and it was strongly advised against nearly everywhere (Ott 115). Sputum and dust were the most feared means of infection, and therefore public spitting ordinances were established and stringent, nearly impossible levels of cleanliness were advocated (Ott 119, 125). Still today, testing for tuberculosis is mandatory in many countries in order to obtain a visa, enter public schools, or work in hospitals, so as to prevent spread of the disease.

Finding a vaccine to prevent initial tuberculosis infection has also long been an endeavor within the research community. French bacteriologist Albert Calmette and

French veterinarian Camille Guérin developed a vaccine in the early 1920’s that was composed of live attenuated M. bovis bacilli suspended in ox bile (F. B. Smith 194).

Testing of this Bacille Calmette et Guérin (BCG) on humans began in 1921, and it was administered orally to newborns (F. B. Smith 195). Calmette initially reported a seemingly miraculous one hundred percent survival rate among the 2,070 newborns he inoculated, all of whom had tubercular mothers and would have reportedly had a twenty- five percent chance of infection and death otherwise. His claims, however, proved to be misleading due to the substandard nature of his follow-up methods and his statistical investigations. This cast a pall over the discovery and led to a great debate among nations and scientists over whether to administer BCG (Dormandy 342-4). The League of Nations approved BCG for human use in 1928, and it became increasingly more accepted in Europe and Canada, although the medical community in the United States remained skeptical about its use (Daniel 136). 32 As Daniel has asserted: “The story of

32 The United States never advocated or implemented widespread use of BCG. Possible reasons for this are the skepticism due to the questionable statistical analyses, and a general belief that other methods of control 40

BCG has been one marked by enormous excitement alternating with disappointment.

Seventy-five years after its first use, we still do not know how effective it is” (Daniel

141). Mark T. Doherty, Martin E. Munk, and Peter Anderson have explained that the efficacy of BCG, which is still administered in developing countries today, varies across populations and locations. Protection seems to lessen over time, offering a reduced defense to adults who had been vaccinated as children, although even natural infection with tuberculosis does not mean that one is immune to further infection for life (Doherty et al. 209). The search for a vaccine continues, but few major strides have been made since the development of BCG.

Prevention of tuberculosis caused by M. bovis , however, proved to be much simpler. The United States attacked this strain aggressively by testing 300 million cattle and then paying farmers to put them down if infected. Death rates from M. bovis between 1910 and 1932 declined by ninety-two percent and by 1940, ninety-nine percent of milk cows in the United States were free of the bacterium (Dormandy 330). Most of

Europe also enacted strict laws regarding bovine testing in quick succession (Dormandy

332).

Following the advent of effective pharmaceutical therapies, the hope was that tuberculosis would soon essentially be eradicated. After decades of decline, however, rates of tuberculosis spiked in the early 1980’s. The reason for this was twofold: the

could be better suited to prevention of tuberculosis. Once the antibiotic isoniazid was commonly used to prevent and cure TB in the U.S., BCG was then unable to be administered due to an incompatibility (Daniel 139). 41

spread of HIV/AIDS, and the emergence of multidrug resistant strains (Dormandy 386). 33

Tuberculosis today therefore remains a global health priority. The most recent data from the World Health Organization indicate that over two billion people worldwide—nearly one third of the world’s population—carry a form of the tuberculosis bacillus, and 1.7 million people died of TB in 2009 (“WHO TB Facts”). There were 9.4 million new infections in 2009, which is an incidence rate of 140 per 100,000 people, a decrease from the 2004 peak of 145 per 100,000 (“WHO TB facts”). In 2008, the most recent year for which numbers are available, 3.6 percent of these cases were MDR (multidrug resistant) tuberculosis, and 5.4 percent of the MDR cases were XDR (extensively drug resisant)

(“Multidrug”, 1-2). According to the Centers for Disease Control and Prevention, there were 11,182 cases of tuberculosis reported in the United States in 2010, which translates to 3.6 cases per 100,000 people. This represents a continuation of the decline of TB rates that began in 1992, and is in fact the lowest rate of tuberculosis since reporting began in

1953 (“CDC TB Fact Sheet”). 34 The rates of MDR are falling in the United States as well, from 2.5% of tuberculosis cases when the recording of MDR TB began in 1993 to

1.2% in 2010 (“CDC TB Fact Sheet”). Germany had 4,432 cases of tuberculosis in 2009, the most recent year with available data (“Daten”). This, too, is part of a pattern of decline. While tuberculosis is no longer the scourge of the western world that it once was, it is still a very present disease worldwide and one that continues to offer new challenges to physicians, scientists, and infected people alike.

33 Enarson, Chiang, and Murray have stated that TB and HIV are a dangerous combination, as each exacerbates the accelerates the progression of the other. TB is the most common cause of death in HIV/AIDS patients today (Enarson, et al. 21). 34 The CDC has noted that the rate of this decline has been slowing in recent years (“CDC TB Fact Sheet”). 42

Part II. Consumptive and Tubercular Writers

Artists have of course been as susceptible to tuberculosis as any other people living in the same time and place. Accordingly, scores of writers have been afflicted with tuberculosis, or with consumption, if they lived before a reliable TB diagnosis was possible. While the list of those writers infected is quite extensive and far-reaching, I will touch upon the most notable. The stories I will outline showcase a full range of treatment options, reactions to the disease during different times, and theories about the etiology of the disease.

The seventeenth-century French playwright and actor Molière likely contracted the disease as a result of the overcrowding he experienced while in debtors’ prison. He would live on for years with active consumption while continuing to act and write. His works included particularly biting commentary about “the murkier side of medicine” and he ridiculed hypochondriacs (Dormandy 10). Molière eventually suffered a pulmonary hemorrhage onstage while acting in his own play, Le malade imaginaire (The

Hypochondriac ) in 1673; after completing the performance, another hemorrhage befell him and he died a few hours later at home (Dormandy 10).

A century later, German poet Christian Fürchtegott Gellert dealt with his own consumption by turning to God, in particular by writing about God as revealed in nature, before he succumbed to the disease in 1769 (Dormandy 85). Friedrich von Schiller

likewise wrote throughout his consumption infection, symptoms of which had been present since his mid-twenties. His first major health crisis would come in 1791, when he was 32 (Alt 48-9). Schiller relinquished his teaching post at the university in Jena due to this, but as Dormandy has explained, “It was during this slow and never complete recovery that he [Schiller] wrote his best reflective poetry, progressing from the youthful celebration of physical freedom to the exploration of the freedom of the soul, moral grace” (Dormandy 86). It was after this, too, that Schiller wrote his most enduring theatrical works, including Wallenstein (1799) , Maria Stuart (1800) , and Wilhelm Tell

(1803/4) . Alt has asserted that Schiller’s productivity was due to his knowledge of having a limited amount of time left to write. This drive created a vicious cycle, however, wherein Schiller’s need to write as much as possible negatively affected his health, leaving him with less time overall to work before his death in 1805 (Alt 54).

The consumption experience of English Romantic poet and licensed physician

John Keats has been described extensively, and is notable for his engagement in the various popular remedies of the time, including the travel cure. 35 The origins of his disease were most likely his exposure to it from his family, as his mother and brother

Tom both died of consumption, and Keats had been very involved in their care. In keeping with the northern European belief that consumption was not contagious, however, this means of contraction was not officially acknowledged during Keats’ illness

(Dubos and Dubos 12). 36 The poet’s first episode of hemoptysis occurred in 1820, after

35 Although Keats was a qualified doctor, he never showed much interest in the field (Dormandy 13). 36 Even though contagion was not officially acknowledged, it was a common belief that those, like Keats, who spent much time in the room of a consumptive would then become consumptive themselves (Dubos 13). 44

which Keats, understanding the significance, said: “That drop of blood is my death warrant. I must die” (qtd. in Hewlett 287). Keats would nonetheless undergo repeated bleedings in attempts to treat the disease, and he adhered to a starvation diet that was at the time thought to be efficacious (Hewlett 289).

Despite his earlier dire proclamation, Keats did experience a few months of optimism when well-known physician Robert Bree attributed Keats’ symptoms to his hypochondria. Bree therefore recommended the cessation of the starvation diet and bleedings, replacing them with a robust diet, exercise, and even a small amount of red wine (Dormandy 17). 37 Unfortunately, Keats’ pulmonary hemorrhaging soon reasserted itself, and, at the urging of his doctors, he decided to accept Percy Bysshe Shelley’s invitation to spend the winter of 1820-21 in Italy, although the two did not stay in the same city (Dormandy 17-18). 38 Shelley had set off for Italy in 1818 due to his own consumption, and thus these two poets joined in the trend of combating consumption with trips south (Dubos and Dubos 18). 39 Keats’ British doctor there prescribed horseback riding as exercise, bled Keats after hemorrhages, and put him on an exceptionally scant diet, but neither these treatments nor the warm southern air could cure him—in fact, the bleeding and diet probably only caused more suffering (Dormandy 20). Keats died on

February 23, 1821 at the age of 25, and the autopsy that followed showed lungs so

37 Bree believed that this hypochondria was due to Keats’ profession as a poet, and suggested he combat this by turning to a scientific career instead (Dormandy 17). 38 Just before Keats’ relapse, he published a collection of poems. John Gibson Lockhart wrote a scathing review of it, and a legend was born that it was the stress of this review that led to Keats’ worsening health (Dormandy 17). 39 Shelley’s consumption was indeed improving during his stay in Pisa, but his life ended suddenly in 1822 due to a sailing accident (Dubos 19). 45

ravaged by tuberculosis that it was amazing he had survived as long as he had (Hewlett

372).

The Brontë family, including writers Anne, Emily, and Charlotte, are a startling example of the contagious nature of tuberculosis and its effect on entire families. The famous Brontë women were the children of Patrick, an Irish Methodist minister, and his wife Maria. For many years, Patrick had had a chronic cough that was attributed to bronchitis, but was in hindsight likely tuberculous (Daniel 30). Maria Brontë died of suspected puerperal sepsis (commonly known as childbed fever) several months after giving birth to her sixth child, Anne, in 1820. Given the extended nature of her illness, it is more probable that she herself had either tuberculosis, potentially contracted from

Patrick, or another such chronic illness. Left to care for the children on his own, Patrick sent his four oldest daughters, Maria, Elizabeth, Charlotte, and Emily, to a boarding school for the children of evangelical clergy. The conditions there were less than favorable and thus epidemics of disease quickly spread through the school’s population

(Daniel 31). Maria, 12 at the time, died of consumption a year after entering the school, on May 6, 1825, and was followed in death by Elizabeth not quite a month later, on June

1, 1825. 40 While it is certainly possible the sisters contracted TB while at the school, the other possibility is that their father was the source, and the harsh conditions at the school led to the disease’s emergence (Daniel 31). Patrick then removed the other two girls from the school and the remaining Brontë children spent the next six years at home in

Haworth, England. They then set off for school, either as pupils or governesses, but

40 Maria’s illness and death were likely the source for the description of Jane Eyre’s friend Helen’s consumption in Charlotte Brontë’s novel Jane Eyre (Daniel 31). 46

always returned home due to the detrimental effects of these departures on either their health or their morale. The lone son, Branwell, pursued life as an artist, poet, and tutor before he also returned home (Dubos and Dubos 36-7). Branwell was the next Brontë to succumb to consumption, dying at age 31 on September 24, 1848, and he was quickly succeeded by his sister Emily, the thirty-year-old author of Wuthering Heights , on

December nineteenth of the same year (Dubos and Dubos 37-38). Before her death,

Emily included consumption in her great novel, wherein several characters die of the illness (Dormandy 92-3).

Anne Brontë attempted to cure her own worsening consumption with the cod liver oil and iron carbonate prescribed by her doctor, as well as a trip to the English seaside where she could breathe in the purportedly efficacious sea air. These actions were all in vain, and she died at the shore on May 28, 1849, at the age of 29 (Dubos and Dubos 38).

Charlotte, the lone remaining Brontë child, remained at Haworth until she was married in

1854, writing in letters of her own tubercular symptoms. She became pregnant soon after her wedding, but she quickly showed worsening symptoms of consumption, and was diagnosed officially as having the illness (Dormandy 104). Charlotte died a few months later on March 31, 1855, still pregnant and one month shy of her thirty-ninth birthday

(Daniel 104). 41 At this point, only the patriarch of the family remained. Patrick died six years after his last child, of his supposed bronchitis (now suspected to be tuberculosis) and digestive problems, at the age of 89 (Daniel 104).

41 The effect of pregnancy on tuberculosis progression is unclear; various studies prior to the advent of effective antibiotics came to conflicting conclusions (Garay 626-7). 47

American author Henry David Thoreau, like the Brontës and Keats, also came from a family rife with consumption. His sister died of the disease; his brother had also had it, but died of lockjaw before consumption could claim him; and his father died of a condition not specifically named as consumption, but with the telltale symptoms (Dubos and Dubos 41). Thoreau had likely been suffering from tuberculosis for years, but his health declined significantly in the spring of 1856, when he was nearly 39 years old. 42

He did regain some of his strength, but he never returned to being completely healthy after this, and according to Daniel, he “[…] retreated to Walden Pond primarily in hopes of achieving a cure” (Dubos and Dubos 42, Daniel 35). Dubos and Dubos have also noted a change in his journal writing before and after his illness. While earlier “[…] the pages overflow with a passionate, almost inebriated, sense of the beauty of nature,” after this point, “[…] the entries deal more and more with minute and dry records of detailed observations and with uninspired plans for a history of Indian life—as if a lack of vitality had stilled his creative genius” (Dubos and Dubos 42). He, too, traveled outside of his home region to find a cure by venturing to a boarding house in the dry climate of

Minnesota, but this proved unsuccessful and he died on May 6, 1862, at the age of 45

(Harding 450, 466). 43

The Scottish author Robert Louis Stevenson likewise lived for a long time with the disease, and during the course of his infection, he traveled extensively to nearly all of

42 Walter Harding has posited that the unnamed illness Thoreau suffered in 1836 was actually his first instance of active TB (Harding 44). 43 Thoreau’s good friend and fellow transcendentalist Ralph Waldo Emerson also came from a family greatly affected by what was likely tuberculosis; he and all his brothers contracted the disease, as did his first wife and several of his children by his second wife, among others. Emerson himself survived the consumption and eventually died of pneumonia at the age of 79 in 1882 (Dubos and Dubos 39-41). 48

the most popular treatment locations. Although he was not told that he likely had tuberculosis until he was 23 years old, he had probably had the disease since boyhood.

His traveling in search of a relief began when his mother took her chronically sick son to the seashore in search of recuperation (Daniel 106-7). Convinced then by his doctor to go to the French Riviera after his initial diagnosis, Stevenson found the climate beneficial and would return there in years to come when his health dictated it (Daniel 107). He later followed his future wife, the then-married Fanny Osbourne, to California in 1879. Here he also engaged in the American open system of TB treatment by first camping out in the countryside and then living in a modest home, spending much time outdoors. While it is not clear whether he did this intentionally or simply because these were the only accommodation options available to him, Stevenson soon recovered his strength (Daniel

107, Callow 132).

When his health took another turn for the worse, he received his official diagnosis of tuberculosis in 1880, and then, at his doctor’s suggestion, traveled to Davos for treatment. There, his health again improved, and he was released from care and returned to Scotland after about a year and a half, only to have his health again decline a few months later. Despite his ill health, Stevenson continued to write while at Davos, even finishing Treasure Island during this stay (Bevan 88-89, 98-99). 44 He was pronounced well enough to leave Davos in the spring of 1882, but his doctor implored him to move to the south of France in order to maintain this state. After a few stops in Britain, where

Stevenson’s episodes of hemoptysis returned, he and his wife did so, settling in

44 In an effort to ease his breathing, Stevenson’s right hand was splinted to his chest, forcing him to write with his left (Daniel 108). 49

Marseilles (Bevan 101-2). Marseilles did not prove to be beneficial, but Stevenson did have several relatively healthy years in England and Switzerland after this, during which time he wrote The Strange Case of Dr. Jekyll and Mr. Hyde. His health failed once more, however, and in 1887, he set out for Colorado in yet another attempt to find relief

(Bevan 103, Daniel 108). Upon his arrival in New York City, Stevenson became too worn out to attempt the rest of the trip to Colorado, and so headed instead for Saranac

Lake and Trudeau’s Adirondack Cottage Sanatorium, where he would spend the winter

(Callow 212). 45 In April of 1888, Stevenson, again relatively well, left with his family and began traveling in the South Pacific. He eventually settled in Samoa, where he felt better than he had in many years, although he still was not entirely well. Stevenson died on Samoa on December 4, 1894, at the age of 44, when he suffered a cerebral hemorrhage (Daniel 110). His cause of death was not specifically linked to his TB, but his life of illness may have well played a role, albeit perhaps indirectly, in his death

(Daniel 109).

Katherine Mansfield, a New Zealand native who is primarily known for her short stories, likewise traveled far and wide in search of a cure. Mansfield was first diagnosed in 1917, after she had left her homeland and was living in Europe (Reibman and Lennon

6). 46 She spent time in the French and Italian Rivieras as well as the mountains of

Switzerland before turning to alternative treatments, such as radiation of the spleen, all the while refusing to stay in an actual sanatorium (Dormandy 279-81, Reibman and

45 Stevenson did not particularly enjoy his time there, as he found Trudeau difficult to get along with and he disliked the laboratory tests performed at the sanatorium (Callow 213). 46 Although it is of course impossible to prove, Mansfield biographer Claire Tomlin believes that D.H. Lawrence is a likely candidate for having spread TB to Mansfield. She not only stayed near the Lawrences for two extended periods of time, but would also stay the night or share meals with them (Tomalin 163). 50

Lennon 6). Mansfield held two strong, yet conflicting, beliefs about her illness: that she was terminally ill, and that she would fully recover and go on to have children and live a happy life with her husband (Tomalin 167). She therefore continued on in her search for a cure, and her journeys finally brought her to the mystic George Gurdjieff in Avon. This alternative treatment—referred to by some as mere quackery—unfortunately also failed to cure her, and she died there in 1923 at the age of 34 (Tomalin 233, 237).

Anton Chekhov, the Russian playwright, short story writer and—like Keats—a medical doctor, learned the night after the “disastrous” first performance of The Seagull in 1896 that he had tuberculosis and was in fact quite ill (Dormandy 187). Although he had long suspected the extent of his illness, this confirmation, and the accompanying strong suggestion that a warmer climate would prolong his life, led to his residence in

Yalta (Dormandy 187). 47 Throughout his writing in the six years to come, Chekhov never once used the word tuberculosis in his works.48 Rather, Dormandy has described

Chekhov’s final plays as “[…] unique insider studies of the tuberculosis destiny without once mentioning the illness” because to do so would have “[…] robbed his plots of their inner tension” (Dormandy 189). This also would have been inconsistent with the way most tuberculous people behaved, which was never to acknowledge their illness as such.

Chekhov would eventually spend time in the south of France and Italy, and would even go on to marry actress Olga Knipper, but his final attempt at finding a cure in

Badenweiler, Germany, was futile and he died there in 1904 (Dormandy 193, 197-8).

47 Yalta was a destination for many Russians seeking health who did not have the resources to finance a stay in the French Riviera (Dormandy 187). 48 Chekhov features tuberculosis in his play Ivanov, but it was first performed in 1887, before Chekhov was officially diagnosed (Dormandy 190). 51

The American poet Paul Laurence Dunbar joined the ranks of the tubercular writers when his disease manifested itself in the form of hemoptysis in 1899. Originally told he had pneumonia, Dunbar was sent by his doctors to recuperate in the mountains surrounding Denver (Gayle 115-17). Dunbar was barred from the sanatoria, hospitals, and clinics, however, due to his skin color. 49 However, he was fortunate not to have been being put in jail or a mental asylum, as was the fate of many African Americans with suspected tuberculosis. While Dunbar tried every available remedy to treat his pulmonary hemorrhaging and the accompanying pain, he continued to write and travel across the United States, giving readings in order to earn money. Dubar survived seven years after his initial episodes suggesting TB, dying of the disease in 1906 at the age of

34 (Reibman and Lennon 4).

The Japanese writer and physician Mori Ogai believed himself to be infected with tuberculosis in a country where this disease brought shame upon one’s entire family.

Although tuberculosis was the cause of death of one in seven Japanese people at the turn of the century, it was still seen as a moral transgression; it was also cause for not only the entire family being ostracized, but also for the prohibition of the next generation to marry

(Reibman and Lennon 5). Ogai therefore refused to be examined until he was on his deathbed in 1922, and even then, the results were not made public until 30 years later, when it was revealed that his lungs were indeed full of bacilli (Reibman and Lennon 5-6).

Unlike Chekhov, Ogai included the topic of tuberculosis in several of his works. In the short play Masks (Kamen, 1909) , he wrote the story of a doctor treating a tubercular student, to whom the doctor confesses his own tuberculosis infection for the first time.

49 For a discussion of the care of black tuberculosis patients in the United States, see Bates 288-310. 52

The doctor also imparts on the student his personal philosophy of remaining detached from others so as not to betray the secret of being infected. This lonely path was the one

Ogai chose for himself, as it was the only alternative to living the life of complete isolation that in Japan his illness would have dictated (Reibman and Lennon 6).

Perhaps one of the best-known tubercular authors was the Prague writer Franz

Kafka. First diagnosed in 1916, Kafka did not see his illness as a complete catastrophe, but instead as his body’s way of providing an escape from the adult world he feared and in which he did not feel comfortable. He viewed it as his the physical manifestation of his feelings of alienation, bringing with it a means of separating from the mainstream world

(Dormandy 313-4). Further, as Sander Gilman writes, “[…] Kafka’s illness was also the axis on which he and his world turned,” (Gilman 5). It would come to shape his view of himself greatly, because for Kafka, this disease was not an entirely physical, personal one, but rather “[t]his is the story of the Jewish patient, whose anxiety is located in the body, but whose real source is the social displacement felt by Jew’s [ sic ] in fin-de-siècle

European society” (Gilman 96). This is not an entirely negative sentiment, because the disease reveals what Kafka considered to be a truth. The cause of Kafka’s disease remains unknown, partly because he could have contracted it by any number of means: like many others, due to the conditions during and after World War I; from the large amount of unpasteurized milk he drank daily; from the stress of being overworked; or, as a result of the weakened state in which the Influenza Epidemic of 1919 left him

(Dormandy 316). Kafka sought care at several sanatoria and spas, one of which was located in Matliary, Slovakia. In this instance, he was a beneficiary of tuberculosis

charities that funded his sojourn. This sanatorium was essentially a boarding house with a doctor who visited daily in order to prescribe the food, rest, and exercise. 50 Kafka enjoyed the congenial atmosphere, but he returned to Prague after six months with no notable improvement (Dormandy 316-7). In 1922, Kafka retired from his job at the

Arbeiter-Unfall-Versicherungs-Anstalt für das Königreich Böhmen due to his health, and while recovering from an episode of hemoptysis in Müritz, he met his final love, the nineteen-year-old Dora Diamant. The two lived together in Berlin, but as Kafka’s condition worsened, his family insisted he return to Prague. His family wanted him to seek care at the Vienna clinic of Professor Markus Hajek, but Dora was appalled by the stringent atmosphere and, with the help of Kafka’s friend Robert Klopstock, she took him to the smaller Kierling sanatorium outside of Vienna. There, the two could care for

Kafka under their own terms and bring in their own specialists (Dormandy 319). The tuberculosis had by then settled in Kafka’s larynx, causing him essentially to starve to death as he could not swallow, and he died on June 2, 1924, one month before his forty- first birthday (Dormandy 319-20).

The British author Eric Blair, better known by his pen name George Orwell and as the author of such novels as Animal Farm (1945) and 1984 (1949), lived long enough to see the advent of the chemotherapeutic treatment for TB. It was difficult to procure streptomycin in Britain, but Orwell called upon his friend David Astor, the wealthy

American newspaper publisher, to obtain the medication for him (Crick 537-8). Orwell was thus one of the earliest patients in Britain to be treated with streptomycin. Although

50 Kafka was a vegetarian, and therefore objected to the prescribed diet because it was heavily based on meat and fish (Dormandy 317). 54

this afforded him the time to finish 1984, he himself believed that this work would have been better had he not been writing while sick (Davison 134). After initially favorable results, Orwell soon suffered such severe allergic reactions to the drug that he had to discontinue treatment after 50 days (Crick 540). Even a later course of paraaminosalicylicacid (PAS) could not cure him, and he died in 1950 at the age of 46

(Reibman 29-30).

Like Orwell, the French Algerian writer Albert Camus contracted tuberculosis during an age with increased treatment possibilities. Diagnosed at 17, he initially was treated by a rich diet and the vaunted surgical intervention of an artificial pneumothorax, and his recurrent illness would continue to be treated with similarly conventional methods (McCarthy 19). Tuberculosis greatly affected Camus’ career path. First intending to be a teacher, he was denied a license due to his disease, and instead worked as a journalist. He then tried to join the Spanish Civil War on the side of the Republicans and later to enlist in the French forces during World War II, but was turned away from these pursuits as well. This left him with ample time to pursue his writing (Reibman and

Lennon 7). Reibman and Lennon even suggest that “[i]f the plague [in Camus’ 1947 novel The Plague ] is clearly a metaphor for the Nazi occupation, the imagery is derived from Camus’ own illness” (Reibman and Lennon 7). Camus’ tuberculosis had gone into an extended dormancy, but he began to suffer episodes of hemoptysis in 1947, and so in

1949, he, too, received a course of treatment with streptomycin and PAS. Having

tolerated the drugs well enough to complete the course of treatment, he was cured of TB at the age of 36, only to die in a car accident 11 years later (Reibman and Lennon 7). 51

51 Reibman and Lennon have posited that though he was free of TB, “[h]aving lived life as a condemned man, Camus could not sanction taking the life of another,” and his illness experience thus continued to affect his political views and stances (Reibman and Lennon 8). 56

Chapter 2: Depictions of the Sentimentalized Consumptive

The dominant depiction of consumption throughout the nineteenth century was that of the angelic consumptive, a person who has either contracted the disease through some virtuous act or whose virtue is enhanced by the very fact of having consumption, with its connotation of goodness. 52 Clark Lawlor, in Consumption and Literature: The

Making of the Romantic Disease (2006) has traced this conception of the disease to the eighteenth century when, as humoral theory was being abandoned, the popular focus turned to the nervous system. With this development, consumption became positively associated with the spiritual and aesthetic realms as a sign of sensibility (Lawlor 44).

This is also the most simplistic usage of the disease, in addition to being the most widespread. The consumptive characters in this model are static in their representation; the fact of having the disease does not change them or their actions, although it may alter the characters that come into contact with them. For these consumptives, the disease is a signification of their inherent goodness, which remains a constant, and therefore they are not in need of personal growth or change through the disease experience. Part of the appeal of this disease’s inclusion in a literary text, as opposed to other infectious illness such as cholera, was in the fact of its comparatively long duration before death. Those who were infected did not die immediately, but rather, as Herzlich and Pierret have

52 I will use the term “consumption” for the works written before a clear diagnosis of tuberculosis could be made. Most, if not all, of the works dealing with consumption were in fact presenting descriptions consistent with TB. 57

explained, remained alive long enough to establish an identity as a consumptive (Herzlich and Pierret 30). As such, literary figures with the disease could be depicted for a sufficient amount of time within the text for their virtue to be established before an inevitable demise. Works of western literature are replete with this portrayal of consumption, and the writers of the mid- to late nineteenth century produced a particularly rich number of works including it. These texts often do not discuss treatments, however, for two reasons: for one, the reality was that the options for treatment were very few during much of this time span, and secondly, the death of the sympathetic character from consumption intensified the positive connotation the consumption had lent him. This paradigm of consumption in literature began to taper off at the turn to the twentieth century as the romanticized imagining gave way to a more naturalistic one.

English and American Representations: Charles Dickens, Louisa May Alcott, and

Harriet Beecher Stowe

This portrayal of tuberculosis was seen early and frequently in British literature.

Many of Charles Dickens’ novels include secondary characters who are afflicted with consumption, and his earlier representations conform to this sympathetic portrayal. 53

One illustration of this is found in The Life and Adventures of Nicholas Nickleby (1838-

39). In this novel, Nicholas Nickleby’s sidekick Smike enters the story as a sympathetic character and remains so throughout. Nickleby first encounters Smike at a home for

53 Attendant to my forthcoming discussion of Thomas Mann’s novella Tristan, I will discuss a later example in which Dickens used consumption in a different manner. 58

unwanted children, where Smike, as he is older than the other children, now essentially acts as an unpaid servant. This creates an initial image of Smike as an outsider character who evokes sympathy through his status not only as unwanted child, but also as a child who no longer even has a peer group amongst the unwanted children. Further, he is abused by the school’s owner, who is also the novel’s antagonist, and Smike is not only perpetually ill, but also portrayed as somewhat dull. Smike is nonetheless a loyal friend to

Nickleby. When he contracts consumption, this serves to intensify and magnify the goodness of his character, as consumption is presented as a disease of the innocent and the good. Smike’s illness also functions to allow Nickleby, who cares for Smike and stays with him until his death, to prove himself to be a positive protagonist whom the reader can champion. This behavior stands in stark contrast to that of the antagonist

Wackford Squeers, who had taken advantage of Smike despite his sickly nature. Dickens thus used Smike’s consumption to mark not only Smike but also Nickleby as even more positive, while simultaneously intensifying the negative nature of Squeers’ character.

Dickens employed tuberculosis in a related manner through the character of Nell

Trent (“Little Nell”) in The Old Curiosity Shop (1840-41). Nell Trent is also an orphan, a condition which, as with Smike, immediately evokes reader sympathy toward her as a parentless child. She then contracts a fatal case of consumption while aiding her grandfather, whose name is never given, in finding sanctuary from the debt collectors who were pursuing him. The grandfather had incurred gambling debt through his efforts to provide for Trent, and so he, too, is a positive character despite what would otherwise

appear to be dubious actions. Nell Trent’s death of consumption is therefore a death of sacrifice and proof of her devotion to her grandfather and her appreciation of him.

Since neither Smike in Nicholas Nickleby nor Nell Trent is an adult, this adds to the feeling of innocence and virtue that accompanies both of their lives and eventual deaths. Emilie Babcox has pointed out in Health, Illness, and Medical Theory in the

Novels of Jane Austen, Charles Dickens, and Charlotte Brontë (1998), that sickness in

Dickens is ascribed to characters who are virtuous and lacking in sexuality (Babcox 117).

Dickens’ depiction of characters with consumption then underscores their purity.

Accompanying this aesethetic is the trope of the gentle consumptive death. In the romanticized view of consumption prevalent at the time Dickens was writing, death from this condition was peaceful and beautiful. As Susan Sontag explains in Illness as

Metaphor (1978), “For over a hundred years TB remained the preferred way of giving death a meaning—an edifying, refined disease. […] Nineteenth-century literature is stocked with descriptions of almost symptomless, unfrightened, beatific deaths from TB”

(Sontag 16). This beautiful death then allows these characters to remain angelic and positive even as they leave the world; their lives lived in the service of others are rewarded with a painless, peaceful death. As Babcox has noted, Dickens actually ceased depicting consumptive people in wholly sentimentalized, angelic manner after witnessing the reality of his sister Fanny’s painful and agonizing death from tuberculosis in 1848

(Babcox 124).

This relatively simplistic usage of consumption employed by Dickens up to his sister’s death was also present in the similarly widely read works of Louisa May Alcott

and Harriet Beecher Stowe. The character of Beth March in Louisa May Alcott’s 1868-

69 novel Little Women is very much akin to Nell Trent. Beth March’s consumption, too, is a result of putting others before herself. She had initially contracted scarlet fever when helping a poor family. Although she survives this illness, her body is weakened, allowing consumption to take hold and to eventually cause her death. Alcott described the change in Beth March as having “[…] a strange, transparent look about it, as if the mortal was being slowly refined away, and the immortal shining through the frail flesh with indescribable beauty” (Alcott 371). This portrayal frames consumption as a spiritualizing disease; her illness, while seemingly tragic in someone so young, good- hearted, and beloved, is also in this way written as a positive occurrence. She may be leaving her mortal body, but the implication here is that through her illness, she is evolving toward an even higher plane of existence. Beth March is ill because she was so virtuous, but her illness then intensifies this characteristic. While Alcott does not entirely leave out the reality of the pain of dying of consumption, her description of it is brief.

She then ends the passage with the assertion that “[w]ith the wreck of her frail body,

Beth’s soul grew strong” (Alcott 415), thus placing emphasis on the positive spiritual result of the disease rather than on the physical suffering. Her death is subsequently quiet and peaceful, with “[…] one loving look and a little sigh” (Alcott 419). Beth March is now wholly spirit, and her seamless passing into this phase is a fitting result of—and reward for—her honorable actions in life.

The character of Evangeline St. Clare (“Little Eva”) in Harriet Beecher Stowe’s anti-slavery novel Uncle Tom’s Cabin (1852) is a white slave owner’s young daughter.

She is a representation of goodness and charity, as she espouses love and forgiveness toward all, including the family’s slaves. She even advocates to her parents on behalf of the slaves in order that her parents might treat them more kindly. Clark Lawlor has aptly described Evangeline St. Clare’s death as “redemptive” in that it is through her consumption that those around her—be they black or white, slave or owner—vow to make major positive changes in their lives (Lawlor 169). Evangeline St. Clare gathers the slaves and family members around her deathbed and asks each to turn to Christianity and lead pious lives so that they might join her in heaven. During Evangeline St. Clare’s final days, she gradually moves from earthly body to heavenly spirit, which is indicated, as with Beth March in Little Women , by the physical change of her skin becoming ever more transparent, emphasizing her ethereality (Lawlor 170). Even more than the characteristically gentle consumptive death, Evangeline St. Clare’s moment of death is a blissful one: “A bright, a glorious smile passed over her face, and she said, brokenly—

‘Oh! love—joy—peace!’ gave one sigh, and passed from death unto life!” (Stowe 297).

Evangeline St. Clare thus leaves those who knew her to change their own lives so as to emulate her goodness. Evangeline St. Clare had been a beloved member of the household before her consumption, but the disease and death serve to deepen this and essentially beatify her in the eyes of those with whom she had interacted.

French and Italian Representations: Alexandre Dumas, fils, Luigi Illica & Giuseppe

Giacosa, and Victor Hugo

Even in works where the consumptive did not wholly conform to the image of purity of spirit, the use of consumption as an illness with a positive connotation served to soften the character’s less savory aspects. This is the case in Alexandre Dumas, fils’

1848 novel La Dame aux camélias .54 The central female figure, Marguerite Gautier, is a prominent courtesan in Paris. 55 Wealthy suitors finance her lavish lifestyle, but her future is now threatened due to consumption. The male protagonist, Armand Duval, falls in love with her despite both her profession and her illness, and the story chronicles their attempts to stay together despite Gautier’s financial needs, which cannot be fully satisfied by Duval without estrangement from his family. Ultimately, Gautier dies alone and in poverty, having forsaken Duval’s affections at the behest of his father in order not to ruin

Duval’s chances for a high social station in life.

Although Gautier had initially engaged in a chaste suitor-courtesan relationship with a duke, she chooses to maintain her opulent standard of living by amassing more suitors with whom she does have a sexual relationship. Dumas’s description of

Marguerite Gautier’s overt behavior toward Armand Duval in particular does not portray her in a positive light. She is controlling and makes financial demands upon him that he cannot truly afford, while at the same time professing her love for him.

54 This novel was adapted into a play in 1852 and then Giuseppi Verdi and Francesco Maria Piave developed it into the opera La traviata , which was first performed in 1853. 55 The figure of Marguerite is based on the real life lover of Alexandre Dumas, fils, Marie Duplessis. Duplessis was likewise a courtesan who died of consumption. 63

Gautier’s consumption softens her character, though, creating a more sympathetic and understandable figure. In fact, it is because of her consumption that she allows

Duval, who is much less distinguished than her other suitors, to be a part of her sphere:

Gautier was touched by Duval holding her hand and shedding tears while she coughed up blood (Dumas 140). Marguerite Gautier’s impending death also adds intensity to the story. The reader knows that she will soon die, and therefore her relationship with Duval is always viewed in light of its inevitable brevity. Further, although Gautier knows Duval would sacrifice everything for her comfort, she alienates his affections so that he will not be ruined, and in so doing condemns herself to die alone and destitute. Her death is not an angelic one, but the way in which she chooses to die is a sacrificial one, mitigating the harder edges to her character that are seen through her earlier interactions. Armand

Duval seems to be the truly virtuous one throughout the novel, but Marguerite Gautier, too, exhibits this willingness to save him rather than herself, thereby redeeming her in the eyes of the reader.

Two other later European works depict tuberculosis amongst the poor, and in each it is used to mark an adult woman as a person to be pitied rather than disdained for her low station in life. As Susan Sontag explains, “TB is often imagined as a disease of poverty and deprivation—of thin garments, thin bodies, unheated rooms, poor hygiene, inadequate food” (Sontag, Illness 15). The romanticized portrayal is retained in these works, but with the addition of an emphasis on the fact that consumption was a condition

primarily of the poor, rather than of the middle or upper classes. 56 The opera La Bohème , with the libretto by Luigi Illica and Giuseppe Giacosa and music by Giacomo Puccini, was first performed in 1896.57 It centers around a group of bohemian artists who are constantly on the verge of financial ruin. The figure of Mimi is a seamstress who becomes the lover of the poet Rodolfo, and it is Mimi who is consumptive. 58 Although

Mimi is not a child, as has been the case in the majority of the works I have thus far discussed, she nevertheless evokes compassion from the audience through her kind heart and her childlike need to be taken care of due to her tenuous physical condition. Mimi’s illness forms the crux of the opera, and it is this that threatens to tear apart Mimi and

Rodolfo. Despite his deep love for Mimi, Rodolfo pushes her away out of fear that he will not be able to care for her adequately. In this work, consumption therefore serves to intensify the love story. This illness and the financial realities of being ill are working against these two lovers being together. Not only do they agree to part so that Mimi can seek out a wealthy suitor in an attempt to improve her health, but even after returning to each other, they have very limited time together due to her health. The small band of bohemians does come together to attempt to help Mimi, thereby demonstrating another effect of consumption in La Bohème : to show the commitment the group has to one another. Rodolfo loses Mimi, but the group remains with him and each has proven their friendship to him by doing all they can to forestall Mimi’s inevitable death.

56 Smike and Nell Trent are also poor, but Dickens did not emphasize consumption’s association with the lower social standing, despite its implied role in their illness. Rather, Dickens focused more on the virtue of each character. 57 The opera La bohème is based on the novel Scènes de la vie de bohème by Henri Murger, which he wrote between 1847 and 1849. 58 The characters in La bohème are not given surnames. 65

Fantine, in Victor Hugo’s novel Les Misérables (1862), similarly leads a life of challenges. She has been abandoned by her daughter Cosette’s father and left to eke out a means of supporting both her child and herself. 59 While she is lacking any of Mimi’s childlike qualities, she is a young woman who has been taken advantage of by her lover, a circumstance which leaves her a pitiable figure. She is alone in the world fighting for the ability to raise her daughter as a single woman of limited means and no social standing. Despite her child’s illegitimate birth, Fantine is portrayed as a positive, sympathetic character. She works in a factory to pay for Cosette’s lodging with the

Thénardiers, who in truth are unscrupulous and cheat her out of money. As the couple ratchets up their demands, Fantine turns to ever more desperate means of attaining the money she believes will go to help her daughter. This indicates a self-sacrificing, hard- working woman who is doing everything she can for one even less fortunate than herself.

It is only after she has lost her position at the factory that Fantine turns to her final option to earn money, prostitution. As it becomes clear that Fantine has consumption and will soon die, her infection serves to intensify the reader’s view of her as a devoted mother and a virtuous but tragic figure whose disease is quite clearly a result of the poor living conditions she endures. Fantine is arguably more sympathetic than Marguerite Gautier in

La Dame aux camellias , as Fantine turns to prostitution only as the final option in order to support her child. Gautier, in contrast, appears to be less virtuous because her courtesan lifestyle, while difficult to leave, would not have been impossible to abandon had she been willing to make the sacrifice.

59 Hugo has provided neither Fantine nor Cosette with surnames. 66

The actions of Fantine’s eventual benefactor, the protagonist of the novel, Jean

Valjean, in the face of Fantine’s illness also serve to define his character. Fantine, unbeknownst to Valjean, had been fired from her job at his factory because of her illegitimate child. Valjean works to make up for this by supporting Fantine in her final days and by then caring for her child after Fantine’s death. Valjean’s actions in the face of Fantine’s consumption thus lend credence to the novel’s overarching thematic that he is a good person who seeks to right the wrongs perpetrated against the powerless.

A German Representation: Paul Heyse

Despite the ubiquitous European and American examples of the sentimentalized portrayal, this was not the case in German literature of the same time period. There are no texts that have attained the prominence of the examples presented above. Paul Heyse’s novella Unheilbar (1862), however, does to a degree fit this model. His presentation of symptoms is similar to that of the sentimentalized portrayal of consumption, which is generally limited to occasional coughing and weight loss. Brigitta Schrader has observed that throughout the course of the story Heyse mentions all of hallmark symptoms of consumption, but he does so without invoking their repulsive and disgusting reality

(Schrader 21). While one could attribute this to the fact that Heyse wrote this novella as a means of instilling hope in his wife, who was herself consumptive, Schrader also contends that there is no place in any of Heyse’s works for the ugly and the sick

(Schrader 12). 60 The storyline itself, told by an anonymous third party in diary form, deviates from the traditional one. Unlike nearly all of the other works I have thus far

60 Heyse’s wife Margarete did eventually die of the disease (Schrader 14). 67

discussed, neither the protagonist Marie nor her consumptive lover Morrik die of the disease. 61 Further, rather than being the typical static figure, each undergoes changes due to contracting the disease. Marie’s consumption brings her the opportunity for personal growth as she leaves the hometown in which she was not particularly happy in order to seek a cure in the milder climate of Merano, a popular Italian destination for sufferers of consumption. This is where she meets Morrik and each helps the other to develop worldly knowledge. In this manner, Heyse uses the illness as a positive force in their lives. In the end, it is revealed that Marie’s case had been misdiagnosed. She actually has had a nervous disorder that has subsequently been cured by caring for Morrik.

Morrik, who does truly have consumption, is cured by his contraction of a typhus-like illness that has allowed his body to vanquish the malady. The pair is rescued from their presumably incurable disease, but they nonetheless emerge as more mature people who have confronted death and considered life. While they are not overwhelmingly angelic characters, they are positive figures who have provoked growth in each other.

Focus on a German Representation: Erich Maria Remarque

Erich Maria Remarque’s 1938 novel Drei Kameraden is a significantly later

German work that does function much more within this established trope of the sentimentalized depiction of consumption. 62 German literature contains few examples of the sentimentalized portrayal between Paul Heyse’s 1862 text and Drei Kameraden.

61 Marie is given no surname. 62 Remarque’s books were banned in Germany during the Third Reich and he wrote Drei Kameraden while in exile. While Drei Kameraden was first published in German by the Querido Verlag in Amsterdam in 1938, the novel also appeared in Danish and English translation (Murdoch 67 and Firda 92). 68

German literature, unlike that in other European countries and the United States, was largely concerned during the intervening years with the unstable political situation of the

Wilhelminian era and then the ensuing instability following World War I. In keeping with this, Remarque used his sentimentalized depiction of this disease for several ends: he highlighted the ravages of World War I; portrayed the development of the protagonist,

Robert Lohkamp, in the wake of the war; and emphasized the buddy relationship among

Lohkamp and his two friends. The tubercular character, Patrice Hollmann (“Pat”), is a flat, typically angelic character that serves as Remarque’s means of establishing these themes, but she herself remains a stock figure that is undeveloped, and she is ultimately a sacrifice to the betterment of these men’s lives.

Drei Kameraden is the final work in the trilogy that began with Im Westen nichts

Neues (1929) and Der Weg zurück (1931). Like the two novels before it, Drei

Kameraden focuses on the interactions among the male characters and their life experiences. This text is primarily the tale of Robert Lohkamp as he navigates life in the post-World War I Germany of 1928 with his two former brothers-in-arms, Otto Köster and Gottfried Lenz. Lohkamp and his friends traverse the big city racing their rebuilt car and pursuing a daily life of drinking and otherwise just trying to get by. 63 While the men are out with racing vehicle one day, Lohkamp meets Patrice Hollmann. Love soon blossoms between the two, only to be cut short by Hollmann’s recurrent tuberculosis.

The character of Hollmann is loosely modeled on Remarque’s first wife, Jutta

Remarque-Zambona, who herself suffered a recurring bout of mild tuberculosis that

63 Murdoch has argued that the city is supposed to be Berlin, but it is only referred to as “die Stadt” in the novel (Murdoch 80). 69

required repeated stays in a Davos sanatorium (Tims 40, 60, 77). Aside from the illness itself and a physical likeness, the stories of the two women do not converge. As Wilhelm von Sternburg has argued, “Pat ist eine idealisierte Frauengestalt, so wie sich wohl der

Autor eine Lebensgefährtin erträumt. […] Die Gestaltung dieser Figur ist vor allem ein

Produkt seiner Phantasie” (von Sternburg 258). Patrice Hollmann is for Lohkamp a new hope and chance at finding direction in an otherwise meaningless existence. Prior to meeting her, there is little indication that Lohkamp has any goals aside from simply enjoying himself with his friends and making it through the days having scraped together enough money for alcohol and rent. His relationship with Hollmann provides him with a true focus for his life. On their first date, he remarks: “Sie erschien mir wie aus einer anderen Welt. Ich konnte mir absolut nicht vorstellen, was sie war und wie sie lebte”

(Remarque 36). This impression is due to her immediately apparent intrinsic goodness and innocence, which then in turn begin to inspire him to alter his behavior.

Hollmann’s mere presence in Lohkamp’s world enables him to focus his energies on something other than his antics with Köster and Lenz, and it is only through Hollmann that Lohkamp is able to overcome the ongoing negative impact that fighting in World

War I has had on him. Seeing Hollmann simply emerge from the ocean, Lohkamp thinks:

Einen Augenblick lang empfand ich die ungeheure, still Gewalt der Schönheit und spürte, dass sie stärker war als alle blutige Vergangenheit, dass sie stärker sein musste, dass die Welt sonst zusammenbrechen würde […] Und mehr als das noch empfand ich, dass ich da war, einfach da war, und dass Pat da war, dass ich lebte, dass ich herausgekommen war aus dem Grauen […] (Remarque 185)

Patrice Hollmann is able to bring Lohkamp peace with regard to his experiences as a soldier. Hollmann’s intentions always seem to be pure and her reactions forgiving to

Lohkamp’s sometimes raucous behavior. His friends even accept her as one of the group, which sets up their later efforts to help her. Her subsequently revealed tuberculosis is then further indicative of this innocent, giving nature Remarque has already established.

Hollmann long concealed her illness so as not to scare Lohkamp away from a relationship with her. Eventually, a hemorrhage reveals her secret, and when Lohkamp does not consequently flee her side, Hollmann tells him simply: “Ich bin ja glücklich”

(Remarque 206). These few words spark a monumental change in Lohkamp, as he reports:

Jetzt sah ich plötzlich, dass ich einem Menschen etwas sein konnte, einfach weil ich da war, und dass er glücklich war, weil ich bei ihm war. […] Es ist Liebe und doch etwas anderes. Etwas, wofür man leben kann. Für die Liebe kann ein Mann nicht leben. Für einen Menschen wohl. (Remarque 206)

Her tuberculosis thus allows Lohkamp to understand how important Hollmann is to him and he to her, and he then subsequently makes major alterations in his lifestyle. As Haim

Gordon has argued, “This love is a divine madness that transcends everyday reality”

(Gordon 80), and indeed, Lohkamp will now revise his everyday life to enable this love.

Upon their return to the city, the focus of Lohkamp’s attentions immediately shifts solely to caring for Hollmann. Hans Wagener has noted that Patrice Hollmann fits into the category of femme fragile (Wagener 48) , and this quality sets her up as a natural recipient of the robust, headstrong Lohkamp’s ministrations; he is taking care of one too weak to care for herself. In keeping with a traditional literary depiction of tuberculosis, she is also a woman who remains beautiful, albeit thinner, until the her death. In an ultimate

show of commitment to Hollmann, he even forgoes going out drinking and carousing with his friends in order to stay by her, telling her: “’Mein größtes Abenteuer heute kommt noch’ […] ‘Ich bleibe den ganze Abend hier mit dir zusammen’” (Remarque

259).

When it comes time for Hollmann to go to the sanatorium for the winter,

Lohkamp accompanies her, and then returns to the city where he earns money by playing the piano. He is concerned now not with earning for his own enjoyment, as he early was, but with having the money to pay for her stay (Remarque 297). Remarque’s use of this extended illness has allowed him to show Lohkamp’s dedication to Hollmann, just as

Dickens similarly used Smike’s consumption to illustrate Nicholas Nickleby’s positive traits. It is easy to devote oneself and one’s resources for a short illness, even though it may end in death. It is much harder to sustain that level of commitment when another’s malady requires self-sacrifice and when the illness has an uncertain outcome, as well as a physical separation in the form of the far-off sanatorium. All of this illuminates how deeply Lohkamp, whose true allegiances are limited to just a few people, has come to feel for Hollmann.

Remarque then reinforced this sentimentalized characterization of Patrice

Hollmann in the revelation of the cause of her tubercular illness. Hollmann is the victim of impoverished circumstances as a result of World War I that had left her without enough nourishment both during and after the war. The sanatorium doctor, in accordance with the scientific reality, blames these conditions for her infection and its emergence

(Remarque 352). Tuberculosis was a fate that befell many Germans during and after the

war, which accounts in part for Remarque’s choice of this disease long after the sentimentalized portrayal had essentially become passé. Patrice Hollmann is ill through no fault of her own, and she continues to suffer the devastating effects of the war long after it has ended. Whereas Lohkamp and his friends have turned to the numbing effects of alcohol to deal with the consequences of World War I, Hollmann virtuously reports that she has used her own “war wound” to lead a more fulfilling life. Since spending a year in bed with her initial infection, she tells Lohkamp: “Ich kann mich seit damals auch so leicht freuen” (Remarque 128). She therefore offers an alternative reaction to the devastation of World War I, using it as a way to improve her life and offering Lohkamp a new perspective on post-war existence that he subsequently begins to adopt.

Throughout this novel, it is the male gaze that brings with it the sentimentalization of the consumptive, as it was in many such representations of this disease. Hollmann’s innocent nature is conveyed through Lohkamp’s descriptions of her and his feelings toward her. She is also largely a character without agency, allowing Lohkamp to be the active partner in the relationship, determining such things as where she will receive treatment, where she will live, and how she will spend her day. This traditional passive female/active male dynamic further emphasizes Hollmann’s helplessness as a sick woman and highlights Lohkamp’s efforts to help her and save her. As a result of

Remarque’s portrayal of her in this way, Lohkamp’s actions are viewed as an example of patriarchal male benevolence coming to the aid of the innocent, defenseless dying woman who cannot do anything to change her situation herself. This is a very simplistic manner of painting Hollmann as the proverbial damsel in distress with Lohkamp as the hero come

to save her. Clichéd as it may be, this serves Remarque’s purpose in that by evoking this dichotomy of male and female roles, the reader easily identifies Lohkamp as the stereotypical man who, as proof of his love, swoops in to attempt to rescue a woman in trouble.

Unlike Lohkamp, Patrice Hollmann remains a very static character within the story. This gentle, loving, giving soul who inspires others to care for her is the one that

Remarque had depicted from the beginning of the novel and she remains so throughout.

Tuberculosis, of course, affects her place of residence and health, but Remarque has not included a fundamental change to her character. In this way, she is much like Fantine in

Les Misérables or Little Eva in Uncle Tom’s Cabin. Although she, like these characters, does not herself change, she inspires change in others. Hollmann’s function is to improve

Lohkamp’s life and to bring the three buddies together, and as such, Remarque has not imbued her with characteristics or a complexity that would deviate from this simple purpose.

Although Hollmann’s tuberculosis is integral to Lohkamp’s development, the sanatorium environment itself plays very little role in this. By the time Remarque wrote this work, the sanatorium was a common means of treatment for tuberculosis, but in keeping with the earlier sentimentalized usages of the disease, there is no true improvement in Hollmann. The sanatorium instead serves as simply one more place for

Lohkamp to express his devotion to this woman. Remarque had himself spent time in a sanatorium for a non-tubercular respiratory weakness following his service in World War

I, and accompanied his wife Jutta on portions of her stays in Davos (Taylor 87 and Tims

60). Perhaps in part due to these experiences, Remarque has accurately depicted the strict sanatorium rules that hinder communication between Hollmann and Lohkamp while they are apart. Thus Lohkamp’s persistence in attempting to talk to Hollmann, in addition to his unwillingness to search out more accessible, healthy women, further underscores his dedication to her. Since the focus of this work is on how Hollmann’s tuberculosis affects

Lohkamp and then bonds him further to his friends, there is also no real reason for

Remarque to delve deeply into the sanatorium experience. It is sufficient for the reader to know that Lohkamp is striving to maintain his relationship with Hollmann while there and in doing so solidifying his dedication to her.

Remarque has included limited scenes of Hollmann’s stay at the sanatorium, but they only serve to reinforce Hollmann’s unfailingly positive nature. Her own description of sanatorium life as “Ein strahlendes, schönes Gefängnis” where “Man lenkt sich ab, so gut es geht” (Remarque 312) is by no means a rousing endorsement of sanatorium life, but nonetheless reinforces her character as one who will try to make the best of the situation. Hollmann ultimately dies at the sanatorium, accompanied by Lohkamp, who has made every effort to make her last days in the sanatorium as pleasant as possible.

The novel ends with Lohkamp’s rather matter-of-fact description of her death as well as of his final attempts to minister to her: “Ich habe ihr dann das Blut abgewaschen. Ich war aus Holz. Ich habe ihr das Haar gekämmt. Sie wurde kalt. […] Dann kam der Morgen, und sie war es nicht mehr” (Remarque 386). Much like Beth in Little Women , she simply slips away in a gentle death befitting her gentle nature.

The description of Hollmann’s death offers no indication as to what he will do next or how his experience of losing his source of happiness and purpose will affect the remainder of his life. Wagener has posited that this novel argues that “[t]he only positive things in the world are happiness, love, and beauty as personified by Hollmann. Since these do not last, their transitoriness is also proof of the senselessness of human existence” (Wagener 51). Wagener then continued on to convincingly argue that the only other positive entity in this work is the relationship among the comrades (Wagener 51).

Patrice Hollmann’s illness is integral to the illustration of this, as it is her tuberculosis recurrence that allows Lohkamp to experience the depth of his relationship with the two others to whom he is closest, Lenz and Köster.

Remarque has used critical moments in Hollmann’s tuberculosis experience to illustrate how tightly bonded these men are to each other. An earlier model for this is the banding together of Rodolfo’s friends in La Bohème. Like Lohkamp’s friends, Rodolfo’s did everything they could think of to save their friend’s lover, thus proving their devotion to their friend. In Drei Kameraden, the most striking example of this is when Köster sells the racing vehicle in order to fund Hollmann’s sanatorium stay. This is the ultimate sacrifice, as this car had been the source of Lohkamp’s greatest times together with his friends. Here, Remarque has shown the strength of their commitment to one another, and this therefore lends an optimistic note to the novel’s end.

Several decades after the sentimentalized portrayal of consumption/tuberculosis reached its high point, Remarque has used it in Drei Kameraden as a means by which to convey the novel’s central themes. By using this well-established paradigm of

tuberculosis, Remarque was able to evoke in the reader the associations of consumption/tuberculosis that render Hollmann, as well as Lohkamp and his friends, as sympathetic characters. Hollmann essentially dies in service to the bond of friendship among these men and to their emotional recovery after their life-altering experiences of

World War I had left them questioning the value of human existence and relationships.

Chapter 3: Naturalist Depictions of Tuberculosis

As authors shifted away from the dominant portrayal of the sentimentalized consumptive, one of the chief depictions of the disease was a naturalistic one. In keeping with the tenets of naturalism, in this paradigm, consumption is generally portrayed in a much more realistic manner, both medically and in other ways that I will discuss below, and the sufferers are predominantly of the working class. This usage of consumption/tuberculosis is far more varied in its expression than the much more simplified and straight-forward sentimental portrayal. These consumptive characters are generally more complex figures and many do not remain static throughout the text.

Instead, the disease presents an opportunity for change within the figure. As Howard

Brody writes in Stories of Sickness (2003), illness creates a situation wherein the person’s life may remain essentially the same, but the trajectory of that life changes (Brody 2).

This can be seen in many of the works that fit into this paradigm. They present a less stylized portrayal of the consumptive or tubercular than the sentimentalized paradigm in favor of a depiction that is truer to the medical and social realities. These works can alternately use the presentation of these realities to serve as a call for the society around the infected person to change, even if the consumptive or tubercular character remains unchanged. It is difficult to ascribe characteristics within this paradigm that run through

all of the presentations, but each shares at least some of the aforementioned traits or themes and as such they are contained within this usage of the disease.

A Russian Representation: Fyodor Dostoevsky

The plot of Fyodor Dostoevsky’s novel Crime and Punishment (1866) centers around the murders of two old women that were committed by the Petersburg student

Raskolnikov, to which he confesses at the end of the novel. He is then sentenced to serve eight years of hard labor in Siberia for the crimes. A sub-plot concerns Katerina Ivanova

Marmeladova, the stepmother of the female protagonist, Sonya Marmeladova. Sonya

Marmeladova essentially serves as Raskolnikov’s spiritual guide and it is to her that he confesses his crimes. She is a wholly positive character, despite her alcoholic father and abusive stepmother. Katerina Marmeladova, in contrast, does everything she can to regain her former standing as minor nobility which she had lost in marrying Sonya’s father. Although she had driven Sonya Marmeladova into prostitution and beaten her own children, she also works tirelessly to improve the family’s standard of living and seems to regret her actions against Sonya Marmeladova as well as against her own children.

Katerina Marmeladova’s consumption is certainly not presented as a beautiful, ethereal, spiritualizing experience. Rather, Dostoevsky writes multiple times of Katerina

Marmeladova coughing up blood, and her death then occurs in a fit of convulsions. This is far from the peaceful, angelic death of the sympathetic model as represented by Beth

March in Little Women or Evangeline St. Clare in Uncle Tom’s Cabin , and it creates a

certain amount of pity for Katerina Marmeladova. Although she is largely a contemptible character, the fact that she dies homeless and in a miserable manner mitigates the reader’s negative feelings toward her. While she is far from a model parent, she is also a victim of her economic status and suffers for not having had the means to have afforded a more comfortable setting for her death. Her consumption is also likely due in part to her poor standard of living, adding to the softening of the reader’s attitude towards her. A further effect of Katerina Marmeladova’s illness and horrible death are that they paint Sonya in an even more positive light. Sonya Marmeladova is kind to a woman who was rarely anything but cruel to her by being at Katerina Marmeladova’s side when she finally dies.

This reaction to Katerina Marmeladova’s consumption adds to Sonya Marmeladova’s characterization as a virtuous, pious woman, which is carried throughout the novel. This is a similar use of consumption as in Dumas’ La dame aux camélias, wherein Marguerite

Gautier’s characterization is tempered in the reader’s view by her illness and Armand

Duval appears to be even more positive due to his reaction to it. What is different in

Dostoevsky’s portrayal is the harshness of the disease and its progression to death, which is not found in literature presenting the sentimentalized portrayal of consumption.

An Austrian Representation: Arthur Schnitzler

Arthur Schnitzler’s novella Sterben (1892) presents the character of Felix, who has tuberculosis, and Marie, his lover, in their struggles during Felix’s illness. 64

Schnitzler was a physician himself, and had travelled to the Italian city of Merano to seek treatment for suspected tuberculosis, which at this time could still not be reliably

64 Schnitzler does not provide surnames for either Felix or Marie. 80

confirmed. Schnitzler spent from the sixth of March through the eighteenth of April of

1886 there (Marxer 56-8). He therefore had a firsthand knowledge of the disease both from the medical perspective and from the personal one, and Sterben reflects this through its accuracy in the medical and emotional arenas surrounding the characters’ respective confrontations with tuberculosis.

Felix is given approximately one year to live, and the text details the development of both Felix’s and Marie’s reactions to this prognosis. Although this is a more dramatic depiction of the phases one might go through when confronted with such news, it is nonetheless an accurate one. Felix at first is in denial about the diagnosis, then tries to convince Marie that they still have much time to spend together. Marie, for her part, does not want to believe Felix will die, and then declares that she shall not live on without him. The story depicts moments of hope and moments of great despair in both characters, consistent with a typical course of reactions. Although Felix’s plans to murder Marie or himself are highly unusual in true life situations, the underlying feelings of the inequity of being sick, in addition to the longing both to put an end to one’s own suffering and to be joined in death by one’s beloved, are not. Further, just as the novella ends with Marie being pushed away from Felix by his intense need to have her accompany him into death, so do many true-life relationships shatter under the pressures of a terminal illness. In keeping with this realistically based storyline, albeit one that is dramatically intensified, Schnitzler has presented the true physical pain and horror of tuberculosis. Schnitzler has provided precise symptoms such as the inability to breathe, hemoptysis, paleness, and the fear of death. Even the trip to Merano in Italy is one where

the rooms are filled with “Grauen” and “Ekel” rather than beauty or peace. Marie herself notes how ugly it is to be dying of tuberculosis, eventually refusing even to kiss Felix’s forehead (Schrader 81-3, 86).

In the end, Felix dies and Marie remains alive, having turned away from Felix and his murderous plot hatched in order to keep himself from dying alone. Marie instead finds love with one of Felix’s doctors. Felix’s death, like Katerina Marmeladova’s in

Crime and Punishment , is realistically horrific, but Marie is left to live on. She has not been the virtuous, selfless caretaker in the way that Sonya Marmeladova is depicted, but she has done her best despite erring occasionally along the way. This scientifically accurate depiction of the effects of tuberculosis, both psychological and physical, thus ends true to this presentation. Marie, left alive when Felix dies, will live on without him, and establishes a romantic relationship past the one she had with him.

An American Representation: Upton Sinclair

Upton Sinclair’s novel The Jungle (1906) presents a similarly scientifically accurate depiction of tuberculosis in a naturalist vein due to the group of people and conditions he depicts. This work is based on the seven weeks Sinclair spent working in the meatpacking plants of Chicago and it chronicles the life of a fictional immigrant family from Lithuania in their efforts to find work and to survive in Chicago. All of those in this working class family who are old enough to find jobs must do so in order that they all might subsist. Many of the family members then are forced to turn to the local meatpacking plant with its deplorable working conditions in order to to earn money.

One such family member is Antanas Rudkus, the protagonist’s elderly father. On account of his advanced age, he is relegated to the “pickle room” where his job is to mop up the chemical pickling agents and beef scraps left there on the perpetually wet floor.

Antanas Rudkus is soon afflicted with a nearly constant cough, indicative of tuberculosis, and eventually collapses while at work. Although he tries each day to get out of bed, his health only declines. He loses weight and he begins to cough up blood, further identifying his affliction as tuberculosis. Sinclair has described the physical wasting in detail, writing that “[t]here came a day when there was so little flesh on him bones began to poke through […]” (Sinclair 91). This vivid, ghastly picture of Rudkus’ suffering not only underscores the horror of tuberculosis itself, but also indicts the working conditions that led to it. This is not the mere passage from human to spiritual form that young

Evangeline St. Clare experiences in Uncle Tom’s Cabin ; this is a disgusting wasting away accompanied by unthinkable pain and indignity. After several hemorrhages, Rudkus is found one morning “stiff and cold” (Sinclair 91), a deathbed depiction wholly lacking any of the beauty of the romanticized consumptive death. Rather, it is the lonely, hard demise of a man who has been worked to death in the meatpacking industry.

Rudkus is only one of many characters who suffer illness or death in Sinclair’s novel, but his advanced age and the conditions he endured to help support his family make his consequent tubercular death a compelling testament to Sinclair’s condemnation of the meatpacking industry and capitalism in general. As such, this work presents aspects of societal criticism, but unlike those I will discuss in the next chapter, Sinclair has used a distinctly naturalistic approach to tuberculosis that underscores and intensifies

his criticism of the working conditions forced on this family by providing the horrific details of the disease’s progression.

Focus on an American Representation: Eugene O’Neill

Eugene O’Neill presents a slightly later usage of this paradigm in his play The

Straw , which he wrote in 1918. O’Neill himself was afflicted with a mild case of tuberculosis and did not begin his career as a playwright until after his six month stay at the Gaylord Farm Sanatorium in Wallingford, Connecticut, which began on December

24, 1912 (Clark 21). 65 O’Neill explained in the 1923 edition of The Journal of the

Outdoor Life : “’At Gaylord I really thought about my life for the first time, about past and future. Undoubtedly the inactivity forced upon me by the life at a san forced me to mental activity […]’” (J. O’Neill 192) . As Travis Bogard noted in Contour in Time: The

Plays of Eugene O’Neill (1988), although O’Neill was released after only six months,

“At the sanatorium, [O’Neill] read Strindberg, Yeats, Lady Gregory, Brieux, Hauptmann.

Then, slowly, unskillfully and with great dependence on his reading, he began to write” after his release (Bogard 6). Subsequently, in the sixteen months following his discharge from the sanatorium, O’Neill wrote eleven one-act plays, two longer plays, and verse. It was not until he was in Provincetown, Massachusetts in 1918 that he began writing The

Straw, his play based on his time in the sanatorium (Clark 22, 69). 66 Although it was unsuccessful in its performed life, having closed after twenty performances Off-

65 O’Neill had contributed poetry to the New London Telegraph while he worked there primarily as a reporter before he entered the sanatorium. 66 The first play O’Neill acknowledged as such, The Web (1913) , also deals with tuberculosis, as the main character is a prostitute with the disease (Richards xv). 84

Broadway, O’Neill considered this work the best of his naturalistic plays (Bogard 115 and New York Sun 83). This autobiographically-based play does include parallels to

O’Neill’s own experience; however, he expanded upon these factual details to create a work wherein the tuberculosis experience and resulting sanatorium stay serve as an impetus to change one’s life. In the female protagonist, Eileen Carmody, tuberculosis is representative of sacrifice for others that ultimately results in her infection and likely death, which O’Neill has also used to criticize the others whose selfishness has led her to this state. While Eileen Carmody conforms in some ways to the early sympathetic portrayal of consumption, the conditions in which she lives and her relationships with men lend the play its naturalistic depiction of the illness. Her fellow tubercular character

Stephen Murray is portrayed in a much less sentimentalized light that reinforces the overall strains of naturalism in the work.

The Straw is primarily the story of Eileen Carmody and Stephen Murray, two young people undergoing treatment for tuberculosis in the fictitious private Hill Farm

Sanatorium. These two characters are based on O’Neill himself and Kitty MacKay, a fellow patient at Gaylord Farm. O’Neill had shared an illicit flirtation with MacKay, but the two never saw each other again after O’Neill’s discharge in 1913. MacKay died of tuberculosis in 1915 (Bogard 112). 67

The play does not open in the sanatorium, however. Rather, Eileen Carmody’s origins are the subject of the entire first scene, wherein O’Neill has drawn a portrait of a very difficult home-life. In a setting typical for a naturalist text, Eileen Carmody’s family

67 O’Neill claimed that the similarities were unintentional, but his early notes for The Straw indicate that the male protagonist was initially named Eugene, underscoring the autobiographical link (Floyd 9). 85

is working class and her father, Bill Carmody, is an alcoholic. Although Eileen Carmody had previously worked as a stenographer, she gave it up to care for her four siblings and her widowed father, who is neither appreciative of her help and sacrifice nor compassionate when she becomes ill. He only agrees to send her to the sanatorium after the doctor threatens to tell the “Society for the Prevention of Tuberculosis” about his refusal and offers to find financial aid for the stay (E. O’Neill, Straw 202-3; Act 1, Scene

1). As Bogard has argued, this portrayal of the gruff, self-centered Bill Carmody who is concerned only with the effect his daughter’s sickness will have on him pulls the audience’s sympathies firmly in Eileen Carmody’s favor even before she enters the scene

(Bogard 111). 68

This feeling is only intensified by the arrival of Eileen Carmody’s presumed fiancé, Fred Nicholls. Despite his assertion that he cannot wait for the day when he can free Eileen Carmody from her father’s house through marriage, as soon as Nicholls learns of her diagnosis, he is solely concerned for his own health. As the doctor relays to

Nicholls that tuberculosis can be spread by kissing, the stage directions read

“[NICHOLLS fidgets uneasily in his chair ] (E. O’Neill, Straw 206; Act 1, Scene 1). It is clear from this point on that Nicholls’ lone impetus for convincing Bill Carmody to send his daughter to the sanatorium is Nicholls’ own fear of being infected by her. As is often the case in naturalist works, the weak, sick female here is in a relationship with a man

68 Bogard has asserted that Eileen Carmody’s living conditions were quite similar to the home life of Kitty MacKay, as she had assumed care for her 10 siblings following her mother’s death and her father was loathe to pay for her treatment. The character of Bill Carmody also bears some traces of O’Neill’s own father, James O’Neill (Bogard 111-2). 86

who cares for himself and his well-being above that of the vulnerable woman who loves him.

With Eileen Carmody’s long-awaited entrance, O’Neill then cements his picture of her as an innocent, loving, and selfless figure in the midst of those who are the opposite. Eileen Carmody’s first fear is for how her diagnosis is affecting Nicholls, expressing that she does not want him to worry and reassuring him that she will soon return (E. O’Neill, Straw 209; Act 1, Scene 1). This selflessness is reinforced when, instead of being hurt by Nicholls’ refusal to kiss her, she responds: “The doctor told you not to didn’t he? Please don’t, Fred! It would be awful if anything happened to you— through me” (E. O’Neill, Straw 210; Act 1, Scene 1). O’Neill has constructed the scene so that the audience is well aware that it is Nicholls’ fear for himself and himself alone that keeps him from kissing Eileen Carmody, thereby heightening the image of her as a caring, unwitting victim of her father’s and fiancé’s self-serving natures.

Unlike Evangeline St. Clare in Uncle Tom’s Cabin, who inspires positive change in everyone in her life, Eileen Carmody’s illness does not induce either Bill Carmody or

Nicholls to alter their behaviors. They are just as begrudging of Eileen Carmody while she grows ever sicker as they are in the opening scene. As in the naturalist work Vor

Sonnenaufgang (1889) by Gerhart Hauptmann, the doomed woman is left behind by the men who remain more observers of than participants in the woman’s conditions.

A similar criticism extends to the figure of Stephen Murray. Despite his tubercular state, Murray, in contrast to Eileen Carmody, is not given a sympathetic background. Bogard has noted that O’Neill initially included information about Murray’s

origins in a draft of The Straw , much of it paralleling O’Neill’s own life, but later removed these passages (Bogard 110). In the final, performed version of the play, the audience knows little of his past before Hill Farm except that his parents are dead, and his sisters, who live far away, are financing his stay. He has been working as a newspaper reporter in a small town, a job that now seems to bore him immensely (E. O’Neill, Straw

219-20; Act 1, Scene 2). Bogard has postulated that O’Neill cut out the background for a number of reasons, including simply shortening the length of the play and cutting out irrelevant information (Bogard 111). Presenting Murray in this way, however, also removes any chance the audience will view Murray’s actions through a more understanding lens due to the conditions of his earlier life. Further, O’Neill has not provided a clear cause for Murray’s tuberculosis that would arouse pity. Although the implication is that he contracted the disease from working nights on the newspaper for so long, even this is not cast in a sympathetic light. In comparison to Eileen Carmody’s responsibilities, this is a middle class job with a comfortable lifestyle. Unlike Eileen

Carmody, who laments being away from her family, and in particular the children in her care, Murray rejoices at being free of his job while in the sanatorium, telling Eileen

Carmody: “This place is honestly like heaven to me. […] It made me happy—yes, happy!—to get out here!” (E. O’Neill, Straw 219; Act 1, Scene 2). His diagnosis provides him with a welcome respite, and, as the audience also knows that Murray’s case is not very serious, one therefore does not view his overall condition, physical and mental, as a perilous one.

This is far from the stereotypical constructed melodrama so often attendant with a tuberculosis patient akin to Eileen Carmody in works of the nineteenth century, and instead shows another equally valid portrayal of the disease. As is the case with Katerina

Marmeladova in Dostoevsky’s Crime and Punishment and Felix in Schnitzler’s Sterben, this was not solely a disease of the virtuous. Unsavory and even despicable people were in truth just as likely to contract the disease as those who had led exemplary lives. Even though tuberculosis was found more frequently among those of lesser means, it was also not exclusively a disease of the poor. Finally, a tuberculosis diagnosis was not necessarily a certain death sentence. It could alternately be a positive, or even transformative, experience for a person in that it could provide a catalyst to change his or her life’s trajectory.

Indeed, the sanatorium in this work provides both main characters in The Straw with a locus of major life change, and it is additionally a space away from their monotonous everyday responsibilities. As Erving Goffman has explained in Asylums:

Essays on the Social Situations of Mental Patients and Other Inmates (1961), tuberculosis sanatoria fit into the category of “total institutions,” which are places in which one’s entire existence is led with the daily routine generally controlled by a higher authority (Goffman 4). As such, those entering a sanatorium experience a break with their former lives. Due to a sense of a “common fate,” they also frequently form inmate relationships with fellow patients with whom they may not have ever come into contact in the outside world (Goffman 4, 14, 59). Murray and Eileen Carmody serve as an illustration of this; they drastically alter the courses of their lives, both through being at

the sanatorium and through knowing each other. For Murray, this change has little to do with the disease itself, and much more to do with physically being at Hill Farm and meeting Eileen Carmody; the disease is simply the reason he is there. It is instead this conversation with Eileen Carmody in which he first mentions creative writing that sparks his new drive. After revealing to her that he has always thought of writing creatively but never found the time, they have the following exchange:

EILEEN: Well, you’ve plenty of time now, haven’t you?

MURRAY: [Instantly struck by this suggestion ] You mean—I could write up here? [ She nods. His face lights up with enthusiasm. ] Say! That is an idea! Thank you! I’d never have had sense enough to have thought of that myself. [ EILEEN flushes with pleasure. ] Sure there’s time—nothing but time up here— (E. O’Neill, Straw 221; Act 1, Scene 2)

This conversation not only establishes the muse-artist relationship that Murray and Eileen

Carmody will experience, but it also delineates the importance of the sanatorium as a place of reprieve where one has the necessary time to allow for major personal change.

This change is somewhat sudden for Murray. He begins to write with Eileen Carmody’s encouragement and support, soon finding modest successes. 69 There is a steady progress in his career as a writer, but he is not an immediate sensation. While beginning this new career is an important development in Murray’s life, this is also a relatively accurate portrayal of such an alteration in one’s direction in life. Eileen Carmody will likely not survive to witness the development of his writing career, but she has been the one to help him begin it.

69 Kitty MacKay fulfilled a similar role for O’Neill by supporting his writing at Gaylord Farm (Bogard 112). 90

Eileen Carmody’s time in the sanatorium also brings about change for her and in her, beginning on the first day. She retains compassionate feelings towards her father, but she does not meet Nicholls’ now readily apparent fear of infection with the understanding she had earlier displayed. As he goes to kiss her goodbye, the line reads:

“EILEEN: [ A faint trace of mockery in her weary voice. ] No, Fred. Remember, you mustn’t now” (E. O’Neill, Straw 217; Act 1, Scene 2). Four months after this, as Act II opens, Eileen Carmody’s affections are solely directed at Murray. He, oblivious to her love, discusses his current writing successes and impending departure. O’Neill writes that Eileen Carmody reacts to this by “[ Trying to force a smile ]”, which indicates her displeasure at the thought of being separated from him, before adding her congratulations. Despite her reluctance to see Murray go, veiling her true feelings in order not to discourage him or disappoint him underscores her giving nature.

Eileen Carmody, now faced with the last chance to reveal her feelings to Murray, first does what he has been encouraging her to do: she writes to end her relationship with

Nicholls (E. O’Neill, The Straw 242; Act 2, Scene 2). Her subsequent declaration of love to Murray is not met with the desired response; Murray neither knew of her feelings nor does he return them. Eileen Carmody tells him: “[…T]hen I had to spoil it all—and fall in love with you—didn’t I? Oh, it was stupid—I shouldn’t—I couldn’t help it, you were so kind and—and different—and I wanted to share in your work—and everything” (E.

O’Neill, Straw 244; Act 2, Scene 2).

Jane Torry has asserted that women in O’Neill’s plays are motivated by “[…] their devotion and obligation to their men,” (Torry 63), and Margaret Loftus Ranald

posits that in this work, O’Neill “[…] celebrates feminine sacrifice” wherein Murray finds his salvation in and through Eileen Carmody (Ranald 58). 70 These arguments certainly apply in part to Eileen Carmody; however, the agency she shows in choosing to break from Nicholls and risk a reasonably certain rejection is a courageous act she would hardly have considered before her interactions with Murray and her time in the sanatorium away from Nicholls. She, too, has therefore benefited from the relationship.

Eileen Carmody maintains her positive image in that she is clearly wary of hurting

Nicholls’ feelings, but she has also become a woman who is no longer afraid to help herself. O’Neill here has presented a character that, through her time at the sanatorium, has learned how to combine both her selfless tendencies and her own desires in such a way that she is no longer bowing to others’ wishes, but at the same time, is not inflicting unnecessary pain on them. This adds to her depiction as a more developed model of the sentimentalized consumptive.

Eileen Carmody’s physical changes are also pronounced and mirror the state of her relationship with Murray. The play shies away from the more grotesque symptoms of tuberculosis, but does use the typical marker of the severity of tuberculosis infection, weight gain or loss, in order to reflect Eileen Carmody’s general happiness. She has initially gained weight in the four months between Acts I and II, which serves as an indication of the pleasure she has found in playing the role of supporter to Murray’s writing. As the stage directions read: “ She has grown stouter, her face has more of a

70 Jane Torry has noted that in most O’Neill plays, “O’Neill’s women are supposed to be devoted to men, but the men have no reciprocal obligations” (Torry 66); the relationship between Eileen Carmody and Murray functions in much the same way, but she nonetheless does profit from her relationship with Murray, albeit to a much lesser degree than he profits from his relationship with her. 92

healthy, out-of-door color […]” (E. O’Neill, Straw 226; Act 2, Scene 1). What immediately follows these words, however, adds an ominous tone: “[…] but there is still about her the suggestion of being worn down by a burden too oppressive for her strength ] (E. O’Neill, Straw 226; Act 2, Scene 1). The knowledge that the man she loves is ignorant of her affections is reflected in her now declining condition. O’Neill deftly portrays this even before Eileen Carmody reveals her feelings to Murray. As all of the patients are weighed to judge their progress, Eileen Carmody and Murray have the following exchange:

EILEEN: [Dully ] So you gained? MURRAY: Three pounds. EILEEN: Funny—I lost three. [With a pitiful effort at a smile. ] I hope you gained the ones I lost. (E. O’Neill, Straw 238; Act 2, Scene 1)

As Kurt Eisen has observed, O’Neill has done this “[…] to make clear how Stephen’s and

Eileen’s individual fates are intertwined” (Eisen 99), and as such contributes to his development of Eileen Carmody as a mixture of a constructed and realistic tuberculosis patient. 71 The tracking of health by weight is an authentic aspect of tuberculosis care, but

O’Neill has imbued it with a sense of drama by including the relation to Murray’s weight.

One again, the virtuous Eileen Carmody is sacrificing herself for Murray’s well-being.

Murray is soon discharged from Hill Farm and the effects of his waning contact with Eileen Carmody continue to be depicted by her ongoing physical decline.

Reflecting the stereotypical tubercular physique, the stage directions note that “ She seems to have grown much thinner. Her face is pale and drawn with deep hollows under her

71 Eisen has further asserted that the fact that Murray does not love her, despite all she has contributed to his art, reflects O’Neill’s own feelings of ambivalence towards those who had been instrumental in his art (Eisen 99). 93

cheek-bones” when Act III opens (E. O’Neill, The Straw 246; Act 3). 72 Eileen Carmody has become a hopeless case bound for the state-run sanatorium by the time Murray returns for a follow-up examination four months after his departure. 73 This return to the sanatorium will then once again afford him a transformation. Eileen Carmody is now sure to die, and the superintendent of the sanatorium asks that Murray make Eileen

Carmody’s remaining time joyful by telling her he loves her and wants to marry her.

Murray agrees, ready to do anything to make Eileen Carmody happy and hopeful once more (E. O’Neill, Straw 256-9; Act 3). Eileen Carmody is as exhilarated as expected at his feigned declaration of love, which includes a proposal and plans to move her to a private sanatorium. She tells him: “I’ll surprise you, Stephen, the way I’ll pick up and grow fat and healthy” and that she will then help him to write his stories (E. O’Neill,

Straw 260; Act 3). O’Neill has constructed the scene so that the audience is fully aware that Murray has been asked to lie to Eileen Carmody, thus ensuring that they will continue to view her with pity and sympathy.

As Murray and Eileen Carmody discuss the plans that will likely never come to fruition, Murray comes to a startling realization: that he truly does love her. Awakening to his feelings, he tells her: “Oh, what a blind selfish ass I’ve been! You are my life— everything! I love you, Eileen! I do! I do!“ (E. O’Neill, Straw 262; Act 3). Here at Hill

Farm, Murray at last realizes that there is someone more important to him than himself, and he finally truly recognizes all that Eileen Carmody has done for him while receiving

72 Murray’s own physical changes are indicative of the difficulties he has found writing in the outside world. He is still free of tuberculosis, but his face and skin no longer appear to be healthy (E. O’Neill, The Straw 253; Act 3). 73 In O’Neill’s own life, he and Kitty MacKay never saw each other again after he was released from Gaylord Farm (Bogard 112). 94

so little in return. This scene reads rather melodramatically and whether Murray does actually love Eileen Carmody or has just been caught up in the moment is unclear, but

Murray does seem to believe he loves Eileen Carmody in that instant.

Murray demonstrates this insight by then lying to Eileen Carmody, saying that his tuberculosis has indeed returned, so that she will not find out it is actually she who is moribund. Rather than losing all hope in the face of certain death, she will instead focus on Murray by caring for him and bolstering him through his supposed illness. Murray laments the “hopeless hope” that Eileen Carmody will survive on his love alone (E.

O’Neill Straw 263; Act 3), for once burying his own concerns to focus on Eileen

Carmody. Despite the positive turn here, O’Neill has left the veracity of Murray’s declaration open and does not let the audience member forget that Eileen Carmody will likely soon die no matter what the truth of his feelings is. Eileen Carmody is not magically healed of her illness, but she will presumably at least die happy. O’Neill has thus provided an ending that preserves Eileen Carmody’s virtuous depiction and supplies her with this reward for her goodness, but he does not shy away from the fact that she will perish and Murray will be left alone regardless of whether or not he loves her. As

Thierry Dubost has phrased it, Eileen Carmody and Murray’s “[…] shared love is a rebirth” for each of them (Dubost 103). Both halves of this couple emerge changed for the better through tuberculosis. There is no denying that Murray still will have profited from Eileen Carmody’s help more than she has profited from his assertion that he loves her, but she profits nonetheless.

It was the sanatorium that brought Eileen Carmody and Murray into contact, and it is ultimately the sanatorium and tuberculosis that allow them the opportunity to realize their potential as individuals and, for a brief time, as a couple. O’Neill has included very little of the sanatorium’s curative measures and daily life in this work, having focused instead on the relationship between Murray and Eileen Carmody. Andrew Malone has argued therefore that the theme of this work is love’s power to succeed where medicines fail (Malone 261). For a brief moment, this seems to be the case for Eileen Carmody.

O’Neill stated in an interview for the New York Tribune printed on February 22, 1920:

“Human hope is the greatest power in life and the only thing that defeats death. I saw it at close quarters, for I was myself an inmate of a tuberculosis sanatorium and through hope and spiritual help beat it” (Mindil 3). O’Neill’s tuberculosis experience gave him the chance to start his own writing career, and to develop his belief in the healing power of hope. The audience sees that idea alive in this work, where the hope inspired by

Eileen Carmody and Murray’s relationship lends a note of optimism at the end, despite the gravity of her condition and likelihood that they will soon be parted by death. This is not a sentimentalized portrayal of the disease because Murray is far from a romanticized victim of the disease. Rather, he is an average young man who has faults and selfish tendencies and is a complicated character. He stands in contrast to Eileen Carmody, but she, too, has room for personal growth. O’Neill’s portrayal of how these two experience their tuberculosis shows nuance lacking in the more straightforward, sentimentalized usage of the disease in works such as Remarque’s Drei Kameraden.

Eugene O’Neill’s Later Representation of Tuberculosis

O’Neill’s 1942 play Long Day’s Journey into Night chronicles a full day in

August 1912 in the house of the Tyrone family, which is a semi-autobiographical representation of O’Neill’s own family. This is not just any day, but rather the day before the younger son Edmund Tyrone, based on O’Neill himself, enters a sanatorium for tuberculosis. This family is at a pivotal point as a whole: the mother Mary Tyrone has just returned from treatment for her morphine addiction, which the children fear she may have resumed; the father James Tyrone is reaching the end of his acting career and is an alcoholic; the older son Jamie Tyrone is having difficulty finding acting work due to his alcoholism and womanizing ways; and Edmund Tyrone, an aspiring writer, is awaiting the news of whether he has tuberculosis. The family is struggling financially and clearly has many problems with addiction, a scenario that play out frequently in naturalist works.

Throughout the play, the family members fight with one another and accuse each other of various wrong-doings. Edmund Tyrone’s tuberculosis is the latest—and perhaps the greatest—complication that threatens to tear the family apart, and so O’Neill has portrayed tuberculosis here as a wholly negative disease.

By the end of the play, Mary Tyrone has returned to her morphine addiction and

James and Jamie Tyrone are facing uncertainty in both their careers and their personal lives, all as Edmund Tyrone finally admits to his drugged mother that he has tuberculosis and must go away to the sanatorium the following morning. The play ends with a feeling that the Tyrone family is headed for more hardship and possibly destruction, with

Edmund Tyrone’s tuberculosis as the final breaking point for the group. Unlike in The

Straw , O’Neill has presented no positive aspect to Edmund Tyrone’s tuberculosis, and the implication at the end of the play is that any life change it may bring about in any of the

Tyrones will be a destructive one. This is far from the journey of self-discovery that

O’Neill has presented in his earlier work and leaves the reader or audience member with the distinct feeling that this family is headed for ruin. Similarly to The Straw , though, this is a work that deals with the reality of a tuberculosis diagnosis and the attendant chaos and upheaval it can cause, rather than containing a wholly constructed portrayal of the disease whereby tuberculosis is a literary tool.

Chapter 4: Tuberculosis and Bourgeois Culture

The third major usage of consumption and, later, tuberculosis is that of an often critical examination of the ramifications of the disease within the middle class and the medical establishment that cared for it. As with the works discussed in the previous section, this paradigm is much more complex than the early sentimentalized usage of the disease and therefore yields a greater variety of depictions. In one, the disease is used to critique the capitalist financial aspirations of a particular middle class figure while in others, the criticism is aimed at the proscriptions of middle class life that lead to the limitation of the tubercular character’s existence. The critique can also be aimed at not just the societal conditions in these works, but also at the medical community, whose members are also generally middle class, that finds profit through interacting with tubercular or consumptive patients of various means and treating them. In the case of

Thomas Mann’s tuberculosis works, his characteristic ironic treatment of the characters and their interactions presents a subtle mockery of the middle class and of those within it who fancy themselves to be artistic souls. There is a general tendency among these works that critique the middle class to include the trope of the angelic consumptive. This may be presented either alone, as a part of the critique, or in conjunction with a portrayal of a consumptive patient or other character that stands in opposition to it. The inclusion of the sentimentalized depiction points to its importance and impact in tuberculosis

stories, thereby this enabling the authors to use it to underscore a contrasting representation of tuberculosis.

An English Representation: Charles Dickens

Such a hybrid is present in Charles Dickens’ novel Dealings with the Firm of

Dombey and Son: Wholesale, Retail and for Exportation (1846-48). In this work, Paul

Dombey is the wealthy proprietor of a shipping business. His dream is for his young son, also named Paul, to take over the business once he is grown. The son Dombey is a sickly child, however, and despite his father’s attempts to send him away to improve his health, he dies at the age of six after having been sent away to a demanding boarding school.

Young Dombey, by virtue of being a child, is cast in a light of innocence. Dickens does not portray him as positively as either Smike in Nicholas Nickleby or Little Nell in The

Old Curiosity Shop . The child has trouble interacting with others and accordingly does not have many friends. Being such a young child, though, he is still a pitiable victim of consumption. Katherine Byrne argues that mercantilism is the true disease of the work and that Paul, by dying, triumphs over his father’s attempt to force him into a life and business he does not want. Through death, he avoids this fate and is a representation of the victory of this one human over capitalist interests (Byrne 55). Essentially, the illness of consumption has rescued the younger Dombey from the purported evils of economic consumption. This novel thus marks an early example of the use of tuberculosis as criticism of bourgeois culture.

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A German Representation: Theodor Fontane

This thematic is then also represented in the later novel Effi Briest (1894-95) by

Theodor Fontane. Here, the seventeen-year-old titular figure marries Baron Geert von

Innstetten, who is more than twice her age. Briest moves away from her home town to

Kessin, where von Innstetten lives. There, she finds her life to be a stark contrast to the earlier vibrant one she had led before her marriage. With von Innstetten often away and with having only one friend in Kessin, Briest leads a lonely existence. She eventually gives in to the charms of the newly arrived Major Crampas, a notorious womanizer, and the two begin an affair. Although the affair breaks off and Briest moves with her husband to Berlin, the dalliance later comes to light and results in a duel between the two men in which Instetten kills Crampas. Von Instetten divorces Briest and takes custody of their daughter, and Briest’s parents refuse to support her due to the scandal she has caused. Briest is therefore established as an outcast from her home and society, and it is only when her death is imminent that her parents take her in again.

Throughout her marriage Briest suffers from vaguely defined nervous disorders that eventually culminate in tuberculosis. As Nicole Thesz has claimed, Fontane thus implicates her incompatibility with the life her marriage demanded in causing her death

(Thesz 29-30). Fontane grants Briest the traditionally peaceful consumptive death, and in so doing, implies that this death is a release from an existence in which Briest could have never found fulfillment and happiness. While the blame for her unhappy life is neither

Briest’s, as she was too young to truly comprehend what her new life would entail, nor von Instetten’s, who treated Briest as well as his station allowed, the expectations of her

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bourgeois married life were what ultimately brought her to a mental and physical breakdown. This represents an alternative to the choice made by the female protagonists in Gustave Flaubert’s Madame Bovary (1856) and Leo Tolstoy’s Anna Karenina (1873-

77). Both Emma Bovary and Anna Karenina are in part driven to commit suicide by the desperation to escape the tedium of their bourgeois marriages and the ultimate failure of their extramarital affairs. This is an active and much more dramatic ending to their lives.

Effi Briest’s death from tuberculosis accomplishes the same release from her unhappiness, but is not of her own volition. Fontane therefore has emphasized that Briest is never free from the constraints placed on her by her position in society; her illness is further evidence that her life was not her own to define and that, unlike Emma Bovary or

Anna Karenina, even in death Effi did not find her own agency.

As with the sentimentalized portrayal of tuberculosis, this usage of the disease often does not include discussion of treatment aside from rest. Dickens wrote his novel before there were many treatment options, but by the time Fontane wrote Effi Briest , both travel cures and sanatorium stays were common means of treating tuberculosis, especially for those who were financially secure. Briest’s lack of treatment then is indicative of her outcast life, in which neither her former husband, whom she had betrayed, nor her parents, on whom her transgression had brought great shame, would provide the money necessary to fund her trip to seek treatment. Further, Fontane has presented tuberculosis as a result of Briest’s discontentment with her marriage and the constraints placed on her by her societal position. Had Fontane included any attempt at treatment, it would have

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undermined the futility of her situation and taken away from the novel’s criticism of the societal conditions that have brought about Briest’s downfall and resultant demise.

A British Representation: George Bernard Shaw

George Bernard Shaw’s play The Dilemma, first performed in 1906, presents a biting commentary of the medical community treating tuberculosis and as well as of the concept of the romanticized, pitiable, and virtuous tuberculosis/consumption patient. In this work, Colenso Ridgeon has just been knighted for his new treatment modality for tuberculosis that involves inoculating a person with a substance called opsonin at a very specific point in the disease’s progression. In the opening scene, Ridgeon refuses to see patients but will entertain the company of his physician friends who have stopped by to congratulate him. Shaw has thus set him up as a dubious figure whose patients are not his first priority. Ridgeon’s dilemma then comes when he must decide to whom he will give the single open slot in the trial of his treatment: Louis Dubedat, the artist husband of a beautiful young woman, Jennifer Dubedat, who appeals to Ridgeon’s sympathies, or

Blenkinsop, a colleague of Ridgeon’s who works in the poorer sections of town and as such is less wealthy than his bourgeois colleagues.

Upon meeting Louis Dubedat at a dinner, the doctors in Ridgeon’s circle are taken in by his charms and artistic abilities and each allows himself to be scammed out of money by Louis Dubedat. Dubedat is revealed to be a confidence man who has not only taken advantage of the doctors financially, but is also not legally married to Jennifer

Dubedat, as he was already married to Jennifer Dubedat’s maid. For Ridgeon, the choice

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comes down to either saving an unsavory man who makes beautiful drawings or a good man whose work Ridgeon esteems as less valuable. In this case, Shaw has initially set up

Louis Dubedat as the traditional artistic, suffering consumptive who is to be pitied. He then complicates this image by showing Louis Dubedat to be far from an innocent, pure victim of the disease; he is an unsavory person who is using his disease to cheat others out of money. Ridgeon’s colleague Blenkinsop, however, does fulfill this role, but he is not viewed by Ridgeon as a person valuable enough to have earned preference over Louis and his artistic ability.

Ridgeon finally decides to treat Blenkinsop over Louis Dubedat, but it has nothing to do with his station in life or value as a person. Rather, he chooses Blenkinsop because he endeavors to marry Jennifer Dubedat, and therefore wants to hasten Louis

Dubedat’s death by relegating his care to someone who does not know how to properly administer the opsonin. In this way, Shaw has criticized both those members of the medical community who privilege personal profit when making crucial, life-and-death decisions as well as the common assumption that those who appear to be the most worthy of charity indeed are.

Blenkinsop is not nearly as vocal about his need for Ridgeon’s assistance and also does not appear to be as sympathetic as the young, sick artist with the beautiful young wife, but it is in fact he who ends up apparently being the most deserving of Ridgeon’s help; he fills the role of pitiable tuberculosis sufferer to a far greater degree than Louis

Dubedat. The irony is that it is only due to Ridgeon’s own selfish desires that Blenkinsop receives the treatment and lives. It is in no way a result of his goodness or value to the

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community, which effectively invalidates the ideal of the deserving patient receiving care from a merciful, selfless physician.

In his extended preface to the play, written in 1909, Shaw expounded upon his distaste for a system that he believed trains physicians to treat patients with their own personal gain in mind rather than the welfare of their patients. Due to a system that rewards physicians financially for performing tests and surgeries, “[i]t is simply unscientific to allege or believe that doctors do not under existing circumstances perform unnecessary operations and manufacture and prolong lucrative illness” (Shaw, “Preface”

2). 74 This general idea is borne out in The Doctor’s Dilemma through Ridgeon’s intention to personally profit through his profession by forcing Louis Dubedat to be treated by a lesser physician. This work indicates that doctors and patients alike may be just as self-serving as the next person, and any general assumption of goodness is therefore a fallacy. Tuberculosis and the search for its cure serve as an apt situation in establishing this point.

Focus on a German Representation: Thomas Mann

Thomas Mann wrote his novella Tristan in 1903 prior to having any personal experience in a sanatorium. 75 Thus, his portrayal of life at the fictional Einfried sanatorium in this novella stems from his own imaginings of sanatorium life. Mann here has used tuberculosis and the location of the sanatorium as a way of creating a world

74 Shaw argues that the answer to this situation is Socialism, wherein physicians would not be put in a position of having to earn money in this manner (Shaw, “Preface” 37). 75 Mann’s first sojourn at a sanatorium took place in late 1901, after he had already submitted Tristan to the Fischer Verlag (Virchow 173). 105

apart from the mainstream bourgeois society. It is not completely separate, however, in that the societal conditions of the middle class world are the basis of the relationships among the main characters within the sanatorium. These circumstances are both viewed from within the condines of the sanatorium and interacted with from there. In this work,

Mann has created a scathingly ironic depiction of middle class dilettantism by using traditional tuberculosis portrayals and the sanatorium experience as literary tools to do so.

Tristan tells the story of Gabriele Klöterjahn, who has entered the sanatorium

Einfried due to a disorder of her trachea that is presumably a symptom of tuberculosis.

There, this wife of a middle-class businessman meets Detlev Spinell, a would-be writer who is at Einfried, as he phrases it, to be “’elektrisiert’” for no explicit illness (Mann

Tristan 14). Spinell takes a particular interest in Gabriele Klöterjahn and persuades her that she has an artistic sensibility beneath the exterior of bourgeois wife and mother.

Spinell entices her one night to release that supposed inner artist by playing first Chopin’s nocturnes and then selections from Wagner’s opera Tristan und Isolde on the piano.

After performing this passionate music, Gabriele Klöterjahn’s tubercular infection quickly intensifies and she dies.

This novella takes place solely in the sanatorium Einfried, a setting that creates a contained society all its own with a transitory population that also then sets the outside middle-class society into relief. The sanatorium setting is certainly not unique in this. A hotel or spa would function in much the same way, as these were places where various members of middle-class society would come together for a temporary stay. The elements of sickness and potential death, however, give the sanatorium a heightened

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drama that Mann has used in his satirical treatment of the two main characters. By the time Mann had begun to conceptualize Einfried, the model of the sanatorium set in a remote location had already been well established as a therapeutic modality that was utilized primarily by the members of the middle and upper classes who could afford long stays there. Einfried is a realistic reflection of the closed model of the sanatorium, wherein a physician prescribed the strict treatment regime to patients who lived within a single building. As Peter Pütz has argued in his 2002 article “Das Sanatorium als

Purgatorium,” “[d]as Sanatorium als Lebensform steht für eine Zwischen- und

Übergangsexistenz zwischen Siechtum und Heilung, zwischen Hölle und Himmel” (Pütz

200), and Mann has created this feeling in Einfried as well. Gabriele Klöterjahn, her husband Anton Klöterjahn, and her treating physician Doktor Leander initially believe that she will return home healed (Mann Tristan 4-5). Although the sanatorium employs another physician, Doktor Müller, for both the very simple cases and the moribund ones, there is no physician for long-term chronic care. Thus, Einfried is for all but one inhabitant either a place to convalesce and then return to the realm of the healthy, or a place to spend one’s final days.

The sole character for whom this does not seem to be the case is Spinell. 76 That he is in the sanatorium to be electrified suggests that he at least initially entered the facility for a medical condition, be it physical or psychological. As Italian scientists Ugo

Cerletti and Lucio Bini did not introduce the use of electroconvulsive therapy to treat mental disorders until 1937 (Abrams 5-6), it is unclear what Spinell’s treatment even

76 Mann modeled the character of Spinell on Arthur Holitscher, the Jewish Hungarian author whose physical characteristics and mannerisms Mann heightened and satirized in Spinell (Rasch 446). 107

entails, leaving the impression that he his reasons for being there are not as concrete as the other patients who do have explicit illnesses. While Mann delved briefly into changes in Gabriele Klöterjahn’s health, he never touched on any alterations to Spinell’s condition or entered into a more extensive explanation of a medical reason for his stay at

Einfried. Mann has thus removed the focus from Spinell’s health, and placed it instead on both his lifestyle as a would-be artist in the sanatorium as well as on his pursuit of

Gabriele Klöterjahn. Any actual malady that allowed Spinell entry into this world is irrelevant. Mann has justified Spinell’s presence there by referencing his treatment, but

Mann does not set him up as a representative of any particular illness or dwell on his symptoms and treatment because Spinell’s more important identity is that of a self- proclaimed artist, not a patient. This is emphasized when, in Spinell’s initial one-on-one conversation with Gabriele Klöterjahn, he states that he is there “’[…d]es Stiles wegen,’” and goes on to explain that: “Diese Helligkeit und Härte, diese kalte, herbe Einfachkeit und reservierte Strenge verleiht mir Haltung und Würde…” (Mann, Tristan 14). Here, the literal architectural style of the sanatorium and its attendant translation into a strict lifestyle are the sources of its professed value to Spinell as he pursues what he believes to be the existence of an artist. This is reflected in his explanation to Gabriele Klöterjahn that as an artist who is inclined to sleep late, “[e]ine gewisse Artigkeit und hygienische

Strenge der Lebensführung zum Beispiel ist manchen von uns Bedürfnis” (Mann, Tristan

16). Rather than providing him with a physical improvement, the sanatorium ostensibly aids him in overcoming what he, and the general bourgeois culture, consider to be the less respectable stereotypical daily lifestyle of the practicing artist. Spinell believes he

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must remain at Einfried in order to keep from slipping back into his natural tendencies of living an unstructured life. Through this explanation, Spinell seems to profess his legitimacy as an artistic spirit, although it is more posturing than reality, as he is merely a dilettante. Spinell also contradicts his disdain for the bourgeois culture, as it is this lifestyle that he believes to be more desirable than that of the artist. Mann has revealed here inconsistency within Spinell’s self-definition as an artist who stands in opposition to the middle class, and Mann has therefore begun to expose Spinell for the hypocrite and fraud he is. Further, Spinell’s long-term presence in the sanatorium suggests that he himself is the product of an upper-middle-class background, as there would have been no other way for him to afford to stay at Einfried.

While Spinell respects the daily regimen of the bourgeois society, he does not accept the other precepts of such an existence. The sanatorium then also serves to separate Spinell from this world for which he feels disdain. 77 As he explains to Gabriele

Klöterjahn: “Wir [he and his fellow late sleeping artists] hassen has Nützliche, wir wissen, dass es gemein und unschön ist, und wir verteidigen diese Wahrheit, wie man nur

Wahrheiten verteidigt, die man nötig hat” (Mann Tristan 16). Spinell simply cannot stand to live amongst those whose professions he considers useful but lacking in beauty.

Einfried provides a place of refuge for him to be able to pursue his writing. This respite from the constraints of bourgeois expectations allows him the freedom to write all day without impunity, and he does indeed spend the greater part of each day crafting letters in order to further his career and seek out publishing support (Mann, Tristan 11). Spinell

77 Peter Pütz has noted that this is typical for Mann’s artistic figures, as “[…] so neigen auch Thomas Manns’ Künstlerfiguren dazu, sich aus den Geselligkeiten zurückzuziehen” (Pütz 203). 109

remains an outsider in the sanatorium as well, with no social circle and only Gabriele

Klöterjahn as an interlocutor, but his fellow residents also do not seem to look down on him for his lack of contribution to the bourgeois world, as would likely happen were he to live again outside the sanatorium’s walls. The residents instead simply leave him alone to pursue his writing just as they go about pursuing their own sanatorium-approved regimens and activities.

In contrast to the general perception that tuberculosis enhanced one’s artistic capabilities, there is no indication that Spinell’s time in the sanatorium improves his abilities in any way. Although he can write unperturbed in the sanatorium, his writings essentially remain confined to his ubiquitous letters and his single large novel, which its sole reader at Einfried pronounced: “’raffiniert’, was ihre [the reader’s] Form war, das

Urteil ‘unmenschlich langweilig’ zu umschreiben,” (Mann, Tristan 11). Thus, while his presumed but little-discussed and undefined ill state stands in contrast to the robust health of Anton Klöterjahn and his son, who are the representatives of bourgeois existence, it is not a sacrifice to his art, because he is merely an amateur. There is no indication that he is actually any more successful with his writing inside the sanatorium than he was before his admittance, even given the regimented lifestyle and time he can devote to it. This suggests that Mann is mocking the idea of the aspiring artist who completely devotes himself to his work despite lacking any true talent or ability.

Gabriele Klöterjahn’s illness, in contrast to Spinell’s, is much more specific in nature. She first began to cough up blood after a particularly difficult pregnancy and the subsequent birth of her son (Mann, Tristan 8). Both Doktor Leander and Anton

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Klöterjahn initially refuse to admit that the problem is anything more than a disorder of the trachea, rather than the much-feared tuberculosis. It is eventually clear that, whether intentionally or not, both men were ignoring the reality that she did indeed have tuberculosis, to which she eventually succumbs. 78 The presumed cause of her illness is in dispute. To Anton Klöterjahn and Leander, it is solely a physical result of her pregnancy that will in turn be cured by the traditional physical treatment of rest and fresh air. They, being men of the worlds of science and business, do not conceive of any other cause or treatment modalities. Spinell, however, sees the situation differently. He places blame for her illness on her child—not for the mere fact of his gestation and birth, but because he, as a representation of the bourgeois culture, has further removed her from her inner artist. For Spinell, the tuberculosis is a direct result of Anton Klöterjahn’s inability to recognize his wife as an artist and instead to imprison her in the common, mundane world of the bourgeois housewife. Spinell admonishes Anton Klöterjahn in a letter for this, writing: “Sie [Gabriele Klöterjahn] mit den Augen, die wie ängstliche Träume sind, schenkt Ihnen ein Kind; sie gibt diesem Wesen, das eine Fortsetzung der niedrigen

Existenz seines Erzeugers ist, alles mit, was sie an Blut und Lebensmöglichkeit besitzt, und stirbt” (Mann, Tristan 41). To Spinell, Anton Klöterjahn’s selfish desire to see himself reproduced has robbed Gabriele Klöterjahn of her artistic sensibility. Spinell here is equating contracting tuberculosis with the submission to outside middle class ideology and expectations that subvert one’s own individual artistic nature.

78 As noted in the first chapter, the diagnosis of tuberculosis in its early stages was still difficult before Röntgens’s discovery of the x-ray in 1895 despite the advances in medical technology, and it took years after his discovery for the x-ray technology to be adopted and become widespread. 111

Mann’s choice of tuberculosis rather than another chronic, potentially fatal illness is a deliberate aspect of his construction of Gabriele Klöterjahn. From the end of the eighteenth century on, consumption was viewed as a disease that “[…] embodied the aesthetic and the spiritual,” which for the middle class meant “refinement and delicate sensibilities” (Lawlor 44, 50). Mann’s very description of her bears the marks of the tubercular representation favored since the late eighteenth century: Gabriele Klöterjahn leans back fatigued in an arm chair, simply following the discussion of others, indicating her fragile state that is further confirmed by the pallor of her skin. The fabrics of the high stiff collar of her proper dress “[…] ließen die unsägliche Zartheit, Süßigkeit und

Mattigkeit des Köpfchens nur noch rührender, unirdischer und lieblicher erscheinen”

(Mann, Tristan 6). This establishes her as one of the “delicate women” consumptives, which was the dominant portrayal of the more privileged middle-to-upper class sufferers in the nineteenth century (Lawlor 43-4) . Further,Vera Pohland has asserted that “[…] around the middle of the nineteenth century, the mystification of consumption accelerates enormously in connection with the Outsider status of the artist and the aesthetic of decadence in European literature as a whole” and therefore tuberculosis becomes “[…] an illness with individualizing, spiritualizing and creatively stimulating potential” (Pohland

147). 79 Utilizing these established associations, Mann’s choice of tuberculosis places further emphasis on Gabriele Klöterjahn’s sensitive, frail nature in contrast to her husband’s hearty one, underscoring Spinell’s conviction that she is someone who does not wholly belong in the concrete middle class world, but rather is a person with a deeper

79 This perception would again shift after Karl Ernst Ranke’s 1917 theory of tuberculosis that paralleled the model of syphilis; tuberculosis was thereafter once more seen as a disease of the dirty (Pohland 153). 112

connection to the less superficial aspects of life. Mann has established Gabriele

Klöterjahn’s inclusion in the trope of the sentimentalized, delicate consumptive in the opening pages of the text, and then satirizes this trope as the story develops in a manner that exposes her lack of artistic sensibility.

A significant component of Mann’s satirical treatment of these characters is their questionable status as artists in the first place. After all, Gabriele Klöterjahn only admits to having had a father who played the violin as a hobby, essentially a fiddler, in addition to she herself having played the piano before it was forbidden by the Einfried doctors

(Mann, Tristan 20-1). Mann sets up Gabriele Klöterjahn as a dilettante, as it is solely

Spinell who turns this background into a romanticized, fictionalized view of Gabriele

Klöterjahn as an artistic soul. This begins when he inquires after her maiden name, having expressed disdain for “Klöterjahn” as he believes it lacks beauty. He responds to her maiden name, Eckhof, by saying: “’Eckhof’ ist etwas ganz anderes! Eckhof hieß sogar ein großer Schauspieler,” (Mann, Tristan 20). 80 Spinell then goes on to alter a scene related by Gabriele Klöterjahn from her teenaged years: Gabriele Klöterjahn and six friends sitting around a fountain chatting, which Spinell changes into a fictionalized version where they were all singing. In Spinell’s vision, Gabriele Klöterjahn even wore a crown signifying her superiority (Mann, Tristan 39). Spinell also convinces himself that not only is Gabriele Klöterjahn unhappy in her life as a housewife, but that it was Anton

Klöterjahn who stole her away from her true self. This is contrary to Gabriele’s direct assertions that marrying Anton Klöterjahn was a natural progression in her life, and it was she who had to convince her reluctant father that marriage to Anton Klöterjahn was

80 Spinell is referring to the famous actor of Goethe’s time, Hans Conrad Dietrich Eckhof (1720-1788). 113

what she wanted. With the birth of young Anton, then, came her happiness (Mann,

Tristan 22-3). Spinell, however, believes what he has conjured up.

This reworking of the facts is the solitary Spinell’s way of convincing himself that he has found a kindred artistic spirit in Gabriele Klöterjahn, albeit one that he must win over to his side. As Spinell writes to Anton Klöterjahn after it is clear Gabriele

Klöterjahn will die: “Sie stirbt, mein Herr! Und wenn sie nicht in Gemeinheit dahinfährt, wenn sie dennoch zuletzt sich aus den Tiefen ihrer Erniedrigung erhob und stolz und selig unter dem tödlichen Kusse der Schönheit vergeht, so ist das meine Sorge gewesen”

(Mann, Tristan 41). Spinell sees himself as her liberator, with the cost of her life not too high a price to pay for the salvation of her buried inner artist.

The intensification of Gabriele Klöterjahn’s illness is in fact not because of her role as wife and mother, but because she gives into—as well as buys into—Spinell’s vision of her as a fellow artist. He i succeeds in seducing her into playing the piano, imploring her with: “’Lassen Sie dies eine Mal ein paar Takte hören! Wenn Sie wüssten, wie ich dürste…,’” and continues on in this vein until she relents and agrees to play one and only one of Chopin’s nocturnes (Mann, Tristan 28-9). Once she fulfills her promise, she continues to play additional nocturnes, without the slightest urging of Spinell, who simply “[bleibt] ohne Laut und Bewegung sitzen” (Mann, Tristan 30). Spinell has lured her into believing his view of her as an artist, but it is now Gabriele Klöterjahn who disregards her doctors’ warnings against playing the piano and instead searches for more music to play. Seeing that Gabriele Klöterjahn wants to continue on, he selects the sheet

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music from Wagner’s opera Tristan and Isolde. 81 This powerful, emotional music is a dangerous shift from the more simply beautiful Chopin that has no tumultuous love story at its core. Peter Pütz has explained that: “Steht das Spiel Chopins für Klarheit und

Begrenzung, so das von Wagner für Auflösung und Entgrenzung” (Pütz 210). Spinell pushes Gabriele Klöterjahn past simply accepting his conception of her artistic nature and on to exploring new realms of emotion and intensity. Although she follows Spinell’s lead as she begins to play the Wagner, it is once again Gabriele Klöterjahn who insists on continuing to play after they are interrupted by a fellow resident: “’Es herrschte Stille.

‘Das war die Pastorin Höhlenrauch,’ sagte er [Spinell]. ‘Ja, das war die arme

Höhlenrauch’ sagte sie. Dann wandte sie die Blätter und spielte den Schluss des Ganzen, spielte Isoldens Liebestod” (Mann, Tristan 34). What Spinell has started, Gabriele

Klöterjahn finishes, despite the forewarned cost to her health. There is a sexual overtone to this interaction as well; the male character has enticed the female one into pursuing a passion with him that leads to a moment of release.

As Susan Sontag has noted in Illness as Metaphor (1978), tuberculosis was conventionally viewed as a disease of a passion by which one is consumed (Sontag 20).

While this generally had an association with a problematic romantic love, with Gabriele

Klöterjahn, Mann has replaced it with her supposed desire to play the piano. In keeping with this, her tuberculosis worsens dramatically upon the eventual release of this passion.

In Wagner’s opera, Isolde dies a Liebestod , a connotation which Mann has fostered with

Gabriele Klöterjahn’s death through this sexualized moment, but in an ironic manner.

81 Pütz has suggested that even the sanatorium’s name, Einfried , is a nod to Wagner’s own villa Wahnfried in Bayreuth (Pütz 205). 115

Mann has mocked Gabriele Klöterjahn as an amateur who risks her very life for a talent that she does not possess. This is not a noble Liebestod , but instead a death in the service of middling piano skills rather than an artistic spirit. In doing this, Mann has also criticized the trope of the sympathetic artistic consumptive. This is similar to Shaw’s treatment of the character of Louis in The Doctor’s Dilemma . Gabriele Klöterjahn is far from the nefarious character of Louis, but she is not the virtuous consumptive set out in

Patrice Hollmann in Remarque’s work. Rather, Gabriele Klöterjahn’s submission to

Spinell’s narrative of her artistic exceptionality plays a role in bringing about her own demise. Mann also does not sentimentalize Gabriele Klöterjahn in any way nor does he privilege a male’s perspective on her situation. Further, traditionally, men were the tubercular patients with the creative drive and women simply had their beauty intensified by the disease (Lawlor 56), but Mann has gone against this dichotomy and so has created a more active female tubercular patient, adding to the view of Gabriele Klöterjahn as a more complex figure that is not completely passive in the progression of her disease.82

Mark M. Anderson has argued that in Mann’s works, a “’deep truth’ comes to the surface in highly staged, theatrical moments of passion, recognition and understanding, often manifesting itself in physical ‘symptoms’ or markings on the characters’ bodies”

(Anderson 87). Here, in this dramatic, pivotal scene when Gabriele Klöterjahn gives herself over to Spinell, to his fictionalized vision, and to the music, she also dooms herself to die. Unlike Murray in O’Neill’s play The Straw, whose development as a writer is steady and much more convincing, Gabriele Klöterjahn’s commitment to the

82 Lawlor has gone on to note, however, that it is much more likely that having tuberculosis did not increase artistic abilities, but rather deterred them (Lawlor 121). 116

piano is sudden and total. This passage is not as dramatic as it is melodramatic in its reading. Mann has presented these two characters in an absurdly impassioned scenario wherein one deluded “artist” seduces the other into believing she has artistic ability worthy of risking her death. The picture of the two, locked in their delusions of grandeur at the piano in Einfried, is one that Mann has set up for the reader to perceive as a mockery of these characters who take themselves and their art so seriously, never recognizing they lack artistic ability. There is a note of dark comedy that comes from the realization that one middling dilettante is luring another to her death through the reawakening her own inner dilettante.

In accordance with her doctor’s warning, Gabriele Klöterjahn becomes sick the following day when the blood issuing forth from her lungs confirms a case of tuberculosis. She is given over to the doctor in charge of terminal cases, Doktor Müller, and succumbs to the illness shortly thereafter, just as she also had succumbed to Spinell’s seduction as well as to her own desire to be the artist he has convinced her he detects within her. 83 It is thus not the bourgeois lifestyle itself that is ultimately untenable.

Rather, it is Spinell’s success in convincing Gabriele Klöterjahn that she is an artistic soul and the attendant release of passion during her piano playing that bring her to her death.

Mann has thus created in Gabriele Klöterjahn a character representative of those vulnerable by their own vanity to predators such as Spinell who work to convince them that they are in some way special or different from the rest of the bourgeois society, when in fact, in this case, she is no more an artist than he is.

83 In Thomas Rütten’s 2002 chapter “Krankheit und Genie,” he has argued that doctors in early Mann stories are essentially unhelpful and powerless to halt the progression of the disease so that the patient’s state is helpless and they can therefore learn something from the state of illness (Rütten 151, 153-4). 117

Wolfdietrich Rasch has argued in “Thomas Manns Erzählung ‘Tristan’” (1964)

“[…] dass der Tod für Thomas Mann einen positiven Aspekt hat, als endgültige

Vereinigung mit dem Ganzen des Lebens” (Rasch 463); death is indeed the only way for

Gabriele Klöterjahn to unite both her bourgeois family and what she believes to be her artistic sensibility. Even though the rest of the world may consider Spinell and Gabriele

Klöterjahn mere dilettantes, they take themselves and their supposed artistic pursuits much more seriously. This makes Gabriele Klöterjahn’s choice between the two lives both necessary and impossible, thereby resulting in her death.

Despite the fact that she does not live long enough to be forced to choose between life inside and life outside of the sanatorium, she does not give up her music even after the intensification of her illness following the night of passionate piano playing. As the nurse rushes in to report that Gabriele Klöterjahn’s death is imminent, she says: “Sie

[Gabriele Klöterjahn] saß ganz ruhig im Bette und summte sich ein Stückchen Musik vor sich him, und da kam es, lieber Gott, so übermäßig viel [Blut]…” (Mann, Tristan 47).

Gabriele Klöterjahn, for the second and final time, gives in to an untenable existence as a dilettante artist over a potential recovery, and she dies.

Martin Travers has posited that Mann resolves this story firmly in favor of the bourgeois culture (Travers 41). However, this does not seem to entirely be the case here, as Spinell, having already indicated his preference to live inside of the walls of Einfried, can therefore remain alive and well within its confines, free to seduce other women in a similar manner. Mann writes that after Gabriele Klöterjahn’s death, “Er ging gesenkten

Hauptes und summte ein Stückchen Musik vor sich hin […] das Sehnsuchtsmotiv”

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(Mann, Tristan 48). Spinell is certainly saddened by Gabriele Klöterjahn’s death, if for no other reason than that his conquest of her is short-lived. His humming of the very piece that led to her death indicates that he will not subsequently abandon his own dilettantism and shallow existence. Anton Klöterjahn’s laughing, jubilant son in the closing scene is likewise an indication that Anton Klöterjahn will return to his business and carry on. Each man will go about in his own sphere, continuing his disdain for the other, but living on.

Mann has used and manipulated the established conceptions of both tuberculosis and sanatoria as literary devices in Tristan in order to expose and ridicule the dilettantism of the bourgeoisie. Many of his other works deal with the artist-Bürger relationship and dichotomy, but using the sanatorium life in Tristan allowed Mann a more isolated setting for this confrontation. This theme is confined rather simply and straightforwardly to the confrontation between Spinell as the artist in his own mind and Anton Klöterjahn as the businessman, with Gabriele Klöterjahn caught between the two. There are no other significant characters in this storyline, and Gabriele Klöterjahn’s fragile health is what then, seemingly logically, brings these disparate men into contact. Anton Klöterjahn and

Spinell would likely never have interacted in the outside world. In dealing with the universality of illness, however, the sanatorium forces people into association with others from whom they might otherwise have remained separated by lifestyle, career, and general station in life. Mann has also employed the already established associations of a physical tubercular infection in his largely satirical usage of the illness. While he has altered the traditional image of the artistic consumptive somewhat by using a female

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tubercular figure, he also works within the norms to lampoon Spinell and Gabriele

Klöterjahn as representatives of the wider population of dilettantes within the middle class.

Thomas Mann’s Later Representation of Tuberculosis

The novella Tristan was a precursor to Mann’s sanatorium novel, Der Zauberberg

(1924). Mann first conceived the idea for the novel in 1912 after his wife Katia’s 1911 stay at the Davoser Waldsanatorium in Davos, Switzerland. During this stay, the doctors suggested Mann, too, might have a case of tuberculosis, but Mann chose to discount the doctor’s admonition to stay at the sanatorium as a patient himself. 84 This is in contrast to the protagonist of his novel, the newly graduated engineer Hans Castorp, who goes to the

Berghof sanatorium in Switzerland during August of 1907 in order to visit his tubercular cousin Joachim Ziemssen. Castorp soon learns that he has a suspicious spot on his lung, and this results in a seven-year stay at Berghof that ends only due to the onset of World

War I.

The sanatorium here functions in a similar way to that in Tristan. In each work, it serves as a literal world apart from the larger society that nonetheless maintains some, albeit limited, interaction with this outside world. Each sanatorium’s inhabitants are also free from their duties and the attendant expectations. As Inge Diersen has described

Berghof specifically, it is “[…] eine Welt für sich, die mit der Welt des tätigen Lebens,

84 Stephen D. Dowden has noted that although Mann first had the basic idea for Der Zauberbeg in 1912, he began seriously working on the novel in 1915 (Dowden ix). As Michael Beddow has added, Mann halted his work on the novel in 1915 in order to write Bretrachtungen eines Unpolitischen (1918), but then resumed work on Der Zauberberg in 1919 (Beddow 138-9). 120

mit der Welt realer gesellschaftlicher Bewegung nicht nur nichts zu tun hat, sondern sich ganz bewusst und mit snobistisch-arroganter Verachtung von ihr, dem “Flachland”, abschließt” (Diersen 139). Both Einfried and Berghof are also places where people whose paths otherwise would likely not have crossed come together due to their common illness. In this microcosm of upper-middle-class patients and lower nobility, Berghof brings together myriad viewpoints and backgrounds, both educational and cultural.

Despite these differences, all of the major characters, including Castorp, belong to the bourgeoisie and present him with their particular beliefs and lifestyles.

Castorp arrives at Berghof from Hamburg as an ordinary twenty-three year old with no true commitment to the world below. His training has prepared him to be a ship- building engineer, but there is no indication that he feels a particular passion for this pursuit, or for any other. As the narrator reports, Castorp respects work, but he does not love it because “[a]ngestrengte Arbeit zerrte an seinen Nerven, sie erschöpfte ihn bald, und ganz offen gab er zu, dass er eigentlich viel mehr Freizeit liebe […]” (Mann,

Zauberberg 52). Berghof thus presents him with a means to delay beginning his career in earnest, as well as an opportunity to be educated by his fellow patients on subjects and view-points that may spark a true intellectual or emotional interest for him. In Tristan ,

Gabriele Klöterjahn is exposed to the single realm of the artistic through Spinell, whereas the Berghof sanatorium provides Castorp with multiple characters who educate him about their particular way of thinking and living. There are four primary interlocutors for

Castorp: Lodovico Settembrini, Leo Naphta, Clawdia Chauchat, and Mynheer Pieter

Peeperkorn.

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The Italian Settembrini is Castorp’s first unofficial instructor, and Settembrini is a representative of the western European rational enlightenment and humanism. Hannelore

Mundt has argued that: “His main function is to defend the values of the flatlands, to offer Castorp ideological and existential security, and to warn Castorp not to be lost to life […] As Settembrini sides with rationality and a strong work ethic, he is an outspoken advocate of humanism, democracy and progress, and the most severe critic in the novel of the world of the sanatorium” (Mundt 119). He repeatedly urges Castorp to return to the flatlands and escape the world of disease and dying, even after Castorp has been officially diagnosed with the moist spot in his lung that suggests tuberculosis (Mann,

Zauberberg 342). In doing so, Settembrini is the strongest advocate for the value of life over death and dying. His vision of the ideal world is one in which bourgeois mores are maintained, but at the same time, one in which, as John Krapp has explained it, “[…] the liberty, fraternity, and equality of any revolutionary humanism” is also present (Krapp

50). 85 Eberhard Hilscher has claimed that “Hans Castorp findet die Darlegungen seines eifrigen Mentors zwar recht ‘hörenswert’, doch er entscheidet sich nicht dafür und öffnet sich ebnso bereitwillig anderen Einflüssen” (Hilscher 65). Indeed, Castorp finds both intellectual and emotional challenges to Settembrini’s teachings in other fellow residents in Davos.

The Kirghiz-eyed Russian woman Clawdia Chauchat offers a counterpoint to

Settembrini’s attempts to lure Castorp’s allegiances that is not intellectual in nature, but rather sexual and emotional. Her very entrance suggests that she does not conform to the

85 Krapp has gone on to argue that the contradiction inherent in Settembrini’s vision is never resolved, and it therefore serves to push Castorp from adopting this world-view as his own (Krapp 51). 122

bourgeois standards of behavior. This is first because she allows the door to the dining room to slam, disturbing the diners, and then secondly due to her appearance: “Sie war nicht sonderlich damenhaft, die Hand, die das Haar stützte, nicht so gepflegt und veredelt, wie Frauenhände in des jungen Han Castorp gesellschaftlicher Sphäre zu sein pflegten,” (Mann, Zauberberg 109). Castorp is immediately drawn to Chauchat, who is married but with a husband never seen at Berghof. She represents to him a flagrant casting off of the bourgeois norms, and his attraction to this and to Chauchat threatens the power of Settembrini’s influence. Castorp remains at the Berghof in part because of his attraction to Chauchat, and Settembrini, noticing Castorp’s interest in Chauchat, attempts to sway him to resist her allure, equating Chauchat with Lilith, who is said to haunt young men (Mann, Zauberberg 452). Despite this warning, Castorp at last approaches

Chauchat seven months after meeting her during the Walpurgis Night party, asking to borrow a pencil. The two subsequently presumably spend the night together before

Chauchat leaves the sanatorium the following day (Mann, Zauberberg 326-38). 86 Krapp has posited that “For Clavdia, sin, hence life, implies deviation from an absolute behavioral standard […] it constitutes concession to the discordant pressures of human desire, to the need to act in the name of passion, to serve the body instead of the intellect, even if the result is something less than beautiful. It is thus essentially the antithesis of

Settembrini’s highly stylized ethic […]” (Krapp 59). Thus, this moment of submission to his attraction to Chauchat indicates that he is favoring her irrational world of emotion and

86 The pencil incident mirrors a similar moment in Castorp’s childhood when he had borrowed a pencil from Pribislav Hippe (Mann, Zauberberg 169-72). Chauchat’s eyes remind Castorp of Hippe’s and the connection lends a suggestion of homosexual attraction to the boy. For more on this, see Hermann Kurzke’s work Thomas Mann: Epoche – Werk – Wirkung (1985). 123

of flagrant flaunting of the bourgeois norms. The first half of the novel ends with

Castorp still at the crossroads between these two figures and the ideals they embody, however. Although he has given in to his attraction to Chauchat, she has left and he thus has no chance to consider a complete commitment to her side of the dichotomy.

Settembrini’s positions are next countered intellectually by the arrival of Leo

Naphta, which occurs soon after Chauchat’s departure. Naphta is a Russian Jew who has become a Jesuit. In the vision Naphta champions, “[d]as Proletariat hat das Werk

Gregors aufgenommen, sein Gotteseifer ist in ihm, und sowenig wie er wird es seine

Hand zurückhalten dürfen vom Blute. Seine Aufgabe ist der Schrecken zum Heile der

Welt und zur Gewinning des Erlösungsziels, der staats- und klassenlosen

Gotteskindschaft” (Mann, Zauberberg 553-4). As Diersen has described Naphta, “[a]ls

Propagandist einer neuen ‘antibürgerlichen’ Weltanschauung bekämpft er den bürgerlichen Humanismus und Demokratismus” (Diersen 150). As such, he stands in direct intellectual opposition to all that Settembrini advocates, and presents Castorp with this completely different way of viewing the world and of what constitutes progress.

The sub-chapter entitled “Schnee” initially seems to bring about a resolution for

Castorp. Lost in the snow, and having just awoken from a startling dream involving the dismemberment of a child, Castorp thinks about what both Settembrini and Naphta have argued. He ultimately comes to the conclusion that they are both “Schwätzer” and further, “[d]er eine ist wollüstig und boshaft, und der andere blast immer nur auf dem

Vernunftshörnchen und bildet sich ein, sogar die Tollen ernüchtern zu können, das ist ja abgeschmackt” (Mann, Zauberberg 678). He then asserts that: “Die Liebe steht dem

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Tode entgegen, nur sie, nicht die Vernunft, ist stärker als er […] Der Mensch soll um der

Güte und Liebe willen dem Tode keine Herrschaft einräumen über seine Gedanken”

(Mann, Zauberberg 679). This appears to be a turning point for Castorp, as he seems to have at last taken a stance on what he believes to be important to one’s existence, rather than simply absorbing what Settembrini and Naphta have attempted to convince him he should. The weather clears, and he is able to return to Berghof, a further indication, as

Mundt has suggested, that Castorp has found his way in life (Mundt 126). By the end of the night, however, Castorp’s thoughts from the episode are already fading (Mann,

Zauberberg 682). He has not truly made any long-lasting decision about his stance on life and death. As Mundt has posited, what he has not forgotten is “[…] his negative judgment of Settembrini and Naphta as windbags and his rejection of their antithetical views” (Mundt 126). This opens up room for the fourth viewpoint, which is represented by the Dutchman Mynheer Pieter Peeperkorn.

Peeperkorn arrives, accompanied by Clawdia Chauchat, and immediately becomes a significant presence at Berghof. As Diersen has explained, he is the only one who does not really belong in this world of decay. Rather, “[m]it dieser Geschichte vom tapferen Sterben eines alternden Mannes kommt ein Stück Leben in unreflektierter, naiver und urwüchsiger Größe in die sterile Krankheitswelt […] das Sanatoriumsmilieu formt nicht ihn, sondern er formt es nach seinen Bedürfnissen um” (Diersen 155). He, going against bourgeois norms, is frequently drunk and is concerned primarily with the enjoyment of life. As Krapp has asserted, “Hans Castorp views him as synthesizing body and spirit without discarding either for the sake of glorifying a lopsided abstract ideal,”

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and even his elliptical speech stands in contrast to Settembrini and Naphta’s rhetorical flourishes (Krapp 64). Peeperkorn eventually kills himself due to his impotence (Mann,

Zauberberg 857). He has died on his own terms, however, rather than waiting for death to claim him. As Krapp has argued, “[w]hen Mynheer Peeperkorn can no longer live his moral, he does not aestheticize it into an ideal image to be glorified theoretically in the manner of a Settembrini or a Naphta,” and has therefore provided a further pedagogical moment for Castorp (Krapp 65). Once again, however, it is not one that Castorp chooses to internalize and adopt as his own lifestyle and belief system.

Throughout Peeperkorn’s residence at the sanatorium, Clawdia Chauchat and

Castorp have a relationship far from the one they had earlier. The sexual tension is essentially gone, and Castorp all but ignores Chauchat as he joins Peeperkorn’s circle.

This indicates that Castorp has essentially avoided having to make the decision he seemed destined to have to make when they parted. He has instead chosen not to follow either the tenets of Settembrini nor to pursue the resumption of a physical relationship with Chauchat. Chauchat’s departure is entirely asexual as Castorp kisses her forehead

(Mann, Zauberberg 127). For Mundt, this is also a sign that Castorp is growing increasingly indifferent towards life, which will be emphasized in the subsequent chapters that detail the next five years of his stay (Mundt 127). Indeed, he turns inwards and becomes withdrawn from the Berghof lifestyle. He has lost his connection to his

Berghof instructors as they have either died, left, or become irrelevant to him. As

Diersen has phrased it, “[a]us Hans Castorp ist ein ‘verirrter Büger’ geworden, der den

Weg zurück ins Bürgertum nicht mehr finden will, der aber den Weg vorwärts, über das

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Bürgerliche hinaus nicht sieht […] (Diersen 146). He is only prompted to leave the sanatorium by the onset of World War I.

Near the end of the novel, Settembrini and Naphta’s conflict finally comes to a head when Settembrini accuses Naphta of molesting the mind of the vulnerable Castorp, and Naphta retaliates to the insult by challenging Settembrini to a duel (Mann,

Zauberberg 957-60). Settembrini, as befits the promoter of life and progress, refuses to shoot Naphta, while Naphta, in response to this, shoots himself in the head (Mann,

Zauberberg 970-1). As Mundt has argued, in contrast to this, “[…] Mann has Naphta affirm his life-negating principles through self-destruction and violence. With Naphta’s death, Mann lets the advocate of progress and humanism survive the spokesperson of totalitarian power, nihilism, and destruction, albeit for only a brief period, as

Settembrini’s health is deteriorating rapidly” (Mundt 123). By this point, Castorp had already come to regard these men and their ideals as irrelevant to him, and so the loss of

Naphta has little effect on him.

Castorp’s cousin Joachim Ziemssen does not have an experience at Berghof that is similar to Castorp’s. Unlike his cousin, Ziemssen has a clear view of himself and of his place in the world below the sanatorium. He sees himself only as a soldier, with the unyielding objective to join the military as soon as possible and begin his career there.

Due to this, he is not susceptible to the pedagogical lectures of his fellow sanatorium dwellers. While he, too, develops feelings for one of the female patients, he does not give in to them, and therefore escapes the fate of a prolonged residence that Castorp experiences due to his attraction to Chauchat. Despite being much more seriously ill than

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Castorp, he in fact insists on leaving against medical advice to join his regiment and return to the everyday life of the life below (Mann, Zauberberg 572-3, 579). He comes back to the sanatorium, however, and this time is deathly ill. Ziemssen dies several months later, never having returned to the flatlands below (Mann, Zauberberg 736).

Although he lived as he chose, his fatal decision to leave the sanatorium is, as Diersen has claimed “heroisch, aber unvernünftig” and “[…] es ist eine Tapferkeit ohne Sinn,

[…] und führt deshalb in den Untergang” (Diersen 154). Ziemssen’s life choices are therefore also not an example of the ideal for Castorp to follow, just as Castorp’s other interlocutors’ had not been.

Mann’s presentation of tuberculosis in this novel is markedly different from that in Tristan. Stephen Meredith has noted that Mann is especially prone to taking sentimental literature and rendering it grotesque (Meredith 119), which he does in both works. In the case of Der Zauberberg , however, this later story is far more specific in the depiction of the disease. This reinforces the notion of a world of illness and death that is set apart from the flatlands. As Castorp is exposed to the symptoms and consequences of the disease treatment, everything is new and generally disturbing. The first tubercular cough he hears is unlike any other he has ever heard, but rather “[…] ein Husten ganz ohne Lust und Liebe, der nicht in richtigen Stößen geschah, sondern nur wie ein schauerlich kraftloses Wühlen im Brei organischer Auflösung klang” (Mann, Zauberberg

23). As Elizabeth Boa has pointed out, this is a description that mixes “[…] sound with imagined visual, tactile and gustatory elements, the most revolting being the taste—or is it more the feel?—of ‘Brei’, of slimy mush in the mouth” (Boa 133). This disgusting

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description of the cough is unlike anything included in Tristan, where allusions to the symptoms of the disease are few and oblique; the focus is solely on the interactions between the main characters during Gabriele Klöterjahn’s initiation in the sanatorium life.

In continuing the more graphic nature of tuberculosis in Der Zauberberg , Castorp is also exposed to the “Verein Halbe Lunge.” This is the group of patients who have undergone an artificial pneumothorax, which was an especially popular treatment at the sanatoria during the time Mann was writing. The group member who can now whistle through her pneumothorax incision is particularly startling to Castorp (Mann, Zauberberg

73-4). She presents a disturbing image to him as well as to the reader, the likes of which is not present in Tristan. Mann’s inclusion of the “blauer Heinrich”, which Boa has explained was a container commonly used for spit and other discharge from coughing so as to prevent the spread of the bodily fluids, is also a vivid reminder that life at Berghof involves elements unknown to most below (Mann, Zauberberg 11 and Boa 104).

Ziemssen’s blasé reaction to Kleefeld and to the other elements of tubercular infection that alarm Castorp attests to the fact that one soon gets used to the life above at the sanatorium and no longer considers such things strange (Mann, Zauberberg 74). Indeed, this is the case with Castorp as well, as he acclimates himself to the realities and normal occurrences at the sanatorium, and, as Boa has claimed, overcomes his “visceral disgust” of bodily functions to move on to his intellectual considerations (Boa 142).

The treatments depicted in this work are likewise true to the reality of the time in which Mann was writing. In Der Zauberberg , the Liegekur is still a primary means of

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treatment, as it was in Tristan , but Mann also includes a detailed description of the prescribed daily routine characteristic of sanatoria, including hearty, frequent meals and exercise. These elements are not only incorporated into the text, but they become integral to it, as they provide the setting for various characters’ encounters, such as the introduction of Clawdia Chauchat during dinner, as mentioned above, and the initial encounter of Castorp with Settembrini during a walk (Mann, Zauberberg 81-2, 109). The

Liegekur also provides ample time for rest and reflection during the stay, and this allows

Castorp to explore his new-found interest in the science of life, including anatomy, physiology, and biology (Mann, Zauberberg 378-94). He seeks to discover the mysteries of life, but again here does not make any overarching conclusions that enable him to form a direction or belief system.

The use of x-rays also becomes a significant aspect of the novel. 87 The primary medical doctor, Hofrat Behrens, diagnoses patients and tracks their disease progression through their use. 88 Castorp’s view of his cousin’s internal organs and skeleton provides a moment of amazement for him. He exclaims“[m]ein Gott, ich sehe!” as he begins to recognize the structures within Ziemssen’s body, and is filled with “Andacht und

Schrecken” at the sight (Mann, Zauberberg 303). The x-rays are both a reminder of the fragility of life, particularly as those who receive them at the sanatorium are ill, as well as of the wonders of the human body. The x-ray plates bear a particular importance at

Berghof, as they serve as a testament that one belongs. Settembrini points this out to

87 As Malte Herwig has noted, Mann did extensive research in a laboratory in Munich on the x-ray technology as it stood during the time of his writing, and so the details of the x-ray usage are quite accurate (Herwig 152). 88 Behrens is based on Friedrich Jessen, the chief physician at the Davoser Waldsanatorium at the time Mann and his wife were in residence there (King 82-3). 130

Castorp, who carries his in his pocket, albeit with the addendum that “[…] ob sie wirklich einen ‘Ausweis’ bildeten oder nicht, einigermaßen in das Belieben des Beuteilers stellten” (Mann, Zauberberg 335). Castorp and Chauchat even exchange x-rays as remembrances of each other, something one hardly would do back in the world below

(Mann, Zauberberg 429). These x-rays are therefore another reminder that life on the mountain follows separate values and mores than the typical middle class outside of its confines, further separating Castorp from existence below.

Behrens’ assistant, Krokowski, offers another parallel to the realities of tuberculosis perception and treatment of the time Mann was writing. Krokowski practices psychoanalysis and lectures the resident of Berghof on the connection between the mind and body. 89 Ulrich Dittmann has contended that “[a]ls Röntgenologe und

Psychoanalytiker stehen Hofrat [Behrens] wie Assistent […] als tätige Vertreter der

Tendenzen ihrer Zeit gegenüber. Behrens und Krokowski vermitteln Castorp zugleich mit neuen Kentnissen […]” (Dittmann 121). The majority of Krokowski’s biweekly lectures concentrate on the connection between love and illness in a series entitled “Die

Liebe als krankheitsbildende Macht” (Mann, Zauberberg 163). Krokowski draws connections between repressed love and the genesis of illness, finally concluding that

“Das Krankheitssymptom sei verkappte Liebesbestätigung und alle Krankheit verwandelte Liebe” (Mann, Zauberberg 179). Castorp therefore connects his illness to his repressed love for Chauchat, and accordingly, as Dierks has argued, Castorp’s fever rises when he interacts with Chauchat (Dierks, “Krokowski” 181). This is in keeping

89 Manfred Dierks has explained that while Thomas Mann knew of psychoanalysis at this time, his knowledge was of the general tenets commonly understood by the educated masses, rather than the result of his own in-depth research (Dierks, Studien 130). 131

with one commonly held perception of tuberculosis in Europe and North America at the time: that it arose from too much passion, producing the reddened cheeks associated with the disease. Krokowski’s character also does not offer Castorp a life direction, but rather, as he veers into the occult, he, too, becomes another figure whose convictions are too rigid and radical to provide a way for Castorp.

While death from tuberculosis is generally not depicted in Der Zauberberg , with the exception of Ziemssen’s death, its occurrence is referenced and the procedures following a patient’s death are described. Mann presents death at this mountain sanatorium as an everyday event, but one on which the inhabitants are not encouraged to dwell. As Ziemssen explains it to Castorp, “’[...] sie [die Todesfälle] werden diskret behandelt, verstehst du, man erfährt nichts davon oder nur gelegentlich, später […] Und der Sarg wird in aller Frühe gebracht, wenn du nocht schläfst, und abgeholt wird der

Bretreffende auch nur zu solchen Zeiten, zum Beispiel während des Essens’” (Mann,

Zauberberg 77). The patients in turn come to view death as either a social happening, as in the case of Castorp and Ziem ss en, who make a tradition out of delivering or sending flowers to the moribund, or as an inevitable but insignificant part of daily life (Mann,

Zauberberg 415-444). This is unlike the world below, where death and funeral rituals have particular rules and traditions. However, those at the sanatorium who are closer to death are given a higher social status, thereby establishing the hierarchy of the ill (Mann,

Zauberberg 283). This mocks the apparent necessity of the middle class to create social distinctions and hierarchies, even when gravely ill.

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Just as Gabriele Klöterjahn dies, so, too, does Castorp face his own probable death, but it is not from tuberculosis. He, like his fellow residents, is roused from his seven years of withdrawal from life below by the onset of World War I: “Die ‘Heimat’ glich einem Ameisenhaufen in Panik. Fünftausend Fuß tief stürzte das Völkchen Derer hier oben sich kopfüber ins Flachland […]” (Mann, Zauberberg 979). The war has broken apart the isolated existence of the sanatorium, and Castorp, having survived the slight degree of disease he had, is depicted facing death as a soldier in World War I

(Mann, Zauberberg 983). He descends from Berghof having resisted adopting the position of any of his bourgeois educators; while he has learned much through his exposure to them at the sanatorium, he has changed little. As Wessell has written, this is in accordance with Mann’s 1915 plan for the novel, wherein he wanted the novel to be

“informative” rather than “decisive” (Wessell 140). Castorp does not leave Berghof due to any particular conviction. As Krapp has argued “[...] the ethical critic of Mann’s text cannot univocally determine either the reason why the engineer descends from the mountain or the possible moral component of that reason” (Krapp 68). 90 What is clear as

Castorp joins the German war effort is that the bourgeois culture as he knew it, both at

Berghof and in the world below, will be changed forever due to World War I.

A Swiss Representation: Max Frisch

Max Frisch’s 1954 novel Stiller is one of the few fictional representations of tuberculosis in western literature after World War II. This work centers around the story

90 Wessell has explained that Mann wrote of World War I having provided a solution for this novel, giving Castorp’s story a way to end that was not available when he first conceived of the work (Wessell 131). 133

of Anatol Stiller, also known as James Larkin White, who has been captured and retained in Switzerland on suspicion of espionage. The prisoner claims that it is a case of mistaken identity because he is the German-American White rather than the Swiss sculptor Stiller, who had gone missing six years earlier. The novel presents

White/Stiller’s notebooks as he retells his life story while in prison awaiting his hearing.

These are then followed by the prosecutor’s notes after White had been declared to be

Stiller. Stiller, as White, recounts many stories from his past, and in varying versions, but he also records the subjective recountings of the primary figures in Stiller’s life before his disappearance. These people include his dancer wife, Julika Stiller-Tschudy; the prosecutor Rolf; and Rolf’s wife Sibylle, with whom Stiller had had an affair before his disappearance. Stiller and Stiller-Tschudy’s relationship forms one of the central storylines of the work, presenting a problematic middle-class marriage and the issue of monogamy within it. This relationship is also one shaped by Stiller-Tschudy’s tuberculosis. 91 As with several of the works I have discussed in this section, the disease is not only integral to the formation of their relationship, but the course and treatments of the tuberculosis also serve to underscore the fundamental problem of the marriage: the insecurity of both partners in their roles as a man and a woman, respectively.

White’s interpretation of the marriage Stiller-Tschudy has described to him is the following:92

Ob zu Recht oder Unrecht, jedenfalls hatte die schöne Julika eine heimliche Angst, keine Frau zu sein. Und auch Stiller, scheint es, stand damals unter einer

91 The other primary strains are his failures as an artist and as a participant in the Spanish Civil War, all three of which led to his departure for America. 92 Michael Butler argued that “[…] the device of ‘Mr. White’ enables Frisch to give subjective truth an aura of objectivity” in the retelling of this marital story (Butler 69). 134

steten Angst, in irgendeinem Sinn nicht zu genügen; […] Sie [Stiller-Tschudy] traute sich offenbar nicht zu, einem wirklichen und freien Mann genügen zu können, so dass er bei ihr bliebe. Man hat den Eindruck, dass auch Schiller sich an ihre Schwäche klammerte; eine andere Frau, eine gesunde, hätte Kraft von ihm verlangt oder ihn verworfen. Julika konnte ihn nicht verwerfen; sie lebte ja davon, einen Menschen zu haben, dem sie immerfort verzeihen konnte. (Frisch, Stiller 104-5)

This shows the role tuberculosis played in drawing these two into a relationship and then marriage. Stiller has found a woman who, due in part to the physical realties of her disease, has a literal weakness that parallels his own weakness of personality, in that he is insecure of himself and his masculinity. Stiller-Tschudy’s more significant difficulty is actually not her tuberculosis, however, although the disease plays a significant role in elucidating and problematizing it. Rather, it is her secretly held belief that she is not a true woman, due in part due to her sexual frigidity, that, in combination with Stiller’s need to hide his own insecurity through their relationship, binds him to her and vice versa. This is therefore far from the sentimentalized depiction of tuberculosis because

Frisch portrayed each of the spouses, including the tubercular one, as having significant deficiencies that lead to the marriage’s failure.

These two people are locked in this marriage due to their inadequacies, and the progression of Stiller-Tschudy’s tuberculosis traces the disintegration of this arrangement as each person’s fear of rejection by the other is strained by the facts of the disease.

Despite a doctor’s warning that she should spend each summer in the mountains, Stiller-

Tschudy cannot do so because Stiller does not earn enough from his sculptures to enable this. Stiller-Tschudy does not tell him of the doctor’s advice, however, in order to spare his feelings (Frisch, Stiller 105). This emphasizes her desire not to upset him or do

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anything to make him feel inadequate. Stiller, for his part, attempts to subsume his feelings of insufficiency by playing the role of caretaker, advising her repeatedly to see the doctor and admonishing her to experience more of life. This only serves to irritate his wife, despite her appreciation for his concern, and to make her feel as though he does all of this “damit sein Gewissen beruhigt wäre, damit sein männlicher Egoismus keine

Rücksicht mehr zu nehmen brauchte” (Stiller 107). This accentuates the fundamental problematic nature of this marriage wherein Stiller-Tschudy wants to be appreciated as a woman, rather than as a means to assuage Stiller’s fear about not measuring up as a man.

Despite Stiller-Tschudy’s assertion to White that it was generally a happy marriage, the strife she describes in connection with her health, including Stiller’s controlling behavior and his increasing irritation with her fatigue, indicates otherwise.

His behavior in fact drove her to flirt with other men as proof of the womanliness she felt

Stiller was reproaching her for not having, culminating in a one-week affair (Frisch,

Stiller 120). It is then Stiller’s change in attitude about her tuberculosis that alerts her to the onset of his own affair with Sibylle. He no longer inquires about his wife’s fever except with a tone of sarcasm, rather than the true care he had earlier seemed to exhibit

(Frisch, Stiller 109). Further, when she reveals to him that her case has progressed to the point where she must go to Davos, and that she has kept this information from him for a full week, he does not react with the concern and horror one would have earlier expected.

Rather, “seine Ruhe war der blanke Hohn, eine Unmenschlichkeit, wie Julika es nicht für möglich gehalten hätte, ja, Stiller lächelte sogar während Julika von ihrem möglichen

Tode spach. Er lächelte! Und die arme Julika, seit fast einer Woche schon allein mit der

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Last dieses ärztlichen Befundes, trauten ihren Ohren nicht” (Frisch, Stiller 112). Stiller-

Tschudy’s tuberculosis therefore acts as a barometer for the state of this marriage. Stiller, who had earlier been so overly solicitous in order to prove the fulfillment of his duties as a man, now essentially reveals the selfish remedy of his inadequacies by another means, namely an affair. As Ulrich Weisstein noted, her disease has also progressed as her marriage has worsened, offering a note of connection between the two occurrences

(Weisstein 58).

The time Stiller-Tschudy spends in the sanatorium serves to heighten the rift between the two. Stiller is upset that his wife does not write to him from Davos, indicating his need for the validation of her affections (Frisch, Stiller 125-6). Stiller-

Tschudy, for her part, initially enjoys the respite from the turmoil of her marriage and the strenuous nature of being a ballerina. She, like Gabriele Klöterjahn, finds a man in the sanatorium who is far different from the one she left behind in Zürich. For Stiller-

Tschudy, this is a Jesuit seminarian and veteran of the sanatorium. The unnamed man encourages her to explore books she had never heard of before, convinces her of the beauty of the human skeleton, and even instructs her on topics such as modern physics

(Frisch, Stiller 133-5), which is similar to Hans Castorp’s academic investigations at

Berghof. Stiller-Tschudy is excited by this new knowledge the seminarian is bringing to her, and so it stands in stark contrast to her stagnant, strife-ridden relationship with

Stiller, to the point where “solche Besuche am Fußende ihres Bettes interessierten sie natürlich mehr als Stillers pflichbewusst-regelmäßige Briefe, die, wie Julika sehr wohl empfand, nicht durchleuteten, im Gegenteil” (Frisch, Stiller 135). This friendship with

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the Jesuit seminarian is also free of any of the sexual problems that plague her marriage, because it is a friendship devoid of sexual or amorous emotions. Stiller-Tschudy seems to have found here the truly fulfilling experience she never has either with Stiller or with this man with whom she had the brief affair, and it is only time away in the sanatorium that allows her this. She is still consumed some nights by thoughts of Stiller and his egocentric, uncaring behavior, but her days are filled with this new friendship and its many positive aspects.

Stiller’s first visit to the sanatorium only reconfirms their problematic marriage.

He demands of his wife that she say whether she ever loved him, and upon her refusal to answer that, he grabs her and kisses her forcefully before dissolving into tears and eventually simply leaving without saying goodbye (Frisch, Stiller 141-2). This erratic behavior indicates Stiller’s inability to move beyond Stiller-Tschudy’s sexual frigidity and the effect it has on his self-image as a man who cannot emotionally or sexually fulfill his wife.

After this event, the Jesuit seminarian further contributes to Stiller-Tschudy’s development by forcing her to confront her own role in her marital conflict, but she will not admit to the veracity of this. (Frisch, Stiller 157). Rather, she maintains that Stiller alone is to blame. Her loneliness at the sanatorium indicates that she has not completely internalized what she has learned from her time away. Rather, she soon gives in to her need for Stiller to acknowledge and care for her, and so instead sets off to find him, despite the risk to her life. She is found and returned to the sanatorium very ill, but Stiller does not appear at her side for three weeks (Frisch, Stiller 158-63).

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It is during this visit that the truth of their relationship is finally openly discussed.

Stiller has ended his affair, and now seeks to end the marriage. He places blame for the problems of the marriage on the fact that, due to cowardly actions during his participation in the Spanish Civil War, he had come to the relationship less than “ein voller und richtiger Mann” (Frisch, Stiller 172). He explains had he been a full man, he would never have married her; the fact that he did was due to her fragility and the delicate nature that came partly as a result of her tuberculosis. He admits that he was unable to help her heal because of the constant fears of inadequacy that led him to continue his selfish actions (Frisch, Stiller 172-3). Stiller blames her as well for wanting to be ill so that he would take care of her and fulfill her, and he suggests that she also should have been with a different man, or even a different version of himself—one who would have enabled her to flourish rather than to continue on in sickness (Frisch, Stiller 174-5).

Stiller recognizes now that Stiller-Tschudy’s tuberculosis had bound them together while each sought to cover perceived deficiencies rather than helping them to reach true self- actualization. Having understood that, he leaves her and begins his gradual disappearance. After his departure, Stiller-Tschudy regains her health at some unspecified point and leaves the sanatorium, an occurrence which Weisstein explained as being the result of her freedom from the conflict-ridden relationship (Weisstein 58). She will then go on to seemingly find satisfaction with her dance school in Paris during his absence.

When White/Stiller and Stiller-Tschudy meet again, each is still drawn to the other, despite the intervening years and the actions. It at first appears that this relationship

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will be a new one, separate from what they had had before Stiller’s disappearance.

Stiller-Tschudy has given up her dance school and her lover in Paris, and they live together again in Glion. In wake of the verdict that pronounced White to be Stiller, however, tuberculosis once more serves as the catalyst for the revelation of the problems that still plague this relationship. According to the prosecutor Rolf, who relays the events of this time, they had been living together again as husband and wife for two years, with

Stiller taking up pottery as a profession and Stiller-Tschudy teaching eurythmics at a girls’ school (Frisch, Stiller 465). Manfred Jurgensen has analyzed these less demanding versions of the artistic aspirations each once pursued as being indicative of the resignation to the previous lonely lives they had earlier led together (Jurgensen 68).

Indeed, the couple remains locked in much the same battles as they previously were.

Rolf reports feeling as though “Stiller [will] immerzu etwas gutmachen […] dann wird er höflich bis zur Ängstlichkeit” (Frisch, Stiller 474). This suggests that Stiller still has not overcome his need to please his wife and be accepted by her. As for Stiller-Tschudy, after she reveals to Rolf that Stiller does not know that her tuberculosis has returned and she must be operated on, Rolf reports that “ich glaube, nie einen einsameren Menschen gesehen zu haben, als diese Frau. Zwischen ihrer Not und die Welt schien eine Wand zu sein, undurchdringlich, nicht Haltung allein, eher etwas wie eine Gewissheit, nicht gehört zu weden, eine alte und hoffnungslose […] Erfahrung […] dass der Partner doch nur sich selbst hört” (Frisch, Stiller 478).

Despite their time apart, during which Stiller has felt himself to be reborn into

White, and despite Stiller’s bold assertion during their last visit at the sanatorium that he

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understands the root of their problems, nothing has truly changed. Stiller-Tschudy’s refusal to tell her husband of her operation is indicative of this, as is the reappearance of her tuberculosis itself, which seems to worsen or improve in accordance with her relationship to Stiller. Stiller, once he does know of her operation, realizes that nothing is different between them, and even admits his belief that he ruined his wife (Frisch, Stiller

496-7). They are once more bound to each other in their misery and through their fears of rejection and inadequacy, and it is again also tuberculosis that definitively brings this conflict to the fore. Stiller-Tschudy dies several days after the operation, and her death is the ultimate indication that these two could not find a way to resolve their marital discord and find fulfillment with each other. Petersen explained that “Frisch läßt in der Tat keinen Zweifel daran aufkommen, dass es in seinem Roman nicht um Stillers

‘Nichtigkeit’, sondern um die Leere menschlichen Daseins überhaupt geht” (Petersen

299). Indeed, at the end of the novel, Stiller is living alone in Glion, where he had lived with his wife, and Stiller-Tschudy is dead, neither having come to find fulfillment in or through the other in the marriage. While the physical facts of the disease are not fully depicted in this work, as in many I have discussed in this section, the emotional elements and points of conflict associated with the tuberculosis point to the untenable nature of this middle-class marriage that led to affairs and unhappy lives together for each partner.

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An Austrian Counter-Example: Thomas Bernhard

Thomas Bernhard suffered from two lung-related ailments, first pleurisy and then tuberculosis. 93 He wrote about his hospitalization for pleurisy in the third volume of his five-volume series of autobiographies, Der Atem: Eine Entscheidung (1978), but his sanatorium stays and tuberculosis infection are the subject of his 1981 continuation of the telling of his life story, Die Kälte: Eine Isolation. 94 This text offers one of the few autopathographies of tuberculosis, as well as one of the only personal accounts of the disease in western literature after the advent of a pharmaceutical treatment. 95 Peter

Friedl, in his discussion of Die Kälte , has claimed that “Bernhards autobiographische

Texte sind nicht […] authentisch, weil sie zeigen, wie es gewesen ist . Sie führen vor, wie

Realität durch das Subjekt transformiert wird, einmal im persönlichen Erleben, dann in der Erinnerung und Schreiben” (Friedl 544), and indeed Bernhard’s text here presents his subjective representation of the role tuberculosis played in his life at the time he was ill. 96

Bernhard entered the sanatorium Grafenhof in St. Veit, Austria in 1950, at the age of eighteen. He would not actually test positive for the tuberculosis bacillus in his sputum until five weeks later. Due to this, he is an outsider to the sanatorium hierarchy, as

Castorp also initially is (Bernhard, Kälte 21). It is only after this positive result that

93 Thomas Berhard died on February 12, 1989, as a result of the intensification due to a heart condition of the lung ailments he had suffered throughout his life (Honegger 15-16). 94 Gitta Honegger has explained that Bernhard wrote this text as his health was faltering once again, and for what would be the final time, placing him in a similar condition to the time he has written about in Die Kälte (Honegger 29). 95 The publication of this text also coincides with the rise of the autopathography movement, which will be discussed in chapter 6 as it pertains to cancer. 96 Honegger notes several instances where Bernhard chose to either alter the reality of the situation or leave out details in his retelling of this part of his life. She points in particular to the fact that he omitted any mention of meeting, Hedwig Stavianicek, a woman who was central to his lfie, at Grafenhof and that he altered the time and circumstances of the car accident that killed the woman who was to tell him more about his father (Honegger 24-5). 142

Bernhard describes feeling acceptance by the other patients and a sense of belonging, therewith fully taking part in the daily life of the other patients at Grafenhof. This includes time in the Liegehallen ; walks; and the administration of doses of streptomycin, albeit ones too weak to effect a cure (Bernhard, Kälte 11-13,17, 21, 30, 40). He soon no longer desires to comply with the strictures of this world, however, and instead claims:

“Zu diesen Menschen gehörte ich nicht, ich war ganz einfach nicht so wie sie […] Wie konnte ich glauben, dahin zu gehören, wo die Fäulnis und die absolute

Hoffnungslosigkeit die Seele abwürgten, das Gehirn abtötete?” (Bernhard, Kälte 19-20).

It then comes to light that Bernhard’s positive result was a laboratory error, and this, added to his change in attitude, leads him to again feel an outsider and spurs his determination to leave Grafenhof (Bernhard, Kälte 21). Whereas Hans Castorp relatively easily integrates himself into the Berghof culture of Der Zauberberg and began to be instructed by his various interlocutors, Bernhard remains apart from his fellow patients, refusing to give in to the hopelessness that permeates the facility. This autobiography is not as concerned with the general culture in and around the sanatorium, as in Der

Zauberberg ; rather, it is primarily focused on the effect the illness and sanatorium stay have on Bernhard as an individual.

Much of the text tells of Bernhard’s interactions with the outside world. There is particular emphasis on the impending death of his mother from uterine cancer, from which Grafenhof initially has provided a respite; on the prior death of his grandfather due to a botched operation; and on his relative lack of knowledge about his biological father

(Bernhard, Kälte 24, 28, 48). He also uses the time at Grafenhof to consider his life

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choices up to this point, which have included leaving Gymnasium for a Kaufmannslehre

(Bernhard, Kälte 38). He then describes unpacking these events, and then repacking them to carry them with him (Bernhard, Kälte 42). This lends neither a note of melancholy nor of undue optimism to these considerations, but rather the reality of the continuing impact of these memories that would not ultimately be confined to his sanatorium stay.

After nine months at Grafenhof, Bernhard is released as healthy, only to have it be determined two days later that his sputum is positive for active tuberculosis infection. He is therefore required to enter a hospital for treatment immediately, but because of his mother’s grave condition, this news was not met with the alarmed response by his family it might otherwise have been (Bernhard, Kälte 58-9). Bernhard’s telling of his subsequent pneumothorax, which is then ruined by an inattentive doctor, and the subsequent pneumoperitoneum, which was still new and seldom practiced at the time, is not privileged over his grandfather’s death and the progression of his mother’s grave condition, which is woven throughout the story. Indeed, Bernhard reports his horror that the same doctor who had caused his grandfather’s death performs the necessary crushing of his own phrenic nerve, and that he had walked through the halls where both his grandfather’s surgery and his mother’s hysterectomy, which came too late to save her life, had been performed. Further, he describes his siblings shuttling between visiting him and staying with their moribund mother (Bernhard, Kälte 62-4, 68). Bernhard’s illness thus does not stand alone as the seminal event in his life, unlike for those at the

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Berghof in Der Zauberberg . Rather, it is presented among the other significant occurrences from around the same time.

Even upon Bernhard’s return to Grafenhof, after receiving definitive confirmation of his tuberculosis and having undergone a procedure no other patient there had, he still does not have a sense of belonging amongst the patients. He instead finds his salvation by independently going against the sanatorium’s policies. Following his mother’s death, however, he seems to have given up on life, forgoing the necessary filling of his pneumoperitoneum and explaining: “Jetzt habe ich alles verloren, dachte ich, jetzt ist mein Leben vollkommen sinnlos geworden. Ich fügte mich in den Tagesablauf, ich ließ alles, gleich was und wie es auf mich zukam, geschehen, ich verweigerte nichts mehr, ich ordnete mich völlig unter” (Bernhard, Kälte 88). This again underscores the fact that

Bernhard’s illness was not the lone focus of his life at this time.

Bernhard’s state is drastically changed by a transfer to a floor that offers views of the valley and the outside world. More importantly, this is a floor on which he is forced to interact with others. In seeing the complete preoccupation with death and disease exhibited by these people, he determines that he must repeatedly disregard the sanatorium rules in order to travel to the town. He would thereby improve his health by breaking away from the strictures of Grafenhof and through forbidden activities such as singing in the town’s church (Bernhard, Kälte 88-89, 94). As Bernhard explains it, “Aufeinmal wollte ich nicht nur meinen Zustand verbessern, ich stellte den höchsten Anspruch: ich wollte Gesund werden,” (Bernhard, Kälte 89). Rather than fostering a drive to remain amongst this community of the ill, the patients of Grafenhof drive Bernhard to seek to

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leave. He subsequently only follows those personal impulses and sanatorium rules that would further this goal. Honegger has explained the importance of this decision as a rebirth: “Breaking away from the deadly protective womb of the sanitarium, he finally succeeded in delivering himself” (Honegger 31). Bernhard’s readings of great works of literature during this time, in particular Dostoevsky’s novel The Possessed (1872), provide another impetus for understanding that leaving Grafenhof is the only way to proceed. Indeed, these two events prove to be the most important treatment modalities of all; after setting his mind to this, Bernhard’s health seems to improve in accordance with the degree to which he willed it. As he wrote, “Wenn ich hinter den Röntgenschirm trat, wollte ich auch schon hören, dass sich mein Zustand verbessert hat, und tatsächlich verbesserte sich mein Zustand von einer Untersuchung zur andern” (Bernhard, Kälte

93). 97 He even decides his own date of discharge from Grafenhof, demanding it of the doctors, never again to return (Bernhard, Kälte 96). This climax of the text contains the powerful image of Bernhard having chosen to pursue life, now without either his mother or his grandfather, rather than to languish. 98

This work is certainly not devoid of the medical realities of tuberculosis.

Bernhard includes a detailed description of his memories of the operation to crush his phrenic nerve, as well as the method used to fill the body cavity in order to induce a pneumoperitoneum. He also describes the particular measures common to that time, including streptomycin and PAS (Bernhard, Kälte 66-7, 84). These seem to be secondary

97 Zoltan Szendi described this moment as likely “eine nachträgliche Projektion der Selbstsicherheit des renommierten Schriftstellers” (Szendi 205), which is in keeping with the overall subjective feel to the autobiography. 98 There is a similar moment at the end of Der Atem, wherein Bernhard makes the decision to concentrate on his health (Berhnard, Atem 105). 146

to his own agency in deciding to heal and leave Grafenhof, however. The final triumphant moment of this text stands in stark contrast to the almost certain doom that will befall Hans Castorp as he leaves Berghof to join World War I.

Gender in Fictional Accounts of Consumption/Tuberculosis

Each of the texts I have analyzed in-depth in my three chapters on consumption/tuberculosis concern ill women, as do a significant number of those that I have looked at more briefly. While gender is not the focus of my argument, it is nonetheless notable how many of the ill figures in the fictional works are woman rather than men. Although the uses and representations of tuberculosis are quite different among Remarque’s Drei Kameraden, Eugene O’Neill’s The Straw and Thomas Mann’s

Tristan , in all of them, it is the women who have the disease. 99 Even in The Straw, which contains a male protagonist with tuberculosis, Eileen Carmody’s case is much more serious, and the one that the play’s end suggests will result in her death. This does not reflect the historical reality, as men were actually more likely to contract the disease, given that they were often coming into contact with more people as a result of their traditional role as a financial provider working outside of the home. For all three women, tuberculosis highlights and enhances their depiction as particularly vulnerable figures.

Not only are they simply women, and as such already at a power disadvantage in comparison to men of this time, but as sick women, they are then portrayed as being at a further disadvantage in their respective social standings because they are seen as being incapable of making decisions about their health and life. These women need the men in

99 For a discussion of the few male consumptives in literature, see chapter four in Lawlor. 147

their lives either to merely continue living, as with Patrice Hollmann in Drei Kameraden , or to explore their previously untapped desires, as with Gabriele Klöterjahn in Tristan and Eileen Carmody in The Straw .

For Patrice Hollmann and Eileen Carmody, this vulnerability also inspires the male protagonists to see their lives from a new perspective and to then act in selfless ways that the works suggest the men earlier would not have. In the case of Gabriele

Klöterjahn, it is just the opposite: her death enables the two men in her life to continue on in the belief that his lifestyle is the correct one, as each expresses his conviction that

Gabriele Klöterjahn found her true calling in his own. She dies before she can offer either man a definitive decision on where she belongs, although her humming suggests she will at the very last not give up her music, and her death is the ultimate result of her inability to truly exist in either. In these ways, each author uses the image of the ill female as a counterpart to the healthy male or males who will survive on after her death, living in the manner her illness has either confirmed, as with Klöterjahn and Spinell, or inspired, as with Lohkamp and Murray. In these works, the female character’s grave illness serves as the locus of the melodrama that each author imbues into the story. They are the point around which the male characters’ stories orbit, but their fates are secondary to those of the men who are the true concern of these authors.

Consumption/tuberculosis also shapes female sexuality in two primary ways. The women are either essentially desexualized, as with Patrice Hollmann, Eileen Carmody, and the many literary childhood sufferers of the disease, or their sexuality is problematized, as with Fantine in Hugo’s Les Misérables , Marguerite Gautier in Dumas’

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La dame aux camélias , and Gabriele Klöterjahn. Fantine and Gautier earn money through selling their bodies—Fantine as a prostitute on the street and Gautier as a courtesan. The deviant nature of prostitution is mitigated in Fantine’s by the fact that she has only turned to prostitution as a means to support her daughter after losing her job, thereby creating a picture of a poor, sick woman doing the only thing she can to support the child she loves. Consumption has a similarly tempering effect on Gautier’s character; while she may have chosen to be a courtesan as her primary means of income, and therefore is less pitiable than Fantine who had no other choice, her consumption places her in a position of weakness and vulnerability that counteracts the negative connotation of her profession. For Gabriele Klöterjahn, however, having tuberculosis causes her to come into contact with Spinell, who seduces her into a climactic, sexualized moment during their pivotal piano scene. Her sexuality in connection to the release of her musical ability is awakened, rather than subdued by her illness.

Consumption/tuberculosis do not generally have the same impact on male patients’ sexuality in fictional accounts, with the notable exception of Hans Castorp in

Der Zauberberg . Here, however, it is the female patient, Clawdia Chauchat’s, sexuality that sparks his own sexual awakening. Regardless of how female sexuality is affected by this illness, the focus in literature is most often on how the sexuality, or lack thereof, shapes the interactions with the male characters whose lives are the central concern of the works.

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Chapter 5: The History of Cancer

Introduction and Incidence Rates

While the multitude of cancer awareness campaigns and prevention programs are a product of recent history, the existence of cancer and tumors in general reaches back to time immemorial. Cancer is not one singular disease with a single cause, but rather there are over one hundred types of cancer with a multitude of origins and symptoms. In fact, as Mel Greaves has asserted in Cancer: The Evolutionary Legacy (2002), every case of cancer is unique; the one unifying characteristic of every instance, however, is “the territorial expansion of a mutant clone” (Greaves 3). This means that one cell undergoes a genetic mutation or a series of mutations that allows it to reproduce uncontrollably.

Having either by chance or by further advantageous mutation escaped the mechanisms in place to prevent such a mutant cell from surviving, it continues to reproduce unchecked until it spreads from the original site throughout the body. Not all types of cancer, such as leukemia and lymphoma, involve the growth of a tumor, but for those that do, a malignant tumor is characterized by a mass of these mutant cells that is no longer solely located within the tissue where it developed. Rather, the tumor has invaded surrounding tissues as well, and has even perhaps spread to more distant locations in the body

(Almeida and Barry 103). 100 This dispersion throughout the body is termed metastasis,

100 Benign tumors, in contrast, are non-cancerous and have not spread to the surrounding tissues. These masses are not generally dangerous unless they are in a location and of a size that causes a disruption in the 150

and generally occurs via the circulatory or lymphatic systems, resulting in secondary tumors. The cancer retains it original character even in the new sites. For example, a lung cancer tumor that metastasizes to the brain is still a lung cancer at the cellular level, not a brain cancer. Cancer kills a person when it overwhelms the body and in doing so disrupts the vital organs and physical processes. This is inevitable in most cases of cancer unless medical intervention is attempted and it is able to successfully arrest the reproduction of cancerous cells.

The oldest tumor thus far identified is a hemangioma, a benign tumor of the blood vessels, found in a dinosaur from approximately 150 million years ago. Greaves has argued that since cancer arises from an essential function of multicellular organisms, the reproduction of cells, it can be convincingly estimated that both benign and malignant tumors have been in existence for somewhere around half a billion years (Greaves 11). 101

The earliest known cases of malignant cancers have been found in human remains from the Bronze Age (1900-1600 BCE). 102 Writings on ancient Egyptian papyri from about

1600 BCE describe what seem to be cancerous tumors themselves, particularly breast cancers, as well as the common methods of treatment, although Siddhartha Mukherjee has noted in The Emperor of All Maladies: A Biography of Cancer (2010) that some of these may also have in fact been other maladies mislabeled as cancers (Mukherjee 39-

40). The oldest cancer discovered in human remains is an abdominal tumor found in an

Egyptian mummy from about 400 CE. Evidence of tumors, if not the tumors themselves,

normal tissue, although some do carry the risk of mutating into malignant growths (Almeida and Barry 103). 101 Cancer is found in all classes of vertebrates, mollusks, and some invertebrates as well (Greaves 11). 102 The information contained in these papyri may actually date back to as far as 2500 BCE (NCI 3). 151

has been found in even older skeletons (Mukherjee 42-43). The mummified bodies of humans from ancient Egypt contain evidence of tumors of both the soft tissue and bone providing additional evidence of cancer’s presence (Rather 8). The oldest probable signs of a tumor were found in a jawbone from approximately 4000 BCE, although malignancy cannot definitively be determined (Mukherjee 43).

It was the ancient Greeks who first recognized cancer as a discrete disease, and around 400 BCE Hippocrates gave it the name by which it is still known today in translations across the western world: karkinos, meaning crab, which is the word cancer in Latin. 103 This descriptive label arose due to the characteristic appearance of breast cancer tumors and the resulting distention of veins in the breast that lent it a crab-like appearance (Rather 13). James Olson has explained that since breast cancer was one of the most visible cancers, as opposed to cancers of internal organs, for much of human history, breast cancer was cancer (Olson 9). Thus the origins of the term karkinos are also rooted in the perceived prevalence of breast cancer in comparison to other types. 104

Outside of the western world, ancient descriptions of cancer have also been found.

Indian Ayurvedic medical books from approximately 500 BCE-1 CE bear descriptions of tumors of the upper gastrointestinal tract, and stories of Chinese folklore contain the suggestion that throat cancer has long been present in the eastern world (Greaves 10-11).

The first cancer cell, however, was not actually described until 1838, when improved microscopy allowed the German professor of anatomy and physiology Johannes Müller

103 The Greeks used this term to describe both malignancies, benign tumors, and other non-cancerous conditions, as they could not yet distinguish among such masses (Greaves 10). 104 The Greek physician Galen, practicing in the second century in Rome, did identify and describe cancers of many other organs, but he believed breast cancer to be the most common (Greaves 10). 152

to view and then report the abnormal cell appearance present in cancer in his monograph

Über den feinen Bau und die Formen der krankhaften Geschwülste . Müller then drew up a classification system based on a tumor’s appearance that was meant to aid physicians in determining whether a mass was benign or malignant (Rather, Rather, and Frerichs 26-9).

It was much easier to detect types of cancer that occurred in solid masses, and so it was not until 1845 that Müller’s student, Rudolph Virchow, discovered leukemia in large part due to the technological advances allowing for the ability to distinguish blood cell counts

(Olson 57-8). 105

Researchers have long since identified the many manifestations of cancer, and about half of men and one-third of women in the world today will have cancer during his or her lifetime. Cancer remains the second most common cause of death in the United

States, Canada, and the European Union. Approximately 1,500 Americans and 188

Canadians die each day of the disease, and 25% of deaths in the European Union can be attributed to it (Greaves 3, Niederlander 10, “Public Health”). 106 There are approximately seven and a half million new cases a year in the world, and cancer accounts for about 11% of worldwide deaths (“WHO Cancer”). As with tuberculosis, cancer statistics from earlier centuries are not wholly reliable for reasons including misdiagnoses and data procurement methods that are not up to twentieth-century standards. However, even accounting for such problems, the first statistical analysis of

105 Scottish physician John Bennett actually wrote the first description of leukemia on March 19, 1845, but it was Virchow who, four months later, recognized that it was a new and unique disease. He at first termed the condition “ weißes Blut ” due to its appearance, but in 1847 changed the name to leukemia, from the Greek word for white (Mukherjee 12-14). 106 Potential reasons for this disparity between the sexes include lifestyle and career choices as well as the biologically determined exposure to hormones (Almeida and Barry 19). 153

cancer deaths, performed by Domenico Antonio Rigoni-Stern in Verona between 1760 and 1839, indicates a lower rate than in more recent times. It is also clear that cancer rates are considerably higher in the twentieth century in North America and Europe than they were in the prior centuries during which records were kept, with mortality rates from the major types of cancer more than ten times higher at the end of the twentieth century than the end of the nineteenth (Greaves 15-16). Reasons for this evidently dramatic rise in cancer deaths include the simple fact that people in the twentieth century lived longer and, due to medical advances, were not dying of diseases and infections they earlier would have. As Greaves has explained, most adult cancers take years to decades to develop because it generally takes this long in order to acquire the necessary traits through genetic mutations. 107 Thus, cancerous cells not only had a larger number of years in the twentieth century during which to mutate and spread, but they also were not in as much competition with previously prevalent causes of death (Greaves 16, 40).

Another potential reason for this increase could be the emergence of industrialized society, and I will discuss this possibility in more depth in a later section. Cancer mortality rates in the United States decreased for the first time since 1930 for the 2001-2 statistical year, and the five-year survival rates of new cases have improved considerably, indicating some progress in treatment of the disease (Almeida and Barry 18, 23).

107 Cancer in infants and children develops much more rapidly, sometimes even taking less than a year (Greaves 40). 154

The Search for the Origins of Cancer

The origins and cause of cancerous disease have been an area of intense debate and study as long as the disease has been recognized. The basic mechanism is the same for any cancer: the genetic mutation of cells. What causes this mutation, however, and allows for the disease’s propagation is still almost always unclear, though it can sometimes be theorized. The truth, as Greaves has argued, is that there is never one singular cause for cancer; rather, as he has written: “What we have in cancer is a plethora of causal pathways or networks within which risk is always a net product of positive and negative factors influencing the roulette wheel of cell proliferation, cell death and mutation” (Greaves 213). This is not to deny the existence of distinct contributing factors that can be discerned; theories abound as to what these causative factors may be. As with tuberculosis, Hippocrates’ humoral theory of disease origins was for centuries the leading theory of cancer genesis. Greek physician Claudius Galen in particular asserted that cancer was the result of an overabundance of black bile. He believed that as black bile accumulated and mixed with the blood, it formed inflammations that could then become tumors (Rather 13). Galen attributed the increase in breast cancer incidence with advancing age to the notion that black bile could become stagnant when the young, fresh blood became older and more lethargic, which led to bile accumulating in the breasts of older women (Wishart 7). This conception lasted well into the sixteenth and seventeenth centuries, waning slowly in popularity until it was finally discarded entirely by the mid- eighteenth century (Olson 29).

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A major factor in the longevity of this flawed idea was the general social more against autopsy. As performing post-mortem exams became more acceptable, physicians and scientists were able to understand more about the processes of disease and death. In

1761, Battista Morgagni, a professor at the university in Padua, published the results and findings from over 700 autopsies in his work De sedibus et causis morborum (On the

Sites and Causes of Disease ), essentially creating the discipline of pathology and paving the way for greater understanding of diseases. Progress was stalled somewhat by a lack of bodies available for dissection in the early nineteenth century in both Europe and

North America, but governmental legislation to regulate the release of bodies eased this particular obstacle (Wishart 12, 15). 108 An English anatomist, Matthew Baillie, then discredited Galen’s theory of black bile in 1793 when he discovered that none of the tumors he dissected contained this substance (Mukherjee 53). 109 With the ever increasing knowledge about anatomy and the incidence of cancer itself, new theories of cancer causation entered the scientific community.

The first link between cancer and environmental elements rather than strictly biological ones was made by John Hill, an English physician who in 1761 made the first argument that tobacco snuff triggers nasal cancer. This was followed a few years later by

English surgeon Pervical Pott’s 1775 description of the link between chimney sweepers and scrotal cancer (Almeida and Barry 9-10). Although it was not recognized as such

108 Illegal body snatchers were employed to find deceased people, either by digging up corpses or by other unsavory means, for use by anatomists and physicians in dissection (Wishart 14-15). 109 The famed Belgian anatomist Andreas Vesalius had first discovered the body’s general lack of black bile around 1555, but as a proponent of the Galenic theory, he did not widely publicize his findings. Instead, he simply left his anatomical drawings which lacked black bile to be interpreted by others (Mukherjee 51-3). 156

until later, the oldest occupational environmental link to cancer is from the Erzgebirge in

Germany. Since mining had begun there in the late fifteenth century, workers had been suffering lung ailments commonly called “ Bergsüchte .” In the 1870’s, two local physicians, Hesse and Härting, asserted that the majority of the cases of Bergsüchte were in fact lung cancer, and postulated that approximately 75% of miners had died from it

(Greaves 196-7). 110 All of these men’s theories would be validated in 1915 when experiments proved that cancer could be induced by chemicals, which are now collectively known as carcinogens (NCI 20-21). 111

The current list of known and probable carcinogens is extensive and it is constantly being amended and expanded by organizations such as the World Health

Organization. Wilhelm Hueper, a German immigrant to the United States, compiled the first listing of chemicals that he believed to be linked to cancer in 1942 in his book

Occupational Tumors and Allied Diseases. Five years later, he was appointed head of the

National Cancer Institute’s Environmental Cancer Section, where he continued to research carcinogenic substances. His work was ultimately thwarted by companies that wanted to dispel any evidence that their work environments or the chemicals in their products were linked to cancer. The power of these companies was far-reaching, and the

Surgeon General of the United States, Leonard A. Scheele, subsequently banned Hueper from studying carcinogens in human cases of cancer in 1952, although he was free to continue working with animals. Not entirely deterred, Hueper gave congressional

110 A mule spinner who contracted scrotal skin cancer brought the first case of litigation against an employer for the contraction of cancer from working conditions in the early 1900’s (Greaves 201-2). 111 This was shown by exposing rabbits to coal tar and observing that they subsequently developed cancer (NCI 20). 157

testimony throughout the 1950’s on chemicals he believed to be carcinogenic, but his power and influence had been significantly curtailed by the campaign against him

(Wishart 72-4).

As Hueper was conducting his work on environmental and industrial substances, compelling evidence of the link between cigarette smoking and lung cancer was beginning to be established by other researchers. One of the earliest reports determining a connection between these two was prepared by a German student researcher, Franz

Müller, in 1939.112 His comparison of smokers with non-smokers indicated that lung cancer sufferers were six times more likely to be avid smokers (Wishart 76). About ten years later, the British government wanted to explain an alarming increase in lung cancer cases in Britain. Richard Doll, a British physician and statistician, found the methods

Müller had used and the conclusions drawn from them to be dubious, and so he, in collaboration with epidemiologist and statistician Austin Bradford Hill, conducted his own research. Their method was completely new: rather than describing existing cases of lung cancer, they tracked a cohort of about 40,000 volunteer physicians in the United

Kingdom for fifty years. A similar tactic was subsequently established by the American

Cancer Society, which followed 100,000 people. In March of 1954, just two and a half years into the British efforts, the evidence was already emerging, as all thirty-six lung cancer deaths had occurred in smokers. The American Cancer Society announced similar results a few months later, and finally in 1964, the United States Surgeon General‘s office announced that smoking triggered cancer (Mukherjee 243-65). Wishart has explained

112 Müller was conducting his research during the Third Reich in Germany. The Nazis had an extensive anti-smoking campaign, which was the first such effort of any country in the world. For more on this, see Chapter 6: The Campaign against Tobacco in Robert N. Proctor’s 1999 text The Nazi War on Cancer. 158

that, although other countries had already made similar pronouncements, “[…] the surgeon general’s remark marked a watershed everywhere. The universal belief in the danger of cigarettes can be traced back to that moment” (Wishart 79-84). Unlike

Hueper’s list of carcinogens, tobacco products are not directly related to industry, although the rise of industrial society may have facilitated their use and manufacture.

Lung cancer cases linked to tobacco products are responsible for about one third of overall cancer cases in the western world, and in fact this is the one instance of an epidemic of cancer unique to the twentieth century (Greaves 16-17). 113

One of the fastest growing cancers in the last eighty years is associated with behavior rather than with exposure to a particular substance. Malignant melanoma rates have been rising steadily since the cult of the sun tan began in western, largely white societies in the 1930’s and 1940’s. No longer considered the uncouth sign that one spent significant amounts of time in the sun performing physical labor, sun tans became an outward indication that one had both the leisure time and financial means for tropical vacations. Further, tanned icons such as Rita Hayworth and Coco Chanel inspired others to attempt to achieve the same level of sun-induced skin color and it became a significant fashion trend that has persisted until the present day (Wishart 88). Those who work in farming, construction or other professions that require substantial time in the sun are persistently exposed to ultraviolet radiation, but the intermittent, intense sun exposure that vacationers and tanners experience is more dangerous. This is because the body builds up defenses over time in order to lessen the genetic change in the skin cells during

113 Wishart has asserted, however, that this number would likely be significantly larger had it not been for the work of Doll and his colleagues, which inspired anti-smoking campaigns (Wishart 86). 159

extended sun exposure. These mechanisms simply are not present in those who experience occasional, prolonged sun exposure, and so the risk of mutation is greater.

This has led to increased rates of non-melanoma skin cancers as well as malignant melanomas as vacations and artificial tanning have become more prevalent (Greaves

182). Awareness campaigns have slowed the rate of increase somewhat, but the increase remains nonetheless.

The rise in rates of certain other cancers may also be the result of lifestyle alterations. Women today are having fewer children in general, and the length a mother breastfeeds is typically far shorter than the two to three years that were once common.

This means that women are experiencing more menstrual cycles and the attendant hormonal changes than earlier generations had. The natural cell proliferation that occurs each month when not pregnant equates to more chances for genetic mutation in the cells, which in turn means more chances that a malicious mutation will cause cancer in the female reproductive organs (Greaves 145-8). This is supported by the fact that breast cancer was a particular problem in the convents of earlier centuries; celibacy meant no pauses in hormonal fluctuations for pregnancy or breastfeeding (Olson 21-2).

Caloric intake is another lifestyle factor that has changed greatly in modern times.

Much of affluent western society now takes in far more calories than are necessary, and these are then stored as fat. This results in excess cell production, which leads to increased chances of a genetic mutation. The other factor is that our nutrition is not what our ancestors’ was. As a whole, diets are composed of significantly fewer fruits and vegetables, but more meat sources with an attendant higher fat intake. The consequence

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of this is the intake of fewer antioxidants, which can help to repair DNA damage

(Greaves 186-8).

In 1910, a viral cause of the spindle-cell sarcoma cancer in chickens was documented, sparking the hunt for viruses that cause human cancer, and scientists today estimate that approximately five percent of all cancers are caused by a virus (NCI 20,

Mukherjee 174). In 1958, the Epstein-Barr virus was linked first to Burkitt’s lymphoma, and then later to several cancers, including Hodgkin’s lymphoma, providing the first evidence of a virus causing cancer in humans (NCI 29, Mukherjee 174). Other cancer- inducing viruses that researchers have since identified include: hepatitis B and hepatitis

C, both associated with liver cancer; human herpes virus 9, associated with Kaposi’s sarcoma; HLTV-1, associated with an adult leukemia; and the human papillomavirus, associated with cervical cancer. Of course, not every person infected with these viruses develops the cancer it can cause, and while reasons for this are not entirely clear, it is likely that an immunological suppression plays a role (Greaves 171-2). There are likewise a few bacteria and parasites that can cause cancer. These include a connection between bile duct cancer and the parasite Clonorchis sinensis , as well as that between both gastric carcinomas and gastric lymphoma with the stomach bacteria Heliobacter pylori (Greaves 173) .

Genetic connections to various types of cancer have also long been sought, although only about five to ten percent of cancer cases arise from inherited genes. The most well-known of these cancer-associated genes are BRCA-1 and BRCA-2. In 1994,

Mark Skolnick of the University of Utah announced that he had cloned and sequenced

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BRCA-1, which is responsible for about 6,000 cases of breast cancer in the United States every year. Approximately one in every two hundred women carry this gene, and of those, 80-90% will develop breast cancer and 40-50% will develop ovarian cancer.

BRCA-2 was identified and sequenced shortly thereafter, and also occurs in one in every two hundred women. BRCA-2 imparts about an 85% chance of developing breast cancer, but carries no attendant association with ovarian cancer. In 1995, having one copy of the ATM gene was then found to have a connection to certain leukemias and lymphomas as well as breast cancer, with an increased risk of four to five times the average for the latter (Olson 255-6). Being a carrier of the gene therefore is by no means a guarantee that one will have these cancers, but it certainly raises the risk significantly.

There are two factors that have been commonly believed to cause cancers, but without the scientific support. The first of these is old age. As Greaves has explained, old age is not a cause, but rather a co-factor. Given the amount of time it takes cells to accumulate the mutations necessary to be considered cancer, it simply stands to reason that the older a person is, the longer these cells have had to do so. Likewise, an older person’s cells have undergone significantly more divisions during their lifespan than the cells of someone who is younger, and therefore there is a greater chance that either a cell with DNA damage will mistakenly be allowed to remain in the body or that the DNA damage will be caused in the first place, be it by outside forces or by faulty replication

(Greaves 116).

The other mistaken source for the origin of cancers is the so-called “cancer personality.” Galen attributed cancer to a melancholy disposition, which correlated with

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the overabundance of the dreaded black bile. The modern idea of a cancer-prone personality type dates to at least the eighteenth century, but the concept enjoyed a resurgence in the 1940’s due to the writings of Austrian-American psychoanalyst

Wilhelm Reich. Reich attributed cancer to several factors, among them a repression of emotions, an aversion to sex, and a stagnation of the flow of life energy.114 Reich’s theory was eventually discredited, but his work spawned a host of additional theories by psychotherapists in the 1960’s and 1970’s that attributed cancer to various manners of emotional dysfunction, mostly centering around the idea of repressed emotion (Olson

158-61).

The Treatment of Cancer

Once cancer has taken hold, the next concern becomes how to treat and potentially cure it. In light of our current understanding of cancer mechanisms, medical intervention is focused on two aspects: stopping the cancer cells from dividing, and taking advantage of the decreased ability of cancer cells to repair damage caused to them

(Almeida and Barry 73). These basic concepts have been in place since at least the time of Hippocrates, although the specific biomechanisms involved in cancer cell reproduction have only recently begun to be understood.

Surgery is often the first line of treatment in modern care because it in effect stops the cancer cells from dividing by simply removing them from the body. While this essential principle was understood by Hippocrates and Galen, surgery was rarely performed. It was considered only in cases where the tumor was readily accessible, such

114 Reich termed the dangerous stagnant life energy “orgone” (Olson 158). 163

as with breast cancers close to the surface of the body. Hippocrates believed that attempting surgery on cancers located more deeply in the body would be more likely to hasten a person’s death than to enable healing. He and other physicians in his time instead turned to other treatments such as salves, bandages, hellebore, belladonna, coal tar pastes, and arsenic to stop the expansion of the disease (Ackerknecht 190, Greaves

10). Galen shared Hippocrates’ reluctance to recommend surgery. In addition to

Hippocrates’ concerns, Galen’s belief that black bile caused cancer also made surgery an illogical choice in his time, and indeed for centuries to come, because it would not cure the underlying problem. Galen instead recommended a change in diet that involved consuming bloodless white meat. He also espoused bloodletting and the use of caustic ointments, both meant to purge the body of the black bile (Wishart 7, Mukherjee 50).

Ackerknecht has noted that palliative care has also been important since the ancients

Greeks, which most often meant doses of opium (Ackerknecht 190).

As humoral theory was abandoned in the eighteenth century, surgery began to gain in importance as a treatment modality. At this time, systematic experiments regarding various aspects of cancer were beginning to take place, and oncology was thereby established as a medical field. In one such study, for example, French physician

Claude Genron, spent eight years studying cancer cases and concluded that cancer was an entirely local disease, establishing itself as a hard, growing mass that cannot be treated with medicinal remedies; surgical excision of the tumor along with what Genron termed its “filaments” was thus the only effective treatment (NCI 14). Even though surgery was becoming much more popular, it remained an object of much debate and scrutiny due to

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the risks involved and the still unproven efficacy. Medicinal treatments retained some of their favor, and new medications were being tried. The list of substances used well into the late 1800’s now included copper, iron, lead, carrots, iodine, cod-liver oil, the bone char of animals, gold, and carbonation—a collection of substances quite similar to the one used to treat tuberculosis (Ackerknecht 192-3).

Two medical innovations drastically tipped the preferences in favor of surgery: anesthesia and disinfectants. Up until the mid-1800’s, surgery was both incredibly painful and risky, leading to a reluctance on the part of both doctor and patient to undergo such a procedure. Patients had to endure a physician cutting into them without any pain medication stronger than an alcoholic beverage or, in the best of cases, opiates, to sedate them. The American dentist William Thomas Green Morton, however, was the first to publicly demonstrate the anesthetic effects of ether. He did so on October 16, 1846, in the surgical theater of Massachusetts General Hospital in Boston. 115 Ether was soon commonly used worldwide in surgical procedures, and thus one of the major barriers to increased surgical intervention was eradicated.116

While the patients would no longer feel pain, they would still be subjected to the very high risk of infection (Mukherjee 56-7). This began to change two decades later when British surgeon Joseph Lister began experimenting with disinfectants in 1867.

Having read an article by Louis Pasteur describing what we now know as microbes,

115 Ether had already been discovered centuries before Morton, but its use had been confined to entertainment purposes and intoxication. Morton was afraid that someone would steal his idea to use it as an anesthetic, and so initially claimed it was a new compound called Letheon (Wishart 20). 116 Olson has noted, however, that there were prejudices surrounding how much pain various groups of people could feel. Women were considered not to feel as much pain as men, and especially poor, older, non-white women. It was not until the 1890’s that these thoughts were disregarded and anesthesia was used on every patient (Olson 54-5). 165

Lister extrapolated this idea to infections. He therefore surmised that a dilute solution of carbolic acid could stop these germs from entering wounds. He began testing his theory by washing instruments, bandages, physicians’ hands, and patient wounds in this solution

(Wishart 22-3, Olson 49). The next step in his work was hastened by the evidence of his sister Isabella Pim’s breast cancer. Pim insisted that Lister perform the mastectomy himself, and so Lister decided to extend his antiseptic practices to the operating room for the first time. Pim survived the operation without infection and Lister went on to present his results at conferences and in medical journals. Over the next two decades, his recommendations, or variations of them, were adopted by nearly all physicians, saving countless lives and making surgery an even more appealing treatment for tumors

(Wishart 23-5).

As surgery became safer and more comfortable, techniques advanced in the late

1800’s to the point where removing tumors in deeper organs, such as the stomach and colon, was becoming more common (Mukherjee 58-9). This is particularly evident in the case of breast cancer. Whereas earlier surgical excision had generally consisted of simply removing the breast itself, and then perhaps the axillary lymph nodes or chest muscles separately, William Stewart Halsted developed the Halsted radical mastectomy at Johns Hopkins University during the 1880-1890’s.117 In this procedure, the breast, lymph nodes and chest muscles were removed with one motion, avoiding cutting into the tumor itself or scattering cancerous cells during the procedure. This method was thought to greatly reduced the chance of recurrence and offered women a real hope of a cure. It

117 Mukherjee has posited that the New York surgeon Willy Meyer independently came up with a similar operation to the original Halsted mastectomy, but in choosing to remove more tissue and lymph nodes, Halsted’s operation went farther and became the standard (Mukherjee 65). 166

also offered palliative care for those cases that were unable to be cured because it could extend the women’s lives and make the remaining time more comfortable. This procedure was deeply disfiguring, however, leaving women with a deformed chest wall, swelling from lymphadema in their arms, chronic pain, and other hollow areas under the collar bone and armpit. Despite these side effects, the operation became the standard of care for breast cancer for decades to come (Olson 46, 61-2, 67). Influenced by the extensive nature of the Halsted mastectomy, equally aggressive surgeries began to be performed for other cancers, despite scant evidence of effectiveness in comparison with more conservative surgeries (Mukherjee 68-70).

The Halsted radical mastectomy would begin to lose prominence in the 1950’s and 1960’s as modified radical mastectomies, which spared some of the musculature and tissue that were earlier removed, became more common and radiation techniques improved to the point where radical mastectomies were no longer necessary. This was particularly evident in Europe, with a slower acceptance in the United States. 118 Another emerging factor in the choice of breast cancer surgeries was development of the options for breast reconstruction. Various methods had been attempted since the 1800’s, but it was in the 1960’s, with the development of implants, that reconstruction became a more prominent issue. These types of implants could not be used after a Halsted mastectomy, though, lending a further reason not to choose that procedure (Olson 104-5, 116). In

1981, a decade-long research study then indicated that this procedure was no more

118 Olson has explained that in countries where female physicians had more of an influence on treatment protocols, such as Sweden, Scotland, and England, the less radical surgery was far more commonly accepted (Olson 106). 167

effective than less aggressive options, and the Halsted radical mastectomy was essentially abandoned (Mukherjee 201).

Surgery in contemporary medicine is generally the preferred treatment options for tumors that are confined to one specific, isolated location, and surgery still offers the best chance for a complete cure in such cases. The development of the sentinel node biopsy for breast cancer and melanoma, a procedure wherein only a few lymph nodes are removed and tested for the presence of cancerous cells, has meant fewer unnecessary lymph node dissections with their attendant complications. Modern advances in surgical technique now also allow for the use of electosurgery, robotic surgery, and cryosurgery, as well as laparoscopic procedures, thereby widening the field of options for surgical oncologists to be able to choose the most effective surgery with the lowest chance of complications (Almeida and Barry 113, 136-7).

In addition to the potential complications of sugery, such as infection, bleeding, and disfigurement, one feared deleterious result of performing an operations is the possibility of inducing metastasis. The current theory on this phenomenon, known as tumor dormancy, is that the primary tumor secretes an angiogenic inhibitor that hinders blood vessel formation and thereby prevents metastases from growing unchecked. With the primary tumor removed, however, there is nothing to prevent the secondary one from growing as quickly as it is able to. For this reason, many patients are treated with an adjuvant therapy, such as radiation or chemotherapy, in addition to surgery. The intention is that the adjuvant therapy will kill the remaining cancer cells that may be lingering dormant within the body (Almeida 138-9).

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At the same time surgical techniques were being improved, a new arena of treatment appeared: radiation therapy. The development of radiation therapy resulted in the end of surgery’s long-held dominance in cancer treatment. Röntgen’s discovery of x- rays in 1895 led to experiments in using them to treat superficial growths. In 1896, the

American medical student Emil Grubbe first used x-rays in cancer therapy when he irradiated patient Rose Lee’s breast tumor (Ackerknecht 194, Mukherjee 73-5). Despite the limited success Grubbe had in curing Lee’s cancer, the shrinkage of the primary tumor was enough to encourage him to continue using x-rays, and the practice soon became widespread (Mukherjee 75). The radioactive element radium, discovered by

Pierre and Marie Curie in 1902, was then found to be even more effective in cancer treatment, and it was first used for this in 1903. Radium would be threaded around tumors in the body, leading to more direct contact with the tumor. This was much more expensive than using x-rays, and so its use was initially limited (Almeida and Barry 11,

Wishart 51-2).

Radiation therapy functions in tumors because it damages the cancerous cells and alters their DNA. The radiation harms healthy cells as well, but cancer cells have a lesser ability to recover from such an attack, and thus die off. It is in fact the incidental damage to healthy cells that leads to the side effects of radiation, which include skin irritation, hair loss near the treatment area, sores, and damage to fertility if the ovaries or testes are irradiated. In very rare cases, radiation may even lead to a new cancer from the DNA damage to healthy cells (Almeida and Barry 11, 144-5). The mechanisms behind the

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efficacy of radiation therapy were not understood while it was first being used, but the positive results led to further research in using radiation.

Claudius Regaud, the head of the medical section of Marie Curie’s institute, recognized in the early 1920’s that radiation spread over smaller doses is more effective than one large dose, and this soon became the standard practice. The reason behind this is that cancerous cells are particularly susceptible to damage in certain stages of their lifespan. Therefore, in administering irradiation over several days, more cells in that vulnerable stage can be affected. During the 1930’s, more powerful x-ray beams were used to be able to attack tumors deeper within the body, and radiation became a true alternative to surgery (Wishart 58, 63). Today, fifty to sixty percent of cancer cases are treated with radiation, either alone, or, as is more often the case, in combination with surgery. Although major advances have been made in the area of radiation, it still is either administered via an external beam or through radioactive seeds implanted near the tumor, as it has been for decades (Almeida and Barry 139, 141-3).

The successful use of chemotherapy took much longer than that of radiation.

Chemotherapy to treat cancer was first attempted around 1910 by the German scientists

Paul Ehrlich and Max Einhorn, working independently but at approximately the same time. Ehrlich repeatedly tested compounds for efficacy against cancer cells, but ultimately did not find any that did not also kill healthy cells (Mukherjee 85-7). Einhorn tested the chemical agent methylene blue to treat stomach and esophageal cancers, although he was unsuccessful in curing either (Ackerknecht 194) . The first truly effective chemotherapy was discovered as a result of World War II. Physicians found

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that soldiers who had inhaled mustard gas during attacks had markedly decreased white blood cells. While this was quite unhealthy for these soliders, researchers began to consider that mustard gas could be effective in treating cancers that increase the white blood cell count, such as leukemia or lymphoma. Studies indicated that injecting the mustard gas was more effective than inhalation, and in fact it did produce a marked improvement in lymphoma, albeit invariably temporary and never to the point of full remission. This success with mustard gas resulted in the testing of many more chemical derivatives as potential cancer treatments, with several of these later becoming standard cancer treatments (Almeida and Barry 12-13).

The first remission induced by chemotherapy occurred shortly after this. Sidney

Farber, the head of pathology at Boston Children’s Hospital, believed that folic acid antagonists could hold the key to treating childhood leukemia. Folic acid had just been identified and it was theorized that this chemical was a key ingredient in cell division. 119

By blocking folic acid, Farber thought, the unnaturally fast pace at which cancer cells divided could be slowed or stopped, leading to an improvement in health. After several failed attempts with various folic acid antagonists, in 1947 Farber was finally achieving marked effects using the drug aminopterin. He announced in April of 1948 that five patients had achieved clinical remission—the very first remissions in history via chemotherapy. Although these children were merely able to live a bit longer rather than be completely cured, Farber’s resolve was hardened to keep testing compounds and protocols, and the medical research community joined him (Mukherjee 28-36, Wishart

119 Farber initially believed folic acid could reinstate normal blood cell production in childhood leukemia patients, but found that it had the devastating effect of significantly accelerating the disease. He therefore determined that folic acid increased all blood cell division (Mukherjee 28-30). 171

90-6, 99). The first cancer to be absolutely cured by chemotherapy was a case of choricocarcinoma, cancer of the placenta. Physicians Min Chiu Li and Roy Hertz of the

United States’ National Cancer Institute had achieved this result in 1956 using the drug methotrexate (Olson 97). 120

There are currently more than one hundred chemotherapeutic agents approved in

North America and Europe, with new candidates emerging and being tested constantly. 121

Unlike radiation or surgery, which target specific areas of the body, chemotherapy is a systemic treatment. Thus, it can not only obliterate known clusters of disease, but also any other cancerous cells throughout the body. Similarly to radiation, it functions by hindering the ability of cancer cells to survive and divide, and it optimally results in a complete cure. Even when this is not possible, chemotherapy can extend the life of a patient significantly, or increase his comfort and quality of life (Almeida and Barry 145-

50). The side effects of chemotherapy are a result of inhibiting the growth of healthy cells in the attempt to do the same to cancerous cells. As with radiation, the results of this can be quite severe and include hair loss, nausea, and decreased fertility, as well as long-term complications such as congestive heart failure, hearing loss, kidney damage, or even a new case of cancer (Almeida and Barry 150, Olson 151).

Other treatment modalities have proven effective for a specific set of cancers.

Scottish surgeon George Beatson experimented in the late 1800’s with removing the ovaries from animals and studying the tissue change. This led to his experimentation on

120 The first metastatic tumor to show improvement through chemotherapy in combination with radiation was a case of Wilms’ tumor, a rare kidney tumor, in 1958. Farber initiated this by assigning his colleagues Giulio D’Angio, Audrey Evans and Donald Pinkel to attempt to achieve this result (Mukherjee 123). 121 Olson has explained, that most of the anti-cancer drugs still used today have actually been in use since the mid-1970’s (Olson 140). 172

women with breast cancer, and the conclusion that the ovaries’ removal could lead to the decrease in size and number of breast tumors, perhaps effecting a total cure (Olson 78-9).

The result of this was the routine removal of the ovaries in the early 1900’s in cases where a radical mastectomy was unsuccessful in treating the breast cancer. As this procedure was not always shown to be efficacious, it became an option of last resort.

What we now know is that certain types of breast cancer feed on estrogen while others do not. Further, the body can compensate for the removal of ovaries when the adrenal glands pick up in their production of the hormone. 122 Thus, the lack of ovaries might produce no effect at all or only a temporary one (Olson 79-81). Prostate cancer in men showed a similar and analogous sensitivity to testosterone, and so removal of the testes and adrenals glands was more popular in those cases as well (Olson 82). Hormone deprivation therapy has since been refined and more intensively researched, and it is still used in cases where breast or prostate tumors are shown to be hormone dependent. In the early 1970’s, the medication tamoxifen was shown to have estrogen-binding properties that block the hormone from reaching the tumor. It has become a routine treatment in cases of estrogen-dependent breast cancers, and in 1998 the Federal Drug Administration in the United States approved it as the first chemopreventative drug that could be administered to women at high risk of developing breast cancer (Almeida and Barry 157,

185).

Bone marrow transplants, in which a cancer patient’s own diseased bone marrow is killed and replaced with healthy donor bone marrow, have proven effective particularly

122 It was later discovered that the pituitary gland could also stimulate estrogen production, and so the removal of the ovaries, adrenal glands, and pituitary gland became treatment options in the 1950’s (Olson 83). 173

in cases of various leukemias and metastatic breast cancer. Such transplants have been in use since the late 1960’s, becoming widespread in the 1980’s, and although the risk of a failed transplant remains at about fifty percent, they do offer a cure or long-term remission when they are successful (Mukherjee 308-321, Almeida and Barry 351-2).

Since the late 1800’s, attempts have been made to find vaccines to activate the immune system against cancer (Ackerknecht 195). These have generally been met with little success, with the exception of the recently approved vaccine to protect against cervical cancer, Gardasil. Even this vaccine is effective in preventing only seventy percent of potential cases. It targets the two main human papillomavirus strains responsible for these cases, while leaving the strains responsible for the other thirty percent unaffected. This is also not a means of treating existing cancers, but of preventing them (Almeida and Barry 163, 221). Other methods that use the immune system to treat cancer include interferon, interleukin and cytonkine therapies, all of which are meant to trigger the body’s immune system into attacking the cancer cells. Up until the present, they have shown limited efficacy, but these are still common subjects of research and testing in the hopes that further development will yield better results

(Almeida and Barry 163).

Medications targeting the vascular expansion of cancerous tumors offer some hope of a new avenue of treatment. The current angiogenesis inhibitors can prolong the amount of time before a tumor recurs or begins to grow again, but do not offer a total cure (Almeida and Barry 159). Similarly, the drug Glivec (known as Gleevec outside of the United States, and generically as Imatinib) is an example of progress in attacking

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cancers at the genetic level. Developed in the 1990’s by British researcher Nicholas

Lydon, Glivec kills bone marrow cells in chronic myeloid leukemias that carry the

Philadelphia chromosomal mutation, which is thought to be responsible for ninety-five percent of cases of the disease. 123 This effectively stops the cancer’s progress.

Unfortunately, the drug invariably misses a few malicious cells, which can then develop a resistance and terminate the drug’s efficacy. As of 2010, there were twenty-four chemical agents targeting specific cancers, albeit with varying success in controlling the disease (Mukherjee 434-43).

Alternative treatments for cancer are also by no means a modern phenomenon, as the early list of substances co-opted to treat the disease since the time of the ancient

Greeks attests. Contemporary alternative medicine, as Wishart has contended, is centered around one concept: a critique of traditional, orthodox medicine. This generally means a reaction to a medical community and treatments seen as dehumanizing or as inflicting further pain and injury. Patients are subjected to whatever the physician decides is correct with little input of their own. Further, the treatments championed by the medical establishment were considered by some proponents of alternative treatments to be as potentially harmful as the cancer itself (Wishart 130). Popularized alternative treatments have included chemist Linus Pauling’s assertion in his 1979 book Cancer and Vitamin C that the key to attacking cancer was megadoses of vitamin C. Although he included anecdotes of patients that he claimed had been cured by this treatment, his research was later largely discredited (Wishart 133-4).

123 The Philadelphia chromosome was the first chromosomal abnormality to be associated with a type of cancer. Peter C. Howell at the University of Pennsylvania and David Hungerford of Fox Chase Cancer Center first described it in 1960 (Almeida and Barry 242-3). 175

Another significant modality of treatment outside of the traditional medical realm has been anti-cancer psychotherapy. These methods have been associated with the

“cancer personality” theories of cancer origin, and have generally revolved around changing one’s way of thinking or purging harmful emotions. One of the most famous examples of such a method was pioneered by O. Carl Simonton, a trained radiotherapist, and Stephanie Matthews-Simonton, a psychologist. Simonton, looking for new options of treatment to offer his cancer patients, turned to Matthews-Simonton and together they developed a method based on Matthews-Simonton’s relaxation and imaging therapies. It was meant to purge the cancer patient of harmful thoughts, emotions, and self-images.

They did not dispute the carcinogenic properties of substances, but they believed that the fact some people developed cancer after exposure to these elements while others did not could be attributed to the effect negative psychological traits could have on the immune system. They opened the Cancer Counseling and Research Center in Fort Worth, Texas in the early 1970’s and, along with psychologist James L. Creighton, published the book

Getting Well Again in 1978. It was a bestseller and soon the Simontons were a well- known force in alternative cancer treatments, training nearly 10,000 therapists by the early 1980’s (Olson 161-4).

At about the same time the Simontons were establishing their place in alternative cancer treatment, acupuncturist Peggy Brohn, herself a British breast cancer patient, was devising her ideas of what cancer patients needed. Basing her protocol on that of the famed Bavarian clinic run by Josef Issels, where Brohn had resided, she believed cancer was a disease of the whole body, physical and mental, and needed to be treated as such.

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Her Bristol Cancer Help Centre, started in 1980, was unique among alternative centers because she did not espouse one strict regimen. Rather, Brohn offered her clients a range of treatment options. Although all patients received psychological counseling, they were simply encouraged, albeit forcefully, to follow other suggestions as well, such as a very strict diet and visualization techniques. The Bristol Centre became world famous, and in

1986, they invited scientists to study the progress of their patients, with the belief their method would prove to be convincingly better than traditional ones. Unfortunately, the study indicated just the opposite. 124 Even though the investigating scientists conceded that this could have been due to the fact that sicker patients went to the Bristol Centre, bookings soon began to decline and it lost its prominent position. Peggy Brohn died of a breast cancer recurrence in 1999, but the Bristol Centre still stands today. The difference now is that it is offered as a complement to the established medical practices rather than as a replacement (Wishart 129-31, 132-3, 136-8, 142-7).

While alternative treatments have had little success thus far in scientifically proving their validity, one major effect they have had is in changing the way patient care is approached in traditional medicine. Waiting rooms and treatment rooms are designed to be more comfortable and comforting, and there is a decided focus on the whole patient rather than just on the disease within. This is is clear from the wig shops and various course offerings in subjects such as relaxation, visualization, and yoga that are now present in most cancer centers.

124 This study was published in the medical journal Lancet , and editorial comments criticized the study for potential weaknesses (Wishart 145). 177

Although it is not a treatment option in the traditional sense, hospice care has also become an increasingly important aspect of cancer care in terminal cases, and hospice was partly an outgrowth of the alternative treatment movement. It was begun in Britain in the 1960’s, and the concept spread to the United States, where the first hospice opened in 1974 at the Yale-New Haven Hospital. Hospice’s focus on palliative care as well as on creating the most comfortable end-of-life experience has changed the way many view death. It no longer must take place within the sterile confines of the hospital, although this remains an option for those who choose it, but it can be tailored to each patient’s specific wishes and set of circumstances (Mukherjee 225-26, Wishart 147).

The Advent and Development of Cancer Societies and Governmental Funding

for Research and Prevention

As with treatments of cancer, the social aspects of the disease have also advanced extensively throughout the last four centuries. As recently as the early 1900’s, the very word cancer was rarely used in public or listed as a cause of death in published obituaries. In the seventeenth century, due to the work on contagion theories by

Abraham Zacuto of Portugal and Daniel Sennert of Germany, there were notions that cancer was an infectious disease. Therefore, cancer patients were no longer accepted in general hospitals and specialized hospitals had to be built (Ackerknecht 192). The first of these was built in Reimes, France, in about 1750 through the financial support of the local cardinal (Wishart 11-12). Cancer remained a disease largely shrouded in silence in

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both North America and western Europe until the twentieth century, when societies promoting research and prevention began to be formed.

Germany was at the forefront of cancer research in the late nineteenth and early twentieth centuries as such efforts were gaining momentum. As Robert N. Proctor has contended in The Nazi War on Cancer (1999), this was in part due to the fact that

Germany had one of the highest cancer rates in the world. In fact, in 1928, cancer surpassed tuberculosis to become the second leading cause of death in Germany (Proctor

21). Further, labor unions were beginning to push for measures to improve worker health. Another major factor was Germany’s status as one of the strongest centers for medical and scientific research in the world (Proctor 20).

The 1900 founding of the Deutsches Zentralkommittee zur Erforschung und

Bekämpfung der Krebskrankheit, which evolved into what is today known as the

Deutsche Krebsgesellschaft, established the “world’s first state-supported anticancer agency,” (Proctor 21, Wagner and Mauenberger 5). 125 This organization was responsible for the building of the first cancer research institute in Berlin. It also awarded grants for research about cancer, arranged for regular lecturers with various prominent figures in cancer research and prevention, and opened the first clinic for cancer patient care in

Berlin in 1905 (Wagner and Mauerberger 5).

The two most important centers for cancer research in Germany were also opened around this time. The Abteilung für Krebsforschung at the Charité hospital was opened in

Berlin in 1903 due to the work of Ernst von Leyden, the Charité’s director at the time.

125 This was the final name of the organization, established in 1911, but it was previously known as the “Comité für Krebsforschung,” the “Zentralkomitee für Krebsforschung,” and the “Deutsches Zentralkomitee für Krebsforschung” (Wagner and Mauerberger 5). 179

The Institut für experimentelle Krebsforschung, in Heidelberg, was then founded in 1906 by surgeon Vincenz Czerny, who led the efforts to secure funding from donors (Wagner and Mauerberger 20, 26). These two institutes, along with many other smaller clinics and research centers, worked in concert with the Deutsches Zentralkomitee zur Erforschung und Bekämpfung der Krebskrankheit in order to further cancer research, treatment, and awareness.

The Nationalsozialistische Deutsche Arbeiterpartei then increased governmental support for cancer research when it came to power in 1933. The Nazi focus on the physical well-being of the German people brought with it an imperative to investigate and stop the alarming cancer rates. This resulted in a push to find treatments, but an even stronger emphasis on the prevention of the disease. This included a campaign from approximately 1936 that was aimed at encouraging women to self-examine their breasts.

This was the first of its kind in the world and it preceded similar American efforts by about thirty years (Proctor 20-31). During The Third Reich, the cancer research center in

Heidelberg experienced disruptions in its work due to the Nazis’ insistence that the significant number of Jewish researchers step down. After World War II, the multidisciplinary model of cancer centers, in which traditional research and clinically applied trials are combined, became the new vision for centers in both East and West

Germany. This concept had become the internationally favored one. In keeping with this, Heidelberg became the home of the successor of the Institut für experimentelle

Krebsforschung, the Deutsche Krebsforschungszentrum, in 1964, which was thereafter the primary location for cancer research in West Germany (Wagner and Mauerberger

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VII). This institute is still in existence today and it remains a major world center for cancer research. The Institut für experimentelle Krebsforschung in Berlin was the East

German counterpart, and in 1965 it was united with the Robert-Rössle-Klinik as one entity, the Institut für Krebsforschung, in which both experimental and clinical research would take place. In 1972, this was replaced by the Zentralinstitut für Krebsforschung, which was converted for other uses in 1992, following the reunification of Germany

(Wagner and Mauerberger 49-50, Eckart XVII-XVIII).

In the United States, it was not until 1913 that the first extensively disseminated discussion of cancer took place. In May of that year Samuel Hopkins Adams’ article entitled “What Can We Do about Cancer?: The Most Vital and Insistent Question in the

Medical World” appeared in the widely read magazine Ladies Home Journal and detailed what were then considered to be the warning signs of cancer (Adams 21-22). That same year, fifteen people, ten of whom were physicians, joined together to form the American

Society for the Control of Cancer (ASCC), which in 1945 was renamed the American

Cancer Society. The ASCC/ACS published information about cancer, and formed the

Women’s Field Army in 1935, which enlisted women to go door-to-door to disseminate information about breast and uterine cancers and to encourage both self-examination and regular medical exams. The volunteers were generally white, middle-class woman, and their efforts most often did not include outreach to other racial groups or those of lesser financial means (Knopf-Newman 16-17). In 1947, the ACS began an extensive public awareness campaign entitled “The seven signs and symptoms of cancer,” which lasted

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until 1980 and played a major role in encouraging the American public to beware of the major hallmarks of various cancers (Almeida and Barry 11-12).

The United States government began its intervention in 1922 when the Public

Health Service opened the Office of Cancer Investigations at Harvard, and increased its involvement with the 1937 National Cancer Institute Act. This bill created the National

Cancer Institute, which would conduct research on cancer and further raise awareness of the disease (NCI 21-22). 126 The next major milestone came in 1971, when President

Richard Nixon signed the National Cancer Act (NCA). 127 Officially launching the so- called “War on Cancer,” the NCA provided increased funding to the National Cancer

Institute and allowed its director more power (Wishart 118). Unfortunately, the hope of a universal cure that was so strong during the early years of the NCA has waned and because of this, the “War on Cancer” as it was initially conceived has largely been a failure. This war nonetheless rages on as research funded by the government is continuously making strides in how cancer is understood and treated.

The Canadian Society for the Control of Cancer, now known as the Canadian

Cancer Society, was formed much later than its American and German counterparts. It grew out of the cancer committee established in Saskatchewan in 1929, and was officially founded in 1938 to promote the understanding and detection of cancer. The Canadian

Cancer Society joined together with the Federal Department of Health and Welfare to establish the National Cancer Institute in 1947 to fund and support cancer-related

126 The National Cancer Institute’s intended efforts were initially stalled by the outbreak of World War II as the hospital facilities and funding available were largely given instead to the war effort (Mukherjee 26). 127 This act was passed in large part due to the vigorous efforts of health activist Mary Lasker, who had spent years lobbying the government officials to do so (Wishart 110-18). 182

research. In 2009, the National Cancer Institute was renamed the Canadian Cancer

Society Research Institute as it became an official part of the Canadian Cancer Society, which funds its work (“Canadian Cancer”). Federal funding for cancer research today is primarily the responsibility of Canadian Institutes of Health Research, which funds the

Institute for Cancer Research. The Canadian Institutes of Health Research is the successor organization to the Medical Research Council of Canada, which was founded in 1960 and existed until the Canadian Institutes of Health Research were created in 2000

(Medical Research 11, 21 and “Canadian Institutes”). Rather than being a physical building, the Institute for Cancer Research is a “virtual institute” uniting cancer physicians and researchers throughout the country (“Canadian Institutes”). The mission of all of these organizations remains, like the analogous organizations and institutes in

Germany and the United States, the effort to reduce the number of cancer cases and deaths through the continuing efforts of public awareness and scientific advances.

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Chapter 6: The Autopathography Model of Cancer Texts

The most prevalent form of lay writing about cancer has been and remains the experiential accounts. Initially, these works were primarily written by the person with cancer, but soon the loved ones of cancer patients began to write their own accounts of the illness as well. Anne Hunsaker Hawkins coined the term “pathography” in her 1993 monograph Reconstructing Illness: Studies in Pathography to refer to texts in which the author or authors write about the illness experience, be it their own or that of a close friend or relative. G. Thomas Couser then added the term “autopathography” in his 1997 text Recovering Bodies: Illness, Disability and Life Writing to distinguish those works written by the ill person from those written by others in their lives .

Arthur Druss, in The Psychology of Illness: In Sickness and in Health (1995), has attributed the proliferation of contemporary pathographical and autopathographical works to the fact that “[w]e live in a confessional age and what was formerly taboo is now exhibited freely” (Druss 3). Indeed, such narratives have become a particular hallmark of literature in the later twentieth century in North America and western Europe as the focus has become squarely centered on the individual, and the layperson’s understanding of science has also increased. The need to form a narrative out of one’s illness experience is far from new, however. Rather, as Arthur Frank postulated in The Wounded Storyteller:

Body, Illness and Ethics (1995), since antiquity there has been a tendency for an ill

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storyteller to create a retelling of his experience. This not only allows the narrator to

“turn fate into experience,” as Frank has termed it, but it also establishes an empathetic bond with the reader, rendering the storyteller a sympathetic audience (Frank, Wounded xi). Further, writings about illness not only allow the sick person to repair the damage the illness has caused on his life’s path and in his self-understanding, but they also serve the basic function of simply letting people know what has happened (Frank, Wounded xi,

53).

During the modern era, the medical narrative of events was the dominant retelling of an illness and it superseded personal accounts. Yet Frank has astutely posited that in the current age, the need to narrate one’s own experience is due to a desire to claim one’s voice and define one’s existence. This is in keeping with what he believes to be the defining ethic of our time, the need to find one’s own story rather than to be the object of other’s reports or observations (Frank, Wounded 5-7). Further, as Hawkins has asserted, the significant increase since the 1970’s in experiential illness writings has been in large part due to a loss of confidence in the medical community; it was no longer viewed as an omniscient entity there to reassure and protect, but with increasing suspicion and mistrust as lay knowledge of medical care increased (Hawkins 5). In addition to this, Couser has contended that the relative dearth of “classics” in the genre of pathography/autopathography before the later twentieth century is attributed to the general marginalization of ill or disabled people within western societies (Couser 7). 128 I would argue that the predominance of illness narratives in the late twentieth and early twenty-first centuries is a reaction to this in which the ill seek in part to break the silence

128 Couser has mitigated this by noting that the field is still relatively young (Couser 7). 185

around their particular malady, so as to remove the stigma and taboo associated with being ill.

Due to cancer’s status as one of the most feared and least understood of the major illnesses, in addition to the political component some cancers have had, autopathographies and pathographies concerning this specific disease became common beginning in the later 1970’s, with the overall rise in autopathographical writing. The prevalence of these works concerning cancer has continued and developed through the present day, but this certainly is not an entirely new phenomenon. Examples from the nineteenth century indicate that, although the works were not published, people have been discussing cancer in letters and diaries for centuries. It is only in the last 40 years, however, that these cancer works have been written with the aim of reaching an audience wider than immediate friends, family, and acquaintances.

Far fewer experiential accounts of tuberculosis appear in the same vein as those of cancer, as by the time the vast majority of autopathographies and pathographies were being written, a tuberculosis diagnosis in the west was no longer the dire event that it once was. There are mentions of the disease in the diary entries or letters of tuberculosis sufferers such as Franz Kafka and John Keats, but this genre of illness writing did not reach the levels that cancer would in the late twentieth century. Authors did, however, use their personal tuberculosis experiences to inform and shape some of their texts, as in the case of Eugene O’Neill, whose plays The Straw and Long Day’s Journey into Night both contain elements of O’Neill’s tuberculosis infection.

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In Anne Hunsaker Hawkins’ classification of pathographies, she suggests that three major categories exist: testimonial pathographies, angry pathographies, and those advocating for alternative therapies. I will discuss significant examples of each below, as they are represented in cancer autopathographies. In testimonial works, the main authorial intent is to impart information on the reader, be it medical or personal, as pertains to the illness (Hawkins 4). This is the category into which the vast majority of early pathographies and autopathographies fall, and this holds for cancer as well, although the other two categories are also strongly represented. I find Hawkins’ use of the word “angry” to be problematic because it could be misconstrued as being pejorative and implying that these people’s feelings were unwarranted. I have therefore replaced the word “angry” with “activist,” as I feel that it better describes how the authors have portrayed their cancer experiences. In the case of the alternative treatment model, I will examine it within the context of its use in works that fit under the other two categories, as it is generally not the sole focus of cancer autopathographies. Rather, it tends to be included as a significant theme within works that are primarily testimonial or activist.

This is because in order to form a convincing argument for the treatment, the context of the person’s illness story must be given as well.

An Early English Testimonial Representation: Frances (Fanny) Burney

The earliest significant written account of breast cancer in the early nineteenth century was written by Frances (Fanny) Burney, the English author of the best-seller

Evelina in addition to several other popular plays and novels. Burney was diagnosed

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with breast cancer in 1811 while she was living with her husband in France. Her twelve- page letter to her sister Esther at home in England, which she wrote between March and

June of 1812, recounts the story of her diagnosis and subsequent mastectomy on

September 30, 1811.129 Breast cancer was a known affliction with an outlined surgical treatment at this time, but there are relatively few written accounts of this disease due to the simple fact, as noted by April Patrick, that the few people to whom one would have revealed a cancer diagnosis nearly always lived closely enough to receive news of the disease by word of mouth, rather than by letter (Patrick 1). 130 In keeping with the social mores that kept cancer from being a publicly discussed illness, Burney’s letter was not published during her lifetime. Rather, it first appeared in 1975 in Fanny Burney: Letters and Journals , edited by Joyce Hemlow (Knopf-Newman 4), during the same time contemporary cancer autopathographies were being written. I have included Burney in this chapter because her letter offers a distinct connection to this later phenomenon of testimonial writings.

This is an early example of a testimonial autopathography in that Burney seems in her letter to be most concerned with explaining to her family what she has experienced before news of her cancer and surgery reaches them through others. She describes her diagnosis, including her feelings and the many doctors she consults, as well as her subsequent mastectomy. Burney tells of her operation in detail, having remained awake

129 Burney lived for 29 years after her mastectomy, dying at the age of 88 of an unspecified cause, and so it was a successful treatment of a case her doctors had believed to be advanced (Patrick 1). 130 In contradiction with the general assumption that women generally did not write about their cancers at this time, Patrick’s 2011 dissertation A Sentence of Death Has Been Passed on Her: Representing the Experience of Breast Cancer in Britain through the Long Nineteenth Century presents several examples to the contrary. Among these are the diary entries of Sara Coleridge from 1850-52 and of Helen Blackwood from 1866-67 (Patrick 82). 188

for the procedure given that it took place before the advent of ether usage. She chronicles both her fear and pain as well as the incisions the doctors made and her weakness during the operation’s aftermath. The content is of course different and the intended audience limited to Burney’s close friends and family, but a major subset of later testimonial cancer works follow a rather similar outline in which the author primarily presents a description of what has happened, albeit with varying amounts of introspection or interpretation of the cancer experience. The style of these texts, as with Burney’s letter, is straightforward and bears no hint of an obvious embellishment of the experience. This demonstrates a certain universality in the need to tell one’s story for oneself that only 160 years after Burney wrote her letter would gain hold as a public phenomenon, and such accounts would be regularly published.

An Early American Testimonial Representation: Betty Rollin

The American NBC news correspondent Betty Rollin wrote one of the first and most widely-read breast cancer autopathographies in the United States. Her work, First,

You Cry , was published in 1976 and it is written as a testimonial autopathography.131

Rollin was 39 years old at her diagnosis, and she chronicles not only her treatment, but also the aftermath of that treatment. This was a ground-breaking work in cancer autopathographies because Rollin wrote openly about the realities of breast cancer in the

1970’s. Rollin did not initially reveal her diagnosis to her television audience, but in this work she discussed her diagnosis and surgery as well as the tumultuous months following her mastectomy, including the low points as well as the more positive moments. In this

131 First, You Cry was made into a television movie with the same title in 1978. 189

candid account, Rollin did not shy away from the difficult, often undiscussed issues of the time, such as whether or not to be honest about her breast cancer with friends, families, and co-workers; facing her altered body image; and wrestling with the options of how to conceal or replace her lost breast. There is little in the way of launching a political discussion or advocating for one treatment over another, but rather her aim seems to be simply to tell her story of cancer diagnosis, surgery, and recovery. In

Rollin’s epilogue to the 2002 edition of the text, she explains that cancer has led her to a career pursuit she finds more satisfying—that of being a writer, although she does occasionally still work in television journalism. Rollin would again face breast cancer in

1984 in her other breast, but she is still alive and working at the present (Rollin 220-21).

A West German Testimonial Representation: Hildegard Knef

Actress, author, and singer Hildegard Knef has presented a more complicated example of this treatment of the cancer experience in her 1975 autobiographical work

Das Urteil oder der Gegenmensch. 132 At the age of 48 she underwent the fifty-fifth operation in a life of various sicknesses, this time for a breast tumor. Knef herself did not intend this work to be a strict retelling of her life, but rather in the epigraph to the text, she states that her characters and their words and actions are freely interpreted and not to be taken as strict fact (Knef 5). This is not solely a text about her experience of having breast cancer, but instead her interwoven stories of the past and present as they are related either to her illness or to her loved ones.

132 This work was a bestseller in Germany as well as in the United States in translation. 190

Although she opened the work with a retelling of her radical mastectomy, Knef went against standard testimonial cancer narratives by not telling the story in chronological order. Rather, the narrative jumps from scenes in the past to those in the midst of her cancer experience, and then those following her surgery. For instance, the fourth chapter concerns her fears over a new symptom that must be investigated, while the fifth relays the story of a gathering of various wealthy and famous people in St.

Moritz the year before, explaining that the hostess of the party had had cancer and describing the hostess’ demeanor and appearance (Knef 46-63). Chapter 6 then again returns to the present. Further, in Chapter 12, Knef has included an extended recounting of her one-woman show put on five years before her cancer. Its only connection to the disease is a brief remark at the end of the previous chapter noting that she had not known at the time that the seeds of cancer were already in her body (Knef 204).

Parts of the work bear dates and are written in a diary style while others are not.

Knef has alternated a first-person and third-person telling of the story, wherein she has seemed to distance herself from the narrative by using either “sie” or “die Patientin” when referring to herself. These aspects of the work create a sense that Knef was attempting to fit her cancer experience into the larger narrative of her life as an artist. By frequently changing the time of the events she is recounting, she has created a weaving together of her pre- and post-cancer lives to the point where the reader does not always know which he is reading. This creates a seamlessness in Knef’s life story that integrates her breast cancer into the larger whole of her life’s experience, albeit as a notable and significant event.

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Knef has included the standard hallmarks of this type of cancer autopathography in that she has chronicled her treatment and surgery as well as her feelings surrounding the entire experience of having breast cancer. She does not seem to have any motivation in writing this work other than to tell her story. As is typical for the majority of cancer autopathographies of this time, she does not advocate for alternative treatments, express anger at the medical community, or extrapolate on the greater meaning of cancer in her life, which.

A Swiss Testimonial Representation: Walter Matthias Diggelmann

Walter Matthias Diggelmann dictated the diary entries for his 1979 work

Schatten: Tagebuch einer Krankheit, which details his experience with a terminal brain tumor .133 He explained that he had recorded these entries because writing and living had always been connected for him. Further, he asserted that if he were to die from this disease, he hoped to at least get a wonderful, exciting story out of the experience of dying

(Diggelmann 28). As Claudia Boldt has posited, Diggelmann’s writings suggest that he was attempting to deal with his cancer in a rational manner, but that he was ultimately unsuccessful (Boldt 101). He instead eventually abandoned his former “ich” and lived entirely as his post-diagnosis “ich” in which he described finding a new language to use.

This new language was primarily concerned with being at one with himself, with others, and with the environment—something he had not had in his pre-diagnosis life.

Diggelmann did not have the chance to develop this new language, because he died one

133 Due to the effects of his brain tumor, Diggelmann could no longer write by hand, and so spoke into a tape recorder. 192

year after his diagnosis. While he recorded his medical interactions and his personal feelings about facing this illness, the role of writing and language in facing cancer is a dominant theme that separates his text from those of other early writers of testimonial cancer autopathographies.

Focus on Two East German Testimonial Representations:

Brigitte Reimann and Maxie Wander

East German novelist Brigitte Reimann and her fellow resident of the German

Democratic Republic, Austrian-born documentarian Maxie Wander, both lived through and wrote about their respective experiences with breast cancer in a time when cancer was still very much a private affair and few experiential accounts had been published, despite the coming wave. Both women died of breast cancer, Reimann in 1973 and

Wander in 1977, and their cancer writings, published posthumously, consist of published diary entries and letters. Reimann’s and Wander’s writings, although published in the

1980’s and 1990’s, were written during this time dominated by testimonial accounts of cancer. Anne Hunsaker Hawkins does not specifically address published diaries or letters, but both Reimann’s and Wander’s collections fit into the category of testimonial tathographies. Authorial intent here cannot be reliably determined, as neither woman expressly asked that her words be published, but each woman’s body of writings on breast cancer charts her individual path through the illness.

Reimann’s cancer writings consist of Die geliebte, die verfluchte Hoffnung:

Tagebücher und Briefe 1947-1972 (1983), Alles schmeckt nach Abschied: Tagebücher

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1964-70 (1998), and published correspondences with friends Hermann Henselmann,

Irmgard Weinhofen, Christa Wolf, and Annemarie Auer. 134 Reimann, in contrast to the many testimonial accounts, has recorded this experience with neither anger nor resentment toward the medical community. Even upon learning that her doctors and her physician husband had concealed the true gravity of her case by telling her that the pain was due to a slipped spinal disc—an instance when one would expect some expressions of anger—Reimann simply admits in her correspondence with Christa Wolf that:

“Wahrscheinlich habe ich selbst nie an diese Bandscheiben-Mär geglaubt” (Reimann and

Wolf 121-2).

The shame and silence surrounding cancer that is discussed and fought against by

Rollin is particularly apparent in Reimann’s writings. In the six collections containing letters from the time of her breast cancer, Reimann only candidly wrote to a few people about her fears regarding her disease and its prognosis.135 Early on in her illness, in fact,

Reimann’s childhood friend Irmgard Weinhofen, architect Hermann Henselmann, and one other unnamed addressee were the only people with whom she discussed such things. 136 A hint at the reasons for this can be found in the letter to the unnamed addressee from September 10, 1968, the day Reimann received her cancer diagnosis. In addition to sharing that news, Reimann asked of the addressee: “Sag niemandem, was mit mir los ist; ich weiß nicht warum, aber ich empfinde Krankheit immer wie einen Makel”

(Reimann, Hoffnung 281). This sense of shame that led to her silence was only broken

134 For the titles of these collections, see the bibliography. 135 I have no record of Reimann’s conversations which may have contained more discussion of these things. 136 The letters in Die geliebte, die verfluchte Hoffnung do not bear the addressees’ names, which Karin McPherson attributes to compliance with censorship practices when the collection was originally published by the Verlag Neues Leben in the GDR in 1983 (McPherson 544). 194

when Reimann could no longer stand to keep her feelings to herself. Reimann explained to Weinhofen on December 11, 1968, that: “Es gibt Empfindungen an denen Du erstrickst, wenn Du sie nicht einmal aussprechen oder hinschreiben kannst. Und ich weiß keinen anderen als Dich“ (Reimann and Weinhofen 162). By February 22, 1969, she had opened up to Henselmann as well, telling him: “[...] wenn ich nicht irgendeine

Möglichkeit finde—ich weiß nicht welche—, mich davon zu befreien, werde ich verrückt oder ich bringe mich um, weil ich die Angst und das Warten nicht mehr ertrage“

(Reimann and Henselmann 91). 137 That other letters from this time contain no such admissions of her fears and anxieties only serves to underscore the isolation she imposed on herself out of shame.

Further letters do indicate that Reimann was also struggling to find the public face she wanted to present throughout this time. She wrote to Christa Wolf on January 29,

1969 that she had thrown away several earlier drafts of a letter because she could not find the right voice: the other drafts were too full of melancholy, too funny, or contained too much “stille Tapferkeit” (Reimann and Wolf 15). Here, Reimann was in effect trying to find the public persona that exhibited no trace of the effects of her illness on her. Any tone that would seem too far from her pre-cancer self in either a direction that was too upbeat or too despondent was unacceptable, as it would have indicated to others that she was not simply taking her cancer diagnosis in stride and moving on with her life. This same idea was repeated several more times in her writings, such as in her accounts of smiling and greeting people she meets, while actually wanting to scream at them for the

137 Dorothea von Törne has written that Henselmann continued to be a support to Reimann throughout her illness, and he was instrumental in establishing her care under Professor Gummer, a leading oncologist in the GDR (Törne 160-1). 195

injustice she sees in their health while she is ill (Reimann, Aber wir 169 and Was zählt

315). Reimann presented the face she believed was most acceptable rather than the one that revealed how she truly felt. On the few occasions when Reimann did delve into her difficulties with people aside from Henselmann and Weinhofen, it was quite brief and nearly always followed by a statement such as “[n]a, genug davon” or “[e]ntschuldige, dass ich so viel von mir rede” (Reimann and Wolf 47 and Reimann, Hoffnung 301).

These seemingly off-hand comments further underscore Reimann’s discomfort in sharing such thoughts with others and thereby revealing this personal struggle with cancer.

As Rollin discussed at about the same time and as Audre Lorde will echo and lament eleven years later, Reimann lacked a larger community of breast cancer patients to whom she could turn for guidance and understanding. Writing to offer advice to

Annemarie Auer, a fellow GDR writer facing cancer of her lymph nodes, Reimann bluntly stated that the comfort others offer is essentially useless because they have not been where she is (Was zählt 311). This idea resurfaced a few months later when, in response to Christa Wolf’s direct question as to how Reimann was doing, she wrote in her diary: “[...S]ie [Wolf] fand es verdächtig, dass ich im letzten Brief nichts persönliches erwähnte. Aber wie? [...] Die ewige Angst (immer häufiger Schmerzen in Hals und

Magen); die kindischen Freuden, die Spaziergänge auf dem Wall [...] das ist doch alles unwichtig für andere“ (Reimann, Abschied 245). Reimann’s reticence therefore also partly stemmed from this absence of a wider network of cancer patients. 138 Since she

138 She and Auer did alternately provide some support for one another, but Reimann never wrote of having found another breast cancer patient with whom to connect. 196

found no benefit in talking to those outside of her closest friends, she simply remained largely silent on what she was experiencing.

Reimann’s work on her novel Franziska Linkerhand , begun in 1963, was for the most part a vital constant during this tumultuous time. She ultimately even credited her will to finish the book with keeping her alive, telling Irmgard Weinhofen on June 11,

1971: “[...W]enn ich nicht das Buch noch zu schreiben hätte, ich glaube, ich würde

Schluß machen“ (Reimann and Weinhofen 283). Reimann wrote several times of her fears that she would not finish Franziska Linkerhand , as in this diary entry from June 10,

1969: “Kaum bin ich zu Hause, erfaßt mich von neuem ein panisches Angstgefühl.

Angst, die Arbeit nicht zu schaffen, Angst wegen Zeit [...]” (Reimann, Abschied 243).

This anxiety over dying before she could complete her novel led Reimann to write feverishly at times, as she reported in letters to Weinhofen (Reimann and Weinhofen 254,

282). At other times, however, she was paralyzed by the fear of not finishing the novel and consequently could not work on it at all. As she wrote to Weinhofen on September

14, 1971, she was suffering from an “[...] Unfähigkeit, auch nur eine Zeile zu lesen, geschweige denn am Buch zu schreiben [...] Ein höllischer Zustand, wahrscheinlich ausgelöst durch den Terminabdruck, die Angst, das Buch nicht zu schaffen [...]“

(Reimann and Weinhofen 257). This mental tug-of-war in writing Franziska Linkerhand has created an image of a woman struggling to find her psychological footing after her diagnosis. The moments where she was motivated to finish the book were quite buoyant ones, as is clear from the repetition in several letters of how crucial this was to her well-

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being. 139 When she could no longer bear to write, however, she seemed to have given up on her own survival and on her book all at once. Reimann’s attitude towards her writing thus also serves as a reflection of her attitude toward her life and her illness. Despite the increasing physical obstacles to her writing, Reimann seemed to make an upbeat turn near the end of her illness. Approximately five weeks before her death, she wrote to

Christa Wolf on January 15, 1973 that she was still intent on finishing the last chapter of

Franziska Linkerhand , even as she entered the cancer clinic for what would turn out to be the final time (Reimann and Wolf 159). At the very end of her life, her writing was therefore a wholly positive force that motivated her to stay alive as long as possible.

Karin McPherson has argued that Reimann’s overall correspondences with Wolf indicate that she never found inner peace and security (McPherson 546). On the contrary, in

Reimann’s last letters about Frankziska Linkerhand , the impression is that Reimann had indeed found peace with her situation, in addition to the will to endure whatever she must in order to finish this novel. Franziska Linkerhand , however, remained unfinished at

Reimann’s death.

Maxie Wander’s cancer writings are contained in the collection Leben wär’ eine prima Alternative: Tagebuchaufzeichnungen und Briefe (1980) and the majority of her writing is likewise testimonial, charting on occasion even the specific times her temperature was taken and the doctors made their rounds (M. Wander 13). In addition to this, she also articulated moments of great frustration with the medical community that are characteristic of the activist pathography. Her experiences exemplify Kathryn

Montgomery Hunter’s assertion that patients are often deserted by physicians, creating

139 For examples, see page 254 in Grüß Amsterdam and page 336 in Die geliebte, die verfluchte Hoffnung . 198

unnecessary stress for the patient (Hunter 137-8). Despite the fact Wander wanted to understand her prognosis and condition, the doctors were not forthright with her. Instead, in reaction to the news that her cancer could not be fully removed, she wrote in her diary on September 17, 1976: “Ich entnehme es ihren wortkargen Sätzen, die ich ihnen nach und nach entreiße [...] Warum kann man dem Kranken nicht seine Lage besser erklären?“

(M. Wander 19). She even stifled her own emotions in her search for answers, writing:

“Wenn du Theater machst, sagen sie dir nie die Wahrheit” (M. Wander 21). 140 Wander’s exasperation continued as she consistently probed for more information on what she should do to optimize her situation. This is best illustrated by her chronicling of the question of whether she should stop taking birth control pills due to the potentially harmful hormone content. Her diary entries reveal a mixture of reactions to this question that range from the doctor who was horrified that she was still taking the prescription, but told her “[w]eiterschlucken bis zur Regel, dann werden wir sehen” to the one who replied

“[e]gal ja oder nein,” finally to the Oberarzt who, two weeks after her initial inquiries finally ordered Wander to stop taking them (M.Wander 18, 34, 38). Wander’s reaction to this final decision is telling: “Schön, aber warum muss ich diese Angelegenheit so hartnäckig betreiben?“ (M. Wander 38). Her frustration and disillusionment with the medical practitioners are quite apparent from this quotation, and these feelings are only underscored by her description of her birth control pills as the pills “[...] zu der kein Arzt

140 Maxie Wander was justified in suspecting her doctors of withholding information. As Fred Wander reported in his 1996 autobiography Das gute Leben: Erinnerungen, Maxie’s surgeon told him immediately after the first surgery that her condition was hopeless. They had discovered the tumor too late and metastases were already developing (F. Wander, Das gute Leben 332). 199

eine Meinung hat” (M. Wander 34). This sarcasm and its underlying anger, although not the main thread of her cancer experience, serve as a strong subtext to her experience.

Maxie Wander also had the common experience of feeling wholly separate from the world of the healthy, but she did not seem to experience this silence and isolation to such a degree as Reimann. When her friend Annerose visited her the day after her initial operation and shared gossip about friends and their problems, Wander thought: “Ich kann’s aber in meiner Lage nicht als Problem sehen, sie leben doch und sind gesund” (M.

Wander 24). Wander tempered this with empathy for her visitor when Annerose made another similar blunder. Wander added to her diary entry: “Mein Gott, was sollen die

Leute wirklich sagen, für jeden ist es eine neue Situation“ (M. Wander 24). As her illness progressed, Wander occasionally wrote about the distance her cancer put between herself and her friends and loved ones, but generally she added a similar note of understanding for the fact they may simply not have known what to say. 141 Her husband

Fred was the one exception. She wrote that try as she might to deceive him about her true feelings, her eyes could not lie (M. Wander 182). This unspoken understanding she has found in him seemed to keep her from the degree of isolation one senses in Reimann, who never wrote of finding that kind of solace in another person. 142

As with Reimann, however, Wander largely viewed her illness as something that reflected back onto her character. While Reimann simply stated that she saw illness as a

“Makel,” and did not dwell on potential causes, Wander took this further by pondering specific reasons for her illness. Cancer indeed lends itself particularly well to this line of

141 For further examples of this, see pages 71, 77, and 182 in Leben wär’ eine prima Alternative. 142 Unlike Reimann, Wander did not report reaching out to any other cancer patients for support. 200

inquiry, since its causes were then, and—with few exceptions—remain, speculative at best. Wander considered in turn nearly all of the most common lay theories of cancer genesis, beginning with her assertion that her cancer was related to having spent too much time thinking about death in the wake of both reading Christa Wolf’s Nachdenken

über Christa T. and writing about her ten-year-old daughter Kitty’s accidental death in

1968 (M. Wander 17, Zermühl 188-89). 143 Wander also repeatedly considered the age- old theory that her cancer was a punishment from God either for her arrogance, pretentiousness, and vanity or as payment for the generally happy life she had led (M.

Wander 21, 72). Wander then later brought up the concept of illness being caused by modern inventions, questioning whether her cancer might have been at least exacerbated by hormone shots she had been given to prevent hay fever (Wander 55). What these potential causes share is that Wander attributed all of them to herself. 144 As Boldt has pointed out, Wander did not write of a hereditary or physiological cause for her illness

(Boldt 134), and Marion Moamai has taken this a step further by suggesting that she believes Wander’s illness therefore served a “sühnende Funktion” for her (Moamai 68). I would agree, as having lived a life of what Wander in hindsight sees as vanity, conceit, and selfishness, she viewed this cancer as her due penance. This is not to say that

Wander wanted to die, only that she viewed her death as in some way due to her own behavior.

143 Kitty had fallen into a sand pit that was part of the construction work on a canal near her house (Zermühl 189-90). 144 As Wander does not blame anyone but herself, Thomas Anz has refered to Wander’s story as a “’regelwidrige’ Vorstellung von Krankheit” (Anz 218). 201

Wrestling with silence and finding oneself at least initially in a community of one are common themes of experiential cancer writings. Hawkins additionally outlined four myths that frequently form the foundation of pathographies, designating the “Myth of

Rebirth and the Promise of Cure” as one of the most prevalent myths. As the myth’s name suggests, these pathographies focus on illness as a transformative experience wherein one is left with a markedly different version of oneself after being ill (Hawkins

33). 145 This myth today may or may not hold religious, specifically Christian, connotations, which is due in part to the changing role religion has played throughout history in the perception of one’s illness (Hawkins 31). 146 As Herzlich and Pierret have stated, “God and the order of the universe have long been considered the ‘first causes’ of illness, and indeed have given a structure to its meaning [...],” however with the advances in medicine and science, this is no longer the case in contemporary western society

(Herzlich and Pierret 129). Although Hawkins has connected the chief use of this myth with those illnesses such as heart disease that involve acute episodes, cancer pathographies have their own kind of rebirth that is generally more gradual in its appearance (Hawkins 40), and this myth was indeed a dominant theme for Maxie

Wander. 147

Wander’s portrayal of her experience in diary and letter form lacks the possibility of a constructed underlying myth with a specific intended effect, but her published

145 The other myths are “Battle and Journey,” “Myths about Dying,” and “Myth as Medicine.” 146 Hawkins explained the illness narrative as a successor to the religious conversion stories of earlier centuries (Hawkins 31). 147 In contrast to these narratives, Brigitte Reimann’s writings do not hold a sense of rebirth through illness, perhaps because she already experienced a life-changing illness in the polio she survived at the age of fourteen (von Törne 16-7). 202

writings nonetheless also portray her own rebirth. Her writings immediately following the diagnosis principally reveal fears about her future and the future of her family. On

September 17, 1979, three days after her mastectomy, she wrote: “Habe wahnsinnige

Angst vor der Auflösung und den Schmerzen und dass ich Fred und die Kinder bis zur

Erschöpfung belaste!“ 148 As time went on, Wander’s angry or depressed thoughts, while still present, became less frequent in her writings—even as her sickness progressed and it became ever more evident that she was terminally ill. What emerged to dominate this image of fear were her thoughts of the positive effects cancer had on the ways she viewed her remaining life and lived it. During Wander’s respite at home between stays at the two clinics that treated her, she wrote to her friend Ernst R. on October 5, 1976 of the new ways in which she regarded her home: “Alles ist fremd und wie verzaubert. Wir wissen, was wir haben, erst wenn die Wände zittern und der Boden unter unseren Füßen wankt, wenn diese Welt einzustürzen droht, ahnen wir, was Leben bedeutet“ (M. Wander

41). Her time in the hospital and her fear of dying allowed her to fully appreciate what she had in her family and her home. She then continued in this letter to write about the little things she found newly sensational, such as sitting at a table while listening to classical music and drinking a cup of tea, which is an image that succinctly conveys a new perspective on life for this woman who had always felt torn between her career ambitions and being a housewife (M. Wander 41). Boldt writes that for Wander, “[d]as

Leben ist durch die Umorientierung wieder lebenswert geworden” (Boldt 144), and this remained the case for her. As Wander began to believe that this sickness would drag on

148 In his autobiography, Fred Wander writes about the deep depression Maxie was in after her diagnosis that led to an emotional collapse (F. Wander, Das gute Leben 318). If Maxie Wander did chronicle this, it is not included in Leben wär’ eine prima Alternative. 203

for years, her new-found appreciation for the everyday experiences gave way to a longing instead to indulge her wish to travel before she became too sick to do anything but sit at the table drinking tea (M. Wander 70). Although this entry represents a shifting ambivalence in her writings about how she wanted to live her post-diagnosis life, what is clear is that cancer has motivated her to reevaluate what it means to live fully and to pursue, as Boldt has suggested, an “Ich-Erweiterung,” be it at home or abroad (Boldt

132). Finally, in a letter to a friend written on September 21, 1977, less than two months before her death, Wander wrote that she had learned to no longer lament what is gone— her daughter, her breast, her general health—but to hold on to the considerable amount still remained (M. Wander 214). These ideas and assertions strengthen the image of

Wander as a woman who used cancer to learn about life. Although she did not survive very long after her diagnosis, she employed these lessons and perceived truths in approaching her death not with bitterness and disappointment, but rather with a new appreciation for what she had learned as a result of the illness.

Maxie Wander’s longing to write was a significant personal conflict in her pre- cancer life; as Boldt has explained, Wander felt constantly torn between her role of housewife and mother and her wish to be a writer, never feeling that she fulfilled either to the best of her ability (Boldt 139). 149 Wander’s one published work, Guten Morgen, du

Schöne (1977), is a collection of Protokolle written from recordings of her interviews with women living in the GDR. Wander wrote of her happiness that Guten Morgen, du

149 Boldt has further asserted that Fred Wander constructed Leben wär’ eine prima Alternative so that it would paint Maxie Wander’s life as a metaphor for the “Lebensfeindlichkeit” of the GDR for the individual, and the writer in particular (Boldt 144-6). It is misguided to make such an assumption, given Wander’s positive views of her life in the GDR that are also present throughout the work. 204

Schöne would be published and noted several times that being able to write again in general was healthy for her, but her writing also does not seem to play as vital a part in her well-being as it did for Reimann (Wander 71, 189). Wander’s only mention of the planned companion piece to Guten Morgen, du Schöne, which was to consist of

Protokolle from children, came in the form of a doubt that she would finish it. In a letter on June 13, 1977, she wrote: “Ich weiß nicht, ob ich das neue Buch schaffe. Auf meinem

Kalender türmen sich die Termine, die ich einen nach dem andern verschiebe, aus

Müdigkeit und Trägkeit und Angst“ (M. Wander 178). These words indicate a certain resignation to not finishing the book, but there is no suggestion that this was either overly upsetting to her or that it carries the significance of a declaration that she has lost the will to live. Writing did not seem to have played the crucial role for her in her post-diagnosis life that it has for other authors. Wander’s writing, while important to her, had never been the driving force of her adult life, and this perhaps accounts for the secondary role it assumed during her illness. Ultimately, however, her testimonial cancer writings in

Leben wär’ eine prima Alternative have become as much a lasting legacy as Guten

Morgen, du Schöne. 150

150 The recent acclaim of the authopathographical testimonial cancer works by the American New York Times journalist and editor Dana Jennings; the German director, author, and artist Christoph Schlingensief; and the German author and artist Wolfgang Herrndorf point to the continuing relevance of this form of autopathography, even as the genre has evolved. Schlingensief’s text about his adenocarcinoma, So schön wie hier kanns im Himmel gar nicht sein: Tagebuch einer Krebserkrankung (2009) is the traditional means of conveying an autopathographical story. Jennings’ series of blog articles in The New York Times (11 November 2008- 29 December 2012) regarding his prostate cancer and Herrndorf’s blog (8 March 2010- present) discussing his life with a glioblastoma point to the utilization of newer media in achieving aims that are similar to the traditional form of autopathographies. The content of all of these writings, while specific to each man’s individual disease and life circumstances, remains quite similar to the model first used by the early testimonial autopathography writers, such as Rollin, Wander, and Reimann, wherein the primary narrative strain is the illness experience and its effect on the life one has lived and is then living after the diagnosis. 205

An American Testimonial Representation of a Childhood Cancer: Lucy Grealy

Authors of cancer autopathographies are typically adults when they face the illness, but writer Lucy Grealy’s autopathography Autobiography of a Face (1994), offers a case in which the cancer shaped an entire adolescence and adulthood. Grealy has told her life story beginning at the age of nine with her diagnosis of Ewing’s sarcoma, a rare and often fatal cancer of the jaw. While each testimonial autopathography charts the substantial changes that accompany a cancer diagnosis, these are usually changes in an adult life that has to some degree already been established, either in terms of career, personal life, or personality. In Grealy’s text, her cancer and its resulting facial disfigurement played a large role in forming her identity, rather than altering it as an adult. She wrote of the effect her disfigurement had on her personality, transforming this formerly bold, outgoing child into one characterized by meekness and shyness, not wanting to incur taunts about her face or attention because of it. As each new attempt at a reconstruction was anticipated and then failed to produce the desired symmetry,

Grealy’s writings expose an inability to accept herself because of her physical imperfection. As an adult, she came to terms with her face after the final surgery had been performed and its results were far better than previous ones. Grealy’s text ends with the understanding that she had accepted her identity, which includes her face, but that her facial deformity, as her most defining feature, would always affect the course of her life and her social relationships. Grealy survived her cancer, but died in 2002 at 39 from a drug overdose. This was the result of an addiction to prescription pain medication that

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she had developed following her final surgery, and so it, too, bore the mark of her cancer.151

An American Testimonial Graphic Novel: Marisa Acocella Marchetto

In addition to the continued popularity of traditional testimonial autopathographies, there have been a few notable graphic novel retellings of cancer experiences as well. 152 American freelance cartoonist Marisa Acocella Marchetto crafted her story in her 2006 graphic novel Cancer Vixen: A True Story. This work depicts her diagnosis, treatment, and recovery from breast cancer, with which she was diagnosed at the age of 43. Much like traditional autopathographies, this work conveys Marchetto’s feelings and experiences as she is confronted with breast cancer, but this form allows for a much more pronounced intermingling of conversation with Marchetto’s private thoughts. Although there are far fewer actual words than in a traditional autopathography, the exchanges between the figures and the addition of the images create an equally rich and detailed text. What Marchetto has described is an experience no less life-altering and serious than in other autopathographies, but her illustrations of the scenes lend a new dimension to the traditional stories of chemotherapy, surgery, and general life changes that accompany cancer. As Frank Cioffi has observed, the graphic depictions often leave a longer lasting impression on the reader than words alone (Cioffi

185), and this is indeed the case with Marchetto’s work with its bright colors and visual

151 Grealy’s life beginning with her years as a graduate student is told by her friend and fellow author Ann Patchett in her 2005 book Truth and Beauty: A Friendship. 152 The earliest of these is Our Cancer Year, which was co-written by cartoonist Harvey Pekar and his wife Joyce Brabner, both Americans, in 1994. As I am concentrating on autopathographies written solely by the cancer patient, I will not discuss it here. 207

depictions of the course of her illness. The advent of graphic novel depictions seems to be a natural development in the genre of cancer autopathographies. As autopathographies first became more prevalent in the 1970’s and 1980’s, merely telling the story in detail was ground-breaking. Such testimonial accounts became ubiquitous and the reading public became accustomed to exposure to the textual accounts of cancer experiences. The illustrations in graphic cancer autopathographies have added a new dimension that renews the impact of autopathographies.

American Representations in Later Testimonial Accounts:

Anatole Broyard and Arthur Frank

As the decades have progressed, testimonial cancer autopathographies have also become progressively more about the effects of illness than about the medical realities of the illness itself. The facts of cancer are now well known, as are the treatment modalities and their consequences, and these continue to be outlined and explained. What is explored in more depth in these works is the impact on the whole of a person’s life. This is the case in the autopathographies of two American men, Arthur Frank’s text At the Will of the Body: Reflections on Illness (1991) and Anatole Broyard’s work Intoxicated By My

Illness and Other Writings on Life and Death (1992).

Sociology professor Arthur Frank wrote At the Will of the Body after suffering a heart attack at the age of 39 and metastatic testicular cancer at the age of 40. 153 Frank

153 Frank’s text is one of the earliest to break the silence on testicular cancer. The American champion bicyclist Lance Armstrong would then publish his autopathography of metastatic testicular cancer, It’s Not about the Bike: My Journey Back to Life , co-written with Sally Jenkins, in 2000. This text was widely read and publicized due to Armstrong’s notoriety, and so furthered the end of the silence on this disease. It is a 208

discussed the differences between the two experiences that arise from the finite experience of a heart attack as it stands in contrast to the ongoing remission with cancer, wherein one is conscious of a possible recurrence. His focus, however, was on the issue of viewing any illness as a chance at renewal and, as he phrases it, on trying to “live cancer actively” (Frank, At the Will 3). He did not discount the various hardships of facing his cancer, but he advocated talking, writing, and thinking about illness, and then moving beyond illness; this does not refer to talking about the medical, objective aspects of the disease, but rather about the subjective experience one undergoes. Frank has urged his readers to view illness as a positive experience that brings with it untold new possibilities for personal growth.

Broyard was a book critic and editor for The New York Times, and he was diagnosed with terminal metastatic prostate cancer in 1989. Similarly to Frank, Broyard wrote of cancer as an invigorating experience for him; he felt suddenly energized to do everything he wanted to do and could do before he died. He read autopathographies others had written about cancer, but found them lacking, and so began to write his own.

Broyard was further motivated by what he saw as a common human need to create a narrative of one’s experience; he wanted to create his own cancer narrative in which he described his illness as a new experience with which he must contend and come to terms.

For Broyard, this was a positive experience in which he at last felt free to do and say what he pleased because he knew his time was limited. He no longer cared what others thought of him. He touched only briefly on treatments, and although he discussed his

late representation of a purely testimonial autopathography, and as such, unremarkable in its telling of the cancer experience. 209

conception of an ideal doctor, these are not his central themes. The liberating effect of cancer is at the core of this text and represents a significant departure from earlier, though no less valid, works that concentrated more on the tragic and difficult aspects of being a cancer patient.

Focus on a Later American Testimonial Account: Reynolds Price

Reynolds Price wrote his 1994 spine cancer autopathography A Whole New Life:

An Illness and a Healing in the same vein. Price’s text is largely testimonial, written out of his expressed desire “[...] to give, in the midst of an honest narrative, a true record of the visible and invisible ways in which one fairly normal creature entered a trial, not of his choosing, and emerged after a long four years on a new life—a life that’s almost wholly changed from the old” (Price vii). He was motivated to write this book by the lack of experiential cancer literature that he found personally useful during his illness

(Price vii), and indeed much of the memoir is a chronicle of his life in the years 1984-

1988, detailing the course of his cancer and the resulting paraplegia. His focus is not solely on the description of the medical and physical facts, but rather on the larger positive changes he made to the way he approached life.

After two major spine surgeries to remove the tumor braided around his spinal cord and five weeks of radiation to destroy what remained of the tumor after the first surgery, Price was left with pain he described as “all-pervading from neck to feet” that had “[...] seized frank control of my mind, my moods and my treatment of friends” (Price

151). Having spent three years on methadone and various other pain medications that

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were virtually useless in dulling the pain, Price turned to a pain clinic for help (Price

153). At this point, the memoir takes on aspects of the alternative treatment pathography as well. In accordance with Hawkins’ criteria, Price did not exhibit significant anger towards the medical field, for it was in fact his neurologist who recommended the biofeedback training and hypnosis that would eventually allow him to stop taking all of the pain medications (Price 150). 154 Price hesitated to try this new suggestion, due partly to his lack of confidence in a medical system that has failed to relieve his pain so far

(Price 150-1). His statement of disappointment in the medical field does not carry any hint of anger, however, just of disillusionment. While Price did not aggressively advocate this alternative therapy for pain relief, he simply and dispassionately attested:

“While I’m aware that my solution might prove of no use to another pain veteran, I’ve discussed it with many and know that some have already invented their own form of it to make real gains against the blind clamor of chronic pain” (Price 160). Further, Price’s claim of nearly immediate freedom from the conscious pain in contrast to his portrayal of the malaise he was under during a “narcotized life” are an endorsement all their own for this alternative practice (Price 109, 134).155

Price gave relatively little thought as to why his cancer occurred. He was assuaged by the theory that his tumor had been present since birth, and thus could not have been due to something he did wrong; on the contrary, he was proud that his body had held the tumor in check for nearly fifty years (Price 56-7). While Price did not share

154 Biofeedback training in this case involves using concentration to relax the fibers in the muscles in order to alleviate pain (Price 154-5). 155 Price was clear that the pain is still present, but he has learned to filter it out of his consciousness just as one does with background noise (Price 157). 211

the shame many of his fellow autopathographers—and particularly his female counterparts—experienced, or dwell on possible psychosomatic causes, he did target a period of depression five years before his diagnosis that could have weakened his immune system and triggered the tumor’s rapid growth (Price 57). Rather than use this suspicion to blame himself for the tumor’s escalation, Price looked to it as hope that if he could strengthen his immune system through a healthy psyche, he would be able to fight the tumor (Price 58). As Herzlich and Pierret have claimed, accepting illness as submission to fate removes personal agency and culpability (Herzlich and Pierret 130).

Having had the tumor since birth lent Price’s cancer experience a sense of inevitability that many other tumors do not readily allow, and therefore it was far easier for him to have accepted his own potential contribution in its emergence. Even without that bout of depression, at some point the tumor would have grown to a size that would have disrupted his life, freeing Price of the personal blame. Price’s spine tumor was also not the kind of culturally charged cancer that breast cancer in particular is in both North

America and Europe, and this made it far easier not to feel personal culpability. There have been no great public debates on what causes spine cancer, nor has there been the culture of secrecy and shame that surrounds breast cancer. The spine is also neither a sexually marked body part nor one that is taboo to discuss in polite company. While Price did suffer extraordinarily debilitating consequences of his cancer, his paralysis was visible to everyone, in contrast to the public invisibility of a mastectomy covered up by a prosthesis or strategically chosen clothing. The public nature of his cancer’s physical

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consequences simply removed any burden of silence that he might have otherwise felt, because he could not have hidden the cancer’s effects even if he had wanted to do so.

Price indeed initially showed no reticence at all for others to know about the existence of his cancer; soon, however, as many other autopathographers have expressed, he talked to no one but his closest friends—people who, as he wrote, would “[...] ask me few questions, give no predictions and make no demands” (Price 53). Although neither shame nor embarrassment played a role in this seclusion, Price did not elaborate on other specific reasons for it. His words suggest that he, like those before him, simply did not find understanding within his general peer group. He did not ever find a group of cancer patients with whom to share his experience, but when he entered a rehabilitation facility for other paralyzed people, he found what early breast cancer patients never did: a community of people who shared his physical challenges and their accompanying psychological ones, much as the residents of sanatoria a century before. He wrote of them all as a group “[...] marooned on an island of damaged men and women intent on getting to the state that would let them visit the mainland again,” thus emphasizing the kinship he felt with them, and their shared goal of returning to relative normalcy (Price

99, 105). After this point, there is little mention of a feeling of isolation, which only lends credence to autopathographers’ many calls for support communities.

The very title of Reynolds Price’s memoir A Whole New Life indicates that this will be a rebirth story, and for him, it was one tightly entwined with his Christian beliefs.

Price reported that during his illness he experienced one encounter with Jesus Christ and one with God, in addition to another stretch of time when he sensed the company of a

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non-human, presumably divine being. The initial encounter occurred as Price laid awake one morning during the recovery from his first spine surgery. He found himself suddenly at Lake Kinnereth (the Sea of Galilee), where Christ baptized him and forgave his sins.

As Christ turned to leave, Price asked if he will be cured of his cancer, and Christ replied

“That, too” (Price 43-44). This baptismal spiritual cleansing then prefigured Price’s own experience of earthly rebirth, which he went on to narrate. A self-proclaimed

“unchurchly Christian,” Price claimed that this event had a realistic character unlike any dream he had ever had. Even during the times when he himself would doubt the reality of the experience, its physical nature would convince him of its truth (Price 44-6). 156

Peter Graham has called into question the Lake Kinnereth experience, asserting that while this would be an appropriate time for a cancer patient to experience such an event, it would also be the perfect point in such a story for an author to include a seemingly miraculous occurrence (Graham 79). Regardless of whether this encounter was the result of divine intervention or hallucinatory post-operative medications, the expressed importance Price placed on the truthfulness of his narrative makes it likely that he did, in one way or another, experience this moment. Price also wrote of sensing a presence in his room during the early morning hours before his radiation, when he was deep in contemplation. He did not specifically say that this presence was Christ or God, but the divine overtones are clear in his description of this being as “a patient listener behind a screen” that was “something more than the loyal but powerless humans near me” (Price

54). Finally, describing a time of particularly severe depression, Price wrote: “In that

156 Price remained convinced of the truth of this experience, but he kept it from all but a few people due to its intensely private nature. He also implied that he is aware that others would be rather skeptical (Price 75). 214

black trough, I remember looking up to the ceiling and addressing what I must have thought was God [...] ‘How much more do I take?’ A long silent pause, then a voice at normal speaking strength said the one word ‘More’” (Price 80). This “more” was to

Price a message that he would survive, but that he would also have to endure further suffering in order to do so.

While all of these encounters with divine Christian entities could be attributed to various medical or psychological explanations, what is not in dispute is the role these events played in the subsequent months of extreme pain and loss of movement.

Regardless of what one’s religious convictions are—and Price did not try to convince anyone of his—his use of these experiences actually highlights his own very human role in his rebirth. As Marilyn Chandler McEntyre has written, pathographies help us to correct our conceptions of what to expect and hope for during illness, and by focusing on what one has to do by oneself in addition to any spiritual assistance one may receive,

Price’s narrative does just that (McEntyre 231). These encounters helped him to gain strength mentally, but unlike many religiously-based narratives, there was no miraculous healing; he went on to live through several more years of physical trials and their various psychological consequences. During this time, Price even came to attribute the feeling of a divine challenge to the word “more” by answering back “bring it on” (Price 82). He did not just trust that God would make everything turn out all right in the end, but he instead pushed himself by putting in hours of physical therapy to make sure that it would.

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Having endured everything with which he had been confronted, Price wrote of surviving to find what he believed to be not just a new life, but an even better one. 157

Price’s trope of human trial and resurrection bears the traces of a Christ narrative, but he in no other way set himself up as a Christ figure. He did not see his illness as sent from

God to either test his faith or prepare him for some greater service to humans. Rather, he viewed his cancer as simply a fact of his life with which he must contend in order to reach this state of rebirth. Christ and God just happened to be helping him garner the courage to do so.

Moamai has posited that one of the key areas where a cancer patient’s life changes is interpersonal relationships (Moamai 89). For Price, this new life was one marked by a greater patience and understanding for those around him. This was borne largely from the fact that he literally could no longer just walk away from people when he became bored or upset (Price 188-9). Rather, he had to sit and listen to what people had to say, and in doing so, he came to grasp human nature more completely than before his cancer.

A frequent outcome in myths of rebirth is also finding a new personal identity

(Hawkins 42 and Herzlich and Pierret 182). Price still primarily viewed himself as a writer, but how he acted within this role shifted. Purely quantitatively, Price’s productivity increased markedly following his cancer. Price attributed this not only to a decrease in sexual interest that allowed his writing to become the central focus of his life, but also to the cancer that, as he explained: “either unleashed a creature within me that

157 Price’s work therefore also fits into Arthur Frank’s conception of a “Quest Narrative” pathography, in which the narrative asserts that there was something to be gained by the experience of illness (Frank 115). 216

had been restrained [...] or it planted a whole new creature in place of the old” (Price 190-

1). 158 With this statement, he portrayed his new creative life as an entirely separate entity from his old one. Speed was not the only difference for him, as he has also found an interest in new topics. One of these was memory, which he claimed stemmed directly from his own experiences recalling memories through hypnosis (Price 190). Price also returned to the characters from some of his earliest novels, such as those featured in both

A Long and Happy Life (1962) and A Generous Man (1966), writing continuations of the figures’ stories that take their harmonious lives and impose new crises and hardships— essentially, stories parallel to his own (Price 141). This new novel, Good Hearts , was published in 1988. He was in effect using his cancer experience to add new depth to his characters by including a layer to their life stories that complicated their earlier, simpler happy ending. James Schiff has observed that while Price’s writing had not changed dramatically, what was different was a new accessibility to readers (Schiff 174), an accessibility that could be easily attributed to his newfound greater empathy for those around him. Price valued these changes in his life as a writer, and his memoir ends on an unabashedly positive note as he listed what he considered to be the blessings of his rebirth in the hopes of encouraging others to see the positive aspects of their own new lives. While his autopathography contains more testimonial elements than either Frank’s or Broyard’s, what is consistent with their works is the ultimate focus on the positive effects of Price’s cancer experience. His text bears no trace of lingering self-pity, but rather its predominant tone is one of appreciation for the positive changes his tumor and

158 Price also gained a new, larger readership, which he partly attributed to the fact “[a] certified gimp, in working order, is often accorded an unearned awe” (Price 191). 217

resulting paralysis have brought to his life and to his work, despite the great cost at which these changes were won.

An Early Swiss Representation of the Activist Pathography: Fritz Zorn

The 1977 posthumously published autopathography Mars: “Ich bin jung und reich und gebildet; und ich bin unglücklich, neurotisch und allein ... “ by Swiss author

Fritz Zorn (the pseudonym of Fritz Angst) marked an early definitive development in the genre of cancer autopathographies. His is what Hawkins terms an “angry pathography,” which I have altered to “activist pathography.” In contrast to the chronicling nature of testimonial pathographies, activist pathographies are most often written in reaction to a medical system deemed at best unhelpful and at worst detrimental to the patient, although the anger from perceived injustices and mistreatment can be directed at other sources as well (Hawkins 5-6). In this seminal work, Zorn placed the blame for the cancer that would claim his life at the age of 32 on the repressive conditions in both his family and in the general middle class Zurich society. As Claudia Boldt has summarized his argument,

Zorn’s attempt to fit in led to self-alienation that he saw as carcinogenic (Boldt 60). Zorn placed a substantial emphasis on the mind-body connection in the genesis of cancer, which subsequently became a common theme in the cancer autopathographies of the

1970’s and 1980’s. This work includes little description of any treatments or the actual cancer experience, but rather focuses on the cause of the cancer and where blame should be placed for it. Due to the very pointed focus of this work, a longer analysis is not fruitful, as his argument is quite succinct. The brevity, however, does not discount its

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prominence in the autopathographical works that would follow and also consider a societal or psychological origin of cancer.

An American Representation of an Activist Cancer Text: Susan Sontag

Susan Sontag’s Illness as Metaphor (1978), is not strictly an autopathography, but rather a theoretical discussion of cancer in western society. However, it served a similar purpose in the English-language discourse about cancer literature that Mars had a year earlier for the German language; it helped to end the literary silence of experiential accounts of cancer and sparked a sharp increase in such works. This is not to say that

Sontag’s work did not prove to be immensely influential in German-speaking countries as well after the publication of the German translation in 1981. Mars was simply published earlier and began the trend there to which she would add a further layer. Sontag wrote this work in the wake of her own diagnosis of breast cancer in 1975, but she did not in any way reference her personal experience in this work, thus precluding it from being a true autopathography, despite its close association with the genre.159 In addition to breast cancer, Sontag would face cancer twice more in her life, a uterine sarcoma in 1998 and acute myelogenous leukemia in 2004. The leukemia would claim her life on December

28, 2004, at the age of 71. Sontag’s son, David Rieff, chronicled his mother’s final illness in Swimming in a Sea of Death: A Son’s Memoir (2008), but Sontag herself never published an experiential account of any of her cancers. In an article in The New York

Times from January 30, 1978, however, Sontag is quoted saying that she found it

159 Lisa Diedrich has argued that Sontag’s illness was widely publicized and so this may not have been completely unknown to some readers of the work (Diedrich 26). 219

important to be open about her cancer "[…]’because it can be helpful to other people, and because it's very important to break the taboo. People are very reluctant to deal with the thought of death; they see it as some shameful secret, and to many people cancer equals death. I thought that, too. And I had to rethink everything—what I thought, what I wanted to do,’"(“Susan Sontag”).

Illness as Metaphor reinforces this assertion. Sontag discussed and compared perceptions of tuberculosis and cancer, elucidating and criticizing the popular conceptions of cancer, as she believed them to be detrimental to people diagnosed with the illness. In this way, the text can be connected to the category of activist autopathographies. Sontag first attacked the physical associations of cancer. While the pallor and weight loss of tuberculosis have been predominantly seen as the results of spiritualizing disease, the weight loss in cancer is seen as the result of a shrinking, shriveling human being. Further, the parts of the body where cancer is found can be embarrassing ones to publicly acknowledge, such as the breast or testes, which brings an attendant association of shame to the cancer patient (Sontag 13-17). This shame is intensified by the spread of the idea of the “cancer personality” that places blame on the cancer patient for his own disease, despite the fact this concept is wholly unfounded

(Sontag 46-58). Sontag also argued against popular metaphors associated with cancer, believing them to also be detrimental to the ill person. The most predominant of these is the war metaphor, wherein the cancer patient and his doctors are seen as fighting a battle against the disease. Sontag found this to be deleterious because it encourages the view of cancer as a foreign invasionby “The Other” within the body rather than a more positive

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view of cancer as a successful mutation (Sontag 64-8). Finally, Sontag criticized the common usage of cancer as a synonym for absolutely wicked situations. She saw this usage of the disease as first of all inaccurate, as historical situations are not akin to any illness, and also as distinctly unhelpful to those facing the disease who would hear it being equated with such negativity (Sontag 80-85). Sontag’s monograph has become one of the most widely read theoretical works on cancer and the themes she discusses can be seen in many of the experiential cancer texts in the decades since.

Focus on an American Activist Pathography: Audre Lorde

American poet, writer and activist Aude Lorde published her autopathography,

The Cancer Journals , in 1980 in the wake of Zorn’s and Sontag’s ground-breaking works. Indeed, Cynthia Wu has viewed The Cancer Journals as being in dialogue with

Illness as Metaphor because Lorde has written passionately about her experiences with the deleterious effects of the shame, fear, and silence that Sontag described (Wu 245).

The Cancer Journals is a collection of diary entries, essays, and the text of a speech given at the Modern Languages Association conference on December 28, 1977, all of which center around Lorde’s breast cancer diagnosis and her radical mastectomy in September

1978 at the age of 44. 160 While Lorde has at times, particularly in the diary excerpts, simply borne witness to her own experience, the overwhelming tone of these three pieces and their introduction is of a fury toward what she alternately calls the “Cancer

Establishment” and “Cancer, Inc.” that she then uses to rouse both visibility and action on

160 Lorde’s MLA conference speech was written before her cancer diagnosis, but it is included in this collection because the theme of the speech is breaking silences, one of the major tenets of Lorde’s cancer writings. 221

the part of women with breast cancer (Lorde, Journals 58, 62). This was especially important within the African American community, because the public visibility of

Happy Rockefeller’s and Betty Ford’s breast cancer experiences, both in 1974, focused attention on the disease as one of the white, wealthy woman (Kopf-Newman 108). 161 In this activist pathography, Lorde’s conception of “Cancer Establishment” or “Cancer,

Inc.” includes not only the medical field, but also any industries that profit from cancer, such as the prosthesis manufacturers or pharmaceutical companies. It also encompasses the cancer advocacy groups, most notably the American Cancer Society.

Visibility of breast cancer was for Lorde a key aspect of forming a community of breast cancer patients. Lorde has argued that by pushing the use of prostheses, the

“Cancer Establishment” had taken away the literal visibility of breast cancer. This keeps these women from being able to find others with whom to form this community that is necessary in order for them to collectively fight for their medical options as well as for the funding to research the disease. Instead they are left separate, silent and therefore powerless (Lorde, Journals 61). Lorde was further enraged by the insistence on prostheses or reconstructive surgery on a personal level. For her this equaled the erroneous assertion that nothing has changed in her own life and further that the comfort of others was more important than her own ability to accept what had happened to her. In

Lorde’s refusal to wear a prosthesis so that others might feel more at ease with her breast cancer, Mary K. DeShazer writes that Lorde “[...] challenges, from African American and lesbian feminist perspectives, the silences that patriarchal cultures have demanded of

161 First Lady Betty Ford publicly announced her breast cancer in 1974, and two weeks later, Happy Rockefeller, wife of the Vice President Nelson Rockefeller, was also diagnosed (Knopf-Newman 9, 60). 222

women with cancer” (DeShazer 12). No good comes of pretending nothing has happened because it simply has, and no matter how great the prosthesis may look, a woman must still come to terms with that—and find her new personal power in doing so. A prosthesis only delays and complicates this process; it does not prevent it. Lorde indeed felt that rather than ignore what had happened, which would admittedly be easiest for both herself and the world around her, what she most needed was to connect with other breast cancer patients—other lesbians specifically—so that they could “[...] sit down and start from a common language, no matter how diverse” for her to begin working through and understanding her post-cancer life (Lorde, Journals 49). 162 Lorde struggled greatly with her own cancer-related fears and found that “[t]hose fears are most powerful when they are not given voice, and close upon their heels comes the fury that I cannot shake them”

(Lorde, Journals 15). Lorde created her own forum to voice these fears by searching out other lesbian, feminist or black breast cancer patients, but an open community of breast cancer patients would allow all women the chance to voice their fears.

In increasing the visible signs of mastectomy, the personal shame that Sontag discussed as being intimately associated with cancer could also potentially be increased for individuals because the wider world would know this personal secret. There is no mention of a feeling of personal guilt or culpability for Lorde’s own breast cancer, however, and she in fact harshly criticized the shame cancer patients experience, as it is an extension of the general trend to blame the victim rather than to find and fix the actual problem (Lorde, Journals 74). Lorde’s argument is that once women routinely encounter

162 Lorde has asserted, however, that she is not against a woman choosing a prosthesis when she can do so free of a societal insistence on it and after having had time to “accept her new body” (Lorde 63). It is the virtually mandatory use of prosthesis that incited her anger. 223

others like them, they would be able to realize that they are not the lone breast cancer patient out there. The questions of “why me?” and “what did I do?” would consequently become less prevalent and relevant. It is easy to blame oneself when no one else seems to share the illness, but it would be far harder to do when a visibly identifiable cohort of women who share the same fate.

Lorde also focused her anger on the American Cancer Society. While this organization provides needed support for some cancer patients, its overwhelming focus on treatment options rather than prevention was suspect to her. Lorde attributed this disparity to the fact that treatment equals profit for “Cancer, Inc.,” while prevention means less revenue from a resultant fewer cases of the disease (Lorde, Journals 71). In a profit-driven society, there is no incentive to prevent a cancer that creates revenue for so many business sectors. By exposing this, Lorde sought to raise an awareness that could lead to women joining together to demand that this practice change.

The Cancer Journals contains its own “Myth of Rebirth” with a similar, albeit distinct aim compared to the others I have discussed. Lorde’s journals show that she at first fought the idea of a post-cancer life, writing in her diary on April 16, 1979: “[...] I can’t accept that turning my life around is so hard, eating differently, sleeping differently, moving differently, being differently. [...] I want the old me, bad as before” (Lorde,

Journals 12). Earlier in the same entry, she had indeed written of the possibility that her breast cancer could make her a new, stronger person and activist: “If I can look directly at my life and my death without flinching I know there is nothing they can ever do to me again;” this is a phrasing she used repeatedly throughout The Cancer Journals (Lorde,

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Journals 11). 163 It became her battle cry, encouraging other women with breast cancer to find and use this resultant newfound empowerment and fearlessness as she had in order to fight the dominant powers in “Cancer, Inc.” In her prose accompaniment to these diary entries, written on August 29, 1980, she wrote of the additional benefit that the

“consciousness of death” had brought by shaping everything else in her life, from the words she spoke and wrote to her “appreciation of living” (Lorde, Journals 16). This was her definitive statement of rebirth into someone who no longer cared about what others might do, say, or think of her; she had to act when she felt the need, because death unremittingly hovered near her. Part of her anger at the insistence that mastectomy patients wear a prosthesis stemmed from the consequent preclusion for women to experience this rebirth, because they are trapped in trying to recreate their past, pre- cancer life that is gone forever (Lorde, Journals 56). This story of rebirth into a stronger, more determined, more vocal self that Lorde has woven throughout these essays and diary entries therefore presents an alternative to what the “Cancer Establishment” is telling these women they should do and be.

Lorde continually referred to herself as a warrior in The Cancer Journals and she then carried this war imagery throughout the text, in effect, as Wu has observed, reclaiming the war metaphors Sontag condemned and using them to construct her own war metaphor of breast cancer (Wu 246). The war imagery begins early on in her diary.

On April 22, 1979 she described her physical pain as a bomb that she must let go through her body; otherwise, as she wrote: “If I resist or try to stop it, it will detonate inside me,

163 Although “they” bears no reference in this entry, it is presumably the white, male-dominated culture that she viewed as oppressing her as a black, lesbian feminist. 225

shatter me, splatter my pieces against every wall and person that I touch” (Lorde,

Journals 12). This graphic image illustrated her view of this illness as a war to be won both by fighting and by knowing when not to fight. Lorde had to accept the circumstances of war, which in this case is physical pain, so that she could survive to fight the battle against the true enemies, the “Cancer Establishment.” In her diaries and other prose, she continued to write both about her personal “small victories” in her “daily battle in the war against despair” as well as the war against her disease. She also wrote about the larger war that could be fought “if an army of one-breasted women descended upon Congress” in order to ban the use of known carcinogens (Lorde, Journals 13, 16,

34). She repeatedly refered to the one-breasted Amazon warriors, as in her allusion to them in this quotation. 164 These warrior women served as role models for her, and she connected herself with their tradition of fighting. Rather than being demoralized by the metaphor of cancer as war, Lorde was energized by it and used it to energize others.

Further, Wu has written that “[...] by invoking the Amazon [Lorde] not only diffuses and redirects the sting of the metaphors Sontag describes, but also reconceptualizes notions of bodily disfigurement and femininity” (Wu 246). By viewing her post-mastectomy body as a warrior’s body, her scars and the scars of all breast cancer patients are “[...] an honorable reminder that I may be a casualty [...] but the fight is still going on, and I am still a part of it” (Lorde 60). Arthur Frank has viewed the references to Amazons as signifying that Lorde, through her mastectomy, has become the warrior that she actually always was at heart (Frank 130) . While she may indeed have been simply recognizing the fighting spirit she has always had, by connecting herself to the Amazons, she was

164 For further references, see pages 35 and 45 in The Cancer Journals . 226

embracing the warrior that she had become through breast cancer. Rather than being the helpless victim of her own fears, she envisioned herself as being on the frontlines of a battle, both personal and public, that was too important to lose because of vanity or a more comfortable silence.

Lorde’s diary entries from the six to eighteen months after her surgery also contain a significant amount of nature imagery, which generally is not associated with pathographies or autopathographies. On January 1, 1979, she wrote: “Sometimes despair sweeps across my consciousness like luna winds across a barren moonscape. Ironshod horses rage back and forth over every nerve” On May 1, 1979, she proclaimed “[...] despair [is] like a pale cloud” and on May 30, 1980, she called herself “de-chrysalised”

(Lorde 11-12, 14). All of these entries are contained in the introduction of The Cancer

Journals ; nature imagery is wholly absent from the rest of the work. The other pieces, however, were published separately, and each contains a similar version of her exhortation to break the silence and end the invisibility of cancer. The use of nature imagery, in addition to being a vivid expression of the experience she has been living, creates a sense that her cancer experience was organic and natural, which strictly goes against her message in the following essays and the speech. She seems to have wanted her audience rather to view the silence and shame around breast cancer as something eradicable to be fought against, and the war metaphor is much more suitable for inciting the kind of action she was advocating.

Like Brigitte Reimann, Audre Lorde’s work as a writer also helped her to live through her post-mastectomy life. However, she mentioned her writings outside of those

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in The Cancer Journals only once and without great detail. On January 1, 1980, she wrote in her diary: “The novel is finished at last. It has been a lifeline. [...] My work kept me alive this past year, my work and the love of women” (Lorde, Journals 13). 165 In the essay “Breast Cancer: A Black Feminist Lesbian Experience,” Lorde wrote: “I am also writing to sort out for myself who I was and was becoming through that time

[immediately after surgery], setting down my artifacts, not only for later scrutiny, but also to be free of them [...] free from having to carry them around in a reserve part of my brain” (Lorde, Journals 53). The construction of the essays in The Cancer Journals , which took place immediately after her mastectomy, thus was not simply a diversion from the pain she felt; it also helped her to work through her experience and to better understand this new self. This activist pathography has not only become one of the most widely read experiential breast cancer texts, but one of the most widely read autopathographies overall. Lorde’s call to action has largely been heeded, as laws mandating health insurance payment for breast cancer detection and treatment have been enacted and the silence surrounding the disease in the western world has been defeated.

Audre Lorde’s Later Cancer Autopathography

Audre Lorde published her second cancer autopathographical writings “A Burst of Light: Living with Cancer,” in 1988. She did so in the wake of her 1984 diagnosis of the breast cancer metastases in her liver that would claim her life on November 17, 1992, at the age of 58. This is a collection of selected diary entries from January 15, 1984,

165 The novel Lorde mentioned is her fictionalized autobiography Zami: A New Spelling of My Name (1982), which was her first novel-length work (De Veaux 308). 228

through December 15, 1986, and ends with an epilogue Lorde wrote in 1987. These entries largely continued themes begun in The Cancer Journals. Lorde has focused in particular on her refusal simply to accept what the doctors had recommended and announced, refusing to have a biopsy of her liver tumor to confirm the malignancy of the mass and later opting not to have surgery (Lorde, “Burst” 55-6). She instead did the research herself to find doctors who would support treatments with which she was more comfortable and satisfied. She subsequently chose to receive injections of Iscador, which is a derivative of mistletoe that was recommended to her by a physician in West Berlin, and, six months later, to make a trip to the Lukas Klinik in Arlesheim, Switzerland, where the medical personnel were conducting research on Iscador (Lorde, “Burst” 59,

75).

Throughout her passages on cancer, Lorde has woven in her current work and her thoughts about the condition of black women around the world at that time. While the tone of this work is less acerbic than in The Cancer Journals , Lorde nonetheless clearly and repeatedly voiced her assertions that all women, and black women in particular, must band together to support each other in general, and also as regards cancer and the patriarchal medical community. In this way, the text is also an activist pathography, albeit with a softened tenor. Lorde did not use the clear war imagery she did in her earlier work, but the undertone is still present. In “A Burst of Light,” Lorde also heavily focused on the drive cancer had given her to complete as much work in the fight for black women as she could before her death. She wrote: “For me, living fully means living with maximum access to my experience and power, loving and doing work in which I believe”

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(Lorde, “Burst” 130). She did not wish to prolong her life through invasive medical procedures that would give her limited additional time, but rather to spend the time she had continuing on in her work. Lorde seems to have come to terms with her terminal prognosis by the end of “A Burst of Light,” where she focused on living her remaining life as she chose, carrying on her work for the betterment of herself and others.

A German Representation of an Activist Pathography: Anemone Sandkorn

Das Signal oder Die Entfernung eines Knotens, is a 1986 autopathography written by the Italian-born West German breast cancer patient Anemone Sandkorn. This work offers a further example of the focus on the cause of disease, albeit with less vitriol than is present in Zorn’s text. Sandkorn essentially chronicled her cancer experience, beginning in 1979, largely concentrating on her suspicion that her disease had its origins not in societal conditions, but in her unhappy, conflict-ridden relationship with her former husband. Speculation about where the cancer came from is common to most experiential works, but she does not imbue it with any further overtones, such as social or political critique; it is straightforward conjecture, which was common to a time when cancer was thought to be at least partly rooted in one’s psychological conditions. Sandkorn saw her cancer as a warning signal that she needed to change her own life so as to avoid as much conflict as possible, but she, unlike Lorde, did not connect this to a call for a political or social movement. Sandkorn documented her treatments, including her various roommates in the hospital, her surgeries and interactions with her physicians, but she did not focus on these topics as much as she did her relationship with her former husband and

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her attempts to change her life in the wake of the cancer. She believed that this would enable her to be in a healthier psychological state that would hopefully not cause her any further illness. In doing so, she offered a call to the reader to do the same, so as to avoid a similar fate. Sandkorn’s work did not attain the status of that by Zorn or Lorde, and the progression of her illness after the book’s publication remains unknown.

A Recent French Language Representation of an Activist Pathography:

Evelyne Accad

Evelyne Accad, who was born in Beirut but lived in both France and the United

States for many years, continued a similar theme in her more recent French-language work Voyages en cancer , which was published in 2000 . In this work, she, like Zorn, believed her cancer to be the result of a larger societal problem. She condemned the worldwide human misuse and destruction of the environment, as she believed it to be at the root of the rising cancer diagnoses, including her own breast cancer. Accad included stories of other women’s breast cancer along with hers in order to bolster her assertion.

She compared the cancer epidemic to the Holocaust of World War II, in that during each, millions of people were killed or, in the case of cancer, are still being killed due to the actions of others, albeit of course much more deliberately during the Holocaust. She therefore advocated for change in the way we treat the natural world in order to reverse this trend. Accad also included details of her treatment and her general cancer experience, but these remain secondary to her claims about the human role in cancer

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genesis. This work is not written with the anger of Zorn’s, but it nonetheless carries a clear message that her cancer is the result of societal actions that could be eradicated.

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Chapter 7: Representations of Cancer as a Transformative Experience in Fiction

Despite the prevalence of autopathographical and pathographical works on cancer, it has also been a theme in fictional literary works for centuries, and particularly frequently from the twentieth century on. This is doubtless in part due to the rise in popularity and abundance of experiential texts. As ever more people wrote autopathographical or pathographical works about cancer during the mid-twentieth century, cancer became a more present topic in general conversation and writings.

Authors therefore began to more frequently include the experience of cancer, with its attendant social issues and life-altering complications, in their fictional works. 166

One of the primary means by which authors have used cancer is as a plot device.

The actual experience of cancer is not the focus of these works, but rather the mere existence of the disease in some way helps to form the basis of the overall storyline.

Cancer is at the heart of these texts due simply to its attribute as an often fatal disease which, until the mid-twentieth century, had few effective treatments outside of surgery.

166 Rainer Maria Rilke’s novel Die Aufzeichnungen des Malte Laurids Brigge (1910), while containing no reference to cancer, is a work replete with images of disease and dying. The central character frequently ruminates on death and recalls the demise of relatives, offering an early twentieth-century example of the impact of death on the individual. For an in-depth discussion of death in this text, see Chapter 4: Rilke: The Holistic Recovery of Death in Sean Moore Ireton’s 2007 book An Ontological Study of Death: From Hegel to Heidegger or Hans Holzkamp’s 1996 article “‘Der Tod Brigges‘: Untergang und Verklärung in Rilkes Aufzeichnungen des Malte Laurids Brigge.“ The German physician and expressionist Gottfried Benn’s 1912 poem “Mann und Frau gehen durch die Krebsbaracke” then offers an early, equally vivid account of the horrors of cancer. As I am limiting my study to those who have had cancer themselves, however, I will not discuss it further in this investigation. 166 First, You Cry was made into a television movie with the same title in 1978.

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Further, cancer patients could then and can still today languish for a long time in great amounts of pain before death. The plots generally center around stories of euthanasia to end a cancer patient’s suffering, or of the search for new treatment options that would either cure the cancer or alleviate its deleterious effects. In essence, any other disease that is similarly incurable and results in prolonged anguish before death, such as amyotrophic lateral sclerosis (ALS, Lou Gehrig’s disease) or muscular dystrophy, could be substituted for cancer in these works. Unlike the sentimentalized depiction of tuberculosis, cancer has not had a comparable universal association that would give it primacy over a choice of other incurable, terminal diseases. Further, tuberculosis was also accompanied by a specific topographical location, the sanatorium, while cancer has had no similar commonly associated locus of treatment. Even in the fictional texts in which a sanatorium is not specifically depicted, the issue of payment for treatment, which invariably implies a sanatorium after the mid-nineteenth century, whether or not it is specifically mentioned, nearly always arises. This lends tuberculosis portrayals a uniqueness that has no analog in cancer depictions. The use of cancer in this way is nonetheless an important literary phenomenon due to its prevalence, and so I have discussed several key examples of this in the first section below.

The prevailing use of cancer in fiction has been that of serving as an impetus for transformative change in either the cancer patient, a person close to the cancer patient, or both. This portrayal has been in existence since the early nineteenth century and it reflects themes that are frequently found in the autopathographical and pathographical works, such as a re-examining of one’s life and work. The most ubiquitous example of

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this in fiction involves substantial alterations in the way a patient lives his life, or in how he reacts to others. This comes as a result of the re-evaluation and reformation of identity after a cancer diagnosis. Like consumptive or tubercular figures, cancer patients in works of fiction generally experience their illness, and, where applicable, their recovery, over a longer period of time in comparison to more acute illnesses, such as scarlet fever or cholera. This is accurate to the reality of the disease, in which many patients, especially as medical treatments improve, live with the disease for a period of months to years before their deaths. Should a patient’s cancer go into remission, this then gives the person even more time. In both situations, this allows time for the characters in these works and those around them to think about their lives, and perhaps to alter the way they have been living, due to having faced a potentially terminal illness.

The extensive use of identity reformation is not as widely seen in works of tuberculosis or consumption. One reason for this is that the vast majority of the literary tuberculosis or consumption patients die in a comparably short period of narrated time.

While they do tend to survive longer than figures with other diseases, allowing for a greater development or establishment of the character, the cancer patients generally survive even longer. The characters of Eileen Carmody and Stephen Murray in O’Neill’s play The Straw undergo personal change through tuberculosis, and through their interaction with each other, but they are in the minority. Those tubercular or consumptive patients who fall into the sentimentalized category of sufferers are held up as the virtuous, exemplary human beings, and so there would be no cause for them to personally change the way they live or think. There are cases where the sentimentalized

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consumption or tuberculosis patient inspires change in others around them. Examples of this can be found in Remarque’s Drei Kameraden , wherein Patrice Hollmann brings the

Lohkamp and his friends closer together. In the case of Thomas Mann’s many tubercular characters, their inability to change even in the face of a deadly illness is indicative of greater ills within their character or their station in life.

In contrast, transformative change is paramount in fictional cancer stories, perhaps because the vast majority of them have been written in the twentieth and twenty- first centuries, where the individual and the individual experience have achieved primacy in the western world. The emphasis is no longer on static, familiar character representations, but rather on depicting a single unique patient as he or she learns from and changes through the cancer experience and, in some cases, catalyzes realizations and changes in others as well.

German, Japanese, and Swiss Representations of Cancer as a Plot Device: Ricarda

Huch, Sawako Ariyoshi, Max Frisch, and Christoph Peters

The German author Ricarda Huch has presented an instance of cancer as a plot device in her 1917 novel Der Fall Deruga . This text centers around a trial in which the physician Sigismondo Deruga is accused of having killed his former wife, Mingo

Swieter, who was terminally ill with cancer. Deruga and Swieter had divorced seventeen years prior to her death, and yet he was to receive her inheritance at her death. This cast suspicion that he had committed murder in order to obtain the money, as he was in debt.

Consequently, he is put on trial for murder, partly through the efforts of Swieter’s sister,

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who felt she should have been the beneficiary of the will. As the trial plays out, it is eventually revealed that Deruga did indeed kill Swieter, but that he did so at her behest in order to end her pain. He is acquitted and vows to close his practice. He will live abroad, refusing to claim his inheritance, and instead giving it to Swieter’s best friend. In this work, Huch has seemed to advocate for the merciful treatment of those who in situations akin to Swieter’s. Deruga is revealed to be a good and decent man. Huch has created in him as a sympathetic character who, when put in a situation where he could end the suffering of someone he once loved, had the courage to do so even at his own peril. The actual cancer itself is rarely referenced, except for mention of the pain Swieter had been experiencing, and so the identity of the disease itself, except as a terminal and incurable one, is not integral to the work.

Japanese author Sawako Ariyoshi has fictionalized the story of the eighteenth- nineteenth century Japanese surgeon Hanaoka Seishu (1760-1835), who is believed to have been the first person in the world to have developed and used general anesthetic, in her 1966 novel The Doctor’s Wife .167 The work is primarily concerned with the increasingly contentious relationship between Hanaoka Seishu’s wife, Kae Seishu, and his mother, Otsugi Seishu, as Hanaoka Seishu experiments to develop his anesthetic agent. The driving force behind Hanaoka Seishu’s search was initially the desire to further science. His sister, however, dies of breast cancer that is inoperable due to the lack of anesthetics available, lending his efforts a new level of intensity. He knows that had he been able to operate, he could have saved her life, and at the end of the work, he

167 Due to the strict isolationist policy of Japan during this time, news of this discovery did not reach the western world, which would not see the advent of general anesthetic until 1846. 237

has indeed successfully removed a tumor from another woman. This is true to life, as

Hanaoka Seishu performed over 150 breast tumor excisions.

Both Hanaoka Seishu’s wife and mother volunteer their own bodies to be the subject of his first human trials, each wanting to do so over the other in order to prove her higher devotion to Hanaoka Seishu. He chooses to use both women in his experiments, but unbeknownst to his mother, he does not give her the true concoctions. Kae Seishu does receive the full dosages, and subsequently loses her eyesight. Hanaoka Seishu, because of his wife’s sacrifice, is able to eventually establish the most efficacious mixture and dosage. While Hanaoka Seishu seems to be driven by the desire to be able to perform surgery on the breast and save other women’s lives, this storyline is secondary to the competition that arises out of his wife and mother’s struggle to prove their devotion to him; cancer is the impetus behind this competition, but there is no real discussion of the experience of cancer outside of a brief description of the sister’s terminal state and eventual death.

This is likewise the case in the Swiss author Max Frisch’s 1978 play Triptychon:

Drei szenische Bilder .168 Each of the three panels in this literary triptych is a different presentation of the interaction between the living and the dead, ultimately highlighting, as

Gertrud Bauer Pickar has explained it, “the pain and strain of failed interpersonal relationships” (Pickar 454). The third panel presents Francine and Roger. These figures are former lovers confronting each other one night in Paris approximately four years after

Francine’s death from cancer. Francine’s cancer simply provides the means of her

168 Triptychon was first performed in French on October 10, 1979, in Lausanne, and on February 1, 1981, in Weimar (Wang 57-8). 238

demise, and it does not bear any greater significance in this work outside of this. It is in fact only briefly alluded to in the scene as Roger remarks that he had written Francine an unsent letter after news of her operation, the cause of which he does not specify. A few lines later, Roger explains that “[…] ein halbes Jahr später war die Rede von

Bestrahlung,” which is the sole indication that the operation had been for cancer (Frisch,

Triptychon 191). The relatively slow death from cancer allows Roger time to consider contacting Francine, but this gradual deterioration is not unique to this disease. The emphasis in this scene is instead on the failed relationship between Roger and Francine as they revisit the night of the dissolution of their relationship and relive other earlier moments of discord. Ultimately, they remain stuck in their inability to resolve their complex conflicts or move past them. Roger ends the scene by committing suicide, but there is no hope that this will result in a resolution of the problems that had plagued the relationship, and then continued to do so after Francine’s death. There is no indication that his actions had anything to do with Francine having specifically had cancer, however.169

The German author Christoph Peters’ 1999 novel Stadt Land Fluß is a more recent literary text wherein the facts of cancer are secondary to the concept of an incurable, terminal illness. The story is relayed by the unreliable narrator, Thomas

Walkenbach, who is an art historian married to the dentist Hanna Martindok. In the

169 While it has been contended that the protagonist in Max Frisch’s 1957 novel Homo faber: Ein Bericht , Walter Faber, died of stomach cancer, there is no evidence in the novel that this is definitively the case. If one is to make the assumption that he had stomach cancer, it is then a further example where the experience of having cancer, as opposed to another terminal illness, is not crucial to the text. It would largely be symbolic of the stress from his complicated relationship with his daughter and wife, but this could have been achieved through any number of terminal illnesses, such as a heart attack or stroke.

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opening chapter, Walkenbach yells to police at the door: “Ich habe sie nicht umgebracht” and then proceeds to narrate the story of his relationship with Martindok, the woman it seems he is claiming not to have killed (Peters 23). Thomas, in a chronologically shifting narrative, tells of his childhood, of meeting Martindok, and then of their life together.

There are brief illusions to Martindok having had—or suspecting she had—cancer, but it is not directly addressed until late in the novel, despite the fact that throughout the work, the reader is aware that Martindok is gone from the house and that Thomas misses her profoundly. In the final third of the text, Walkenbach tells of supposedly non-cancerous lumps in Martindok’s breast as well as a fluid coming out of the nipple and the subsequent visits to specialists to determine the cause. Walkenbach never straightforwardly announces an actual diagnosis, but the implication of cancer is clear.

What is not as apparent is what happens after this. Walkenbach tells of the ravages of chemotherapy and radiation, but he does so in such a way that there is doubt as to whether this is a true scenario or an imagined one. Further, it seems that he has strangled

Martindok, with the implication that he did so as euthanasia, but it is also unclear whether this is reality or a daydream. The bulk of the novel, which is framed between the police’s arrival and Walkenbach’s description that “Hanna bewegt sich heftig durch einen dunklen Traum. Sie ringt nach Luft. Der Griff mit dem sie mein Handgelenk umklammert, zu spät” (Peters 277), seems to be Walkenbach’s testament of his love for

Martindok. It is as if he is defending himself to the reader. The intrigue lies in discerning what has been fact and what fiction within the world of the novel, and the cancer storyline here provides the impetus for a potential case of euthanasia. This could

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have been accomplished with any number of terminal illnesses, and so Peters’ use of cancer is not nearly as integral to the novel as the question of what Walkenbach did and why he did it.

Irish and German Representations of Cancer as a Transformative Experience: Maria

Edgeworth and Theodor Storm

An early usage of cancer as a transformative experience appears in the Irish author Maria Edgeworth’s 1801 novel Belinda. This work centers around the young woman, Belinda Portman, who has been sent by her aunt to live in London with her friend, Lady Delacour, in order that Portman might find a suitable husband. It quickly becomes apparent to Portman that Lady Delacour leads an unhappy life of frivolity that is primarily concerned with maintaining the highest possible social status. Lady Delcour’s belief that she is terminally ill with breast cancer has led her to give up any semblance of domesticity, along with her belief that she can lead a virtuous life. She remains estranged from her daughter as well as her alcoholic husband. Portman, one of the few people aware of Lady Delacour’s breast cancer, reunites her with her daughter in an attempt to bring happiness to Lady Delacour. This reunion sparks a willingness in Lady Delacour to seek treatment and attempt to live. Unfortunately, she comes under the care of a disreputable quack doctor, who gives her drugs that cloud her thinking. April Patrick has asserted that Lady Delacour’s hesitance to tell anyone about her cancer and her fear at facing the surgery are typical for woman at the time in which Edgeworth wrote the novel

(Patrick 169-70), but in this text, the secrecy also serves to heighten the tension in the

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novel as Lady Delacour endangers her health unnecessarily by continuing to see the quack without her husband’s knowledge.

After a brief estrangement from Lady Delacour, Portman returns and convinces

Lady Delacour to tell her husband about her cancer. He pledges his support and Lady

Delacour consults a surgeon to perform the dreaded mastectomy. Just before performing the operation, the surgeon examines Lady Delacour and declares that she has never had cancer in the first place, and therefore will not require a mastectomy. Lady Delacour rejoices at this news, and consequently commits to a life with her husband and daughter.

As Leah Larson has argued, Lady Delacour’s perceived breast cancer is a manifestation of her belief that her breast milk had poisoned her first daughter and therefore marked her as an unfit mother; the breast that killed her infant is now killing her (Larson 196). The discovery that her breast is not diseased reflects for Lady Delacour the fact that she is indeed capable of being a proper mother and wife. In this work, it is the belief that she has cancer that allows Lady Delacour, with the help and encouragement of Portman, to reconcile with her husband and daughter and reaffirm her commitment to society’s mores for her gender by giving up forever her earlier life of frivolity.

German author Theodor Storm’s 1887 novella Ein Bekenntnis offers another early usage of cancer as a life-altering event. In this work, it is not the cancer patient whose life is changed, but rather that of her husband. Ein Bekenntnis tells the story of a young doctor, Franz Jebe, who is newly married to Elsi Jebe. They share a very happy life together until Franz Jebe diagnoses his wife with a terminal carcinoma. Elsi Jebe repeatedly begs her husband to kill her and end her suffering. Franz Jebe eventually does

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so, only to soon after read an article in a journal that he had neglected to read while his wife was ill. This aricle offered a new procedure that could have cured her cancer. Franz

Jebe is able to perform this procedure on a patient and save her life, which only adds to his guilt over killing his wife. Rather than remarry when he has the opportunity, Franz

Jebe departs for Africa, where he intends to spend the remainder of his career treating those in need as atonement for Elsi Jebe’s euthanasia. As with Lady Delacour, cancer places Franz Jebe at a crossroads, but this does not lead to a betterment of his existence.

In choosing to acquiesce to his wife’s wishes rather than to adhere to his personal medical ethics, Franz Jebe condemns himself to a life of remorse and regret wherein he shall never again find true contentment.

Focus on a German Ironic Treatment of Cancer as a Transformative Experience:

Thomas Mann

In Thomas Mann’s extensive oeuvre of works about illnesses, he wrote one text involving cancer, Die Betrogene , which was published in 1953. Mann himself had had lung cancer and underwent a successful resection of the tumor in 1946 (Naef 285). This novella was Mann’s final completed work before his death in 1955 of an aneurysm unrelated to his earlier lung cancer, and this text bears no evidence of a connection to

Mann’s own experience. Die Betrogene tells the story of the Rhenish widow, Rosalie von Tümmler, and her pursuit of the much younger American Ken Keaton in Germany of the 1920’s. Rosalie von Tümmler has just turned fifty and has been living in Düsseldorf with her unmarried twenty-nine year-old daughter Anna and her teenaged son Eduard

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since her husband’s death ten years earlier. When Eduard von Tümmler requests a tutor in English, Rosalie von Tümmler employs the twenty-four year old Ken Keaton for this position. Rosalie von Tümmler quickly becomes besotted with the attractive American, and the story then follows her attempts to garner his attention. Believing the apparent return of her menstruation following years of menopause to be a sign of nature’s approval of this relationship, Rosalie von Tümmler becomes emboldened to declare her feelings to

Keaton. The two arrange to meet to commence their love affair, but Rosalie von

Tümmler is not able to do so because she begins to hemorrhage. After the doctors examine her, they declare that her bleeding has been a result of extensive cancer of the female reproductive tract. Rosalie von Tümmler soon dies, although she does so praising nature for having given her the chance to experience love once more and to feel rejuvenated before she died. Mann presents cancer as a transformative experience for

Rosalie von Tümmler, but he does so with a tone of mockery.

Much of the scholarship to date has focused on the story as an allegory either for

Germany during the Weimar period or for Mann’s ambivalent feelings towards the

United States, which was his home from 1939-1952, and a country in which he became a naturalized citizen in 1944. 170 In these interpretations, cancer is viewed as the symbolic death of Germany or Europe, as represented by Rosalie von Tümmler. For Lois Agnew,

Claudine Albini-Stephens, and Martha Warren in their jointly written 1995 article “ The

Black Swan : Thomas Mann’s Last Song,” the cancer is Hitler, who, like the protagonist’s bleeding, at first was taken as a new hope, but would then later be revealed as Germany’s

170 For the full arguments, see articles by Lois Agnew, et al. (1995), Henry Hatfield (1979), Dirk Jürgens (1999), and George Schoolfield (1963). 244

destruction (Agnew, et al. 4). Dirk Jürgens in “Thomas Manns Novelle Die Betrogene oder die Zurücknahme des Doktor Faustus ” has also viewed Rosalie von Tümmler as representative of Germany between the World Wars, insofar as she cannot separate herself from the legacy of the Wilhelminian Empire and then allows herself to be deceived by her body’s cancer (Jügens 327-8). In Henry Hatfield’s 1979 book From The

Magic Mountain: Mann’s Later Masterpieces , he has similarly argued for Rosalie von

Tümmler as a “dying Mother Europe,” with Ken Keaton as the representation of an

America that is likewise unhealthy, as Keaton is missing a kidney (Hatfield 205-6).

George Schoolfield’s interpretation of Keaton in “Thomas Mann’s Die Betrogene ”

(1963) is that of the “clean-cut young American” who, without malicious intentions, comes in and precipitates the end of the “delicate balance of older and subtler culture” that was Germany in the Weimar period, as represented by Rosalie von Tümmler

(Schoolfield 98). 171 I view Mann’s use of cancer as largely symbolic as well, but in a non-allegorical manner. This cancer of the reproductive tract represents nature’s indifference to humanity—an indifference that occurs even in the face of one’s willingness to bend perceptions of its workings in order to see nature as a benevolent entity acting in one’s best interests. Mann uses this scenario as an example of the trope of a transformative cancer experience, but he twists the earnest, positive usage of this trope in order to make fun of Rosalie von Tümmler, who so sincerely attempts to view nature positively.

171 Schoolfield has also noted that Ken Keaton is the only extended portrayal of an American in Mann’s works (Schoolfield 99). 245

Die Betrogene is based on a true account of an aristocratic woman who suffered a similar fate. Mann’s wife Katia Mann related the story of this woman to him in 1952

(Elsaghe, Krankheit 69). 172 The critical reception of this final work was quite mixed, with even Mann himself asserting that he was not fully satisfied with the text, and did not consider it among his finest works (Anew, et al 6). Alan Latta, in his 1987 study of the reception of Die Betrogene , has attributed this lukewarm reception to the thematics of this work, which include the discussion of three major taboos of the time: menstruation and menopause, an older woman having an affair with a significantly younger man, and death from cancer, in this case Rosalie von Tümmler’s (Latta “Tabus, Prejudices” 238-

43). 173 Any kind of cancer at this time was not discussed in public, let alone cancer of a region of the body seldom discussed even in its healthy state. Although Mann based this work on a true occurrence, he himself chose the specific details of the disease’s origins and areas to which it had spread. 174 As he has described it in the novella:

Die bimanuelle Untersuchung, von Muthesius [der Arzt] vorgenommen, ließ einen für das Alter der Patientin viel zu großen Uterus, beim Verfolgen des Eileiters unregelmäßig verdicktes Gewebe und statt eines schon sehr kleinen Ovariums einen unförmigen Geschulstkörper erkennen. Die Curettage ergab Carzinomzellen, dem Charakter nach vom Eierstock herrührend zum Teil; doch ließen andere nicht zweifeln, dass im Uterus selbst Gebärmutterkrebszellen in voller Entwicklung begriffen waren. (Mann, Betrogene 123)

172 Katia Mann had been told the story by her mother around 1940, but she did not relay it to her husband until twelve years later (Elsaghe, Krankheit 69). Jens Rieckmann has argued that Mann was also drawn to the story due to his own attraction to the seventeen year old Klaus Heuser, whom he met in 1927. Heuser, like Rosalie von Tümmler in the story, lived in Düsseldorf (Rieckmann 246-7). 173 Die Betrogene is commonly perceived as having had a negative reception; however, although the initial criticism was largely negative, ultimately positive reviews were more numerous than negative ones. Journal articles and book discussions of the text are also largely mixed, with slightly more positive than negative, but no clear consensus (Latta, “Tabus, Prejudices” 254 and Latta, “Part II” 131-9). 174 Even when there was no real-life story behind a work of literature dealing with cancer, Elsaghe has explained that the cancers portrayed were all women’s cancers. This was partly because this then separated men from the threat of the disease and its ravages (Elsaghe, Krankheit 106). 246

This reflects the long-held general association of cancer as what Susan Sontag terms a

“demonic pregnancy” that dates back centuries (Sontag 13-14), but Mann has altered this somewhat. He has seated the cancer in the fallopian tubes, a reproductive organ even more rarely mentioned in conversation or in literature than the ovaries or uterus, thus intensifying the taboo nature of the cancer. As the organ responsible for carrying mature, unfertilized eggs from the ovary to the uterus, the fallopian tube is essential in allowing reproductive potential to become a reality. Likewise, the bleeding that Rosalie von

Tümmler mistakes for menstruation is integral to the hope and sense of rejuvenation that had been sparked by her interest in Ken Keaton. Further, had Mann located the primary cancer in Rosalie von Tümmler’s uterus, it would have connoted sexual completion, which does not occur in this story. Rather, the association of fallopian tubes with mere potential, rather than success, mirrors the ultimately unrealized potential of Rosalie von

Tümmler and Ken Keaton’s relationship.

Without the occurrence of the initial bleeding, their relationship would have remained completely unrequited; although Rosalie von Tümmler’s feelings for Keaton were strong, her lack of youthful potency kept her from making them known. When nature then seems to have granted her a renewed youth, she explains to her daughter

Anna: “[Die Natur] hat mein Gefühl zu ihrer Sache gemacht und mich unmißverständlich bedeutet, dass es sich nicht zu schämen hat vor ihr und vor der blühenden Jugend, der es gilt“ (Mann, Betrogene 83). As Marguerite DeHuszar has argued, Rosalie von Tümmler is able to successfully deny that her bleeding is anything but a reawakening of her youthful fertility because she refuses to accept the image of herself as a reproductively

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worthless old woman; viewing her bleeding in this light “[…] affirm[s] her self-image as still youthful, attractive and vital” (De Huszar 121-2). 175 Mann has constructed Rosalie von Tümmler’s self-delusion so that the reader will view her as foolish; her bleeding makes her no younger than she was before it, but her willingness to believe this makes her a naïve and laughable figure—which is then only deepened when it is revealed that she in fact has cancer.

Just as the potential of the egg in the fallopian tube is no guarantee of success in conception, so, too, does Rosalie von Tümmler’s firmly held belief in the initial promise of rejuvenation hold the possibility of the failure to produce a relationship with Ken

Keaton. Rosalie von Tümmler confesses her love to Keaton, and he responds by embracing her happily (Mann, Betrogene 118). Although Rosalie von Tümmler does the majority of the speaking in this scene, he agrees that they will meet as soon as possible in his room to commence their physical relationship (Mann, Betrogene 120). 176 For the time being, it appears as though Rosalie von Tümmler has triumphed and the promise of her bleeding has been realized. Even in this moment, Mann has crafted Rosalie von

Tümmler to appear as a foolish woman. Ken Keaton is rumored to have been pursuing older women throughout the town, and his relative lack of verbal response to Rosalie von

Tümmler indicates that he, while perhaps willing to carry on a sexual relationship with her, is not invested in her to the degree she is in him.

175 De Huszar’s 1989 article “Denial and Acceptance: Narrative Patterns in Thomas Mann’s Die Betrogene and Kleist’s Die Marquise von O. ” traces parallels between the two stories, noting that Mann had written Die Betrogene immediately after reading Die Marquise von O. and that both contain plots involving self- denial and symbolism of the swan. 176 Elsaghe has pointed out the reversal of gender stereotypes in this work, the only one of Mann’s to contain a female protagonist. It is Rosalie von Tümmler who pursues Ken Keaton, rather than the man taking the active role in the relationship, and she is also his employer (Elsaghe, Krankheit 11-12). 248

As Paul Felder has succinctly explained it, before Ken Keaton and Rosalie von

Tümmler can meet up for their planned tryst, it is revealed that “[...] der Eierstock, dieser

Spender von Lebenskernen, gebiert in Wirklichkeit den Tod“ (Felder 136) when Rosalie von Tümmler begins to hemorrhage. This enriches and complicates the story, as it is the lack of fulfillment in her relationship with Ken Keaton that Rosalie von Tümmler must face in being told her signs of rejuvenation are in truth signs of impending death. Instead of having to face the loss of a consummated relationship, Rosalie von Tümmler must face the loss of the hope of that ever happening. This organ that enables but not does guarantee reproductive success, which is in turn equated with youth, here deceives

Rosalie von Tümmler and denies her hope of a true rejuvenation and the attendant realization of a relationship with Ken Keaton. Rather than curse the body that has betrayed her and convinced her to pursue Keaton in vain, she finds a way to reconcile herself with her diagnosis, further emphasizing Mann’s mockery of her as a flighty, silly woman.

Throughout the novella, Rosalie von Tümmler has identified herself as a

“Maienkind” who finds solace in nature while going through menopause. Mann wrote that “In der Natur hatte sie zu der Zeit einen Freund, ganz nahe bei ihrem Heim in einem

Winkel des Hofgartens [...] Es war ein alter einzeln stehender Eichbaum“ that, while only able to produce leaves on some branches while others had withered and died, is still respected by people for its refusal to give in entirely to advanced age (Mann, Die

Betrogene 23-4). 177 As William Rey has observed, her very name is associated with

177 Rosalie’s daughter Anna, in contrast, does not share this adoration of nature, but instead experiences headaches when she is outdoors (Mann, Die Betrogene 20). 249

nature, and in keeping with this, Mann has explained in the text that “Die Rosenzeit war ihre ganze Wonne” (Rey 437 and Mann, Die Betrogene 18). Mann has further emphasized this connection to nature by imbuing Rosalie von Tümmler with an apparent ability to perceive “[…] alles, was die Natur dem Weibe auferlegt hat” by noticing small signals other people did not pick up (Mann, Die Betrogene 14-15). Although she is, as

James McWilliams has claimed, an atypical protagonist for Mann, since she is “simple and cheerful, […] sociable by nature, [with] her attitude towards art naïve” (McWilliams

59), she, like Anton Klöterjahn and Detlev Spinell in Tristan , remains true to her beliefs.

She incorporates her loyalty toward nature into this experience by explaining to her daughter Anna von Tümmler: “’Ist ja doch der Tod ein großes Mittel des Lebens, und wenn er für mich die Gestalt lieh, von Auferstehung und Liebeslust, so war das nicht

Lug, sondern Güte und Gnade’[…] Die Natur—ich habe sie immer geliebt, und Liebe— hat sie ihrem Kinde erwiesen’” (Mann, Die Betrogene 126-7). In this way, she is a simplistic devotee to nature, which for Mann is not a positive attribute; this portrayal lends her a naïveté that leads her to self-delusion and to making a fool of herself.

Rosalie von Tümmler does not hold any malice towards nature for afflicting her with cancer and its associated false promise of rejuvenation, but instead praises nature for the resurrection of her ability to desire a man, seeing it as an act of kindness that accompanies nature’s destruction of her physical life. She does not consider herself “die

Betrogene,” with its negative implication of deceit, but rather as one blessed by nature to have had this brief reawakening. It was Mann who layered his own interpretation on

Rosalie von Tümmler’s by assigning this title, thus underscoring his illustration of the

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human potential to cling to one’s belief system in any way possible. Nature is indifferent to humans; it is only the human interpretation of nature’s processes that casts it in a particular light. Felder has argued that it is only by accepting death as a part of life that

Rosalie von Tümmler can be reunited with nature (Felder 133). 178 This holds true, as for

Rosalie von Tümmler to come to terms with her death in addition to her tragic misinterpretation of the bleeding, she must view nature as benevolent, and her cancer as a positive occurrence, rather than as the impetus of a cruel irony.

Mann has intimated that the origins of Rosalie von Tümmler’s cancer in this work are essentially psychosomatic, further adding to his criticism of Rosalie von Tümmler’s persona. Dr. Muthesius, the chief surgeon at the gynecological clinic, explains to his assistant Dr. Knepperges that “[…] die Geschichte vom Eierstock ausging,—von unbenützten granulösen Zellen, nämlich, die seit der Geburt da manchmal ruhen und nach dem Einsetzen der Wechseljahre durch Gott weiß welchen Reizvorgang zu maligner

Entwicklung kommen“ (Mann, Betrogene 125). This stimulating factor is Rosalie von

Tümmler’s longing to be young again, which has been catalyzed by her attraction to Ken

Keaton. Felder has highlighted Mann’s use of the phrase “dies Überströmt-,

Überschwemmtweden ihres [Rosalies] Inneren“ in Keaton’s presence, which Felder has argued is the initial biological stimulation in the cells’ transformation to malignancy

(Felder 131). Rosalie von Tümmler herself even attributes her bleeding to her own longing to be young and fertile again, telling her daughter “’[…] dass die Seele sich als

Meisterin erweist über den Körper,’” not yet realizing that it is cancer her desires have

178 Herbert Lehnert has argued that Rosalie von Tümmler accepts her death in religious terms, “[…] a religion that draws from her love of nature” (Lehnert 297). 251

produced instead of fertility (Mann, Betrogene 81). Mann’s depiction of the cancer’s cause is in keeping with the limited knowledge of biological origins of cancer at the time.

The blame for disease was then often placed on something the sufferer had or had not done, as in this novella. As William Rey has explained it, “Indem sie [Rosalie von

Tümmler] dem natürlichen Liebesdrang folgt, vergeht sie sich gegen das ebenso natürliche Gesetz des Alterns,“ and in this choice condemns herself (Rey 446). Mann has not placed the blame fully on Rosalie von Tümmler’s wholehearted yearning for Ken

Keaton, as well as for her own youth, but rather has also brought in a vague biological explanation as well; although the cells’ mutation was initiated by Rosalie von Tümmler’s attraction to Ken Keaton, the actual tumors were produced by biological processes, thus freeing Rosalie von Tümmler from being completely at fault. She may have provided the impetus, but nature itself produced the disease from there. Mann’s softening of Rosalie von Tümmler’s blame in her disease adds weight to the depiction of nature as the indifferent participant in her cancer; nature proceeded with the disease when the opportunity arose, but did not seek to destroy Rosalie von Tümmler on its own.

In discussing Mann’s depiction of Rosalie von Tümmler’s cancer, James

McWilliams has remarked that “[…] Thomas Mann is utterly ruthless in describing the course of the fatal disease. He seems to take delight in the clinical precision with which he destroys his leading figure […]” (McWilliams 62). Indeed, Mann’s detailed descriptions serve to highlight the grave nature of her case and also to emphasize the destruction of her entire reproductive tract in a manner that seems to be beyond what is necessary to convey the basic point of her terminal state. Mann’s graphic depiction of

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this disease also stands in stark contrast to his protagonist’s insistence on the goodness of nature, which adds weight to his indictment of her as naïve and unrealistic in her staunch refusal to change her opinion of nature.

This work does not focus extensively on the experience of being a patient and enduring treatments. Rather, Rosalie von Tümmler and her family’s interactions with the medical professionals are brief. Her family doctor, Dr. Oberloskamp, immediately refers her on to the specialists, Drs. Muthesius and Knepperges. As with the doctors in Tristan and in many of Mann’s other works, these men are unable to do little more than watch the disease progress. In keeping with the most effective treatment of cancer at the time,

Muthesius and Knepperges do attempt surgery, but the disease it too advanced to be excised, and so they simply close the incision and allow the cancer to take its course

(Mann, Die Betrogene 125-6). Elsaghe has pointed out than Mann’s literary physicians tend to show very little scientific optimism (Elsaghe 55), and that is also the case here: although radiation would have been a viable alternative treatment, they do not even discuss this possibility, instead concluding that uremia will soon set in, ending Rosalie von Tümmler’s life (Mann, Betrogene 125). 179 As with Tristan , this is not a work about the experience of being ill, but rather one in which Mann uses terminal illness to mock those who take themselves and their beliefs so seriously. A dramatically fast death in which doctors are ineffective in halting the disease focuses the reader on the character’s steadfast beliefs, of which Mann has been making fun, rather than the process of dying.

Rosalie von Tümmler’s reconciliation with nature is the true focus of the final pages of

179 This is Mann’s only work that deals with a hospital rather than a sanatorium or other treatment center, and Elsaghe has argued that he does so in an unmistakably critical manner, highlighting again the ineffectiveness of the medical community in curing disease (Elsaghe 109). 253

this work, not her ever-declining physical condition. In this way, Mann has twisted the classic storyline of an existential cancer text in which the illness leads one to a realization about life or to a change in one’s way of thinking or living. In the end, Rosalie von

Tümmler has the same naïve way of viewing life as she had in the beginning; cancer has only allowed her to reaffirm a creed Mann has portrayed as laughable and silly.

Mann treats Rosalie von Tümmler in no less a scathing manner than he does

Gabriele Klöterjahn, Anton Klöterjahn, and Detlev Spinell in Tristan . While the author chiefly aims his vitriol at the middle class dilettantes in Tristan , in Die Betrogene it is instead the older middle-class woman who fancies herself to be at one with nature, and so longs to still be in possession of her youth that she is able to delude herself. The artistic character in this work, Rosalie von Tümmler’s daughter, is a more positive figure who is realistic in her perceptions of the world than her mother. This is in contrast to Tristan, where the would-be artistic figures are the most satirized. In each, though, it is the female character who dies of the portrayed disease, seduced by her own imagining of herself as something she is not. A male character also has a hand in this as well, however. Spinell deliberately preys upon Gabriele Klöterjahn, and Ken Keaton, although not as malicious a figure, is also willing to accept the ardent affections of Rosalie von

Tümmler which he does not return with equal passion.

Mann’s depiction of the ravages of cancer is far more graphic than that which he includes of tuberculosis in Tristan , in which the disease is only alluded to and its symptoms barely shown. It is, however, more in keeping with the depiction of tuberculosis and its treatment that Mann has portrayed in Der Zauberberg, in which

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passages are spent discussion the gruesome results of surgery for tuberculosis. The actual disease in Tristan is far less important than the setting of the sanatorium, as a place in which to bring together these characters. This is less the case in Die Betrogene , because the shock value and terminal nature of this advanced reproductive cancer, as opposed to a more innocuous illness that could cause similar symptoms, are integral to Mann’s mockery of Rosalie’s insistence on viewing her illness as a blessing of nature. The gruesome detail he includes and the general public’s perception of cancer as a horrific disease are vital to the reader’s understanding of how far Rosalie von Tümmler will take her delusions, underscoring Mann’s harshly critical depiction of her.

Focus on a Canadian Representation of Cancer as a Transformative Experience:

Margaret Atwood

Bodily Harm is Canadian author Margaret Atwood’s 1981 novel that, in contrast to Die Betrogene , represents an earnest portrayal of the existential change that can be sparked by cancer. Bodily Harm was at the forefront of the wave of fictional accounts of breast cancer that would emerge beginning in the early 1980’s, and it weaves together the story of a Toronto journalist, Renata (“Rennie”) Wilford, and the political turmoil of the fictional Caribbean island nations of St. Antoine and Ste. Agathe. Wilford has left

Toronto of the early 1980’s after three major events in her life: surgery for breast cancer, the end of her relationship with her boyfriend Jake that has come as a consequence of her breast cancer, and a break-in at her apartment. 180 Wilford goes to St. Antoine to report on the island as a tourist destination for a travel magazine, but quickly and unwittingly

180 Atwood does not include Jake’s surname. 255

becomes involved in the politics of the twin islands, which are about to hold their first election following freedom from British colonial rule. As Wilford’s story on St. Antoine unfolds, she flashes back to her experiences both as a child and as a breast cancer patient.

The novel ends ambiguously, with Wilford telling of her future release from a prison cell on St. Antoine, although it is not clear whether this release will actually occur or whether it is simply her hope and she will instead die imprisoned. In this work, Atwood has used breast cancer and the confusion and tumult it brings to Wilford’s life as a catalyst for her ultimate realization that she cannot remain detached from the world and subject to others’ desires. She must instead forge connections with people and engage herself, rather than simply passively observing and reporting.

The Renata Wilford the reader first encounters is an isolated figure. In the present tense narration, her long-term boyfriend Jake had just moved out the previous day, and she flashes back to various points in the near past, particularly those involving their relationship. These memories evoke an image of a person who makes it a point not to stand out. As Atwood has explained of her clothing and make up choice: “This is the effect she aims for: neutrality; she needs it for her work, as she used to tell Jake.

Invisibility,” (Atwood 7). When Jake urges her to wear something more flamboyant, so as to “make a statement,” Wilford replies with: “Other people make statements. I just write them down” (Atwood 7). Wilford is living on the fringes of life rather than within it. She observes and at times manipulates larger society, such as when she writes about trends she has invented, only to see them then become actuality (Atwood 15-18). As

David Lucking has written of Wilford, she exhibits a “[…] studiously cultivated

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detachment, [a] cultured non-participation in life […]” (Lucking 78). Atwood has intensified this image of Wilford through her breast cancer. In 1981, breast cancer did not have the social cachet it does in the present day. It was still a shame-filled disease not yet commonly talked about in public, and it was therefore difficult for even the most well-supported women to confront the disease with a feeling of dignity and empowerment. Autopathographies that would break the silence around the disease were becoming more frequent, but their effect had not yet been widely felt. Atwood’s very usage of this particular cancer thus causes Wilford to be still further on the outside than she already was before her operation.

This is then intensified through Atwood’s addition of the details of Wilford’s personal breast cancer experience. It is through cancer that Wilford first realizes how isolated she is. Sonia Mycak has claimed that the cancer “[…] robs [Wilford] of her ability to feel like a conventional social being, attesting to what amounts to a threat to her subjective identity” (Mycak 474). This is indeed the case, as due to her diagnosis,

Wilford rethinks her relationships. In doing so, she makes the distinction between contacts, who can help her professionally, and friends. Atwood has included the detail that “[w]hile [Wilford] was in the hospital, she decided that most of her friends were really just contacts,” (Atwood 8). While this conclusion is not further explained or qualified with reasons for this, the implication is clearly that the experience of having cancer and being in the hospital following the operation have led her to believe this.

Her cancer experience has the most illuminating effect on her relationship with her boyfriend Jake. On the night before her mastectomy, Wilford views everything Jake

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does with suspicion, believing he is only doing what he thinks he is supposed to do in this situation, rather than doing things because he genuinely cares. For instance, when Jake takes Wilford to dinner to cheer her up, “At first he held her hand, but she felt he was doing it because he thought he ought to and after a while he stopped. He ordered a bottle of wine and urged her to drink more of it than she wanted to. Perhaps he thought she would be less boring if she got drunk, but this was not the case” (Atwood 11). Wilford can do nothing but think about the impending operation, but she does not want to discuss it with Jake, instead letting him tell stories that she used to enjoy but no longer does

(Atwood 11-12). This dynamic continues on once they are home. Preparing to have sex with him one final time before her breast is potentially completely removed, “[Wilford] wanted to make it easy for him, she wanted to help him along with the illusion that nothing bad had happened to her or was going to happen” (Atwood 12). She then later fakes an orgasm, something she had vowed never to do, so that his efforts at pleasing her appear to have been successful (Atwood 12-13). Jake, in delaying his own orgasm, had thought he was being kind to Wilford, but “[s]he couldn’t stand the idea of anyone doing her a favor” (Atwood 13). Just as Wilford is masking her feelings and emotions, playing the part she believes she should, so is Jake attempting to do what he thinks will make things easier for her. Neither, however, is successful in this, highlighting the emotional disconnect between them.

After the operation Jake continues do what he thinks he should, but the distance between the two only becomes greater. As Roberta Rubenstein has explained, in Wilford and Jake’s first attempt to have sex after the operation, Jake in fact only exacerbates the

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Wilford’s difficulties in dealing with her disease. Jake concentrates only on her lower body, avoiding her breasts altogether, and thus causing Wilford to feel even more removed from her body than she already had (Rubenstein 123). Wilford also no longer wants to play the sexual games they did before, while Jake needs her to prove she is who she was prior to the operation. Atwood has written that “[…] he could not bear to see her vulnerable like this,” (Atwood 190), but Wilford’s experience with cancer has made her unable to play the part he has designed for her, and so eventually Jake has an affair and moves out. Wilford’s cancer experience has driven an irreparable rift between the two as each strains to establish a new normalcy after the operation, and so their relationship is a casualty of the disease as well, leaving Wilford further isolated.

In contrast to the extremely objective physicians in Die Betrogene and the many examples in the autopathographies of physicians who ignore the humanity of their patients, Wilford’s surgeon, Dr. Daniel Luoma, is an involved, compassionate caregiver.

He is, in fact, the person to whom Wilford next turns, even before her relationship with

Jake has come to an end. 181 She believes “[s]he fell in love with him because he was the first thing she saw after her life had been saved,” later adding that another reason for this is that “[…] he knows something about her she doesn’t know, he knows what she’s like on the inside” (Atwood 24, 72). Although she feels ashamed at having fallen prey to such a cliché, she nonetheless seeks out a relationship with the married doctor. Wilford is, as Denise Lynch has remarked, looking for a savior in Luoma; someone to cure her both physically and emotionally (Lynch 49). Far from the detached surgeon figure so

181 Lucking has claimed that “[a]t this point, Rennie is still suspended between the dimensions of surfaces and depths,” with Jake being the man in her life privileging surfaces, and Luoma depths (Lucking 84). 259

prevalent other accounts, Luoma seems to take a true interest in Wilford, as well as in helping her to cope with her diagnosis. Wilford in turn wants to earn his approval, and so when he admonishes her to have a more positive attitude, she does so by constructing an entire lifestyle she hopes will impress him (Atwood 74-5). Wilford persists in trying to get from Luoma what she thinks she needs, but neither his advice nor her reactions to it seem to help her in any way. Wilford postulates in the third person at one point that

“[p]robably she didn’t really want him to go to bed with her or even touch her; probably she loved him because he was safe, there was absolutely nothing he could demand,”

(Atwood 135).

Wilford’s state of mind during her relationship with Luoma reflects that of a woman in turmoil due to her cancer, grasping at anything to give her hope, and yet at the same time, grappling with her own fears. She trusts Luoma to save her, and yet at points, she does not trust that he is being honest with her about her disease. She wants to know if she will live or die, and yet she does not want to know. She wants to have sex with him, and yet she also does not. 182 Finally, Wilford summons him to apartment, leading him to believe she is suicidal. She wants him to comfort her, but when he arrives, his face shows “[a]nger and fear, and something else, a need but not a desire” (Atwood 226).

The two have sex, but this changes everything for Wilford because she has seen that

Luoma needed something from her, too: “She’d been counting on him not to [need her]: she was supposed to be the needy one, but it was the other way around. He was ashamed of himself, which was the last thing she’d wanted,” (Atwood 227-8). Wilford has at last

182 This dichotomous thinking begins with her diagnosis, when “[s]he believed two things at once: that there was nothing wrong with her and that she was doomed anyway, so why waste the time [operating]?” (Atwood 14). 260

come to the realization that Luoma cannot help her to get through and past her cancer, as she had longed for him to do. In needing her, Luoma has shown weakness, and her ideal vision of him has been burst. Just as she and Jake could not heal each other, neither can she and Luoma; the cancer that Luoma excised from her provided the basis for an illusion of connection, but in the end, Wilford runs from trying to form a true relationship based on mutual need, because her need to deal with this disease is too great to allow in

Luoma’s needs.

The women in Wilford’s current life prove to be of no more help to her than the men. She does not even tell her mother of the cancer, knowing from past experience that her mother tends to “[…] regard such things not as accidents but as acts Rennie committed on purpose to complicate her mother’s life,” and further, that she would see cancer as “[…] something you brought upon yourself” (Atwood 73), reflecting the commonly held view that the cancer patient did something to cause the disease.

Wilford’s closest friend Jocasta does her best to respond to Wilford’s call for support, but

Jocasta does not give Wilford what she needs; instead, “[p]olitely, elaborately, she

[Jocasta] avoided the subject of Rennie” (Atwood 153). 183 Wilford wants Jocasta to reassure her that she will be fine, and Wilford also wants to confess that she believes she is dying, but neither of these things occur. Jocasta attempts to support Wilford in the only way she can, by paying for lunch and providing amusing stories. While Wilford appreciates this, it is not what she needs (Atwood 157-8). Atwood has thus painted a picture of a woman abandoned to her own suffering in the aftermath of her cancer. She is

183 Atwood does not reveal Jocasta’s last name. 261

herself unsure of exactly who or what can help her, but she is sure that the three people closest to her in Toronto cannot, despite their best efforts.

Wilford leaves for the Caribbean following three seminal events: Jake leaving her, her own rendezvous with Luoma, and the burglary of her apartment. Wilford is also still in the midst of the turmoil her cancer has caused in her life. As she boards the plane, she is reminded of her scar when the baggage she is carrying pulls at her skin. She is immediately thrown into the mindset of knowing what she should feel, i.e. lucky that her scar was not as big as some women’s, but at the same time, not feeling fortunate because she has had cancer (Atwood 14). This luggage, literally weighing her down, is a representation of the conflict she experiences between attempting to retain a falsely positive outlook, and allowing herself to admit what she is truly feeling. Once she is on the island of St. Antoine, she does not escape her cancer-related fears. Rather, she continues to sleep with her hands on her breasts, as if reassuring herself that they are still there and healthy, at least on the surface. She thinks about the radiology appointment she has skipped in order to leave for the island, and she also thinks about the tests Luoma has scheduled that she will likewise miss. She wonders if, in leaving, she, too has become a cancer patient who cannot stand one more hospital stay, and so instead wanders the globe in search of a cure (Atwood 40-1, 51-2).

In addition to her inability to find a fulfilling connection with anyone in Toronto,

Wilford’s cancer has left her in a state of ongoing confusion over how to frame her illness experience, which is a common conundrum for a cancer patient in the late twentieth century. Given the large number of women who did not survive breast cancer in the

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1970’s and 1980’s, a woman whose prognosis seems to be better nonetheless experiences the same fear a cancer diagnosis brings the majority of patients. Accompanying it, however, is a weighty sense of guilt over having that fear when others’ situations are so much more dire.

These feelings of isolation and confusion initially continue for Wilford during her stay on the islands. Stepping out of the airport into onto the streets of St. Antoine,

Wilford reasserts the same longing to find anonymity she had earlier professed to Jake:

“She discovers that she’s truly no longer at home . […] The difference between here and home isn’t so much that she knows nobody as that nobody knows her. In a way she’s invisible. In a way she’s safe” (Atwood 30). Although she is still wrestling with the fear and uncertainty caused by her cancer, as well as by her relationships with Jake and

Luoma, she is no longer searching to find the answers in other people, as this tactic has already failed her. When she meets the American ex-patriot marijuana smuggler, Paul, she resists having sex with him, despite wanting to and acknowledging that in her pre- cancer life it would have been a perfect opportunity because of the partial anonymity. 184

She in fact wants someone in bed with her, explaining that it could be “[a]lmost anyone, as long as he would keep still. Sometimes she just wanted to keep still” (Atwood 91-2).

Her sexual life is more complicated now, owing to her insecurity due to her surgical scar as well as to the lack of fulfillment in her relationships with Jake and Luoma. Her cancer has sparked a situation in which she paradoxically wants someone to be by her side for comfort and companionship, but does not want to face the risk of having someone there because her illness has problematized intimate relationships both physically and in terms

184 Atwood does not provide a surname for Paul. 263

of emotional connection. She initially cannot risk the lack of understanding she found in

Jake and Luoma by beginning a relationship with Paul.

In their ensuing encounters, Paul demonstrates to Wilford that he sees her for who she is, unlike how Jake, in particular, had treated her. Wilford “feels seen through,” although she questions whether Paul’s assessment of her as a nice, naïve woman who wants to do good, but who also wants to know more than everyone in order to prove she is not naïve, is true anymore (Atwood 141-2). Nonetheless, Paul has recognized the essence of her personality as none of the other characters have. Atwood has marked him here as a potential point of connection for Wilford, but Wilford does not yet view it that way. On their next encounter, when Paul offers Wilford a much needed place to spend the night on Ste. Agathe, the two have sex.

Wilford is not drawn to Paul for his understanding of her as a person, though. She instead views him as a safe choice. In pondering whether to warn him of her scar and of her missing breast tissue, and in then considering running away so as to avoid a failed encounter, she finally comes to the conclusion that “[s]he doesn’t care what he thinks of her, she never has to see this man again if she doesn’t want to” (Atwood 192-3). When

Wilford had sex with Jake and Luoma after her operation, she had already had expectations and an emotional investment attached to each of them. Each then disappointed her by his behavior, but with Paul, she can open herself up without such a risk because she does not have such an emotional investment in him. He also has no prior knowledge of her body, lessening the potentially negative impact of her post- surgical appearance.

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Paul does not reject her body marked by cancer, though. Atwood has written that

“[h]e doesn’t look away or down, he’s seen people a lot deader than her” (Atwood 193).

At this point, Wilford makes a statement marking a turning point in her cancer experience: “’I was lucky’” (Atwood 193). This declaration stands alone, definitive, rather than being followed immediately by Wilford’s customary negation of any statement regarding her cancer. These three powerful words are then followed by a longer description of this change in her thinking:

She’s open now, she’s been opened, she’s being drawn back down, she enters her body again and there’s a moment of pain, incarnation, this may be the body’s desperation, a flareup, a last clutch at the world before the long slide into final illness and death; but meanwhile she’s solid after all, she’s still here on earth, she’s grateful, he’s touching her, she can still be touched. (Atwood 193)

Sonia Mycak has argued that in having sex with Paul, the “reaffirmation of [Wilford’s] corporeal self is a kind of awakening through which she finally comes to terms with her illness” (Mycak 477), and this does seem to be the case. As Theodore Shenkels has observed, Wilford’s full first name, Renata, means rebirth, and it is in this scene that she experiences this (Shenkels 164). Wilford reconnects with her body by having sex with

Paul, who has accepted her as she is and has asked nothing of her in return. Unlike Jake or Luoma, Paul has given Wilford exactly the type of reaction and support that she needs.

He does not view her as a cancer patient, which is the major complication in her relationships with Jake and Luoma, but rather he views her as a whole, complete, healthy woman. Through his doing so, Wilford is at last able to find an initial peace with the uncertainty cancer has brought into her life, and she begins to view herself in the way

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Paul does: as a woman worthy of his affections, without regard for her cancer or what cancer may mean to her future health.

Her romance with Paul does not turn into a love affair; he asks her not to expect too much from him, halting Wilford’s “vast, sentimental, grandiose, technicolour, magical, ridiculous” expectations that she was not even aware of until Paul forbade them

(Atwood 216-7). Wilford is disappointed, but by no means devastated by this lack of romance. Paul has already fulfilled one significant function by helping her to come to terms with her cancer. Atwood has written that “She’s [Wilford’s] given up deciding what will happen next” with Paul, in contrast to how she has approached the other men in her life (Atwood 230-1). This can also be applied to her own struggle with cancer, as

Wilford, for the first time since her diagnosis, is no longer agonizing over what will happen to her body and her life, and instead accepting what is happening to her in the present.

Paul’s purpose in Wilford’s life does not end there, however. It is because of her involvement with him that she ends up a political prisoner during the violent unrest following the failed first election on St. Antoine and Ste. Agathe. The development of this violent political situation constitutes the other major narrative strain of the novel. 185

The British had controlled the islands until recently in the narrated time, at which point the corrupt and repressive government led by a man named Ellis took over with the backing of the United States’ CIA. This government is responsible for staging the first election on the islands, which offers an opportunity for the citizens to overthrow Ellis,

185 Grace Epstein has claimed that “[…] Paul’s heroism is confirmed, in part, through his seduction of Rennie and his later willingness to ‘save the girl’ before continuing his pursuit to ‘save’ the whole island” as Paul has attempted, albeit unsuccessfully, to evacuate Rennie before continuing on (Epstein 81). 266

and indeed they do. However, the winner of the election and the other opposition candidates end up being killed during an operation that involves the influence of the CIA, and perhaps was orchestrated by it. Many of the opposition supporters are killed or arrested during this time as well.

Up until her involvement with Paul, Wilford had known little about the impending elections, despite having unwittingly supplied an opposition candidate’s suporters with weapons. She actively shied away from learning too much about the issues and people who were key elements. As Ildikó de Papp Carrington has claimed,

“[…] Rennie is too absorbed in her disease and too agonized by what she believes to be her scarred untouchability to pay any serious attention to what is going on” (Carrington page). Paul is a gun runner for the opposition candidates, albeit with unclear allegiances amongst the opposition. Wilford’s known association with Paul leads to her arrest “on suspicion,” but Wilford is never told for what she is under suspicion (Atwood 251).

Wilford shares a cell with Lora Lucas, a fellow Canadian and former lover of Paul’s, whose current lover was one of candidates. Conditions in the prison are unusually harsh, and Lucas trades sexual favors with the guards for niceties such as cigarettes. She also does so in the hope of thereby procuring a visit with her lover, whom the guards tell her is also imprisoned (Atwood 275). Unsure of what will happen to her or if she will ever be released, Wilford’s priorities shift: “Once she would have thought about her illness: her scar, her disability, her nibbled flesh, little teethmarks on her. Now this seems of minor interest, even to her. […] She may be dying, true, but if so, she’s doing it slowly, relatively speaking. Other people are doing it faster: at night there are screams” (Atwood

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273-4). Wilford is a witness to the brutality the Ellis regime perpetrates on the people around her, and this awakens in her the awareness that her fears of death from cancer are trivial in comparison with the violent ends people are meeting in that present moment.

This change in Wilford is completed as she attends to Lucas, who has been beaten nearly to death by the guards. Holding Lucas’s hand, Wilford pulls Lucas back to consciousness (Atwood 288). Wilford brings Lucas back to herself, just as Paul had earlier brought Wilford back to herself. Wilford is now focused on the pain of others— no longer detached from those around her, and no longer plagued by the uncertainty and fear that her breast cancer brought to her life. Wilford is also moving away from what

Sandra Lee Bartky has termed a “consciousness of victimization, ” wherein she is trapped by her uncertainty about her cancer and requires the men in her life to help her. Bartky has argued that Wilford now has full awareness of her own agency to help others, and women in particular (Bartky 15-16). 186 Wilford at last realizes that her pain is no longer the greatest force in her life; instead, the pain of others is the motivating force and the source of Wilford’s power to change the world around her, be it in the prison with Lucas or later outside of it.

Wilford in this way has overcome the tumult that cancer has brought into her life.

As several critics have pointed out, Atwood links Wilford’s literal cancer to the violence on the islands. The Ellis government is the metaphorical cancer of the society that is killing off its own members. According to Susan Sontag, this is a classic usage of cancer throughout world literature, one that Sontag has criticized, citing the negative emotional

186 Brownley has claimed that the women in the novel are only brought into the politics through relationships with men, and are then often used as pawns. In allying herself with Lora, Rennie turns to a more positive and active political activism (Brownley 89). 268

effect on cancer patients having their disease compared to the world’s greatest evils

(Sontag 85). However, in this case, the comparisons yield a positive overall association in terms of the fight to cure both evils. For David Lucking, the novel insists […] that only through a process of radical subversion is it possible to confront the malignant cell that lurks both within and outside the self […]” (Lucking 92). Wilford takes the final step in coming to terms with her cancer only when she opens her eyes to the malignancy of the corruption and brutality present in her midst. In the end, Atwood has shown the reader that Wilford finds this metaphorical cancer to be the greater threat than her physical cancer, and it is the one which she will fight from then on. Rubenstein has offered a compelling complementary interpretation, noting that in fighting the torture and abuse, Wilford is also able to “oppose” both cancers (Rubenstein 134). Martine

Brownley, however, has taken issue with the extension of cancer to a metaphor.

Brownley has argued that there are marked differences between the violence against the women wrought by the guards and that perpetrated by surgeons in the operating room.

The former is purely self-serving brutality, while the latter is undertaken in hopes of a cure (Brownley 71). I would argue that in either case, the motive is not nearly as relevant to the work as the results of the violence. Although Luoma’s surgical motives are pure, the results are nonetheless devastating for Wilford. She must work to rebuild her concept of herself, just as the people of the islands are devastated by the Ellis government, and so must also find a way to defeat them and move on.

Atwood intentionally does not make it clear whether Wilford was truly rescued or whether it was just in her imagination, stating in an interview that it is irrelevant because

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the change in the state of consciousness Wilford has undergone is the true value of her experience (Ingersoll 228). Through having breast cancer and following the path down which it leads her, Wilford has first realized her isolation and then played a role in rescuing herself from it. Regardless of whether she returns to Canada or dies in the prison, she has found a connection to others that has been her salvation. As Brownley has written, Wilford has essentially undergone a “conversion experience” through her conversations with Lucas in the cell (Brownley 68-9). Wilford vows that she will turn from the trivial journalism that has been her specialty and be a journalist who is “a subversive” (Atwood 290). She will now concentrate on the meaningful stories about people, such as what she has experienced in prison and on the islands, rather than on fashion trends or tourism articles. Atwood’s characterization of Wilford is not an entirely positive, sentimental one, as many lesser depictions of the transformative power of cancer are. In the same spirit as the autobiographical writings of the time period, such as those by Audre Lorde and Brigitte Reimann, who both admit to weaknesses in their personal lives, this fictional character is also a realistically flawed woman. Among other aspects, she has made poor choices in her relationships and has pursued a vapid line of work.

Without the moment of crisis forced on her by cancer, Wilford would still be viewing life from the outside, but through it she has found self-understanding and a greater purpose to her life’s work.

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Focus on an American Representation of Cancer as a Transformative Experience:

Margaret Edson

Playwright Margaret Edson’s lone work Wit (spelled W;t in its published edition), like Bodily Harm , also depicts the experience of a female cancer patient as she wrestles with her identity. Written in 1991 and first performed in 1995, Wit is a one act play presenting the fifty-year-old Vivian Bearing, an English professor and John Donne scholar who now also finds herself to be a terminal, stage four ovarian cancer patient. 187

The play alternates between scenes of Bearing in the hospital, where she is being treated, and scenes from her past, primarily from her life as a scholar and professor. Bearing announces at the very start of the play that she will die, stating drolly: “It is not my intention to give away the plot; but I think I die at the end. They’ve given me less than two hours,” (Edson 6). This is therefore not a story of moving past cancer, as Bodily

Harm is, because Bearing will never experience a post-cancer life. Edson has instead presented a work in which the intersection of Bearing as a cancer patient and Bearing as an accomplished professor ultimately leads her to redemption and grace. Although this is a similar theme to the role cancer plays in Die Betrogene , here Edson has focused on the experience of being treated for cancer as the motivating force, as opposed to Mann’s emphasis on the effects of the cancer itself, both physical and emotional, and his mocking depiction of Rosalie von Tümmler.

187 Wit was initially performed at the South Coast Repertory Theater in Casa Mesa California on January 24, 1995 and premiered in New York at the MCC Theater in September, 1998. Wit won the 1999 Pulitzer Prize for Drama and HBO produced a film adaptation of the play in 2001. Martini notes that the play was initially rejected by nearly every theater as it was considered too depressing to perform (Martini 23). 271

Edson, who wrote this play after working as a social worker in an AIDS and oncology ward in Washington, D.C. (Martini 24), has presented a harsh indictment of physicians who lack an appreciation for their patients as people, echoing the frequent examples of this found in the cancer autopathographies. Bearing defines herself as a person of the mind: an internationally recognized John Donne scholar who has dedicated her life to her profession. Unmarried, with no friends or family, save her former advisor, she is an uncompromising researcher and professor. As Elizabeth Klaver has noted,

Bearing even admits that she privileged her work above her physical health, not consulting a physician about her symptoms until after she had completed an important

Donne article (Klaver 664 and Edson 27-8). Once she is thrust into the role of cancer patient, her stature within her profession becomes irrelevant. Her medical caretakers see her as simply another case, for the most part ignoring her primary personal identity. This becomes clear during the following exchange:

Technician 1: Name. Vivian: My name? Vivian Bearing. Technician 1: Huh? Vivian: Bearing. B-E-A-R-I-N-G. Vivian. V-I-V-I-A-N Technician 1: Doctor. Vivian: Yes, I have a Ph.D. Technician 1: Your doctor. Vivian: Oh. Dr. Harvey Kelekian. (Edson 16-17)

In the realm of the hospital, it is immaterial that Bearing has ever been anything other than a patient. This continues when Jason Posner, the clinical fellow on her team who also happens to be a former student of Bearing’s, asks her about her “life history,” which includes marital status, parents’ health, age, and job title. When he has run through these

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perfunctory questions, he ends with: “Well, that about does it for your life history.”

Bearing replies with: “Yes, that’s all there is to my life history” (Edson 23-4), emphasizing the absurdity of summing up fifty years of life and experience in such a manner. Posner, seemingly oblivious to Bearing’s implied criticism, simply moves on to the next series of questions.

Bearing herself then compares Grand Rounds, with the chief physician Dr.

Kelekian and his fellows, to an arena she once ruled, a graduate seminar. She notes one important difference, explaining that “[…] in Grand Rounds, they read me like a book.

Once I did the teaching, now I am taught” (Edson 37). Bearing shares one moment of professorial camaraderie with Kelekian, when they briefly commiserate about students, and this leaves Bearing, as the stage directions assert, “delighted” (Edson 39). 188 This illustrates a brief moment in which the doctor sees Bearing as a whole person rather than a case, and the positive effect of this is immediately apparent. This fleeting exchange, in which Kelekian addresses Bearing as an equal, is then quickly overshadowed when the team departs, having left Bearing’s stomach uncovered, and therefore Bearing herself in an exposed position incongruous with the dignity of her professional stature (Edson 39-

40). The medical professionals in this play are never outright hostile towards Bearing, nor do they do anything to harm her, but they also do not take care to consistently see her as anything more than the cancer patient she is to them. 189 Even the compassionate

188 Madeline Keaveney has pointed out that in an earlier scene, Kelekian addresses Vivian as Miss Bearing, despite knowing she is a professor, until the two share annoyances about their students, at which point he switches to Dr. Bearing, suggesting that he has come to respect her as more of an equal (Keaveney 41). 189 As Catalina Florescu has claimed, Kelekian and Posner would likely use Vivian’s case to write an article about her treatment, and in such a way, “[…] the body of the ill person is unjustly claimed by the medical staff” (Florescu 276). 273

nurse, Susie Monahan, who is the one medical character truly attentive to Bearing’s comfort and humanity, does not address her as a renowned academic, but rather still as a sick and, eventually, a dying person. Further, whereas Bearing had once been the person in control of her life as well as her classroom, now others—including a former student— dictate what she should do when and leave her in uncomfortable and exposed positions, reinforcing her powerlessness in contrast to her earlier control. Klaver has remarked that agreeing to Kelekian’s experimental treatment is a means for Bearing to “[…] separate and master her body as an object of science, regardless of the havoc it wreaks on her flesh” (Klaver 679), but even in this, she remains subject to her caretakers’ directives and her body’s reactions to the treatment with no ability to have a say in either; she does not have the medical knowledge to contribute to her treatment plan, and she simply cannot dictate how her body will tolerate the medications.

The one way she may maintain her former status, as Schlomith Rimmon-Kenan has explained, is by assuming the role of narrator (Rimmon-Kenan 353). Her body and those around her dictate nearly every aspect of her hospitalized life, but she can still maintain the ability to report her story as she chooses, much as her non-fictional counterparts wrote their own autopathographies. Bearing may not be able to change what has happened to her in the hospital, but as a conscious narrator, she can make sure that it is portrayed in the manner she would like, and in doing so, expose her caretakers for their transgressions against her dignity.

The thoughtless treatment exhibited by the medical staff is only half of Bearing’s shift in identity that occurs through becoming a patient. Although Bearing had earlier

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neglected her physical state until her professional commitments were fulfilled, now she can no longer manage her situation in such a way. This begins as Kelekian tells her she should take a semester off from teaching due to the experimental treatment he suggests, a situation she does not want to accept (Edson 11). From this point on, Bearing’s body and her doctors’ invasions of it dictate her life. This includes the indignity of wearing hospital gowns, watching herself go bald, being given a pelvic exam by a former student, and being unable to complete a sentence before vomiting from the chemotherapy (Edson

31-2). She is reduced to exclaiming: “Oh, God. What’s left? I haven’t eaten in two days.

What’s left to puke? You may remark that my vocabulary has taken a turn for the Anglo-

Saxon,” (Edson 32). Edson here has depicted the sense of humiliation and the inability to retain personal dignity that cancer has forced upon Bearing. She is reduced to eating popsicles and measuring her fluid intake and output, just as any other cancer patient in her place would be, regardless of his level of education or professional standing.

The flashbacks to Bearing’s past add weight to this reversal. The audience sees her as a young college student meeting with her advisor, the renowned Donne scholar

E.M. Ashford. Professor Ashford admonishes Bearing for shoddy scholarship that led to a misinterpretation of a Donne poem. After Ashford has made it clear to Bearing that she must recast her paper and improve her methods of research, she urges Bearing to go out and have fun with her friends. Bearing, however, still thinking about Donne and her misinterpretation, instead returns to the library (Edson 13-15). Bearing has chosen her work over human interaction, and in flashbacks to her teaching career, this is only reinforced. She is an uncompromising professor, refusing to coddle her students or give

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extensions for deaths in the family, and demanding nothing less than complete preparation for class. She still has hope that some among them will rise to higher levels of thoughtfulness and insight, but she is unsurprised when this hope is not borne out, explaining: “So far so good, but they can think for themselves only so long before they begin to self-destruct” (Edson 61-3). These classroom scenes take place immediately after Bearing and Posner have discussed his preference for pure research over patient care, and Bearing herself notes the irony that the same woman who has always preferred the analogous scholarship over teaching now “[…] in her pathetic state as simpering victim wishes the young doctor would take more interest in personal contact” (Edson 58).

Bearing has been humbled by cancer, and as a result, after recalling the scenes with her students, she, who has placed such value on the articulation of thoughts and the meaning of words, is left unable to describe her reaction: “I don’t know. I feel so much—what is the word? I look back, I see these scenes, and I…” (Edson 63). The thought is never completed and Bearing returns to her bed. While she does not specifically admit regret or remorse for having acted this way, she also does not staunchly defend herself. Her inability to finish the sentence suggests that her experience as a cancer patient who is at the mercy of the powerful medical field has led her to at least reevaluate her reactions in these student encounters.

What she does after her return to bed is most telling: she pinches her I.V. line so that her nurse Monahan will come keep her company. She exposes her fears to Monahan, and admits, crying, that: “I don’t feel sure of myself anymore […] I used to feel sure”

(Edson 65). Bearing now finds solace in eating a childhood treat, the popsicle, although

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she does not entirely lose her scholar-self, explaining to the audience the physical benefits to eating them (Edson 65-6). Monahan, the one person Bearing voluntarily allows to see her true emotions and vulnerability, is hardly the choice the pre-cancer

Bearing would have preferred. She is a nurse, and therefore not the commanding figure in her field that equates to Bearing’s standing as a full professor, and Monahan is also not of Bearing’s intellectual capabilities. Even her childlike nickname, Susie, in contrast to the regal-sounding “Vivian Bearing,” places a separation between the two. Yet it is

Monahan, with her compassionate understanding of Bearing’s situation who brings

Bearing comfort—Posner or Kelekian with their academic pronouncements. Monahan is the one who tells Bearing her cancer is advancing and presents her choices for a “Do Not

Resuscitate Order.” The doctors, as Monahan explains, are great researchers, but as such, always want to know more and will keep patients alive at all costs. Bearing responds with: “I always wanted to know more things. I’m a scholar. Or I was when I had shoes, when I had eyebrows” (Edson 68). Now, however, she is a patient, and she agrees to sign the order. Bearing is well aware of the shift in herself from stalwart professor to a patient in search of comfort and peace. She notes, too, that in confronting life and death, the time for “verbal swordplay” is over and “[n]ow is a time for simplicity. Now is a time for, dare I say it, kindness” (Edson 69). Bearing has been able to accept her current state, and through her illness, she can finally see the value in human contact and true benevolence.

Bearing’s sole visitor, her advisor E.M. Ashford, is the one character that seems to embody both an uncompromising scholar and a comforting friend. She did not know

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of Bearing’s cancer until Bearing is in the final day of her life, and comes directly to see

Bearing. Ashford climbs into the bed to console a crying Bearing, and offers to recite

Donne sonnets. Bearing demurs, and so Ashford instead reads her the book she has bought for her grandson, Margaret Wise Brown’s The Runaway Bunny . Scholar Bearing has rejected the object of her years of study in favor of patient Bearing’s preference for a simple, soothing children’s story. 190 Ashford reads the story of the young bunny whose mother will always find him, interpreting it as “[a] little allegory of the soul. No matter where it hides, God will find it. See, Vivian?” (Edson 78-80). Bearing falls asleep to the story, never to regain consciousness. Ashford has brought solace to Bearing not with the complexities of Donne, but with the uncomplicated love between mother and child, or, as

Ashford interprets it, between God and human. Margaret Eads has remarked that having

Ashford read the story is Edson’s assertion that objective scholarship and love need not be mutually exclusive (Eads 243), and it is this synergy found in Ashford that reflects what Bearing only in her final days has come to understand is possible and desirable.

Bearing’s powerlessness as a patient is once more exploited when Posner finds her unresponsive. Forgetting the DNR order, he begins CPR and calls a resuscitation code. Monahan tries to stop him, and his reply of “She’s research!” calls attention one final time to his—and his superior’s—view of her as a case first, and person second.

Although Posner reverses his call for a code, Bearing’s body is nevertheless subjected to the rigors of attempts to resuscitate her. After the code is halted, a dead Bearing steps out of the bed, removes all of her hospital garb, and walks towards a light. As she is naked,

190 Margaret Eads has posited that Vivian turning from Donne and to The Runaway Bunny mirrors Edson’s own decision to leave her graduate studies in English literature in order to teach kindergarten (Eads 242). 278

reaching for the light, the house lights go out (Edson 81-5). In this final tableau, Bearing has freed herself from her illness as well as her patient identity and has found what is suggested to be a rebirth or a resurrection in death. This moment lacks a specific religious affiliation; although the overtones of resurrection are decidedly Christian, there is no indication that Bearing has committed herself to a belief in Christianity or in God during her hospitalizations. What is important here is that Bearing, having learned the value of a balanced life, has been able to move on. Eads terms this a “redemptive moment” (Eads 242), and indeed Bearing moves naked, free of any markings as a scholar or as a patient, into a new existence in which she, too, can redefine herself, incorporating what she has learned as a cancer patient. 191

Posner, however, is left seemingly devastated by his mistake, repeating to himself

“Oh, God” (Edson 85). Bearing has learned through her cancer to view human compassion and kindness as just as—if not more—important than intelligence and academic rigor, but Posner has not yet. As Wayne Booth has explained, “[t]he power of the ending requires us to share, without question, the author’s implied judgment that humane, honest, compassionate treatment of patients is ethically far more important than the pursuit of research results” (Booth 10), and indeed as the play ends, Bearing has entered a presumably enlightened existence, while Posner, representing one who holds to the primacy of truth over feeling, is left suffering. For Posner, the hope exists at the end of the play that his exhibited anguish over the drastic error in calling Bearing’s code will enable him to follow Bearing in achieving a similar epiphany. Eads notes that Posner is

191 Edson herself has remarked that Vivian could have reached the moment of redemption much sooner, “[…] but she keeps putting it off and putting it off and putting it off, and finally there’s a breakthrough, and it happens in the last ten seconds of her life, which is plenty of time” (Edson “John Donne” 26). 279

at this moment, like Bearing before him with her popsicles and story, reverting to a childlike state in his despair, and it is perhaps this return to pure emotion that will likewise lead him to redemption (Eads 248-9). 192

Edson’s choice of ovarian cancer is, as with Mann’s choice in Die Betrogene , a key element in developing the play’s central theme. This woman, who has chosen career over family, is now nonetheless forced to confront her reproductive tract. Despite her attempt to focus solely on a non-gendered life of the mind, it is her ignored femininity that brings about her downfall. During the time this work was written breast cancer had gained visibility and there was a large community of breast cancer patients and survivors, but ovarian cancer remained a disease shrouded in mystery and largely in silence. The disease’s warning signs are few, and yet once it has reached metastasis, there are no reliable treatments. This all therefore adds to the portrayal of Bearing as an isolated person facing this disease, left standing alone against the doctors, technicians, and nurses in what will almost certainly be a futile attempt to survive. The use of ovarian cancer also intensifies the humiliation this dignified woman endures. Not only must the doctors examine her by performing pelvic exams, but still worse, her own male former student must do so. Eric Leuschner has asserted that “[t]he repeated references to procedures related to the lower anatomy erase the division between public and private, a distinction often maintained and cultivated by academia” (Leuschner 343). This professor’s most private body parts are laid bare for her student to manually explore, wholly reversing the

192 Connie Canam has remarked that Wit has so far been used in thirty medical schools throughout the United States in order to teach future physicians about not only the “effects of poor communication between physicians and patients,” but also to “[…] suggest [to the students] that medical personnel need to consider the non-physical needs of patients” (Raoul, et al. 290). 280

power structure in their relationship, and leaving her at her most defenseless. This moment of having Posner’s hands inside her vagina is the absolute depth of mortification for Bearing. 193 No non-reproductive cancer would have presented this instance of complete vulnerability and indignity that is integral to Bearing’s ultimate realization that there is value in compassion and consideration of others’ comforts.

Jacqueline Vanhoutte is quite critical of Edson’s use of cancer in general, stating that she believes Edson to be placing the blame for the cancer squarely on the sufferer,

Bearing (Vanhoutte 394). Vanhoutte has argued that Edson presents the cancer as essentially Bearing’s fault, due to the traditional conception of cancer caused by repressed emotions. Vanhoutte continued her argument by admonishing Edson for by extension making Bearing responsible for her own cure, rather than her physicians

(Vanhoutte 394-5). There is no indication with the play, however, that either Bearing or her doctors place the blame for the origins of disease on her. Further, this is not a work about cure, which the audience knows will not occur, but rather it is a work about the personal growth than can occur even while facing a terminal diagnosis.

To this end, Edson chooses Bearing’s area of scholarly study to underscore, and in part to reflect, the conversion she undergoes. Seventeenth-century English poet John

Donne’s work was primarily characterized by his intellectual wit and his Christian faith in exploring issues of human motality, particularly in his Holy Sonnets . The scholar

Bearing approaches these complex poems as puzzles to be deciphered rather than as emotionally moving works of art. In talking about Bearing’s course, Posner tells

193 Leuschner has pointed out the reversal inherent in the exam: instead of the professor trying to get the class to open up in a discussion, now her body is being urged to open for her student’s examination (Leuschner 343). 281

Monahan: “Listen, if there’s one thing we learned in Seventeenth-Century Poetry, it’s that you can forget about the sentimental stuff. Enzyme Kinetics was more poetic than

Bearing’s class” (Edson 77). Bearing has been trained by Ashford to look at the text objectively, leaving behind her feelings (Edson 14), and that is how Bearing has continued to approach the works. Donne’s chief topics are death, dying, and salvation, yet for Bearing there is a scholarly attachment that allows her to dissect the works without becoming emotionally involved in them. As Klaver has posited, Bearing has examined literature in the same way Posner researches cancer: by breaking it down to explore at its most basic structural level (Klaver 661). The emotional impact of the poems, while not entirely lost on Bearing prior to her cancer, has also not concerned her as much as the uncovering of meaning and the appreciation of the complexity of the sonnets. As she explains to the audience, “Donne’s wit is…a way to see how good you really are. After twenty years, I can say with confidence, no one is quite as good as I,”

(Edson 20). Her cancer diagnosis does not at first seem to affect this approach to Donne.

As Bearing awaits Posner’s examination of her, she recites Donne’s “Holy Sonnet X,” beginning with the phrase “Death be not proud,” but she does so only after running through the times tables (Edson 29). She is simply filling the time, not stopping to contemplate this work in light of her current situation. Bearing’s lifelong passion for words, which in large part sparked her interest in Donne, does serve her during her illness by decreasing the gap of knowledge between patient and physician. She aims to learn as much medical vocabulary as possible, so as to be able to understand her physicians, but this is as far as her scholarly training has entered her illness until she becomes sicker.

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After having endured eight rounds of a treatment regimen no other patient had managed to tolerate for as long, Bearing finds herself again waiting for a medical caretaker. She recites from “Holy Sonnet VI,” which begins “This is my playes last scene” (Edson 52). This time, she connects the work to her own situation, noting that “I have always particularly liked that poem. In the abstract. Now I find the image of ‘my minutes last point’ a little too, shall we say, pointed ” (Edson 52-3). This is the first instance where she has revised her opinion of a Donne poem to reflect her own vulnerability, and in doing so, admits to herself and to the audience that she is not an implacable force of nature. This sentiment continues a bit later on, when she fails at expressing the pain she is in: “I want to tell you how it feels. I want to explain it, to use my words. It’s as if… I can’t… There aren’t…” (Edson 70). This woman who has always found pleasure in words is now intensely frustrated that she cannot find a way to express herself in the precise manner she would like. These are both signs of the lack of control Bearing is experiencing throughout her cancer experience. She no longer views

Donne with the complete objectivity she has cultivated, and she cannot trust her vocabulary to aid her, just as she lacks agency in her hospitalized life. Bearing then turns to Donne for what she states will be her last coherent words. She chooses the final lines of “Holy Sonnet X,” which had formed the basis of her first scholarly interaction with

Ashford. Bearing chooses to use an erroneously punctuated copy of the text: “And

Death-capital D—shall be no more—semi-solon. Death—capital D —thou shalt die— exclamation point! ” after which the stage directions read: “ (She looks down at herself, looks out at the audience, and sees that the line doesn’t work. She shakes her head and

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exhales with resignation) ” (Edson 72-3). Bearing chooses the bombastic, aggressively punctuated version of the work that Ashford had earlier chastised her for using rather than the true version of the text, “And death shall be no more, Death thou shalt die,” wherein death is much less dramatically defeated by the Christian concept of resurrection and eternal life. In Ashford’s words, “Nothing but a breath—a comma—separates life from life everlasting. It is very simple really. With the original punctuation restored, death is no longer something to act out on a stage, with exclamation points. It is a comma, a pause” (Edson 15). Bearing recites the inauthentic text, signaling a hope of convincing herself and perhaps also the audience that she, like Donne’s speaker, shall overpower death. Her illness experience has changed her to such a degree that she has abandoned her cherished academic integrity in an attempt to find one last moment of strength great enough to overcome her disease, but this is ultimately futile.

What actually lies in wait for Bearing, however, is the intended meaning of the text in its original form, albeit minus the strictly Christian overtones: the quiet defeat of death she experiences as she moves toward the light, having come to understand the value of human compassion. Sean McDowell has argued that Edson has misused Donne because in Wit “[a]n active pursuit of grace is not required; redemption simply happens when you die,” whereas for Donne, one must repent to receive grace (McDowell 170,

173). While Bearing does not overtly repent, her attitude towards others and towards her life priorities has markedly changed. Further, as John Sykes has noted, “[t]his notion [in

Donne’s sonnets] that suffering may indeed be a vehicle of God’s mercy in crucial to an understanding of Wit” and “[…] Professor Bearing herself undergoes an inner religious

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drama remarkably like the one portrayed in the sonnets in which she is expert” (Sykes

166). Sykes has thus emphasized that the sonnets do indeed hold relevance to Bearing’s own twentieth-century story, and he has continued on to note the importance of her humiliating illness experience in preparing Bearing for her salvation (Sykes 167).

Although Bearing abandons the scholarly detachment in Donne as she turns from him and towards The Runaway Bunny , her story in the end bears out the meaning of this sonnet’s closing line. As Robert DeSmith has explained, The Runaway Bunny is not a rejection of Donne, but rather the “[…] antidote to Donne’s complexity and a fulfillment of what his poems seek—rest in God’s irresistible grace” (DeSmith 155). The children’s book brings Bearing’s crucial transformation to its completion. The Bearing the audience meets at the beginning of the story would hardly have accepted a children’s book as the final text she would hear in life, but her humbling illness experience has enabled her to accept and appreciate comfort in whatever form it may come.

An American Representation of Cancer as a Transformative Experience for Others:

Anna Quindlen

One True Thing, a 1994 novel by Anna Quindlen, is another work that deals with the topic of euthanasia, but while it is an important theme, it is secondary to the development of the character of Ellen Gulden, whose mother is dying of an unnamed cancer located in her abdomen. Ellen, the twenty-four-year-old daughter of Kate and

George Gulden, had connected best with her English professor father and emulated him.

Ellen Gulden has returned home at the behest of her father to care for her mother in her

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final months because he believes his wife would want a female to do so. Further, he seems to be unwilling to give up his own work. In this case, it is also important that cancer is the cause of Kate Gulden’s illness because it is partly the fact that the terminal illness is related to, and perhaps located in, her reproductive system that makes her husband uncomfortable. Quindlen has depicted the demoralizing effects of the treatment, and the dehumanizing decline in physical abilities that are strongly associated with cancer. It is in caring for her mother through the traumatic and pitiful moments, such as using a wheelchair for the first time or soiling herself, that Ellen Gulden undergoes her transformative change. Whereas she had earlier always associated herself with the father she considered a god, albeit a flawed one, through caring for her mother she realizes the value of her mother’s life as a homemaker and comes to appreciate all that her mother had done for her. The time they spend together also imbues Ellen Gulden with a sense of appreciation for the quiet wisdom of her mother in contrast to her blunt father. Due to

Kate Gulden’s cancer, Ellen Gulden for the first time begins to see herself as a product of both of her parents. Kate Gulden herself remains steadfast in who she has always been during the months she is dying.

Unlike in many stories, cancer does not significantly alter Kate Gulden’s outlook or behavior, although it does bring her closer to her daughter just as her daughter becomes closer to her. Kate Gulden’s unwavering devotion to her family and her understanding of them is cemented when Quindlen reveals that Kate Gulden has euthanized herself, contrary to Ellen Gulden’s suspicion that her father had done so and her father’s belief that she had. Kate Gulden understood that neither her husband nor her

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daughter would be able to do so, and instead of forcing them to do it, she found a way, for the final time, to ease her loved one’s lives. As a result of her mother’s disease, Ellen

Gulden chooses to change career paths. She gives up her life as a journalist and instead goes to medical school to become a psychiatrist who primarily helps adolescent girls.

Rather than giving up entirely on her father, she integrates both parents into her career by assigning literary works to her patients. This indicates that she has found her path and reconciled who she is through the experience of being her mother’s caretaker during the ravages of her cancer.

A South African Representation in Reaction to the Trope of Cancer as a

Transformative Experience: Nadine Gordimer

Nadine Gordimer takes a different approach to a transformative awakening as the result of cancer. In her 2005 novel Get a Life , Paul Bannerman is an ecologist undergoing treatment for thyroid cancer. Due to the use of radiation, he is in quarantine at his parents’ house for sixteen days so as not to contaminate his young son or wife

Berenice, who could then spread the contamination to the son. His parents also have as little physical contact with him as possible. Paul Bannerman is therefore, as a result of his cancer, left essentially in isolation. He is powerless to do anything in his personal or work life and must leave all of his responsibilities to others. This gives him seemingly endless hours he would not otherwise have in order to contemplate his life and his work.

In doing so, he realizes that he, as an ecologist fighting the erection of nuclear plants, is

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in direct opposition to his wife, who, as part of her job as an advertising copywriter, works to create public support for the nuclear plant.

While this time to ponder his relationships and life’s work leads Paul Bannerman to see things differently, he does not in the end change his life in any way. Rather, he goes back to living with his wife and continues his work. By the end of the novel, he has a new child, his father is dead, and his mother has adopted an HIV/AIDS-infected orphan, but he has not altered his own existence in any substantial way, despite his cancer experience and the revelations it had led him to. He notes the irony of fighting the nuclear plant while potentially being saved by radiation, but this does not enter his ponderings in any meaningful manner. Gordimer therefore presents an alternative to the classical epiphanic cancer narrative; although Paul Bannerman has these epiphanies because of the treatment unique to thyroid cancer, he, unlike the protagonists of those texts, merely reverts to his former life, showing the alternate reality that cancer is not always a lasting transformative experience.

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Chapter 8: Representations of Cancer Linked to Social or Ethical Concerns

The third principal manner in which authors use cancer within texts is to engage with social or ethical concens that are either related to cancer or portrayed through it.

This is present to some degree in Atwood’s work Bodily Harm , but in that novel the focus is less on one specific situation and more on the protagonist’s recovery and personal change. Further, several of the works I discussed in the previous chapter, such as Richard Huch’s novel Der Fall Deruga and Theodor Storm’s novella Ein Bekenntnis , are concerned with the topic of euthanasia. This remains a political and ethical issue as countries decide what measures are legally acceptable in easing or shortening a terminally ill patient’s end-stage pain, both physical and psychological. However, each of these works centered around euthanasia is more focused on an individual situation and its consequences than on advocating for change in the laws or inciting a more critical look at the issue. There is a much deeper, more integral connection between cancer and social or ethical situations in the works I discuss below. In each of these texts, all of which are based on non-fictional situations or influenced by them, the authors use cancer to critique a social or ethical situation that endangers the well-being of a people, be it physically, psychologically, or both. This is the least prevalent usage of the disease among cancer literature, perhaps because it is the most complicated and least intuitive of the depictions to the extent that cancer itself is representing more than simply the disease

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and the disease experience. These authors have nonetheless created compelling texts addressing important topics of the time in which they were writing.

A Russian Representation: Alexandr Solzhenitsyn

Alexandr Solzhenitsyn’s novel Cancer Ward was first published in 1967 and it is set in a cancer ward in the post-Stalinist Uzbekistan of 1955. Much like Berghof in

Thomas Mann’s novel Der Zauberberg, the ward serves as a means of bringing together a microcosm of this society. While the community at the Berghof is confined to the bourgeoisie, the one in Cancer Ward is comprised of a larger cross section of the post-

Stalinist Soviet Union. The characters range from students, as with the young Dyomka, to dissenters in perpetual exile, as with the central character, Oleg Kostoglotov, to governmental dignities, such as Pavel Rusanov. Each of these figures in a hospital in an unnamed city is now confronting the social leveler of a potentially terminal illness. In several cases, the cancers the patients have are connected to their roles during the

Stalinist era. For example, as Ericson and Klimoff have pointed out, Rusanov, who had betrayed a neighbor, has cancer of the throat; Aleksei Shulubin, who had compromised himself morally, has colon cancer that results in a perpetual foul smell serving as a reminder of his ethical compromises; and Yefrem Podduyev, a perpetual liar, has a cancer of the mouth (Ericson and Klimoff 103). In this way, Solzhenitsyn has used the various forms of cancer to condemn the actions these people have perpetrated. The cancers seem to be a just punishment for their misdeeds and also to underscore their nefarious behaviors.

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In other cases, the cancer serves to highlight a character’s virtue, such as with the sixteen-year-old Dyomka, a positive figure who suffers from a cancer of the leg.

Dyomka’s cancer is not one that can be connected to character flaw, but rather is constructed to evoke sympathy and admiration for this adolescent who is literally hobbled by the disease. As Scammell has argued, Dyomka “[…] represented childlike honesty and human perplexity in the face of the enormous, and seemingly unjust, challenges of his illness” (Scammell 564). By bringing these characters together in one hospital,

Solzhenitsyn has painted a stark contrast between those who represent the worst of the

Stalinist era and those who either represent the goodness that survived regardless of the ills of that era, as with Dyomka, or rather the victims of Stalinism, as with Kostoglotov, as discussed in more detail below. The ward also serves as an extension of the labor camps for those patients who are trapped there while ill, as they remain without recourse against the authority figures. Much like the guards in the labor camps, the doctors take on the role of master, often recklessly and heedlessly doing whatever they please to the patients.

Oleg Kostoglotov arrives at the ward with a cancer of the abdomen. He is admitted in 1955 during the period of perpetual exile following the seven years he served in the Gulag labor camps where he had been sent for speaking negatively about Stalin.

This character bears connections to Solzhenitsyn himself, who was also admitted for cancer to a hospital in Tashkent, Uzbekistan in 1953 while he was serving his own perpetual exile following an eight-year term in the Gulag labor camps. Solzhenitsyn had been sentenced to the labor camp system for writing negatively about Stalin in letters to

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his friend Nikolai Vitkevich. He consequently began serving his term in July, 1945, and then, shortly before his release, he had a cancerous tumor removed from his groin on

February 12, 1953 while at the labor camp in Ekibastuz, Kazakhstan. Histopathology indicated that it had been a cancer of the lymph node and the doctors were confident that they had rid Solzhenitsyn’s body of the disease (Scammell 304). After Solzhenitsyn had served his eight years, he was sent into internal exile, as was customary, in the northeastern region of Kazakhstan, where he remained until 1956. During this time in exile, either a metastasis of the original cancer or a wholly new tumor was spreading and growing unbeknownst to him. When the symptoms became too severe for him and for those in charge of his medical care to ignore, he was finally admitted to the hospital in

Tashkent, Uzbekistan, on January 4, 1954. There he received six weeks for treatment for what was determined to be a seminoma, a cancer of the testis. This extended hospital stay is the one that informed Cancer Ward . The care he received there first shrunk the cancer, and then sent it into remission (Thomas 93-224).

Both men, the author and his fictional character, were treated with surgery, hormones and x-rays to combat the cancer (Meyers 58). Kostoglotov’s cancer, given its autobiographical basis, does not necessarily carry a constructed connotation similar to those mentioned above. The abdominal cancer could, however, be seen as a manifestation of the negativity and anger towards the Stalinist government endangered in

Kostoglotov by his time in the camps. This cancer is at the physical core of a human body, threatening to poison his entire being, just as Stalin had poisoned the body of the

Soviet Union. As important as this conception of the disease, however, are the treatments

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Kostoglotov receives and the decisions he must make regarding his treatment. These underscore the current conditions in the Soviety Union as well as Solzhenitsyn’s hope for the future in this time immediately following Stalin’s rule.

As part of his doctor’s efforts to rid him of cancer, Kostoglotov must choose between impotence and remission. 194 This becomes a major point of conflict between himself and his doctor, Lyudmila Dontsova. While she believes that doctors should be able to do what is best for the patient without the patient’s consent, Kostoglotov believes that it is his decision, as it means a substantial change in his life. Although Dontsova is a generally positive physician character in this work, as opposed to the more staunchly authoritarian physicians depicted, she nonetheless here reveals a belief in the authority of the state over the individual, putting her at opposition with Kostoglotov’s belief in the supremacy of individual choice. Despite his reservations about submitting to the hormonal treatment, Kostoglotov comes to the conclusion that he can still find love even if he cannot have a physical relationship. He therefore consents to the treatment, but he does so after a measured consideration rather than as a simple acquiescence to

Donstova’s opinion. Kostoglotov later ultimately reverses his belief that romantic love can occur without the physical, and so he forgoes a romantic relationship with Dontsova to spare her the pain of also realizing this.

In spite of this, there is hope at the end of the novel in that Kostoglotov is still alive, indicating an attendant hope for the future of the Soviet Union, even given the ways in which Stalinism has wounded it. Solzhenitsyn has emphasized that Kostoglotov,

194 Solzhenitsyn underwent hormonal therapy himself , which, as D.M. Thomas has explained, left him suffering “[…] from a sense of being castrated [… and he] felt bitter despair at ever being a man, even should he survive.” His sexual drive did return, however, following his treatment (Thomas 224-9). 293

while alive, nonetheless still suffers the life-altering effects of his cancer, which mirror the residual negative effects of the Stalinist era that linger in the Soviet Union.

Solzhenitsyn has used cancer to place opposing ideological viewpoints in one physical space, with all the representatives facing the same illness. This indicates that no one human is intrinsically better than any other, and each is deserving of being free of disease. Solzhenitsyn has further used the cancer experience to show that although the detrimental effects of Stalinism will long be felt, those who have survived its injustices will find a way to move on, just as those, such as Kostoglotov and Dyomka, who have survived cancer will be forever altered, but will likewise find a life worth living after the illness.

An East German Representation: Christa Wolf

The German author most closely tied to stories of cancer is Christa Wolf, who lived and wrote in the German Democratic Republic until the reunification of Germany in

1990. In two of her three works about cancer, Wolf has presented the disease as representative of larger social and ethical problems, be they within the GDR as with

Nachdenken über Christa T. (1968), or the wider world, as I will discuss below with

Störfall: Nachrichten eines Tages (1987). 195 In Nachdenken über Christa T. , the unnamed first-person narrator tells the story of her friendship with Christa T., with whom she had much in common. Their relationship began in 1943 in school and lasted until

Christa T.’s death from leukemia in 1963 at the age of thirty-five. The text consists of

195 In Sommerstück , Wolf’s 1989 novel, the character of Steffi is a loosely veiled presentation of Maxie Wander, who at the time the novel was set, 1975, had breast cancer. This novel does not center around cancer, though, as Nachdenken über Christa T. and Störfall do. 294

the narrator’s reminiscences and evolving thoughts about Christa T. These thoughts are catalyzed by going through Christa T’s papers after her death, and are also an attempt to keep the memory of Christa T. from fading. As Sonja Hilzinger has noted, Wolf based the titular character in part on her childhood friend Christa Tabbert-Gebauer, who likewise died in 1963, leaving behind letters and diary entries. While Wolf does not specifically name Tabbert-Gebauer, she does state in the brief preface that “[a]uthentisch sind manche Zitate aus Tagebüchern, Skizzen und Briefen” (Hilzinger, Christa T. 225-6 and Wolf, Christa T. 8) .

In Nachdenken über Christa T., the narrator and Christa T. lose contact after school. Christa T. had gone to Mecklenburg to work as a “Neulehrerin,” but leaves to pursue her Germanistik degree in Leipzig in order to become a teacher. There, Christa T. and the narrator meet again in 1952. She briefly works as a teacher in Berlin, but leaves her position when she meets and married Justus, a veterinarian. Teaching had not been a fulfilling career for Christa T, as it only served to further highlight the emphasis of the state on fitting into society. As Sonja Hilzinger has written, “[i]hre [Christa T.’s] Arbeit als Lehrerin konfrontiert sie mit der ersten Generation der in der DDR Aufgewachsenen; deren Verhalten—unkritische Anpassung, menschliche Unsensitbilität,

Rücksichtslosigkeit, unausgebildete Moral und Gewissen—wecken Zweifel in ihr, dass faschistische Stukturen im Denken und Handeln bewältigt seien” (Hilzinger, Christa

Wolf 34). Christa T. and Justus begin a family and remain mainly in the countryside.

Christa T. does not find herself or fulfillment with life in the country either, and so carries on a brief affair and occupies herself with plans to build a new home, which is set apart

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and isolated on a hill. She also continues her attempts at writing, which had been a generally unsuccessful lifelong pursuit. During this time, Christa T. experiences further bouts of a depression that has periodically plagued her since her studies in Leipzig and while she is pregnant with her third child, Christa T. discovers she has leukemia. It is only upon learning of her terminal illness that she is finally about to say “I” and to feel as though she understands herself and her place in the world; she in fact longs to keep living. Her house is finished and she is able to write a poem, indicating a breakthrough in her years of attempts to write. She dies, however, shortly after the birth of her daughter.

Christa T., from the time the narrator meets her in the Gymnasium at the end of the Third Reich, is an individual unconcerned with fitting into the crowd. This is problematic for Christa T., as she is initially living within the strictures of the time of

National Socialism. The difficulty continues after the creation of the German Democratic

Republic. This socialist society in which Christa T. believes and where she wants to remain also does not allow for a lack of conformity. Despite the fact that, as Anna Kuhn has argued, “Christa T.’s search for self-knowledge, her desire to explore and develop all aspects of her personality, is consonant with Marx’s ideals of fully developed individuality,” she is not able to find and understand herself and her place in society

(Kuhn 51). Even moving far from the populated center of the country does not alleviate the strain this puts on her. Her bouts with depression are the manifestation of her inability to live as a unique figure in the country in which she wants to remain. As

Theresa Hörnigk has explained it, “[e]s ging ihr [Wolf] darum, die besonderen Qualitäten von nicht an Erfolgsnormen und –ziffern ausgerichteten Menschen ans Licht zu bringen

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und herauszufinden, woran es lag, dass ihnen in der gesellschaftlichen Beurteilung ein so geringer Entfaltungsraum beigemessen wurde” (Hörnigk 122-23). This is then further compounded by her diagnosis with leukemia. Christa T.’s death from cancer is Christa

Wolf’s criticism of a societal framework that does not allow for non-conformists such as

Christa T. to flourish within it. Leukemia, a disease that affects the blood, is a choice in concert with this thematic. E. Brähler explains that the concept of psychosomatic medicine encompasses the idea that the mind influences the condition of the body, as well as that the body influences the condition of the mind (Brähler 11). Christa T.’s very blood, which runs throughout her body and is therefore a part of her entire being, has become diseased, representing a diseased state of her whole self. This malfunction of a fundamental, systemic part of her body reflects an incapacity to bring into harmony who she is and the society in which she lives. Her ability to say “I” that comes only when it is clear she will die then underscores the reciprocal connection between her life and her illness; her dying body has freed her mind to be able to at last use the first-person personal pronoun and claim her identity.

Dieter Sevin has contended that “Christa T. sieht und fühlt sich als

Schriftstellerin, zweifelt aber an sich selbst, da sie weiß, dass sie den Erwartungen des

Sozialistischen Realismus nicht entsprechen kann” (Sevin 218). Wolf wrote Nachdenken

über Christa T. in the wake of her speech during the eleventh plenum of the

Zentralkomitee of the Sozialistische Einheitspartei Deutschlands (SED) in December,

1965, which criticized the GDR’s cultural politics as being too restrictive and resulted in

Wolf’s expulsion from the list of candidates for the Zentralkomitee (Hilzinger, Christa T.

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224). This criticism of the restrictions for writers is thus emphasized through Christa T.’s ability to produce a poem only after she has learned she will die, indicating that knowledge of her impending death also lends a liberty to write, in addition to the ability to say “I,” that she had not previously felt. It seems that Christa T. needs to face death in order to come to terms with her life in a place where she did not feel free to be herself and to then finally find her voice as an artist. Her continued failed attempts to find self- realization indicate that this self-understanding would not have been possible were she to have continued living, rather than dying relatively quickly from the leukemia.

For Christa Wolf, illness and the condition of the soul, particularly in women, are tightly entwined. She expounded on this in her 1984 lecture to the East German

Arbeitsgruppe für psychosomatische Gynäkologie, entitled “Krankheit und

Liebesentzug.” She firmly believed that one’s psychological state and emotions can have a profound effect one’s health. Wolf criticized what she referred to as the “absurde

Trennung von Körper, Geist und Seele,” and instead argues for a medical model that incorporates an acknowledgement that one’s psychological state can cause or worsen physical illnesses (Wolf, “Krankheit” 414). This is an assertion clearly seen in the earlier text Nachdenken über Christa T. Christa T.’s illness has an apparent origin in her depression and in her enduring inability, from life in Germany at the end of the Third

Reich up until her death, to conform to her society and fit in.

Wolf has continued to write about cancer, and in her November 1991 lecture at the Jahresversammlung der Deutschen Krebsgesellschaft in Bremen, entitled “Krebs und

Gesellschaft,” she again emphasizes the role the mind plays in cancer and illness in

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general. Wolf pointed in particular to the continued social pressure to assimilate oneself to the proscribed norms, one that is integral to Christa T’s illness, as a particular danger in stimulating cancer growth. In this work, she did not name a specific society that is at fault, but left the criticism ostensibly open to all (Wolf, “Krebs” 337-38). She also argued for the treatment of the whole person, rather than focusing solely on the physical point of illness, noting that when she was gravely ill with a bacterial infection, reading poems by Goethe had helped her just as the antibiotics had (Wolf, “Krebs” 348). 196 I discuss a slightly different usage of the cancer in the following section, albeit one in which the mind-body connection continues to play a prominent role in Wolf’s criticism of social conditions.

Focus on Christa Wolf’s Later Cancer Text

Störfall: Nachrichten eines Tages is Christa Wolf’s 1987 account of one day in the aftermath of the nuclear explosion at Chernobyl on April 26, 1986.197 Wolf initially began the text in May of 1986, and wrote the second, final version between June and

September of 1986 (Hilzinger, Störfall 30). 198 This complex story weaves together several narrative strains: the narrator going about her day at her country home, which includes telephone discussions, chores and outings; the narrator waiting for her news of

196 Wolf’s 2002 text Leibhaftig: Erzählung is the fictionalized account of Wolf’s serious infection following a burst appendix in 1988. This work also deals heavily with the connection between the mental and physical states, as the protagonist must confront aspects of her past she had tried to ignore and a relationship in her more recent past before she can return to health. 197 According to Rechtien, Wolf wrote this work in an atypically short amount of time, and thus it is “[…] eine unmittelbare Reaktion der Autorin auf das Unglück […]” (Rechtien 230). Wolf never specifically named Chernobyl, but it is clear throughout the text and from the dates that this is the event to which her narrator is referring. 198 Sonja Hilzinger commented in her afterword to the text that the second version does not differ significantly from the first (Hilzinger, Störfall 380) 299

her fifty-three-year-old physicist brother, who is undergoing surgery for a brain tumor; her imagined discussions with her brother; and television and radio reports on the disaster. 199 As with Nachdenken über Christa T. , Wolf based her text on her personal circumstances as well. A letter from Wolf to an American friend reported that Wolf was indeed alone at her Mecklenburg house when news of the Chernobyl accident reached her on the same day her brother underwent brain surgery (Hilzinger, Störfall 381). Wolf then took this personal situation and described the technological advances employed to treat the brother as a counterbalance to the destruction wrought by the advances in nuclear technology. The crux of this text is the unnamed Ich-Erzählerin ’s struggle with the idea of progress, both technological and social, and her own role within it. To this end, cancer is an ideal representation of both the consequences and benefits of technology in the late twentieth century.

The accident at Chernobyl caused more than 100 times the radiation to be released into the atmosphere than the atomic bombs in Hiroshima and Nagasaki. More than 400 million people as far away as the United States were subject to the radioactive fallout from Chernobyl, and an estimated 2,500 people died as a result of the disaster.

The number of fatalities could still rise by as many as 30,000 people, since some cancers take decades to develop into identifiable disease (Rigby 122-3). 200 Wolf’s use of cancer in this work therefore establishes an initial link between the brother’s case and the events

199 Hausmann has explained that this is Wolf’s fourth text written like a diary, and asserts that therefore “[…] diese Schreibform treibt eine aktive schriftstellerische Selbstverständigung voran“ (Hausmann 385). 200 Hatch, et al., in their 2005 study of the effects of the Chernobyl accident on both emergency responders and the general public, noted that the most common cancer related to the disaster has been thyroid cancer in children. Further, while risks for thyroid cancer and leukemia do not appear to be elevated in adults of the general public, there does appear to be a link between emergency workers immediately involved in the clean-up and the development of leukemia (Hatch, et al. 63). 300

of the day. As with most cases of cancer, there is no indication as to what may have caused the brother’s tumor, but it is understood that the day’s catastrophe will surely result in an untold number of new cancers. The brother’s tumor therefore serves as a representation of the lingering destruction of life that will follow for years and decades to come.

Just as cancer can be catalyzed by the byproducts of scientific progress, so can it be cured by the results of that same drive to further technological advances. The narrator details her thoughts about what kind of saw will be used to open her brother’s skull, the instruments the surgeons will use, and how they will do so. In her mind, she addresses her anesthetized brother far away in the hospital, describing “[…] dass ein metallenes

Instrument gerade jetzt an deiner Hirnhaut entlangführt, vermutlich die Hirnmasse beiseiteschiebt, um Platz zu schaffen für ein anderes Intrument, an dessen Ende sich ein

Mikroskop befindet” (Wolf, Störfall 15-16, 19-20). The narrator then goes on to tell of a new computer she had seen on television that was developed to have better precision than human hands in a brain surgery (Wolf, Störfall 20). In describing these technological advances, the narrator is exposing the positive, beneficial outcomes of the push for new knowledge. Just as her brother will be ostensibly cured with the help of such technological developments, so will many cancer patients in the future be aided by products such as the computerized surgical tools.

The other side of these advances, however, is the criticism implicit in the intertwining of Chernobyl and her brother’s illness. After all, how many people would be spared the need of such tools in the first place if the modern world had not brought with it

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the deleterious side effects of the continuous, relentless push for scientific progress? The narrator exposes the ultimate link between the two when she, speaking from the future, mentions that the doctor will not recommend radiation treatment in her brother’s case

(Wolf, Störfall 30). Here, the very thing that on this day in 1986 is causing so much worry and uncertainty, as well as leading to new cases of cancer, is also an option sought by many for a cure.

“Wieder einmal, so ist es mir vorgekommen, hatte das Zeitalter sich ein Vorher und ein Nacher geschaffen,” writes the narrator, and indeed, this twin occurrence of

Chernobyl and the brother’s tumor create this division of life before and life after both

(Wolf, Störfall 44). 201 The nuclear accident prompts the narrator to consider whether humans can or should limit their drive for progress. She implies that the brother’s tumor may have been partly a result of his own occupational ambitions, explaining that post- operatively he will have to relax, rather than “[…] in immer neuem Anlauf jene Gebiete deines Nervensystems hochpeitschen, die dir vielleicht mit Hilfe der Krankheit gerade nahelegen ‘wollten’, sie ein wenig zu schonen (Wolf, Störfall 92). This is in keeping with Wolf’s general belief, as discussed in the previous section, that illness can be a direct result of one’s mental state. In this case, she suggests that the brother’s cancer is at least in part a consequence of his unhealthy dedication to his work. His body has forced him to cut down on the hours spent following his own ambitions, just as the nuclear reactor accident is a sign to those scientists and the world at large to curtail their own efforts in order to stave off such disasters.

201 Hilzinger has explained that the other moments of this type of division are the end of World War II in Germany and in Japan (Hilzing, Störfall 377). The use of the atomic bomb in Japan is another instance of the harm that technology can cause in the name of doing something beneficial for other lives. 302

Wolf has woven into this work the indictment of those, including her narrator, who pursue knowledge without regard for possible effects of this ambition. This theme forms the basis of Wolf’s Erzählung and in extending its reach, Wolf’s central question of how to approach this problem becomes applicable not just to nuclear researchers, but to any profession whose practitioners, in seeking to further that profession, lose sight of the potentially negative consequences of their exploration. In the same way the nuclear researchers seem to have lost sight of the hazards of their research, so have her brother’s surgeons “[…] in unvermeidlicher Berufsroutine, deine [des Bruders] und meine ehrfürchtige Scheu vor einem Eingriff in jene Sphäre verloren haben, in der beschlossen liegt, ob wir so oder so anders sind“ (Wolf, Störfall 51). In this case, the surgeons are able to probe the brain and remove her brother’s tumor. The narrator asserts, however, that they need to remain aware that what they are doing can have serious ramifications that could alter this man’s personality or otherwise affect him for life, rather than simply seeing her brother’s case as a technical challenge to be mastered.

It was the physicist brother who had first suggested to the narrator that she, too, could be complicit in such deleterious actions. In a discussion prior to the brother’s surgery, wherein the narrator criticizes scientists for not reigning in their desire to know more and achieve more, the narrator notes that her brother had countered this by asking:

“Ob ich nicht mal zu ihm gesagt habe, Worte könnten treffen, sogar zerstören wie

Projektile; ob ich denn immer abzuwägen wisse […] wann meine Worte verletzend, vielleicht zerstörend würden?” (Wolf, Störfall 55). This exchange highlights Wolf’s assertion that it is not just the scientific community that needs to be wary of how its

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creations are utilized. Words can be just as harmful to the individual as nuclear radiation or reckless surgical ambitions. This is particularly significant when considered in light of

Wolf’s strongly held belief in the connection between one’s mental state and physical health. Writers must therefore be as cautious as scientists in recognizing the limit where a positive ambition can turn into one with devastating consequences. While the bulk of this text is focused on the scientific community, Wolf has not granted other types of creators freedom from responsibility.

The brother’s brain tumor also becomes analogous with the “blinder Fleck” the narrator sees as present in each person’s mind. This blind spot, she theorizes, is responsible for the drive that compels people to be ignorant of the consequences of moving past a critical point in progress which then leads to harmful effects rather than beneficial ones (Wolf, Störfall 65). As Ute Brandes has remarked, this type of occurrence is a quest for utopia gone wrong which has turned into a dystopia (Brandes

106). The scientific researchers have pushed technology to the point of creating nuclear power, which in theory is a type of energy production that could be a promising alternative to traditional ones. This has also led to the Chernobyl disaster, however, the dystopic result. This idea also corresponds with the surgeons’ attempt to root out the cancerous lesion causing harm, the “Kern des Übels” (Wolf, Störfall 28). Ideally, the surgeons will use the latest advances in tools and technique to cure the narrator’s brother of this malicious growth, causing no harm. However, in the process of doing so, they may overstep the limits of their abilities with serious or even catastrophic negative effects, as discussed above (Wolf, Störfall 28). If this blind spot allowing for progress

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without thoughts of consequences can be identified and extricated, then the path of progress will be accompanied by an enlightened understanding of where it could lead, thus enabling humans to prevent or alleviate the negative results.

Wolf’s narrator identifies two further destructive drives within the scientific community in addition to the blind pursuit of creation: an obsession with destruction and death, as well as the pursuit of personal glory. The narrator focuses in particular on the scientists connected with the Strategic Defense Initiative (“Star Wars”) efforts of the

United States, which was established in 1983 to create anti-missile machinery. The narrator describes the lives of these men who are ostensibly working for the greater good of the citizens of the United States and driven solely by their work:

Dies waren ja Menschen auf einer Isolierstation, ohne Frauen, ohne Kinder, ohne Freunde, ohne andere Vergnügungen als ihre Arbeit, strengstens Sicherheits- und Geheimhaltungsvorschriften unterworfen; […] Was sie kennen ist ihre Maschine. Ihr lieber geliebter Computer. An den sie gebunden, gefesselt sind, wie nur je ein Sklave an sein Galeere. (Wolf, Störfall 68-9)

The narrator surmises initially that they are working toward the goal of confining any nuclear warfare to the skies, which was in keeping with the official explanation of the program (Wolf, Störfall 69). This would not ultimately afford people much protection, but at least is not an inherently destructive pursuit. She then remembers her viewing of the film Star Wars in California, near the Livermore laboratory where these men research. The narrator imagines the director, the researchers, and the politicians working together to create the weapons in the film. At this moment, she realizes that: “Nicht das

Phantom ‘Sicherheit’—nein: der Sog des Todes ist es, die Machbarkeit des Nichts, die einige der besten Gehirne Amerikas da zusammentreibt” (Wolf, Störfall 70). These men

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are working, isolated from all other human interaction, in order to feed their own impulse to create weapons of destruction, despite their stated mission at Livermore.

This does not impel all of the scientists there, however. The narrator describes one named Peter Hagelstein who works fourteen to fifteen hours a day not for the security of the United States nor for the destruction of other countries, but because his ultimate goal is to win the Nobel Prize. Fame provides his reason to work on the

Strategic Defense Initiative, without regard for the ways his laser may be used. In his pursuit of this goal, he has lost his lover, who continues to demonstrate against the development of bombs—which he, too, had earlier claimed to despise (Wolf, Störfall 70).

Through these two descriptions, Wolf has established further evidence for the dehumanizing effects of ambition blind to consequences that extends beyond the Soviet

Union and her own country. These American scientists all seem to have either lost sight of how their work could be used to harm people, or perhaps never cared about that in the first place as they continued on in pursuit of scientific progress and weapons development. This “blinder Fleck” is an international epidemic that must be removed from the minds of people, and scientists in particular, throughout the world, but especially within the super powers of this time due to the especially devastating consequences of their research. The Chernobyl disaster, with its far-reaching repercussions crossing many borders as the fall-out spreads, serves as a stark reminder that the actions of individual nations and even individual men can have an impact that extends across the globe.

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Rechtien draws a parallel between the operation being performed by the surgeons and the narrator’s own “Bewusstseinsarbeit” on how to remove or prevent this blind spot

(Rechtien 241-42). As the narrator considers the relationship between progress and its potentially harmful effects, the first step in alleviating this problem is looking deeply into oneself to recognize that the blind spot exists. Her daughter first suggests this, asserting that “[…] warum solle es nicht eine Chance für eine ganze Kultur sein, wenn es möglichst viele ihrer Mitglieder wagen können, der eigenen Wahrheit ohne Angst ins

Gesicht zu sehen?” and the narrator responds to herself that indeed, this would be “die allerutopischste von allen Utopien” (Wolf, Störfall 98-99). As with a tumor, the chance for a cure begins with the exploration of the true nature of the malignant element. Only then can the proper course of action be determined in order that the best results may be obtained. The narrator also examines and reconsiders what she realizes is the primacy of human interactions and relationships over all else, and which is therefore the ultimate cure to this problem of the blind spot.

This becomes clear when she addresses her absent brother with the declaration that each person wants to be loved, but that when that does not come to fruition, “[…] dann schaffen wir uns Ersatzbefriedigung und hängen wir uns an ein Ersatzleben,

Lebensersatz, die ganz atemlos expandierende ungeheure technische Schöpfung Ersatz für Liebe” (Wolf, Störfall 40). Much as the brother’s brain tumor must be excised to prevent further damage, so, too, can the relentless inner drive for progress be tempered if people can remove this dangerous blind spot—or perhaps never form it in the first place—by retaining a connection to others, rather than by assigning priority to

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technology. 202 Only then can a sense of the boundaries needed in their work and their ambitions be attained, as one does not lose sight of the potential consequences to humans.

Wolf’s narrator offers hope that this can happen when she, speaking in a parenthetical aside written five months past this April day she is describing, learns that

Peter Hagelstein has left the Livermore research laboratory in California. Upon hearing the news, she writes: “Einer hat es geschafft. Nichts ist endgültig,” (Wolf, Störfall 97).

While the narrator does not provide further details on Hagelstein’s departure, and she does not seem to know whether the realization of his “blinder Fleck” is the actual cause, the very fact of his resignation gives her hope that Hagelstein had left for reasons connected to an understanding of this principle. 203 This then lends an optimism that it would be possible for the other researchers to do the same. Further, as Franz Hebel notes, “der Störfall im Fall des Bruders wird vermieden“ with the successful operation

(Hebel 43), and this adds hope that the same will be true in the future for potential nuclear disasters as well as any other possible disasters associated with the products of modern life.

The relationship between the brother and sister also imparts a positive note to the narrator’s story. She believes the cause of this deleterious lack of love in the lives of the researchers is the sacrifice of love to the pursuit of their work, consequently resulting in the drive for knowledge (Wolf, Störfall 69). As Dieter Saalmann has explained it, the scientists place primacy on thanatos (death drive) over eros, contributing to their blind

202 As William Rey has claimed, the importance of love in order to have humanity is a common theme in Wolf’s writings (Rey, “Blitze” 375). 203 According to Hagelstein’s website through the Massachusetts Institute of Technology, he joined their faculty after leaving Livermore. His current research focuses on finding inexpensive sources of electricity and low-energy nuclear reactions for the same purpose (“Peter L. Hagelstein”). 308

spot (Saalmann 21). The narrator’s connection with her physicist brother, though, is so strong that she even senses the very moment he awakens from his operation. She spontaneously begins to sing “An die Freude” at 1:45 PM, which she later confirms was the time he had regained consciousness (Wolf, Störfall 63).

At the same time the brother’s doctor tells him that the operation has been successful in removing all of the harmful cells, the narrator is at a spot in the woods where the ancestors of Homo sapiens are said to have performed their ceremonies. Her feelings about the development of culture and customs are not wholly positive, and indeed tinged with criticism. She describes that through the development of ceremonies,

“[…] sie [diese Leute] sich in ihrer Überzeugung von der Überlegenheit, ja

Allgemeingültigkeit ihrer Wesensart befestigten” (Wolf, Störfall 75). In juxtaposition with the positive outcome of her brother’s surgery, this again highlights the theme of reigning in the negative sides of progress while fostering the positive aspects. The tracing of his operation and her concerns for his health both underscores the love and connection she feels towards her brother, and also emphasizes the conundrum with which she wrestles throughout the work.

Their relationship also brings up an issue Wolf has earlier also covered: that of men in the scientific world. In her 1972 Erzählung “Selbstversuch,” Wolf had written of a female scientist who submitted herself to be the first human test subject for a pharmaceutical that turns women into men. The narrator had to a large extent already assimilated herself to the expectations of the masculine world: she is unmarried, has no children, and is dedicated to her work. When she awakens as the male Anders, she

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experiences both the world-view and the emotional impulses of a man, and ultimately decides to end the experiment early and return to her female body. Helen Fehervary and

Sara Lennox, in their introduction to the English translation of “Selbstversuch” in New

German Critique, described the differences the narrator discovers in the masculine mode of perception. They argue that:

The male mode corresponds to what one might term positivistic, or scientific in its worst sense: the external world is taken to exist independently, unaffected by the subject’s interaction with it […] The heroine, on the other hand, has perceived the world holistically, as the much richer interaction of objective fact and subjective response […] (Fehervary and Lennox 110-11) 204

This traditionally male mode of thinking is essentially the same phenomenon Wolf’s narrator criticizes in Störfall , and it is the female one for which she advocates. Although the female narrator does admit to having used her words in the past in ways that harm others, and therefore does not entirely exclude either women or writers from such behavior, it is predominantly the male sphere of science to which her brother belongs that is responsible for the massive destruction in the world, either potential or realized, at the time of Chernobyl. Just as the narrator in “Selbstversuch” ultimately decides she will now pursue, as she explains it, “[…] der Versuch zu lieben. Der übrigens auch zu phantastischen Erfindungen fürht: zur Erfindung dessen, den man lieben kann” (Wolf,

“Selbstversuch” 501), so too does Störfall ’s narrator advocate for a scientific realm in which the scientists maintain connections to others rather than isolating themselves with their work. Friederike Eigler, in her article on “Selbstversuch” argued that “[…] the

204 Fehervary and Lennox have discussed the work’s thematic by explaining that: “The critique of patriarchy exhibited by Wolf’s story is intended most explicitly in the context of the GDR as a critique of the Marxist-Leninist Party and the societal forms which have evolved from it” (Fehervary and Lennox 111), but this work can also be seen as a critique of the scientific process in general.

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narrator-scientist adopts a new subject position, one that is capable of and responsible for designing alternative experiments and for formulating different research objectives”

(Eigler 410), and the same idea could be applied to Störfall. This female-associated understanding will be what brings science back to humanity and human-centered objectives, rather than veering even further towards political, personal, or destructive aims.

The text ends with the narrator settling down to read Joseph Conrad’s Heart of

Darkness before she goes to sleep, after having just gone through her nightly routine with the unsettling addition of a brief meditation on the first signs of radiation poisoning

(Wolf, Störfall 109). Conrad’s text seems to lend the narrator a certain resolve that

Therese Hönigk has explained as “[…] die Gewissheit und die Ermutigung, weiterhin die

Sprache als Medium des gesellschaftlichen wie individuallen Erkenntnisprozesses einzusetzen” (Hörnigk 233). The narrator will continue writing, and, as Axel Goodbody explains, just as Conrad was able to expose the blind spot of his time, “exploitative colonialism,” (Goodbody 18) the narrator may likewise be able to do the same with her words by expressing her thoughts about scientific research. Despite the uncertainties and upset of the day, due both to the accident at Chernobyl and to her brother’s surgery, the final words of the text are simple and lacking any hint of fear: “Wie schwer, Bruder, würde es sein, von dieser Erde Abschied zu nehmen” (Wolf, Störfall 112). Her brother’s tumor has been removed and she seems to be filled with a new resolve to advocate for the excision of that metaphorical tumor that drives people toward destruction rather than toward connection with others.

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An American Representation in Fiction: Cherríe Moraga

Chicana-American author Cherríe Moraga has used cancer in her play Heroes and

Saints, which was first performed on April 3, 1992, at the El Teatro Misión of San

Francisco, to thematize the inequity of the immigrant and first-generation living conditions due to the actions of large, powerful corporations. The basis of the storyline is the rash of birth defects and cancers experienced by the Mexican-American farm workers in the San Joaquin Valley town of McFarland, California, in the mid-1980’s (Greenberg

163). The action of the play centers around the Latino community of the fictional

McLaughlin, California in 1988. The pesticides used in growing the crops harvested by many of the community members have leached into the water source and caused an eruption of birth defects and cancer deaths in children. The living children of the community have taken to attaching the bodies of the dead children to crosses, in imitation of Christ’s crucifixion, and placing the crosses amongst the fields as a sign of protest against the poisonings. The central family of the play has a daughter, Cerezita Valle.

This character is based on a child Moraga had witnessed in McFarland who was born without limbs (Greenberg 163). Cerezita Valle is missing her entire body due to the contamination, and so is just a head, albeit a fully functioning one. The family also suffers the loss of an infant granddaughter, Evalina, who dies of a tumor during the course of the play.

These staged crucifixions gain mainstream media attention, as it is unclear to those outside the community who is creating them. This situation leads to conflict amongst the family. The mother longs to keep Cerezita Valle, as a severely deformed

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child, secluded from the ridicule of the outside world, and so does not want her to take part in any traditional protests against the unnamed corporation that are being organized by her close friend. She also does not want Cerezita Valle to reveal who is responsible for the crucifixions out of fear for the safety of all, as the children who are staging them are coming under gunfire as they take the crosses to the field. The occasional sounds of the crop duster planes spraying pesticides indicate that the company has not given in, but in a final act of defiance, Cerezita Valle and her priest friend, having been given her mother’s blessing, take the cross with the body of her dead cousin out into the fields. The two are gunned down by the company. The play ends with those villagers who have witnessed this, led by Cerezita Valle’s brother, running into the fields and setting them on fire, ruining the crops.

This play is chiefly a harsh indictment of the working conditions under which many immigrant and first generation families suffer. The company does not care for their well-being and exploits them as a labor force. Moraga uses the deformities and cancer deaths of innocent children because this is the most severe consequence of corporations who act in this manner. Not only do children needlessly die, but in doing so, these communities will not be able to continue, as they will soon die out due to a lack of progeny surviving to adulthood. Further, Moraga condemns the mainstream society for its lack of interest in these injustices. It is only when the community begins to protest using the children’s lifeless bodies on crosses that any notice is taken of the atrocities being perpetrated. Using cancer rather than another disease is not only more powerful, as

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it brings with it images of a long and painful death, but it is also an accurate choice, given the reality on which it was based.

An American Representation in Non-Fiction: Jonathan Harr

Jonathan Harr’s 1995 non-fiction work A Civil Action is a text that explores social and ethical aspects relating to cancer from another angle. It presents the legal case surrounding a cluster of leukemia deaths in Woburn, Massachusetts, during the 1970’s.

This work first briefly chronicles the eight families who lost loved ones to leukemia and then moves on to focus on the cases the families brought against Beatrice Foods; W.R.

Grace, a chemical company; and UniFirst, a company that rents out professional uniforms and also cleans them. The families brought the cases against these companies because they believed each had contaminated the water wells serving their homes with the chemical trichloroethylene (TCE). They contended that this chemical had caused the cluster of leukemia deaths.

Ultimately, UniFirst settled the case for one million dollars in the fall of 1984 and

W.R. Grace settled for eight million dollars on September 22, 1986. The case against

Beatrice was dismissed by a jury for lack of culpability on July 28, 1986. That following winter, the Environmental Protection Agency issued a report showing that both W.R.

Grace and Beatrice had indeed contaminated the water, thus, too late, proving the jury wrong. It was then only a few months later that the primary plaintiff’s attorney, Jan

Schlichtmann, discovered a private study of the land in question that had been completed in 1983, and also indicated the water had been contaminated. Schlichtmann attempted to

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re-try the case based on the fact that this evidence had not been released by the defendants during the discovery phase of the trial, but his efforts were stalled by a judge whom Harr portrays as partial to the defendants. The cancer cases that serve as the backdrop to the work as well as the impetus for the trial highlight both the environmental dangers of unchecked, uncontrolled waste disposal by companies, and also the prejudice that can be shown by these companies when they are asked to accept responsibility for their actions by compensating the families affected by their recklessness. This serves as a call for stricter governmental control and greater support for the less powerful individuals who suffer at the hands of these companies’ quest for profit.

A Swiss Representation: Verena Stefan

In Verena Stefan’s 2007 novel Fremdschläfer , she has used cancer to comment on the political and social situations in Canada, as well as in her native Switzerland . In this work, which is autobiographically based, the protagonist, also named Verena, but without a specified surname, has moved to Montreal to be with her female lover Lou. Verena is favorably impressed by the equal value placed on heterosexual and homosexual relationships in the Canadian immigration process, as well as by the positive attitude in

Canada towards all immigrants as it stands in contrast to that of Switzerland, as evidenced by the experience of Verena’s German-Czech father.

Verena, however, soon discovers a lump in her breast that is diagnosed as cancer, as was the case in Stefan’s life following her own emigration to Canada in 2000.

Following the fictional Verena’s cancer diagnosis, she is not only a foreign body in

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Canada, no matter how well-received her residency is, but she also houses a foreign body within her own. She comes into conflict with her new homeland through her cancer, as she longs for the greater presence of holistic, alternative care in Switzerland. These options stand in opposition to the strictly hospital-based treatments in Canada that she believes give too much power to the medical establishment and leave the patient feeling helpless. This lack of control over her care distances Verena from her body, and therefore also from her identity as connected to her body. She experiences some panic, too, as her body loses hair and skin cells due to treatment, reflecting the casting off of her

European identity for her Canadian one. Leaving behind parts of Switzerland is also a positive process for her, however, because she escapes the negative associations she holds for her birthplace. These include her horror at the capture and display of the bears continuously housed in Bern as a nod to the city’s name, as well as the difficulty her father had finding a home in Switzerland. In the end, the cancer experience is very much tied to Verena’s immigration experience, and so the physical is intertwined with the social and political as she seeks to establish her life in Canada.

Gender in Texts Concerning Cancer

The gender divide in fictional works about cancer carries a different significance in the cancer texts than it does in the consumption/tuberculosis works. As with consumption/tuberculosis, a majority of the figures with cancer are women. This is due in part to the increasing public awareness of breast cancer, as well as this particular cancer’s associations, as discussed above. The cancer texts involving women, however,

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are also frequently written by women, and present strong figures such as Vivian Bearing in Wit , Renata Wilford in Bodily Harm , and Christa T. in Nachdenken über Christa T.

These female cancer patients are the center of these texts, rather than being included in service to the male figures, as was the case with the tuberculosis works. They are not drawn as weak figures who need to be taken care of by men; although male figures may help them during the story, they are the primary agents of their own lives and decisions.

This is also a reflection of the increasing fight for women’s rights and the recognition of their equal capabilities that were developing in the 1960’s and 1970’s. Thomas Mann’s condescending treatment of Rosalie von Trümmler in Die Betrogene as a flighty woman stands in stark contrast to Renata Wilford, Vivian Bearing, and Christa T., and it seems outdated in comparison to these women, as well as to similar representations that would come to be common.

Sexuality is also problematized in cancer autopathographical and fictional works, although again in a different way than in consumption/tuberculosis fiction. The problematic in cancer texts is predominantly focused on self-perception, rather than on the view of the outside world. Audre Lorde, for example, described in The Cancer

Journals her struggle, which is ultimately successful, to view herself as a sexual being after having a part of herself removed that had been so central to her sexuality, and

Brigitte Reimann recorded similar feelings in her cancer writings. The fictional Renata

Wilford goes through a similar conflict in Bodily Harm , as she must rediscover her sexuality in the wake of her breast cancer surgery. Reynolds Price likewise has his sexual life altered by cancer, despite his tumor’s location in his spine, a non-sexual organ.

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The reduced importance of sex in his post-cancer existence is a primary theme of A

Whole New Life . The impressions and views of others are not without impact on the cancer patient’s view of his sexuality, but they are not the primary concern, as they are in the consumption/tuberculosis texts. This is in concert with the focus on the individual and the individual’s experience that is the hallmark of works concerning cancer, be they fictional or experiential.

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Conclusion

The tuberculosis and cancer works that I have discussed confirm the interrelation among biological disease and its treatment modalities, the societal perceptions of that disease, and its literary manifestations, whether the text dates from the nineteenth century or the present day. The societal reactions across Europe and North America have proven to be quite similar, and the literary reactions to them also bear striking commonalities.

As I have shown, for each disease, this has resulted in three predominant representations.

For tuberculosis, these are: the sentimentalized depiction of the consumptive/tubercular person, the naturalist depiction of the disease, and the intersection of tuberculosis and bourgeois culture. For cancer, these are: the autopathographical model, the depiction of cancer as a transformative experience in fiction, and the representations of cancer linked to social or ethical concerns. In the texts concerning tuberculosis, there is a clear historical progression in the primary literary depictions of the disease, while this is less the case with the cancer literature, where the principal portrayals of the disease overlap significantly in their chronology.

The earliest and most popular construction of tuberculosis was that of the sympathetic consumptive or tubercular figure. This depiction emerged in the nineteenth century and it was a reflection of the popular conception of this disease at the time in

North America and Europe as being etherealizing and spiritually edifying. This can be

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seen in texts such as Charles Dickens’ novel The Life and Adventures of Nicholas

Nickleby (1838-39) and Victor Hugo’s novel Les Misérables (1862). This is also the most simplistic portrayal of the disease, and these figures generally were uncomplicated representations of goodness and purity that stood in contrast to the world around them.

Although there were consumptive characters, such as Marguerite Gautier in Alexandre

Dumas fils’ La Dame aux camélias (1848), who were more complicated representatives of this paradigm, they were the exceptions. These works then also in turn reinforced and disseminated this association of tuberculosis and goodness, which lasted to some degree until the early twentieth century. Erich Maria Remarque’s novel Drei Kameraden (1938) offers evidence of the longevity of this perception of consumption/tuberculosis and its sufferers, as Patrice Hollmann is a late representative of the earlier sentimentalized consumptive and tubercular figures whose virtue is a counterpart and example to the less exemplary figures around them.

In concert with the rise of the naturalist movement at the end of the nineteenth century, the next prevailing paradigm of tuberculosis was a naturalistic presentation of the disease. These works, such as Eugene O’Neill’s The Straw (1918), offer scientifically accurate depictions of tuberculosis as a scourge that particularly affects the poor and the disadvantaged. With this usage of the disease, the authors often condemn the forces that have led to this situation, be they personal, societal, or political, and highlight the true nature of the disease as a painful, debilitating experience. Another theme frequently present in the naturalist portrayals is that of tuberculosis as the catalyst for a moment of crisis that changes the nature of relationships or highlights problems within them for the

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patient and those surrounding him. This is again an accurate usage of this disease that was still often fatal, given the lack of any truly efficacious treatment modalities. Its diagnosis was thus a significant, life-altering event, which, as with any potentially fatal illness, frequently results in considerable turmoil for the patient and those around him.

This can be seen in both Arthur Schnitzler’s novella Sterben (1892) and Eugene

O’Neill’s later play, Long Day’s Journey into Night (1942), wherein the tuberculosis diagnosis catalyzes important revelations and considerable alterations in the interactions of the tubercular figure and his intimates . For many of the naturalist texts, the sanatorium as a locus of treatment plays a major role. This is historically accurate due to the rise in popularity of sanatoria during the end of the nineteenth century. It also provided the authors with a true situation in which relationships are tested, broken, and potentially newly formed, and the patients themselves are changed, as borne out in particular in The

Straw . The naturalist depictions were largely confined to the late nineteenth century and the early twentieth century, but, as with all depictions of tuberculosis in North America and Europe, disappeared almost entirely by the 1960’s as medicine advanced in its cure rates.

The latest and most complex depiction of tuberculosis was as a means of engaging with aspects of bourgeois culture, using the disease to reflect cultural conditions that may have little to do with the disease itself. The mores and lifestyles of the middle class were a frequent topic of criticism in all literature during the height of the production of these tuberculosis works from the mid-eighteenth century through the early twentieth century, and so they are a further extension of this trend. This was largely a phenomenon

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of the very late nineteenth century and early twentieth century in tuberculosis fiction, although Dickens’ novel Dealings with the Firm of Dombey and Sons (1846-48) is an early example that uses tuberculosis to criticize capitalism and the middle-class striving for wealth. The authors employing tuberculosis in this manner nonetheless engage with the established popular conceptions of tuberculosis and its treatment, particularly its then- incurable nature and the sanatorium culture it engendered, using them to make broader criticisms. Thomas Mann is the author most closely associated with this paradigm, which can be seen in a concentrated form in the 1903 novella Tristan , whereby he uses the location of the sanatorium as a means of bringing together Spinell and Gabriele

Klöterjahn in his criticism of bourgeois dilettantism and the progression of Gabriele

Klöterjahn’s disease to mirror her seduction into Spinell’s vision of her. Mann’s novel

Der Zauberberg (1924) offers a more expansive look at bourgeois culture through sanatorium life, as the protagonist Castorp is confronted with an international array of middle class convictions and lifestyles, ultimately choosing not to follow any of them.

Mann’s inclusion of the realities of tuberculosis treatment in Der Zauberberg , such as pneumothoraces and x-rays, is far more extensive than in Tristan , and these details add to the establishment of the sanatorium as a world foreign to Castorp, in which he will encounter these new possibilities. The approach of World War I and Castorp’s descent from the Berghof sanatorium to join the war and likely die in battle connote the end of the bourgeois life and culture as he experienced it. This depiction of tuberculosis likewise essentially ended with the advent of antibiotic cures.

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The paradigms of cancer portrayals under discussion exhibit a similarly strong connection to the medical and cultural realities of the disease, but the development of its primary modes of portrayal occurred with a less defined chronological progress.

Occasional fictional accounts of cancer appeared in the nineteenth century, long before the publication of experiential accounts, but there was no substantial trend in cancer fiction before the late twentieth century; rather, it was isolated examples, such as Theodor

Storm’s novella Ein Bekenntnis (1887). The autopathographical accounts published in the late 1970’s in both Europe and North America were the first widely identifiable trend, inaugurated by the publishing of Betty Rollin’s account First, You Cry (1976), Fritz

Zorn’s text Mars (1977) and Maxie Wander’s diary entries Leben wär’ eine prima

Alternative (1980). This was in keeping with the general tendency to focus on the individual experience, and as such, these accounts exhibit much variation in the details of each cancer case and the focus of the writings. Each writer has been able to present his unique story, told in the midst of his unique life circumstances. Cancer is also a much more varied disease than tuberculosis, which is primarily presented as a pulmonary illness. Experiential accounts therefore present a multitude of individual cancer locations, which leads to an attendant variety of treatment plans, prognoses, outcomes, and cultural associations accompanying the type of cancer.

Although there are themes, such as rebirth, that are common to many autopathographies, the variations are too great to be able to establish a unified presentation of the cancer experience. Breast cancer, for example, is a type that brings with it issues of sexuality and gender that are simply absent from accounts of leukemia or

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spine cancer. Added to this are the social, ethical, and political situations that surround certain cancers. This is especially true for works concerning breast cancer, in which the general societal silence about the disease and the lack of agency felt by many women throughout North America and Europe have led to a particular focus on these topics in accounts of the illness. In the works I have discussed, women have exposed and criticized the problematic societal relationship to breast cancer and advocated for change.

There is no similar phenomenon in specifically male cancers, such as prostate or testicular cancer. These diseases have received particular attention in the last decade, especially with the publication of Lance Armstrong’s work chronicling his testicular cancer, but they have otherwise appeared much less frequently as the subject of autopathographies arguing for political or societal change. This could be due in part to the stigma that continues to be attached to cancers of the male genitalia. Further, as pathographies and autopathographies concerning these diseases began to be produced, the issues of awareness and social change had largely been taken up by organizations linked to general cancer awareness, which was not the case when breast cancer autopathographies were first being written in the late 1970’s and early 1980’s.

Interaction with the medical community is much more important in this representation of cancer than it is in any representation of tuberculosis. This is due in part to the reality of tuberculosis treatment; physicians could do little more than supervise and so were not often an integral part of the illness experience. Rather, the locations of treatment, the sanatorium, and the interactions among the patients there, were much more fundamental and influential. For cancer patients, this is not the case. As medical

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advances have meant ever more treatment options for the disease, the interaction with the physicians and healthcare workers are far more central to the experience than those with fellow patients. Hospital stays are also generally limited, and so the chance to interact with fellow cancer patients on a daily basis is restricted or non-existent. This is therefore an important aspect of cancer autopathographies; patients report their relationships with their medical caretakers, presenting both positive and negative experiences, as they pursue remission or a cure. Maxie Wander, Audre Lorde, and Reynolds Price each wrote extensively of their experiences with caretakers in their respective autopathographies.

The negative experiences often serve to expose deleterious medical practices, and act as an implicit or explicit call for change, as is particularly the case with Lorde. Cancer autopathographies continue to be written to the present day, both in the testimonial and activist models, and this will likely continue until prevention and cure are achieved.

The paradigm of fictional accounts of transformative change through cancer emerged in earnest just after the onset of the autopathographical model, with the earliest significant fictional works in this trend, such as Margaret Atwood’s novel Bodily Harm

(1981), being published in the early 1980’s. These accounts deal with many of the topics commonly broached in autopathographies, such as often negative interactions with the medical community, the issue of body image, and identity. They are somewhat more uniform than experiential accounts, but it is largely a unity in thematic rather than in terms of a particular representation of the disease. The most frequent theme in fictional cancer texts is that of transformative change due to the diagnosis of cancer. Thomas

Mann’s novella Die Betrogene (1953) is a fictional treatment of this theme in, written

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well before it would become a standard usage of cancer. While Mann’s depiction is ironic, it nonetheless underscores the popularity of the re-formation of identity in the wake of a serious illness, which, in the decades following this work’s publication, would ever more frequently be cancer as the use of this disease grew in popularity.

Breast cancer has here, too, proven to be an especially popular choice, owing not only to the true prevalence of the disease, but also to the questions of sexuality and selfhood that this particular cancer brings with it. Bodily Harm serves as an example where breast cancer has led to significant personal growth and change for the central character. The medical community has played a role in this text, but it is only one of many influences in this process of transformation. In the play Wit (1991) , Margaret

Edson then focuses on the identity shift brought about through much more sustained contact with the medical community. With a few exceptions during flashbacks, Vivian

Bearing is shown almost exclusively as a patient in a hospital whose sole interlocutors up until her last day alive are her physicians and her nurse. Edson has used these interactions to advocate for the acknowledgment by the medical community that patients are more than their disease-assigned disease, and also for the primacy of compassionate human interactions in daily life. This usage of cancer continues to be the predominant one in fiction today.

The most complex depictions of cancer are those in which the disease is employed to criticize another entity, as was also the case in analogous works involving tuberculosis. The central concern of these works is not the experience of the disease, but rather its relation to another social or ethical issue. In the tuberculosis fiction, this

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criticism was most frequently leveled at the middle-class culture, as in Tristan . Whereas one can determine a very slight chronological progression from experiential to fictional accounts of transformative change involving cancer, cancer fiction linked to social or ethical concerns has occurred throughout this time and even earlier, albeit with a much lower frequency than the other two modes of depiction. While autopathographical and transformative fictional accounts seem to be linked in terms of the themes within each, there is generally not this clear connection between those portrayals of cancer and this one. Rather, it seems to exist separately from those, albeit with its occasional commonalities in the description of cancer diagnosis and treatment.

In the latter half of the twentieth century, larger social and ethical questions, both national and international, were becoming increasingly present in the literature of the time, and the criticism that utilizes cancer is therefore of a wider range of entities.

Christa Wolf’s cancer works are particularly representative of this paradigm. While

Nachdenken über Christa T. (1968) deals with cancer in conjunction with conformity and society, Störfall: Nachrichten eines Tages (1987) is a text in which cancer is used in a criticism of technological innovation and development worldwide, and particularly in the western world. Literary texts that align with the paradigm of cancer depiction also continue to be written today, indicating the perpetuation of cancer illness as a means of effecting change or highlighting social or ethical problems.

The medical and social realities of tuberculosis and cancer have provided authors with material for countless works and a variety of treatments in the western world. The exact details and characterizations vary in each author’s presentation of the disease, but it

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has nonetheless been possible to draw three distinct means of using each disease. The predominant narrative strains for each are common across works in each paradigm, although there are of course elements specific to the country in which each author was writing. The literary manifestations of each disease suggest, however, a similar understanding of the medical and cultural realities of these diseases across Europe and

North America, and in Germany and North America specifically. Tuberculosis has largely disappeared from literary works in the industrialized world in the wake of effective antibiotics, but cancer continues to offer authors an evolving landscape of realities and perceptions with which to create new usages of the disease in future literary works.

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Bibliography

Medical Literature and Histories of Disease

Ackerknecht, Erwin H. “Zur Geschichte der Krebsbehandlung.” Generus 47.3/4 (1980): 189-97. Print.

Abrams, Richard. Electroconvulsive Therapy. 4th ed. Oxford: Oxford UP, 2002. Print.

Adams, Samuel Hopkins. "What Can We Do About Cancer? The Most Vital and Insistent Question in the Medical World," Ladies' Home Journal , 30 (May 1913): 21-22. Print.

Almeida, Craig A. and Sheila A. Barry. Cancer: Basic Science and Clinical Aspects. Oxford: Wiley-Blackwell, 2010. Print.

Bates. Barbara. Bargaining for Life: A Social History of Tuberculosis: 1876-1938. Philadelphia: U of Pennsylvania P, 1992. Print.

Benedek, Thomas G. “The History of Gold Therapy for Tuberculosis.” The Journal for the History of Medicine and Allied Sciences 59.1 (2004): 50-89. Print.

Blanc, Léopold and Mukund Uplekar. “The Present Global Burden of Tuberculosis.” The Return of the White Plague: Global Poverty and the “New” Tuberculosis. Eds. Matthew Gandy and Alimuddin Zumla. New York: Verso, 2003. 95-111. Print.

Boyd, Arthur D., Bernard K. Crawford, Jr. and Lawrence Glassman. “Surgical Therapy of Tuberculosis.” Tuberculosis. Eds. William N. Rom and Stuart M. Garay. 2 nd ed. Boston: Little, Brown, 2004. 639-50. Print.

Brähler, E. “Body Experience: A Neglected Dimension in Medicine.” Body Experience: The Subjective Dimension of Psyche and Soma . Ed. E. Brähler. New York: Springer, 1988. 3-18. Print.

--, ed. Body Experience: The Subjective Dimension of Psyche and Soma . New York: Springer, 1988. Print.

“Canadian Cancer Society.” www. cancer.ca. Canadian Cancer Society, 2011. Web. 2 December 2011.

329

“Canadian Institutes of Health Research.” www.cihr-irsc.gc.ca, 2 December 2011. Web. 3 December 2011.

“CDC TB Fact Sheets Trends in Tuberculosis.” CDC.gov. Centers for Disease Control and Prevention, 19 October 2010. Web. 10 November 2011.

Condrau, Flurin. Lungenheilanstalt und Patientenschicksal: Sozialgeschichte der Tuberkulose in Deutschland und England im späten 19. und frühen 20. Jahrhundert. Kritische Studien zur Geschichtswissenschaft 137. Göttingen: Vandenhoeck & Ruprecht, 2000. Print.

Daniel, Thomas M. Captain of Death: The Story of Tuberculosis. Rochester: Rochester UP, 1997. Print.

Daniels, Marc. “Tuberculosis in post-war Europe: An International Problem.” Tubercle 28.10 (1947): 201-10. Print.

“Daten des Gesundheitswesens 2010.” BMG.Bund.de. Bundesministerium für Gesundheit, August 2010. Web. 10 November 2011.

Davis, Anne L. “History of the Sanatorium Movement.” Tuberculosis. Eds. William N. Rom and Stuart M. Garay. Boston: Little, Brown, 1996. 35-54. Print.

Doherty, T. Mark, Martin E. Munk and Peter Anderson. “Reflections on the Role of Science in Tuberculosis Control.” The Return of the White Plague: Global Poverty and the “New” Tuberculosis. Eds. Matthew Gandy and Alimuddin Zumla. New York: Verso, 2003. 207-21. Print.

Dormandy, Thomas. The White Death: A History of Tuberculosis. New York: New York UP, 2000. Print.

Dubos, René and Jean Dubos. The White Plague: Tuberculosis, Man and Society. 1952. New Bruswick: Rutgers UP, 1987. Print.

Eckart, Wolfgang Uwe. Einleitung und Übersicht. 100 Years of Organized Cancer Research—100 Jahre Organisierte Krebsforschung. Ed. Wolfgang U. Eckart. Stuttgart: Thieme, 2000. XV-XX. Print.

Enarson, Donald A., Chen-Yuan Chiang, and John F. Murray. “Global Epidemiology of Tuberculosis.” Tuberculosis. Eds. William N. Rom and Stuart M. Garay. 2 nd ed. Boston: Little, Brown, 2004. 13-29. Print.

Gandy, Matthew and Alimuddin Zumla. Introduction The Return of the White Plague:

330

Global Poverty and the “New” Tuberculosis. Eds. Matthew and Alimuddin Zumla. New York: Verso, 2003. 7-11. Print.

Gandy, Matthew. “Life without Germs: Contested Episodes in the History of Tuberculosis. The Return of the White Plague: Global Poverty and the “New” Tuberculosis. Eds. Matthew Gandy and Alimuddin Zumla. New York: Verso, 2003. 15-38. Print.

Garay, Stuart M. “Tuberculosis, Pregnancy and Tuberculous Mastitis.” Tuberculosis. Eds. William N. Rom and Stuart M. Garay. 2 nd ed. Boston: Little, Brown, 2004. 625-37. Print.

Greaves, Mel. Cancer: The Evolutionary Legacy. Oxford: Oxford UP, 2002. Print.

Harrington, Anne. The Cure Within: A History of Mind-Body Medicine. New York: Norton, 2008. Print.

Hass, Francois and Sheila Sperber Hass. “The Origin of Mycobacterium tuberculosis and the Notion of its Contagiousness.” Tuberculosis. Eds. William N. Rom and Stuart M. Garay. Boston: Little, Brown, 1996. 3-19. Print.

Hueper, Wilhelm C. Occupational Tumors and Allied Diseases. Springfield, IL: Charles C. Thomas, 1942. Print.

Kinghorn, Hugh M. “Hermann Brehmer.” Transactions of the American Climatological and Clinical Association 37 (1921): 193-210. Print.

Medical Research Council of Canada. Celebrating the Medical Research Council of Canada: A Voyage in Time 1960-2000. Ottawa: Public Works and Government Services Canada, 2000. Print.

Mukherjee, Siddhartha. The Emperor of All Maladies: A Biography of Cancer. New York: Scribner, 2010. Print.

“Multidrug and extensively drug-resistant TB (M/XDR-TB): 2011 Global Report on Surveillance and Response.” WHO.int. World Health Oraganization. n.d. Web. 10 November 2011.

The National Cancer Institute. Closing in on Cancer: Solving a 5,000-Year-Old-Mystery. 1987. Bethesda, MD: U.S. Department of Health and Human Services, 1998. Print.

Niederlander, Elodie. “Causes of Death in the EU.” Statistics in Focus: Population and Social Conditions. Eurostat. 2006, Print.

331

Olson, James S. Bathsheba’s Breast: Women, Cancer & History. Baltimore: Johns Hopkins UP, 2002. Print.

Ott, Katherine. Fevered Lives: Tuberculosis in American Culture since 1870. Cambridge: Harvard UP, 1996. Print.

Proctor, Robert N. The Nazi War on Cancer . Princeton: Princeton UP, 1999. Print.

Public Health Agency of Canada. “Leading Causes of Death and Hospitalization in Canada.“ www.phac-aspc.gc.ca/publicat/lcd-pcd97/table1-eng.php , n.d. Web. 3 December 2011.

Rather, L.J. The Genesis of Cancer: A Study in the History of Ideas. Baltimore: Johns Hopkins UP, 1978. Print.

--, Patricia Rather and John B. Frerichs. Johannes Müller and the Nineteenth-Century Origins of Tumor Cell Theory. Canton, MA: Science History Publications- Watson Publishing International, 1986. Print.

Rom, William N. and Stuart M. Garay. Preface. Tuberculosis . Eds. William N. Rom and Stuart M. Garay. Boston: Little, Brown, 1996. ix-x. Print.

Simonton, O. Carl, Stephanie Matthews-Simonton and James L. Creighton. Getting Well Again: A Step-By-Step, Self-Help Guide to Overcoming Cancer for Patients and their Families . New York: St. Martin’s P, 1978. Print.

Smallman-Raynor, Matthew and Andrew D. Cliff. “War and Disease: Some Perspectives on the Spatial and Temporal Occurrence of Tuberculosis in Wartime.” The Return of the White Plague: Global Poverty and the “New” Tuberculosis. Eds. Matthew Gandy and Alimuddin Zumla. New York: Verso, 2003. 70-92. Print.

Smith, F.B. The Retreat of Tuberculosis 1850-1950. New York: Croom Helm, 1988.

Soolingen, Dick van, et al. “A Novel Pathogenic Taxon of the Micobacterium tuberculosis Complex, Canetti: Charaterization of an Exceptional Isolate from Africa.” International Journal of Systematic Bacteriology 47.3 (1997): 1236-45. Print.

Thorson, Anna and Vinod K. Divan. “Gender and Tuberculosis: A Conceptual Framework for Identifying Gender Inequalities.” The Return of the White Plague: Global Poverty and the “New” Tuberculosis. Eds. Matthew Gandy and Alimuddin Zumla. New York: Verso, 2003. 55-69. Print.

Waksman, Selman A. The Conquest of Tuberculosis. Berkeley: U of California P, 1964.

332

Print.

Wishart, Adam. One in Three: A Son’s Journey into the History and Science of Cancer. New York: Grove P, 2007. Print.

Wagner, Gustav and Andrea Mauerberger. Krebsforschung in Deutschland: Vorgeschichte und Geschichte des Deutschen Krebsforschungszentrums. Heidelberg: Springer, 1989. Print.

“World Health Organization Cancer.” WHO.int. World Health Organization, February 2009. Web. 10 June 2010.

“World Health Organization Tuberculosis Facts 2011 Update.” WHO.int. World Health Organization, n.d. Web. 10 November 2011.

Literary Works

Accad, Evelyne. Voyages en cancer. Tunis: Aloès Editions, 2000. Print.

Alcott, Louisa May. Little Women. 1868-69. New York: Penguin Books, 1989. Print.

Ariyoshi, Sawako. The Doctor’s Wife. 1966. Trans. Wakako Hironaka and Ann Siller Konstant. New York: Kodasha, International, 1981. Print. Trans. of Hanaoka seishu no tsuma , 1966 .

Armstrong, Lance and Sally Jenkins. It’s Not About the Bike: My Journey Back to Life . New York: Putnam, 2000. Print.

Atwood, Margaret. Bodily Harm. 1981. New York: Anchor Books-Random House, 1998. Print.

Benn, Gottfried. “Mann und Frau gehen durch die Krebsbaracke.” 1912. Gedichte des Expressionismus. Ed. Dietrich Bode. Stuttgart: Reclam, 2000. 84-5. Print.

Bernhard, Thomas. Der Atem: Eine Entscheidung. 1978. Salzburg: Residenz, 1998. Print.

--. Die Kälte: Eine Isolation. 1981. Salzburg: Residenz, 1998. Print.

Brabner, Joyce, Harvey Pekar and Frank Stack. Our Cancer Year. New York: Thunder Mountains P-Avalon, 1994. Print.

Broyard, Anatole. Intoxicated by My Illness and Other Writings on Life and Death. Ed.

333

Alexandra Broyard. NewYork: Fawcett Columbine, 1992. Print.

Burney, Frances. “To Esther (Burney) Burney.” The Letters and Journals of Fanny Burney. Vol. 6. Ed. Joyce Hemlow. Oxford: Clarendon P, 1975. 596-616. Print.

Dickens, Charles. Dealings with the Firm of Dombey and Sons: Wholesale, Retail and Exportation. 1846-48. London: Folio Society, 1984. Print.

--. The Life and Adventures of Nicholas Nickleby. 1838-39. Norwalk, CT: Heritage P, 1968. Print.

--. The Old Curiosity Shop. 1840-41. London: Folio Society, 1987. Print.

Diggelmann, Walter Matthias. Schatten. Tagebuch einer Krankheit. Zürich: Benziger,1979. Print.

Dostoevsky, Fyodor. Crime and Punishment. 1866. Trans. Jessie Coulson. New York: W.W. Norton & Co., 1989. Print.

Dumas, Alexandre fils. The Lady with Camellias: Camille. 1848. New York: Société des beaux-arts, 1905. Print. Trans. of La Dame aux camellias, 1848.

Edgeworth, Maria. Belinda. 1801. New York: Oxford UP, 1994. Print.

Edson, Margaret. “John Donne Meets The Runaway Bunny. ” Interview with Betty Carter. Books and Culture (1999): 24-6. Print.

--. W;t. 1991. New York: Faber and Faber-Farrar, Straus and Giroux, 1999. Print.

Fontane, Theodor. Effi Briest. 1894-95. Frankfurt: Insel, 1976. Print.

Frank, Arthur W. At the Will of the Body: Reflections on Illness. 1991. New York: Mariner-Houghton Mifflin, 2002. Print.

Frisch, Max. Homo faber: Ein Bericht. 1957. Frankfurt: Suhrkamp, 1977. Print.

--. Stiller . 1954. Frankfurt: Suhrkamp, 1965. Print.

--. Triptychon: Drei szenische Bilder. 1978. Max Frisch Gesammelte Werke in zeitlicher Folge. Vol. 7. Ed. Hans Meyer. Frankfurt: Suhrkamp, 1986. 93-204. Print.

Giacosa, Giuseppe and Luigi Illica. La bohème. 1869. Trans. Ruth and Thomas Martin.

334

New York: Schirmer, 1954. Print.

Grealy, Lucy. Autobiography of a Face. 1994. New York: Perennial, 2003. Print.

Harr, Jonathan. A Civil Action. 1995. New York: Vintage-Random House, 1996. Print.

Herrndorf, Wolfgang. Arbeit und Struktur. www. wolfgang-herrndorf.de. N.p. 4 February 2012. Web. 8 February 2012.

Heyse, Paul. Unheilbar. Novellen: Auswahl fürs Haus. 1862. Berlin: Wilhelm Herz, 1890, 201-329. Print.

Huch, Ricarda. Der Fall Deruga. Berlin: Ullstein, 1917. Print.

Hugo, Victor. Les Misérables. 1862. Trans. Lee Fahnestock. New York: Signet Classic- Penguin, 1987. Print. Trans. of Les Misérables , 1862.

Jennings, Dana. “The Good Cancer?” New York Times. New York Times, 11 November 2008. Web. 8 February 2012.

Knef, Hildegard. Das Urteil oder der Gegenmensch. 1975. Gütersloh: Bertelsmann, 1979. Print.

Lorde, Audre. A Burst of Light: Essays. Ithaca, NY: Firebrand, 1988. Print.

--. The Cancer Journals . San Francisco: Aunt Lute Books, 1980. Print.

Mann, Thomas. Betrachtungen eines Unpolitischen. 1918. Frankfurt: Fischer, 1956. Print.

--. Der Zauberberg. 1924 . Frankfurt: Fischer, 1991. Print.

--. Die Betrogene. Frankfurt: Fischer, 1953. Print.

--. Tristan. 1903. Stuttgart: Reclam, 1988. Print.

Marchetto, Marisa Acocella. Cancer Vixen: A True Story. New York: Knopf, 2006. Print.

Moraga, Cherríe. Heroes and Saints. 1992. Contemporary Plays by Women of Color. Eds. Kathy A. Perkins and Roberta Uno. New York: Routledge, 1996. 230-61. Print.

O’Neill, Eugene. Long Day’s Journey into Night. 1942. New Haven: Yale UP, 1989. Print.

335

--. The Straw. 1918. Early Plays: Eugene O’Neill. Ed. Jeffrey H. Richards. New York: Penguin, 2001. 195-264. Print.

Patchett, Ann. Truth and Beauty: A Friendship. New York: Harper Perennial, 2005. Print.

Peters, Christoph. Stadt Land Fluß. Frankfurt: Frankfurter Verlagsanstalt, 1999. Print.

Price, Reynolds. A Whole New Life: An Illness and a Healing. New York: Atheneum, 1994. Print.

Quindlen, Anna. One True Thing. New York: Random House, 1994. Print.

Remarque, Erich Maria. Drei Kameraden. Drei Kameraden, Arc de Triomphe, Liebe deinen Nächsten: Drei Romane. 1938. Vienna: Kurt Desch, 1965. 5-386. Print.

Reimann, Brigitte. Aber wir schaffen’s, verlaß dich drauf!: Briefe an eine Freundin im Westen. Ed. Ingrid Krüger. Berlin: Elefanten Press, 1995. Print.

--. Alles schmeckt nach Abschied: Tagebücher 1964-1970. Ed. Angela Drescher. Berlin: Aufbau, 1998. Print.

--. Die geliebte, die verfluchte Hoffnung: Tagebücher und Briefe 1947-1972. Eds. Elisabeth Elten-Krause and Walter Lewerenz. West Berlin: Luchterhand, 1984. Print.

-- and Hermann Henselmann. Briefwechsel . Ed. Ingrid Kirschey-Feix. Berlin: Verlag Neues Leben, 1994. Print.

-- and Irmgard Weinhofen. Grüß Amsterdam: Briefwechsel 1956-1973 . Eds. Angela Drescher and Dorit Weiske. Berlin: Aufbau, 2003. Print.

-- and Christa Wolf. Sei gegrüßt und lebe: Eine Freundschaft in Briefen 1964-1973 . Ed. Angela Drescher. Berlin: Aufbau, 2003. Print.

Rilke, Rainer Maria. Die Aufzeichnungen des Malte Laurids Brigge. 1910. Frankfurt: Suhrkamp, 2000. Print.

Rollin, Betty. First, You Cry. 1976. New York: Quill-Harper Collins, 2000. Print.

Schlingensief, Christoph. So schön wie hier kanns im Himmel gar nicht sein: Tagebuch einer Krebserkrankung. 2009. Munich: btb Verlag-Random House, 2010. Print.

Schnitzler, Arthur. Sterben. 1892. Stuttgart: Reclam, 2006. Print. 336

Shaw, George Bernard. The Doctor’s Dilemma: A Tragedy. 1906. Baltimore: Penguin Books, 1965. Print.

Sinclair, Upton. The Jungle. New York: Doubleday, Page & Co., 1906. Print.

Solzhenitsyn, Alexandr. Cancer Ward. 1967. Trans. Nicholas Bethell and David Burg. New York: Modern Library, 1983. Print.

Sontag, Susan. Illness as Metaphor . New York: Farrer, Straus and Giroux, 1978. Print.

Stefan, Verena. Fremdschläfer. Zurich: Ammann, 2007. Print.

Storm, Theodor. Ein Bekenntnis . 1887. Zwischen Abend und Nacht: Novellen. Gütersloh: Bertelsmann, 1953. 323-76. Print.

Stowe, Harriett Beecher. Uncle Tom’s Cabin. 1852 New York: Dutton, 1972. Print.

Wander, Maxie. Leben wär’ eine prima Alternative: Tagebuchaufzeichnungen und Briefe. Ed. Fred Wander. West Berlin: Luchterhand, 1980. Print.

Was zählt, ist die Wahrheit: Briefe von Schriftstellern der DDR. Halle (Saale): Mitteldeutscher Verlag, 1975. Print.

Wolf, Christa. “Krankheit und Liebesentzug: Fragen an die psychosomatische Medizin.” 1984. Werke: Essays/Gespräche/Reden/Briefe 1975-1986. Vol. 8. Ed. Sonja Hilzinger. Munich: Luchterhand, 2000. 410-433. Print.

--. “Krebs und Gesellschaft.” 1991. Werke: Essays/Gespräche/Reden/Briefe1987-2000. Vol. 12. Ed. Sonja Hilzinger, Munich: Luchterhand, 2001. 326-351. Print.

--. Leibhaftig: Erzählung. Munich: Luchterhand, 2002. Print.

--. Nachdenken über Christa T. 1968. Werke. Vol. 2. Ed. Sonja Hilzinger. Munich: Luchterhand, 1999. Print.

--. “Selbstveruch: Traktat zu einem Protokoll.” 1972. Werke: Erzählungen 1960-1980. Vol . 3. Ed. Sonja Hilzinger. Munich: Luchterhand, 1999. 468-501. Print.

--. Sommerstück. Ed. Sonja Hilzinger. 1989. Werke. Vol. 10. Munich: Luchterhand, 2001. 7-270. Print.

--. Störfall: Nachrichten eines Tages. 1987. Werke. Vol. 9. Ed. Sonja Hilzinger. Munich: Luchterhand, 2001. 7-112 . Print.

337

Zorn, Fritz. Mars: “Ich bin jung und reich und gebildet; und ich bin unglücklich, neurotisch und allein... .“ Munich: Kindler Verlag, 1977. Print.

Criticism on Illness in Culture and Literature

Agnew, Lois, Claudia Albini-Stephens and Martha Warren. “ The Black Swan: Thomas Mann’s Last Song.” Conference of College Teachers of English Studies 60 (1995): 1-9. Print.

Alt, Peter-André. Schiller: Leben Werk Zeit. Vol. 2. Munich: Verlag C. H. Beck, 2000. Print.

Anderson, Mark M. “Mann’s Early Novellas.” The Cambridge Companion to Thomas Mann . Ed. Ritchie Robertson. Cambridge: Cambridge UP, 2002. 84-94. Print.

Anz, Thomas. Gesund oder krank?: Medizin, Moral und Ästhetik in der deutschen Gegenwartsliteratur . Stuttgart: Metzler, 1989. Print.

Babcox, Emilie Dorothy. Health, Illness, and Medical Theory in the Novels of Jane Austen, Charles Dickens, and Charlotte Bronte. Diss. Rutgers The State University of New Jersey - New Brunswick, 1998. Dissertations & Theses: Full Text, ProQuest. Web. 7 May. 2011.

Bartky, Sandra Lee. Femininity and Domination: Studies in the Phenomenology of Oppression. New York: Routledge, 1990. Print.

Beddow, Michael. “The Magic Mountain.” The Cambridge Companion to Thomas Mann. Ed. Ritchie Robertson. Cambridge: Cambridge UP, 2002. 137-50. Print.

Berger, Christel. “’Lebensfragen’ und Literatur: Brigitte Reimann in ihren Briefen und Tagebüchern.“ DDR-Literatur im Gespräch 83 . Ed. Siegfried Rönisch. Berlin: Aufbau, 1984. 163-9. Print.

Bevan, Bryan. Robert Louis Stevenson: Poet and Teller of Tales. New York: St. Martin’s Press, 1993. Print.

Boa, Elizabeth. “The Aesthetics of Disgust in Der Zauberberg. ” Publications of the English Goethe Society 78.3 (2009): 131-46. Print.

Bogard, Travis. Contour in Time: The Plays of Eugene O’Neill. New York: Oxford UP, 1988. Print. 1993. Print.

338

Boldt, Claudia. Die ihren Mörder kennen: Zur deutschsprachigen literarischen Krebsdarstellung der Gegenwart. Freiburg: 1989. Print.

Booth, Wayne. “The Ethics of Medicine, as Revealed in Literature.” stories matter: The Role of Narrative in Medical Ethics. Eds. Rita Charon and Martha Montello. New York: Routledge, 2002. 10-20. Print.

Brandes, Ute. “Probing the Blind Spot: Utopia and Dystopia in Christa Wolf’s Störfall .” Selected Papers from the Fourteenth New Hampshire Symposium on the German Democratic Republic. Studies in GDR Culture and Society 9. Lanham, MD: University P of America, 1989. 101-113. Print.

Brody, Howard. Stories of Sickness. 2nd Ed. Oxford: Oxford UP, 2003. Print.

Brownley, Martine Watson. Deferrals of Domain: Contemporary Women Novelists and the State. New York: St. Martin’s Press, 2000. Print.

Butler, Michael. The Novels of Max Frisch. London: Oswald Wolff, 1976. Print.

Callow, Philip. Louis: A Life of Robert Louis Stevenson. Chicago: Ivan R. Dee, 2001. Print.

Carrington, Ildikó de Papp. “Another Symbolic Descent.” Essays on Canadian Writing 26 (1983): 45-63. Print.

Cioffi, Frank L. “Graphic Fictions on Graphic Subjects: Teaching the Illustrated Medical Narrative.” Teaching the Graphic Novel. Ed. Stephen E. Tabachnik. New York: MLA, 2009. 179-87. Print.

Clark, Barrett H. Eugene O’Neill: The Man and his Plays. New York: Dover, 1967. Print.

Click, Bernard. George Orwell: A Life. New York: Penguin, 1982. Print

Couser, G. Thomas. Recovering Bodies: Illness, Diability and Life Writing. Madison: U of Wisconsin P, 1997. Print.

Davison, Peter. George Orwell: A Literary Life. Literary Lives. New York: St. Martin’s Press, 1996. Print.

De Huszar, Marguerite Allen. “Denial and Acceptance: Narrative Patterns in Thomas Mann’s Die Betrogene and Kleist’s Die Marquise von O .“ The Germanic Review 64 (1989): 121-8. Print.

DeShazer, Mary K. Fractured Borders: Reading Women’s Cancer Literature. Ann

339

Arbor: U of Michigan P, 2005. Print.

DeSmith, Robert J. “Whose Wit?: Margaret Edson’s Play and John Donne’s Poems.” Proceedings of the 14 th Northern Plains Conference on Earlier British Literature April 7-8, 2006. Eds. Bruce E. Brandt and Michael S. Nagy. (not sure of rest of citation: English Dept. South Dakota State Univ, Brookings, SD). 145-62. Print.

De Veaux, Alexis. Warrior Poet: A Biography of Audre Lorde. New York: W.W. Norton, 2004. Print.

Diedrich, Lisa. Treatments: Language, Politics and the Culture of Illness. Minneapolis: U of Minneapolis P, 2007. Print.

Dierks, Manfred. “Doktor Krokowski und die Seinen: Psychoanalyse und Parasychologie in Thomas Manns Zauberberg .” Das ‘Zauberberg’-Symposium 1994 in Davos . Ed. Thomas Sprecher. Thomas-Mann-Studien 11. Frankfurt: Vittorio Klosermann,1995 173-95. Print.

--. Studien zu Mythos und Psychologie bei Thomas Mann: An seinem Nachlass orientierte Untersuchungen zum “Tod in Venedig”, zum “Zauberberg” und zur “Joseph”- Tetrologie . Thomas-Mann-Studien 2. Bern: Francke, 1972. Print.

Diersen, Inge. Untersuchungen zu Thomas Mann: Die Bedeutung der Künstlerdarstellung für die Entwicklung des Realismus in seinem erzählerischen Werk. 1959. Berlin: Rütten & Loening, 1960. Print.

Dittmann, Ulrich Sprachbewusstsein und Redeform im Werk Thomas Manns: Untersuchungen zum Verhältnis des Schriftstellers zur Sprachkrise . Studien zur Poetik und Geschichte der Literatur 10. Stuttgart: W. Kohlhammer, 1969. Print.

Dowden, Stephen D. Introduction. A Companion to Thomas Mann’s The Magic Mountain. Ed. Stephen D. Dowden. Columbia, SC: Camden House, 1999. ix-xix. Print.

Druss, Arthur G. The Psychology of Illness: In Sickness and in Health. Washington, D.C.: American Psychiatric P, 1995. Print.

Dubost, Thierry. Struggle, Defeat or Rebirth: Eugene O’Neill’s Vision of Humanity. Jefferson, NC: McFarland & Company, 1997. Print.

Eads, Martha Greene. “Unwitting Redemption in Margaret Edson’s Wit. ” Christianity and Literature 51.2 (2002): 241-54. Print.

Eigler, Friederike. “Christa Wolf’s ‘Selbstversuch’: Cyborgs and Feminist Critiques of

340

Scientific Discourse.” The German Quarterly 73.4 (2000): 401-15. Print.

Eisen, Kurt. The Inner Strength of Opposites: Eugene O’Neill’s Novelistic Drama and the Melodramatic Imagination. Athens, GA: U of Georgia P, 1994. Print.

Elsaghe, Yahya. Krankheit und Matriarchat: Thomas Manns Betrogene im Kontext. Berlin: De Gruyter, 2010. Print.

Epstein, Grace A. “ Bodily Harm: Female Containment and Abuse in the Romance Narrative.” Genders 16 (1993): 80-93. Print.

Ericson, Edward E., Jr. and Alexis Klimoff. The Soul and Barbed Wire: An Introduction to Solzhenitsyn. Wilmington, DE: ISI Books, 2008. Print.

“A Eugene O’Neill Miscellany” New York Sun 12 January 1928: 31. Rpt. in Conversations with Eugene O’Neill. Ed. Mark W. Estin. Jackson, MS: UP of Mississippi, 1990. 81-3. Print.

Fehervary, Helen and Sara Lennox. Introduction. “Self-Experiment: Appendix to a Report.” New German Critique 13 (1978): 109-112. Print.

Felder, Paul. “ Die Betrogene , ‘Unverkennbar von mir’.“ Thomas Mann Jahrbuch 3 (1990): 118-38. Print.

Firda, Richard Arthur. Erich Maria Remarque: A Thematic Analysis of his Novels. American University Studies Series XIX 8. New York: Peter Lang, 1988. Print.

Florescu, Catalina Florina. “Verbal and Visual Rhetorics of Cancer: Defying Silence in Margaret Edson, Audre Lorde and Jo Spence’s Works.” Journal of International Women’s Studies 8.1 (2006): 271-92. Print.

Floyd, Virginia, ed. Eugene O’Neill at Work: Newly Released Ideas for Plays. New York: Frederick Ungar, 1981. Print.

Foucault, Michel. The Birth of the Clinic: An Archaeology of Medical Perception. 1963. Trans. A. M. Sheridan Smith. New York: Vintage-Random House, 1994. Print. Trans. of Naissance de la clinique: une archéologie du regard medical .

Frank, Arthur. The Wounded Storyteller: Body, Illness and Ethics. Chicago: U of Chicago P, 1995. Print.

Friedl, Peter. “’Die Kälte’” von Thomas Bernhard.” Literatur und Kritik 159 (1981): 531- 44. Print.

341

Furst, Lilian R. Idioms of Distress: Psychosomatic Disorders in Medical and Imaginative Literature. Albany: State U of New York P, 2003. Print.

Gadamer, Hans-Georg. The Enigma of Health: The Art of Healing in the Scientific Age. 1993. Trans. Jason Gaiger and Nicholas Walker. Stanford: Stanford UP, 1996. Print. Trans. of Über die Verborgenheit der Gesundheit: Aufsätze und Vorträge.

Gayle, Addison, Jr. Oak and Ivy: A Biography of Paul Laurence Dunbar. New York: Doubleday, 1971. Print.

Gilman, Sander. Franz Kafka: The Jewish Patient. New York: Routledge, 1995.

Goffman, Erving. Asylums: Essays on the Social Situations of Mental Patients and Other Inmates. New York: Anchor, 1961. Print.

Goodbody, Axel. “Nature’s Revenge: The Ecological Adaptation of Traditional Narratives in Fifty Years of German-speaking Writing.” Tamkang Review 37.1 (2006): 1-17. Print.

Grady, Andrew. The Disillusionment of Youth in Erich Maria Remarque’s Im Westen nichts Neues, Der Weg zurück and Drei Kameraden. Thesis. Bowling Green, 1994. Print.

Graham, Peter W. “Metapathography: Three Unruly Texts.” Literature and Medicine 16.1 (1997): 70-87. Print.

Greenberg, Linda Margarita. “Learning from the Dead: Wounds, Women and Activism in Cherríe Moraga’s Heroes and Saints .” MELUS: The Journal of the Society for the Study of Multi-Ethnic Literature in the United States 34.1 (2009): 163-84. Print.

Haim, Gordon. Heroism and Friendship in the Novels of Erich Maria Remarque. Studies on Themes and Motifs in Literature 63. New York: Peter Lang, 2003. Print.

Harding, Walter. The Days of Henry Thoreau: A Biography. New York: Dover, 1982. Print.

Hatfield, Henry. From The Magic Mountain: Mann’s Later Masterpieces . Ithaca: Cornell UP, 1979. Print.

Hatch, M., E. Ron, A. Bouville, L. Zablotska, and G. Howe. “The Chernobyl Disaster: Cancer Following the Accident at the Chernobyl Nuclear Power Plant.“ Epidemiological Reviews 27.1 (2005): 56-66. Print.

342

Hausmann, Reinhild. “Die Literaturrezeption in Christa Wolfs Erzählung Störfall .“ Zeitschrift für Germanistik (1992): 385-99. Print.

Hawkins, Anne Hunsaker. Reconstructing Illness: Studies in Pathography . W. Lafayette, IN: Purdue UP, 1993. Print.

Hebel, Franz. “Technikentwicklung und Technikfolgen in der Literatur.” Der Deutschunterricht: Beiträge zu seiner Praxis und wissenschaftlichen Grundlegung. (1987): 35-45. Print.

Hemlow, Joyce. Introduction. Fanny Burney: Selected Letters and Journals. By Fanny Burney. Ed. Joyce Hemlow. New York: Oxford UP, 1986. viii-xx. Print.

Herwig, Malte. “Magic Science on the Mountain: Science and Myth in Thomas Mann’s Der Zauberberg .” The German Review 74.2 (1999): 146-56. Print.

Herzlich, Claudine and Janine Pierret. Illness and Self in Society . 1984. Trans. Elborg Forster. Baltimore: Johns Hopkins UP, 1987. Print. Trans. Malades d'hier, malades d'aujourd'hui : de la mort collective au devoir de guerison .

Hewlett, Dorothy. A Life of John Keats. 1937. New York: Barnes & Noble, 1970. Print.

Hilscher, Eberhard. Thomas Mann: Sein Leben und Werk. Berlin: Volk und Wissen Volkseigener Verlag, 1968. Print.

Hilzinger, Sonja. Christa Wolf. Sammlung Metzler Band 224. Stuttgart: Metzler, 1986. Print.

--. Nachwort. Nachdenken über Christa T. Vol 2. By Christa Wolf. Ed. Sonja Hilzinger. Munich: Luchterhand, 1999. 211-238. Print.

--. Nachwort. Störfall. Vol. 9. By Christa T. Ed. Sonja Hilzinger. Munich: Luchterhand, 2001. 371-387. Print.

Holzkamp, Hans. “‘Der Tod Brigges‘: Untergang und Verklärung in Rilkes Aufzeichnungen des Malte Laurids Brigge .“ Etudes Germaniques 51.3 (1996): 481-512. Print.

Honegger, Gitta. Thomas Bernhard: The Making of an Austrian. New Haven: Yale UP, 2001. Print.

Hörnigk, Therese. Christa Wolf . Göttingen: Steidl, 1989. Print.

343

Hunter, Kathryn Montgomery. Doctors’ Stories: The Narrative Structure of Medical Knowledge. Princeton: Princeton UP, 1991. Print.

Ingersoll, Earl G., ed. Margaret Atwood: Conversations. Princeton, NJ: Ontario Review P, 1990. Print.

Ireton, Sean Moore. An Ontological Study of Death: From Hegel to Heidegger . Pittsburgh: Duquesne UP, 2007. Print.

Jürgens, Dirk. “Thomas Manns Novelle Die Betrogene oder die Zurücknahme des Doktor Faustus. ” Mutual Exchanges: Sheffield-Münster Colloquium II. Ed. Dirk Jürgens. Frankfurt: Peter Lang, 1999. 325-41. Print.

Jugensen, Manfred. Max Frisch Die Romane: Interpretationen. Bern: Francke, 1976. Print.

Keaveney, Madeline M. “Death Be Not Proud: An Analysis of Margaret Edson’s Wit. ” Women and Languages 27.1 (2004): 40-44. Print.

King, Martina. “Inspiration und Infektion: Zur literarischen und medizinischen Wissensgeschichte von ‘auszeichender Krankheit’ um 1900.” Internationales Archiv für Sozialgeschichte der deutschen Literatur. 35.2 (2010): 61-97. Print.

Klaver, Elizabeth. “A Mind-Body-Flesh Problem: The Case of Margaret Edson’s Wit .” Contemporary Literature XLV.4 (2004): 659-83. Print.

Knopf-Newman, Mary Jane. Beyond Slash, Burn and Poison: Transforming Breast Cancer Stories into Action. New Brunswick, NJ: Rutgers UP, 2004. Print.

Krapp, John. An Aesthetics of Morality: Pedagogic Voice and Moral Dialogue in Mann, Camus, Conrad, and Dostoevsky. Columbia, SC: U of South Carolina P, 2002. Print.

Kuhn, Anna K. Christa Wolf’s Utopian Vision: From Marxism to Feminism. Cambridge: Cambridge UP, 1988. Print.

Kurzke, Hermann. Thomas Mann: Epoche – Werk – Wirkung. Munich: Verlag C.H. Beck, 1985. Print.

Larson, Leah. “Breast Cancer and the ‘Unnatural Woman’ in Edgeworth’s Belinda .” Explicator 67.3 (2009): 195-98. Print.

Latta, Alan D. „The Reception of Thomas Mann’s Die Betrogene : Part II: The Scholarly

344

Reception.” Internationales Archiv für Sozialgeschichte der deutschen Literatur 18.1 (1993): 123-56. Print.

--. “The Reception of Thomas Mann’s Die Betrogene : Tabus, Prejudices and Tricks of the Trade.” Internationales Archiv für Sozialgeschichte der deutschen Literatur (1987): 237-72. Print.

Lehnert, Herbert. “Betrayed or Not Betrayed: A Testament?” A Companion to the Works of Thomas Mann. Eds. Herbert Lehnert and Eva Wessell. New York: Camden House, 2004. 297-305. Print.

Leuschner, Eric. “Body Damage: Dis-Figuring the Academic in Academic Fiction.” The Review of Education, Pedagogy and Cultural Studies , 28 (2006): 339-54. Print.

Lawlor, Clark. Consumption and Literature: The Making of the Romantic Disease. New York: Palgrave-Macmillan, 2006. Print.

Lucking, David. “In Pursuit of the Faceless Stranger: Depths and Surfaces in Margaret Atwood’s Bodily Harm. ” Studies in Canadian Literature 15.1 (1990): 76-93. Print.

Lynch, Denise E. “Personalist Plot in Atwood’s Bodily Harm .” Studies in the Humanities 15.1 (1988): 45-57. Print.

Malone, Andrew E. “Eugene O’Neill’s Limitations.” O’Neill and his Plays: Four Decades of Criticism. Eds. Oscar N. Cargill, Bryllion Fagin and William J, Fisher. New York: New York UP, 1961. 256-65. Print.

Martini, Adrienne. “The Playwright in Spite of Herself: Wit’s Margaret Edson Talks About Redemption, Kindergarten and Unintended Fame .” American Theater (1999): 22-5. Print.

Marxer, Bettina. Liebesbriefe, und was nun einmal so genannt wird. Würzburg: Königshausen und Neumann, 2001. Print.

McCarthy, Patrick. Camus: A Critical Study of his Life and Work. London: Hamish Hamilton, 1982. Print.

McDowell, Sean. “ W;t , Donne’s Holy Sonnets, and the Problem of Pain.” John Donne Journal 23 (2004): 161-83. Print.

McEntyre, Marilyn Chandler. “Hope in Hard Times: Moments of Epiphany in Illness Narratives.” The Gift of Story: Narrating Hope in a Postmodern World. Eds. Emily Greisinger and Mark Eaton. Waco, TC: Baylor UP, 2006. 229-45. Print. 345

McPherson, Karin. “’Kann man sich denn auf irgendeinen Briefpartner verlassen?’: Brigitte Reimann-Christa Wolf. Eine Freundschaft in Briefen.“ Zeitschrift für Germanistik 3 (1997): 543-558. Print.

McWilliams, James R. “Thomas Mann’s Die Betrogene—A Study in Ambivalence.“ College Language Association Journal (1966): 56-63. Print.

Meredith, Stephen C. “Mortal Illness on the Magic Mountain.” A Companion to Thomas Mann’s The Magic Mountain. Ed. Stephen D. Dowden. Columbia, SC: Camden House, 1999. 110-40. Print.

Meyers, Jeffrey. “ Cancer Ward and the Literature of Disease.” Twentieth Century Literature 29.1 (1983): 54-68. Print.

Mindil, Philip. “Behind the Scenes.” New York Tribune 22 February 1920: sec. 3,1. Rpt. in Conversations with Eugene O’Neill. Ed. Mark W. Estin. Jackson, MS: UP of Mississippi, 1990. 3-5. Print.

Mitchell, David T. “Narrative Prosthesis and the Materiality of Metaphor.” Disability Studies: Enabling the Humanities. Eds. Sharon L. Snyder, Brenda Jo Brueggemann and Rosmarie Garland Thompson. New York: The Modern Language Assoc., 2002. 15-30. Print.

Moamai, Marion. Krebs schreiben: Deutschsprachige Literatur in der siebziger und achtziger Jahre. St. Ingbert: Röhrig Universitätsverlag, 1997. Print.

Morris, David B. Illness and Culture in the Postmodern Age. Berkeley: U of California P, 1998. Print.

Mundt, Hannelore. Understanding Thomas Mann. Columbia, SC: U of South Carolina P, 2004. Print.

Murdoch, Brian. The Novels of Erich Maria Remarque: Sparks of Life. Studies in German Literature, Linguistics and Culture. Rochester, NY: Camden House, 2006. Print.

Mycak, Sonia. “Divided and Dismembered: The Decentered Subject in Margaret Atwood’s Bodily Harm .” The Canadian Review of Comparative Literature (1993): 469-78. Print.

Naef, Andreas P. “William E. Adams: Thomas Mann and The Magic Mountain .” The Annals of Thoracic Surgery 65 (1998): 285-7. Print.

346

O’Neill, J.F. “What a Sanatorium Did for Eugene O’Neill.” Journal of the Outdoor Life 20.6 (1923): 191-2, 221. Print.

Patrick, April Nicole. A Sentence of Death Has Been Passed on Her: Representing the Experience of Breast Cancer in Britain through the Long Nineteenth Century. Dissertation. May 2011.

“Peter L. Hagelstein, Associate Professor of Engineering.” www.rle.mit.edu. Research Laboratory of Electronics at MIT. n.d. Web. 26 November 2011.

Petersen, Jürgen H. “Max Frisch: Stiller (1954).” Deutsche Romane des 20. Jahrhunderts. Ed. Paul Michael Lützeler. Königstein: Athenäum, 1983. 206-308. Print.

Pickar, Gertrud Bauer. “Hades Revisited: Max Frisch’s Triptychon . The German Quarterly 59.1 (1986): 52-64. Print.

Pohland, Vera. “From Positive-Stigma to Negative-Stigma. A Shift of the Literary and Medical Representation of Consumption in German Culture.” Trans. John Davidson. Disease and Medicine in Modern German Cultures. Ed. Rudolph Käser and Vera Pohland. Western Societies Program Occasional Papers 28. Ithaca: Cornell UP, 1990. 144-68. Print.

Pütz, Peter. “Das Sanatorium als Purgatorium.” Literatur und Krankheit im Fin-de -Siècle:Thomas Mann im europäischen Kontext. Thomas Mann Studien 26 . Ed. Thomas Sprecher. Frankfurt: Vittorio Klostermann, 2002. 199-212. Print.

Ranald, Margaret Loftus. “From Trial to Triumph (1913-24): The Early Plays.” The Cambridge Companion to Eugene O’Neill. Ed. Michael Manheim. Cambridge: Cambridge UP, 1998. Print.

Rasch, Wolfdietrich. “Thomas Manns Erzählung ‘Tristan.’” Festschrift für Jost Trier zum 70. Geburtstag. Ed. William Foerste and Karl Heiz Borck. Cologne: Böhlau, 1964. 430-65. Print.

Raoul, Valerie, Connie Canam, Gloria Onyeoziri and Carla Paterson. “Margaret Edson’s Play Wit : Death at the End or the End of Death?” Unfitting Stories: Narrative Approaches to Disease, Disability, and Trauma . Eds. Valerie Raoul, Connie Canam, Gloria Onyeoziri and Carla Paterson Waterloo, Ontario: Wilfrid Laurier UP, 2007. 285-96. Print.

Rechtien, Renate. “’Prinzip Hoffnung’ oder ‘Herz der Finsternis’: Zu Christa Wolfs ‚Störfall.’“ New German Studies 17.3 (1993/3): 229-53. Print.

347

Reibman, Joan. “Phthisis and the Arts.” Tuberculosis. Eds. William N. Rom and Stuart M. Garay. Boston: Little, Brown, 1996. 21-34. Print.

Reibman, Joan and Thomas Lennon. “The Writer’s Voice: Tuberculosis in the Arts.” Tuberculosis. Eds. William N. Rom and Stuart M. Garay. 2 nd ed. Boston: Little, Brown, 2004. 3-11. Print.

Rey, William. “Blitze im Herzen der Finsternis: Die neue Anthropologie in Christa Wolfs Störfall .“ The German Quarterly 62.3 (1989): 373-83. Print.

--.“Rechtfertigung der Liebe in Th. Manns Erzählung ‘Die Betrogene.’ ” Deutsche Vierteljahrsschrift für Literaturwissenschaft und Geistesgeschichte 34 (1960): 428-48. Print.

Richards, Jeffrey H. Introduction. Early Plays: Eugene O’Neill. Ed. Jeffrey H. Richards. New York: Penguin, 2001. ix-xlvi. Print.

Rieckmann, Jens. “The Gaze of Love, Longing, and Desire in Thomas Mann’s ‘The Transposed Heads’ and ‘The Black Swan.’” A Companion to the Works of Thomas Mann. Eds. Herbert Lehnert and Eva Wessell. New York: Camden House, 2004. 245-56. Print.

Rigby, Kate. “Tragedy, Modernity and Terra Mater: Christa Wolf Recounts the Fall.” New German Critique 34.2 (2007): 115-41. Print.

Rimmon-Kenan, Schlomith. “Margaret Edson’s Wit and the Art of Analogy.” Style 40.4 (2006): 346-56. Print.

Rothman, Sheila M. Living in the Shadow of Death: Tuberculosis and the Social Experience of Illness in American History. New York: Basic-Harper-Collins, 1994. Print.

Rubenstein, Roberta. “Pandora’s Box and Female Survival: Margaret Atwood’s Bodily Harm .” Journal of Canadian Studies 20.1 (1985): 120-135. Print.

Rütten, Thomas. “Krankheit und Genie.” Literatur und Krankheit im Fin-de-Siècle: Thomas Mann im europäischen Kontext. Thomas Mann Studien 26 . Ed. Thomas Sprecher. Frankfurt: Vittorio Klostermann, 2002. 131-70. Print.

Rüttimann, Beat. “Die Lungentuberkulose im Zauberberg .” Auf dem Weg zum “Zauberberg.” Ed. Thomas Sprecher. Thomas-Mann-Studien 16. Frankfurt: Vittorio Klostermann, 1997. 95-109. Print.

Saalmann, Dieter. “Christa Wolf’s Störfall and Joseph Conrad’s Heart of Darkness: The

348

Curse of the Blind Spot.” Neophilologus 76 (1992): 19-28. Print.

Scammell, Michael. Solzhenitsyn: A Biography. New York: Norton, 1984. Print.

Schiff, James A. Understanding Reynolds Price. Columbia, SC: U of South Carolina P, 1996. Print.

Schoolfield, George C. “Thomas Mann’s Die Betrogene .“ Germanic Review 38.1 (1963): 91-120. Print.

Sevin, Dieter. “Frauenschicksal und Schreibprozeß in Ost und West: Christa Wolfs Nachdenken über Christa T. und Peter Handkes Wunschloses Unglück. ” Kulturpolitik und Politik der Kulture/Cultural Politics and the Politics of Culture: Festschrift für Alexander Stephan/Essays to Honor Alexander Stephan. Eds. Helen Fehervary and Bernd Fischer. Bern: Peter Lang, 2007. 211-220. Print.

Sheckels, Theodore F. The Island Motif in the Fiction of L.M. Montgomery, Margaret Lawrence, Margaret Atwood and Other Canadian Women Novelists. Studies on Themes and Motifs in Literature 68. New York: Peter Lang, 2003. Print.

Schrader, Brigitta. Schwindsucht: Zur Darstellung einer tödlichen Krankheit in der deutschen Literatur vom poetischen Realismus bis zur Moderne. Frankfurt: Peter Lang, 1987. Print.

Smith, Sidonie. Subjectivity, Identity and the Body: Women’s Autobiographical Practices in the Twentieth Century. Bloomington, IN: Indiana UP, 1993. Print.

Sternburg, Wilhelm von. “Als wäre alles das letzte Mal”: Erich Maria Remarque: eine Biographie. Cologne: Kiepenhauer & Witsch, 1998. Print.

Sykes, John D., Jr. “ Wit , Pride and the Resurrection: Margaret Edson’s Play and John Donne’s Poetry.” Renascence 55.2 (2003): 163-74. Print.

Szendi, Zoltan. “Das Ich und seine nahen Verwandten: Zu Thomas Bernhards autobiographischem Zyklus.” Nicht (aus, in, über, von) Österreich: Zur österreichischen Literatur, Zu Celan, Bachmann, Bernhard und anderen. Ed. Tamás Lichtmann. Frankfurt: Peter Lang, 1995. 197-206. Print.

Tanner, Laura E. Lost Bodies: Inhabiting the Borders of Life and Death. Ithaca: Cornell UP, 2006. Print.

Taylor, Harley U. “Autobiographical Elements in the Novels of Erich Maria Remarque.” Philological Papers 17, 1970. 84-93. Print.

349

Thesz, Nicole. “Marie Nathusius’ Elisabeth and Fontane’s Effi Briest : Mental Illness and Marital Discord in ‘The Century of Nerves.’” The German Quarterly 83.1 (2010): 19-37. Print.

Thomas, D.M. Alexander Solzhenitsyn: A Century in his Life. New York: St. Martin’s P, 1998. Print.

Tims, Hilton. Erich Maria Remarque: The Last Romantic. New York: Carroll & Graf, 2002. Print.

Tomalin, Claire. Katherine Mansfield: A Secret Life. New York: Viking, 1987. Print.

Törne, Dorothea von. Brigitte Reimann: Einfach wirklich leben: Eine Biographie . Berlin: Aufbau, 2001. Print.

Torry, Jane. “The Role of Women in O’Neill’s Plays.” Readings on Eugene O’Neill. Ed. Thomas Siebold. San Diego: Greenhaven P, 1998. 60-66. Print.

Travers, Martin. Thomas Mann. New York: St. Martin’s Press, 1992. Print.

Vanhoutte, Jacqueline. “Cancer and the Common Woman in Margaret Edson’s W;t .” Comparative Drama (2004): 391-410. Print.

Virchow, Christian. “Das Sanatorium als Lebensform. Über einschlägige Erfahrungen Thomas Manns” Literatur und Krankheit im Fin-de-Siècle: Thomas Mann im europäischen Kontext. Ed. Thomas Mann Studien 26 . Thomas Sprecher. Frankfurt: Vittorio Klostermann, 2002. 171-198. Print.

Wander, Fred. Das gute Leben: Erinnerungen. Munich: Carl Hanser, 1996. Print.

--. Vorbemerkung. Leben wär’ eine prima Alternative: Tagebuchaufzeichnungen und Briefe. By Maxie Wander. Ed. Fred Wander. West Berlin: Luchterhand, 1980. Print.

Wang, Luzia Mei-Ling. “Lebens- und Todesauffassung bei Max Frisch: Triptychon: Drei szenische Bilder. ” Fu Jen Studies 40 (2006): 55-83. Print.

Weisstein, Ulrich. Max Frisch. New York: Twayne, 1967. Print.

Wessell, Eva. “Magic and Reflections: Thomas Mann’s The Magic Mountain and his War Essays.” A Companion to the Works of Thomas Mann. Ed. Herbert Lehnert and Eva Wessell. Rochester: Camden House, 2004. 129-46. Print.

Wu, Cynthia. “Marked Bodies, Marking Time: Reclaiming the Warrior in Audre Lorde’s

350

The Cancer Journals.” Auto/Biography Studies. 17.2 (2002): 245-61. Print.

Zermühl, Sabine. Das Leben, dieser Augenblick: Die Biografie der Maxie Wander. Berlin: Henschel, 2001. Print.

351