Doctor Faustus

180 PRACTICAL NEUROLOGY

NEUROLOGY AND LITERATURE THOMAS MANN (1875–1955) Thomas Mann, the famous German novelist, essayist and cultural critic, was awarded

the Nobel prize for literature in 1929. He was Pract Neurol: first published as on 1 June 2004. Downloaded from born in Lübeck, into a wealthy trading family that moved to Munich in 1891, where Mann worked in an insurance company, at the same time attending some lectures at the University of Munich. His writing career started in the magazine Simplicissimus. Inspired by the works of Schop- penhauer, Nietzsche and Wagner, he soon started on his ﬁ rst major work, Buddenbrooks, published in 1901. Here he used the technique of leitmotiff, which he adapted from Wagner, to describe the saga of a wealthy German family declining from strength to decadence. Indeed, the main topic of all his novels was the moral decline of 20th century society, which culmi- nated in the Second World War. In 1905 Thomas Thomas Mann, 1937 (Carl Van Vechten, Mann married Katja Pringsheim. They had six photographer, Library of Congress, Prints and children, among them Klaus Mann, a novelist, Photographs Division [LC-USZ62-42522]). actor and journalist. http://pn.bmj.com/

Thomas Mann: on September 23, 2021 by guest. Protected copyright. Neurological cases from Doctor Faustus

Uroš Rot, MD Department of Neurology, Medical Centre, Zaloška 7, 1525 Ljubljana, Slovenia; E-mail: [email protected] Practical Neurology, 2004, 4, 180–183

After Buddenbrooks, Mann concentrated on the chancre. In the letter a detailed conversation short novels such as Death in Venice (1912), the with the devil is described. The devil reveals story of Gustav von Aschenbach, a writer who itself to Adrian Leverkühn: fell hopelessly in love with a young teenager I, too, have my self regard and know

Tadzio. Obsessed with the boy he stays in Venice that I am no unbidden guest. In short and Pract Neurol: first published as on 1 June 2004. Downloaded from during a cholera epidemic and himself dies of plain, metaspirochaetosis, that is the me- cholera. Mann’s second major book – The Magic ningeal process. And I do assure you that it Mountain (1924) – took him 10 years to write. is indeed as if some certain of these small In this masterpiece he desribed a sanatorium folk may have a passion for the uppermost, as a physically and morally unhealthy setting a special estimation for the region of the that almost destroyed young Hans Castorp who head, the meninges, the dura mater, the came just to visit his cousin, but stayed there for tentorium, and the pia, which defend the seven long years under the pretext of suffering tender parenchyma within, and would from tuberculosis. swarm ardently thither from the moment After the Nazis came to power, Mann moved of that fi rst general infection. fi rst to Switzerland and settled fi nally in the The prolonged paretic phase of lues terminates United States in 1936, where he worked at the Leverkühn’s creative life after 24 years of genial University of Princeton. In 1947 he returned to composing. His friend Sereneus Zeitblom fi rst Europe but avoided Germany and lived mostly notices his strange look – ‘I realized that it was near Zürich, where he died on August 12, 1955. caused by the pupils, which were not perfectly His last satire, the Confessions of Felix Krull, was round, but somewhat irregularly lengthened, left unfi nished. and always stayed the same size, as if they were not subject to the infl uence of any change in The Faustian pact light’ – a fair description of Argyll-Robertson The Faust myth, a pact that an artist makes with pupils. Zeitblom last visits Leverkühn shortly

the devil in search for mastery, is best known before his death and fi nds him in the late stages http://pn.bmj.com/ from Goethe’s famous work. Thomas Mann of dementia. He remembers: used the same theme in his last major novel, …there lay, under a light woollen Doctor Faustus (1947): the life of the German blanket, a man who had once been Adrian composer Adrian Leverkühn as told by a friend. Leverkühn, and whose immortal part now Doctor Faustus is the story of a former theology bears that name. The pale hands, whose student who trades his soul and body to become sensitive shape I had always loved, lay on September 23, 2021 by guest. Protected copyright. a musician of genius (Mann 1999). His oppo- crossed on the chest, like those of a fi gure site, representing humanity and moral values, is on a medieval gravestone. The now pre- his friend and the teller of the story – Sereneus dominantly grey beard made the narrow Zeitblom. In the background is the innovative face look even longer, so that it bore strik- 12-tone music of Arnold Schönberg. The novel ing resemblance to that of a nobleman by is fl avoured with profund philosophical and El Greco. What a sardonic trick of nature, psychological discussions that refl ect the spirit one might well say that she is able to create of the time and, the reason for an article in a neu- the image of highest spirituality where the rological journal, it provides excellent descrip- spirit has departed. tions of various neurological diseases. Through the book all the different stages of luetic infection are presented from primary Neurosyphilis chancre followed by secondary luetic meningitis Adrian Leverkühn is possessed by the devil who 1 month later, and terminating with dementia is represented as a young, magical, black-eyed and the pupil abnormalities of tertiary general prostitute. Unable to resist her charms, he con- paresis many years later. tracts syphilis. Although the words syphilis or lues are not mentioned in the text, the different Bacterial menigitis stages of the disease are well described. Shortly In Leverkühn’s life there are few acts of hu- after his visit to the prostitute, Leverkühn goes manity, one of them being his affection for his to see a doctor for a ‘localized infection’. About sister’s son Nepomuk. Unfortunately Nepomuk a month later Zeitblom receives a long hallu- falls ill and Leverkühn notices the boy’s irritabil- cinating letter from the composer, from which ity, photo- and phono-phobia, the prodromal we can assume that luetic meningitis followed symptoms of meningitis:

Snifﬂ es now dulled the sweet clarity of his eyes and surely it was only this annoying infection that robbed him of his appetite, made him irritable, and increased the Kürbis inserted his needle

sleepiness… Soon, then, there developed Pract Neurol: first published as on 1 June 2004. Downloaded from an intolerance of light and sound more between separated disquieting than previous moodiness. He appeared to be excessively sensitive to the vertebrae, driving it into wagons pulling into the farmyard, to the sound of voices. the spinal canal, from The disease gets worse: Nepomuk had had an abrupt eruption which liquid emerged of vomiting, and along with a moderately high fever came headaches that inside of drop by drop a few hours had grown obviously unbear- able. A local physician Dr Kürbis visits the patient and ﬁ nds: The pulse was rapid and the onset of stiffness of neck was evident.’ He also performs the bedroom, when he had checked the a diagnostic procedure: shutters to see how dark he could get the Frau Schweigstill, pale but energetic room; for darkness, lying in the dark, night, and loyal as always to her humane princi- black, with no light whatever in the eyes, ples, held the whimpering child as he lay that was just the thing, as long as the misery crouched in bed, his chin and knees almost lasted, plus real strong tea, made real sour touching, and Kürbis inserted his needle with lots of lemon.

between separated vertebrae, driving it Even today our therapeutic suggestions for a http://pn.bmj.com/ into the spinal canal, from which liquid migraine attack often include sleep, rest and emerged drop by drop. darkness. Triptans are, however, more helpful From the vivid description of bilateral abducens than tea with lemon! palsy we can even localise the disease to the basal meninges: Essential tremor

Let me say in addition that for those There are also some good descriptions of move- on September 23, 2021 by guest. Protected copyright. who saw Nepomuk, perhaps the most ter- ment disorders in the novel. Our story-teller Se- rible thing was a secondary symptom, the reneus Zeitblom suffers from essential tremor. way his heavenly eyes dimmed, squinting Writing during bomb attacks in Munich in the tighter and tighter… Second World War he remembers: Shortly after the beginning of the disease Nep- I sit here in my study, turning ashen, omuk is dying, comatose beacause of raised shaking like the walls, doors, and window- intracranial pressure: panes of my house and writing this account The eyes were not completely shut, but of a man’s life with a trembling hand. But between the lashes nothing of the blue of since this hand has reason to tremble in any the iris could be seen, only the black of case because of my subject, I did not let it pupils, which had grown larger and larger, bother me that a familiar difﬁ culty was though each of a different size, until they augmented a bit by a terror outside. had almost swallowed up the lash of col- our. Hemifacial spasm The doctor that Adrian Leverkühn visits after Migraine his rendezvous with the prostitute has a strange Adrian Leverkühn, like his father, suffers from look: terrible migraine attacks. The characteristics are A kind of tic that lifted one cheek and a well described and the treatment suggested by a corner of the mouth, while the eye joined landlady, Frau Schweigstill: in with a squint, gave him a problematic Aha, so he had the migraine sometimes, sour look, an uneasiness and touchiness and right nasty, too? She had thought so. that boded no good. She had indeed thought so just now up in We can easily recognise hemifacial spasm.

Hyperekplexia not just on detailed knowledge of particular

The last neurological case from Doctor Faus- neurological diseases, but also on good obser- Pract Neurol: first published as on 1 June 2004. Downloaded from tus is a neurological pearl. When introducing vations of people. After all, the ability to observe Kaisersaschern, Leverkühn’s birth place, Mann is one quality of a good clinician. In addition, describes its characters, and among them: Mann was able to desribe the observations in But to return to eccentrics of Kaiser- such a way that the reader can easily recognise saschern there was for instance a man of the neurological disorders. It is another quality indeterminate age, who at any sudden of a good neurologist, to precisely document shout would feel compelled to perform a his ﬁ ndings. Mann’s descriptions, especially kind of jerky dance with knees pulled high, of Nepomuk’s purulent meningitis, were very and making a sad and ugly face, he would detailed. There is a tendency in modern neu- smile, as if to apologize to the urchins after rological textbooks for clinical descriptions him in yowling pursuit. to be shortened and replaced by voluminous This poor character could have stimulus sen- information on sophisticated methodology sitive epilepsy, but the description suggests and basic science. But facing a patient, even hyperekplexia or even more likely the Jump- today, the neurologist needs to establish the ing Frenchmen of Maine (Saint-Hillaire et al. differential diagnosis before embarking on 1986). The Jumping Frenchman of Maine, in investigations – detailed knowledge of the clini- the middle of Germany? It is possible. When cal presentations of neurological diseases, as Saint-Hillaire and colleagues described the Thomas Mann reminds us, is an essential pre- eight jumpers, they mentioned that similar condition. Furthermore, basic science research behaviour patterns after a startle reaction were in medicine is only possible in well-selected

observed in different cultures (Saint-Hillaire patients with the correct diagnoses, which are http://pn.bmj.com/ et al. 1986). again based on astute clinical observations. And last but not least, Mann demonstrates to us, CONCLUSIONS with his discussions from philosophy, theology, All these examples of neurological disorders psychology, music theory and his neurological were collected from a single book, Thomas cases, just how much knowledge and effort is

Mann’s Doctor Faustus. It is somehow expected needed for a truly great work to be created. Per- on September 23, 2021 by guest. Protected copyright. that novelists introduce into their fi ction philo- haps we should think about that when writing sophical discussions, psychological analyses, our neurological papers. and even touch on other spheres of art, such as music. But, in addition, in Mann’s novels a ACKNOWLEDGEMENTS reader can also fi nd extensive descriptions from Reviewed by Jan van Gijn, Utrecht. the fi elds of science and medicine. For example, in his novella, The Black Swan, the female repro- REFERENCES ductive cycle, symptoms of the menopause and Dettmering P (1970) The theme of suicide in the work of uterine tumour are all described. Searching the Thomas Mann. Humanitas, 6, 23–44. van Dijck J (2000) X-rays between art and science. In: medical literature one can fi nd specialists from The Magic Mountain Gewina, 23, 91–106. various fi elds, from infectious diseases and der- Klein P (1980) Die Infektionskrankheit im erzahler- matology to radiology and psychiatry, who have ischen Werk Thomas Manns. Medizinhist Journal, been inspired by the medical aspects of Thomas 15, 3–15. Mann’s work (Dettmering 1970; Klein 1980; Leyh F (1998) Thomas Mann mystifi es dermatology. Hautarzt, 49, 516–8. Leyh 1998; van Dijck 2000). Mann T (1989) Death in Venice and Seven Other Stories. We can understand the neurological descrip- New York: Vintage. tions in Doctor Faustus as an extension of Tho- Mann T (1994) Buddenbrooks: The Decline of a Family. mas Mann’s profound interest in medicine. And New York: Vintage. although one could regard them merely as an in- Mann T (1999) Doctor Faustus: the Life of the German teresting addition to Doctor Faustus, I think they Composer Adrian Leverkühn as Told by a Friend. New York: Vintage. also offer material to be refl ected on by neurolo- Saint-Hillaire M-H, Saint-Hillaire J-M & Granger L gists. There are many lessons a neurologist can (1986) Jumping Frenchmen of Maine. Neurology, learn from Thomas Mann. His cases were based 36, 1269–71.