In Heart of Darkness, why does Kurtz get sick?

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Whatever the actual physical cause may be, Kurtz's illness is a metaphor of the disease of the spirit that has overtaken him and, by extension, the whole imperialist effort that is at the heart of the story.

When Marlow first arrives at the colonial outpost, he observes the illnesses...

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Whatever the actual physical cause may be, Kurtz's illness is a metaphor of the disease of the spirit that has overtaken him and, by extension, the whole imperialist effort that is at the heart of the story.

When Marlow first arrives at the colonial outpost, he observes the illnesses prevalent among the "native" workers in the camp, and that no one is doing anything to help them. This is a form of concrete evidence of the abusive conditions upon which imperialism is based. The material conditions in camp, the inefficiency, and the fact that equipment is lying about unused are all signs of the dysfunctional dynamic that governs the situation.

As the saying goes, whatever goes around comes around, and it's inevitable that the colonialists themselves will suffer the consequences of their own actions, through disease and death. Through the entire novella the mystery of what has become of Kurtz is a cloud that oppressively affects Marlow. There is a premonition of some terrible and inexplicable thing that has happened to Kurtz, but in some way Marlow seems already to recognize that whatever it is, it's nonetheless a logical consequence of the conditions that exist in the colonial world, and the wrongness of the European effort to exploit the people and the resources of this land. Kurtz has gone mad, descending into megalomania as he sets himself up as a demigod over the native people in the interior. The title of the novella alludes to not only the darkness of Kurtz's "kingdom" but to a darkness of the human spirit that allows such things to happen. And the illness afflicting Kurtz is a physical analogue to this spiritual disease—not only his personal madness, but the madness of the enterprise in which Marlow himself and the others are taking part.

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We don't really know what causes his physical illness; we can assume that he has caught malaria or is suffering from some other fever illness.  

However, he has looked into the depth of his soul (the heart of darkness) and what he has seen there and discovered within himself is corruption and depravity.  

Marlowe recognises that not only does Kurtz suffer because he has seen into the depths of his own soul and found corruption but he recognised that all men have this possibility in within themselves.  This 'seeing' has made Kurtz ill. 

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