inactivity begets mental activity; giving up the ordinary pursuits of life must be recompensed. In his Introduction to Dr. J. A. Myers'Fighters of Fate Dr. Charles H. Mayo says: "The years spent in voluntary obedience to the rules of treatment may have a lasting influence and remove the one great obstacle to success in life." In some individuals only the vision of death brings a consciousness of "the divine reality of life." It has been said that "success dwells in the silences." Certainly, during the silent watches accompanying the course of tuberculosis many a sufferer has discovered the saving presence of a creative instinct. It is appropriate to add that those afflicted with this disease are among the first to appreciate the truth of Hippocrates' famous aphorism: "Life is short and art is long."

In the course of a long illness the essential elements of personality must be ultimately revealed. Often an otherwise imperious individual gradually yields to the inevitable mandates of his disease and exhibits an enviable poise, accompanied by growing tenderness and tolerance.

In Greek Thinkers Gompertz refers to the "heightened respect for reason and reflection as the supreme arbiters of human affairs, which may perhaps be termed intellectualism." He goes on to say that "on the soil of Italy and Sicily, the new confidence, which was produced by the reign of criticism and by the revolt from authority, went hand in hand with the growth of refinement of thought." In a sense, the chronic invalid's detachment encourages the Hellenic spirit. He has time for reflection and the quiet exercise of reason. He is no longer wholly subject to the world's conventional authority; consequently, he is in a position to exercise a free, critical spirit.

Erich Ebstein in Tuberkulose als Schicksal referred to the fact that biographers and critics have long recognized progressive tuberculosis in geniuses as a possible factor contributing to their individual greatness. He does not admit that the disease causes genius but agrees that it may fan into flame an otherwise dormant spark. On the other hand, he believes that advanced tuberculosis with physical prostration may inhibit creative effort.

Again quoting Dr. Charles H. Mayo's Introduction to Fighters of Fate: "We know that victims of chronic tuberculosis have learned the significance of unusual vitality and vigor that often precedes increase in cough, slight fever and another bout with the enemy. Man is not the only creature whom Nature has cunningly equipped for the struggle of life; the little speck of living matter known as the bacillus of tuberculosis paves the way for its destructive action by stimulating its host to overactivity. Like the Roman gods, whom it seeks to destroy, it first makes mad."

Erich Stern is inclined to attribute the manifestations of genius to the toxic action of the tubercle bacilli. The poet Novalis, who died of tuberculosis in early life, said: "The disease consists probably of the most interesting products and stimuli of our thoughts and activities." He also inquired "if disease might not be a means of higher synthesis." The tuberculous poet Klabund believed that a history dealing with the literature of the tuberculous should be written, because "this constitutional malady possesses the peculiarity of altering the mentality of its victims."

In The Psycho-Pathology of Tuberculosis D. G. Macleod Munro calls attention to the stimulation of the mental faculties with an unusual desire for accomplishment. "The patient has an insatiable craving for a full and active life. He lives in an atmosphere of feverish eagerness to seize the fleeting moments before they pass. These characteristics are particularly noticeable in those of naturally artistic or literary tastes."

In another chapter Munro discusses the psychoneurosis accompanying pulmonary tuberculosis and makes the following statement, which is significant in that it helps to explain the occasional diversion of genius from its original goal. "The theory of cerebral intoxication by the products of the tubercle bacillus, which has been taught by Cornet and others, appears to be the one most generally held at present, and I am unaware of any more plausible explanation."

In the first chapter of his book on The Development of Our Knowledge of Tuberculosis Dr. Lawrence F. Flick said: "In individuals in whom the tubercle bacillus grows meagerly, in whom it has produced but slight toxemia, and in whom it has set up no serious changes in the tissues, it not only may give no discomfort but may stimulate the functional activity of those organs of the body which have to do with the enjoyment of life. In this way the tubercle bacillus may make life more pleasant and make the individual more profitable to society than he otherwise would be."

Dr. J. A. Myers in Fighters of Fate made the following statement: "Havelock Ellis, in A Study of British Genius, has pointed out that tuberculosis was present in at least forty British personages, each of them a genius. What is true of British genius is no doubt true for the most part of other nations. Tuberculosis does not produce genius, but the life of physical inactivity which the tuberculous patient is frequently compelled to live may give him an opportunity to discover or to develop his native power. Such is the case of Eugene O'Neill. Tuberculosis is accredited with causing a mental exaltation and increased excitability, during which great visions and plans for their realization come to the patient. Chopin is said to have been motivated in the composition of some of his masterpieces by such a condition. In some measure this may be true, but the greater opportunities for increased mental activity as a result of the decreased physical capacity account for most of the relationship between tuberculosis and genius."

In Dr. Arthur C. Jacobson's Genius: Some Revaluations we find the following: "Now it is entirely conceivable that the tuberculous by-products are capable of profoundly affecting the mechanism of creative minds in such a way as to influence markedly their creations. Indeed, they are bound to do so, for the spes phthisica, admittedly a result of such by-products, must necessarily affect the whole psychologic switchboard." Dr. Jacobson also said: "Were the present writer to give an almost sure recipe for producing the highest type of creative mind, he would postulate an initial spark of genius plus tuberculosis."

In a recent editorial in Medical Times Dr. Jacobson laments the decline in the quality of American writing, and, after discussing the unfavorable influence of political events on our "cultural front," he offers the following rather disturbing suggestion: "We believe that there is another aspect to this matter a medical reason why the candles are snuffed; why the fires smolder; why genius is dead; why the descending curtain signalizes the end of the show. The decline in tuberculosis coincides with the decline in creative writing.… In the healthful days to come we may not apprehend the past role of tuberculosis in quickening creative faculties; and by way of compensation for good health we may lack certain cultural joys." In a previous editorial we find the following: "No other disease with equally extensive lesions exalts a victim physically and psychically [spes phthisica]. Other diseases, as they devastate tissues, devastate creative powers. Tuberculosis, paradoxically, prods a Shelley or a Keats into finer productivity."

One of the critics of John Millington Synge is quoted as having said: "He was of such an intense super-sensitive temperament that he naturally clutched at extremes with all the hectic greediness of a consumptive."

J. Middleton Murry said of Katherine Mansfield: "When the full tide of inspiration came, she wrote till she dropped with fatigue sometimes all through the night, in defiance of her illness."

In The Psycho-Pathology of Tuberculosis Munro quotes Matthew Arnold as having said of Maurice de Gudrin: "The temperament, the talent itself is deeply influenced by the mysterious malady; the temperament is devouring; it uses vital power too hard and too fast."

After Thomas Hood had "submitted to a decline" and his health had improved, he again developed active disease, and one of his biographers said that he manifested that "fever for work which has been observed in the consumptive." Munro said of Hood: "As his health declined his poetical fire seemed to burn more brightly, and the 'Song of the Shirt,' as he pathetically put it, came from a man on his death-bed. 'The Bridge of Sighs' soon followed this, and these two poems, written within a few months of his death, set the seal upon his greatness as a poet." Discussing the life of John Addington Symonds, who, at Davos, shared with Robert Louis Stevenson the conscious stimulation of disease, Munro said: "Symonds seems to have been fully aware that he was in a febrile condition while carrying on his mental and physical activities, but confessed that he felt the recklessness of disease, and was possessed of that nervous, fretful, and fitful energy which is so characteristic a feature of the artistic or intellectual phthisical [tuberculous] patient."

Haldane Macfall in his biography of Aubrey Beardsley made this significant statement: "Beardsley knew he was a doomed man even on the threshold of manhood, and he strove with feverish intensity to get a lifetime into each twelvemonth."

Writing about Sunrise, Sidney Lanier's "ultimate symphony," Lincoln Lorenz said: "His bodily fever heightened the temperature of his spiritual passion, and indeed permitted him to peer the better over the sea's brink as the first rays diverged." The following reference to Lanier's work at Johns Hopkins, when "life seemed about to vacate the physical tenement," is interesting: "The energy of his thought showed little relation to the weakness of his body; in fact, his lectures now often achieved their best design and farthest reach."

In the Journal of the American Medical Association, June, 1932, the London correspondent said: "The number of great writers who have suffered from tuberculosis has long been a subject of remark. Some authorities have held that the disease has an effect in promoting mental development." Continuing to quote from his London letter, we find the following: "At the Congress of the Royal Institute of Public Health, Dr. S. Vere Pearson, physician to Mundesley Sanatorium for Tuberculosis, delivered an address on the psychology of the consumptive. Referring to such authors as Tchekov, Stevenson, Keats, Elizabeth Browning, and D. H. Lawrence, he said that some people ascribed their genius to the stimulating powers of the toxins of tuberculosis. Undoubtedly, a sort of restless agitation was produced in certain phases of pulmonary tuberculosis. There was also a feeling of apprehension lest life should be shortened. Both the apprehension and the restlessness might act as a stimulus to production and particularly to the production of authors, who could pursue their calling without much bodily exertion." The letter closes with the following interesting comment: "It might be said in criticism of Dr. Pearson's interesting address that he somewhat misses the point, which is not the effect which the trouble of tuberculosis has in molding the writings of authors, but that the toxins of the disease act in some way as a stimulus to the brain in the production of the imagination. The list of writers who have suffered from tuberculosis, some, such as Keats, the Brontds and Stevenson, supremely great, is so long as to suggest something more than coincidence."

Discussing John Keats's reaction to his tuberculosis, Dr. Robert L. Pitfield said: "It is more than likely that the tuberculous poisons intoxicated and enriched the imaginations of Stevenson and Chopin and other geniuses. These poisons no doubt added much to the fervid vision of this man. I am sure that they guilded his genius. A peculiar mental hyperesthesia characterizes this disease in even the most commonplace minds. There can be no doubt that Keats was hyper-esthetic, acutely so. He, by this time, had a little fever, yet his disease was to run for years."

Sidney Colvin said of Keats: "It was not often nor for long that the stings either of love or of poetry abated for him the least jot of their bitter sweet intensity, or the anticipation of poverty or the fever of incipient disease relaxed their grip."

With keen perception, perhaps sharpened by the swift discernment of disease, Katherine Mansfield described her doctor as follows: "He has the disease himself. I recognized his smile—just the least shade too bright—and his strange joyousness as he came to meet me—the gleam—the faint glitter on the plant that the frost has laid a finger on."

Quoting Jeannette Marks in Genius and Disaster: "It has been said that a man is what his microbes make him, and in nothing, it would seem, is this more true than with the man of genius." After referring to James Thomson's pessimism as possibly pathological, she said: "It should be remembered that there are types of optimism equally pathological which are due to the quick burning of disease. For example, the buoyant hopefulness created by tuberculosis." She suggests that "in Shelley's 'Ode to the West Wind' it is doubtful whether the flight of his song and the tumult of wind and leaves would have been so swift without the quickening which Shelley had from tuberculosis. In the case of Emily Brontd, life may have been shortened physically by consumption, but study convinces the reader that psychically in Wuthering Heights and in her poems power and passion were made the greater by the spes phthisica."

Again referring to her discussion of James Thomson, she writes: "In any event, the nearer disease and death press on a sensitive mind perhaps all the more passionately does that mind press towards the consolation of art which is immortal."

John B. Huber in his work on Consumption and Civilization made the following statement: "It appears to me that the quality of the genius of a great man, if he be consumptive, may be, in some cases at least, affected by his disease."

Dr. John Brown of Edinburgh, author of Rab and His Friends, observed a certain mental exuberance as he studied the psychology of his tuberculous patients. In the latter part of the nineteenth century he recorded the results of his observations in a beautiful tribute to his young friend and colleague, Dr. William Henry Scott, who died at the early age of twenty-four. The conclusions of this careful observer are quite obvious, as shown by the following: "He died of consumption and had that sad malady, in which the body and soul, as if knowing their time here was short—bum as in oxygen gas—and have 'hope, the Charmer' with them to the last—putting into these twenty years the energy, the enjoyment, the mental capital and rapture of a long life." Of the same "marvelous boy, whose sun went down in the sweet hour of prime," Mr. George Sim said: "It is difficult to imagine how it was possible in so short a life to acquire so varied an amount of knowledge as Dr. Scott possessed, especially when we consider his delicate constitution and toilsome course of education."

Nevinson has said of Schiller: "It is possible that the disease served in some way to increase his eager activity, and fan his intellect into keener flame."

Aretaeus, the well-known Cappadocian anatomist and physician, who lived in the second century A.D., in describing death from the "pouring out of blood" said: "Really, this is not much to be wondered at; but what is most wonderful is that in a case where the blood comes from the lung, in which the disease [tuberculosis] is most serious of all, patients, even when it is about to come to the end, do not give up hope." We also find the following reference to chronic lung conditions: "Such patients are hoarse; they are short of breath; they speak in a weak voice; their chest walls are dilated yet they do not seem to be broad enough, because a great deal of humor is pent up within them; the black part of the eye flashes; in such cases it is simply wonderful how the strength of the body holds out; the strength of the mind even surpasses that of the body." Aretaeus made additional references to "the confidence and hopefulness of persons expectorating matter from the lungs."

In many cases the mental activity and creative powers seem to vary directly with the progress of the disease. As striking examples of this, we might mention Voltaire, Robert Louis Stevenson, Marie Bashkirtseff, Keats, Shelley, Sidney Lanier, Thomas Hood, and John Addington Symonds. As Dickens has suggested, even after the body becomes a mere mummied crucible, the fires of genius may be observed to burn with a brightness not often seen in the nontuberculous. On this point it would be interesting to let some of the sufferers speak for themselves.

Sidney Lanier, lyric poet and psychic counterpart of Edgar Allan Poe, furnishes a striking example. His creative powers were not in evidence until after his disease was well under way, and his capacity for mental work increased as the disease advanced. He well expressed the peculiar psychology of the tuberculous, when, in 1873, he wrote as follows: "Were it not for some circumstances which make such a proposition seem absurd in the highest degree, I would think that I am shortly to die, and that my spirit hath been singing its swan-song before dissolution. All day my soul hath been cutting swiftly into the great spaces of the subtle, unspeakably deep, driven by wind after wind of heavenly melody. The very inner spirit and essence of all wind-songs, sex-songs, soul-songs, and body-songs, hath blown upon me in quick gusts like the breath of passion and sailed me into a sea of vast dreams, whereof each wave is at once a vision and a melody." Again he wrote: "Know, then, that disappointments are inevitable, and will still come until I have fought the battle which every great artist has had to fight since time began. This—dimly felt while I was doubtful of my own vocation and powers—is clear as the sun to me now that I know, through the fiercest tests of life, that I am in soul, and shall be in life and utterance, a great poet."

Marie Bashkirtseff, whose frail young body was constantly overtaxed by the sheer exhilaration of her exceptional mind, when only twenty-four exclaimed that art alone was the sustaining factor in her life.

Balzac, who died at fifty-one, was a prey to physical frailty and "a horrible spasmodic cough" which recurred from year to year. In 1836 he wrote: "My forces are being exhausted in the struggle; it is lasting too long; it is wearing me out.… A nervous sanguineous (!) attack. I was at death's door for a whole day." In 1838: "… if there is success, success will come too late. I feel myself decidedly ill.… Such fevers … crush me." In 1846: "I feel young, full of energy … before new difficulties." In 1848: "I have had to get a valet—being unable to lift a package, or to make any movement at all violent.… I am as thin as I was in 1819.…

Katherine Mansfield, while resting at 47 Redcliffe Road, lamented the slow delivery of the many stories already written in her mind. "And don't I want to write them? Lord! Lord! it's my only desire—my one happy issue. And only yesterday I was thinking—even my present state of health is a great gain. It makes things so rich, so important, so longed for—Changes one's focus.

Dr. Jacobson suggests that Francis Thompson was thinking of his own struggle with tuberculosis when, in The Hound of Heaven, he said:

Ah! Must—
Designer infinite!—
Ah! Must Thou char the wood ere Thou
Canst limn with it?

Ebstein reported the following as coming from the pen of an inquiring patient:

Many questions trouble me
Torture also in the stillness.
Is perhaps my knack of rhyming,
Caused by the dread bacillus?

Ralph Waldo Emerson, who suffered from a chronic form of tuberculosis, seemed to be quite sure of his dual personality. In his own words, the one "toiled, compared, contrived, added, argued"; the other "never reasoned, never proved; it simply perceived; it was vision; it was the highest faculty." He added: "In writing my thoughts, I seek no order, or harmony, or results." After going south in November, 1826, to escape the "northeast winds," the following May we find him writing: "I am still saddled with the demon stricture [pleurisy], and perhaps he will ride me to death. I have not lost my courage, or the possession of my thoughts.…" Approximately a year later he said: "It is a long battle, this of mine betwixt life and death, and it is wholly uncertain to whom the game belongs.…"

Keats once said: "I feel more and more every day as my imagination strengthens, that I do not live in this world alone, but in a thousand worlds."

If we accept the teaching that there is a dual personality in every individual, the two personal entities being designated as primary and secondary—the primary personality as that part which conforms to the usual conventions of life, constantly being restricted by established habits and customs, and the secondary personality as that part, which, under ordinary conditions, is kept in leash but occasionally released through the influence of some subtle force to override all conventions and restraints—we can readily see how the world may be blessed or cursed by the unconventional sway of this secondary personality. In those of superior intellect this release of the secondary personality may paralyze restraining inhibitions and cause a flair of genius with power to open the doors leading to the magic fields of creative achievement, doors otherwise closed by the prohibitions of intellectual, moral, and social locksmiths.

How unhappy many pious, prohibiting souls might be if they really knew through what questionable avenues the most beautiful and significant creations of genius have traveled. Fortunately, our archives contain no recorded fingerprints for the detection of psychic derelicts. How surprised these same prohibiting individuals might be if they knew what a frightful price has been paid for many of the literary, artistic, and scientific treasures in which we are permitted to revel without thought of their laborious birth. Certainly, we must admit the intimate relationship of many of these treasures with disease, drugs, and alcohol. As contributing factors we should also consider poverty, persecution, imprisonment, isolation, and often the consciousness of approaching death and, for the scientist, not infrequently, the voluntary risk of life. On the other hand, in those of inferior mental qualities the primary personality may be submerged by the reign of the secondary personality with the danger of irrational behavior. According to Dr. Jacobson, it is in this low-mentality group that we usually find the so-called medium, claiming supernatural communications. There is also a tendency toward vagabondage, while those of exceptional mentality rise on the wings of genius.

As mentioned above, among the factors and forces which seem to destroy inhibition and temporarily set free the secondary personality are alcohol, opium, and possibly the toxins of tuberculosis. While scientific proofs may be wanting, it is easy to build up plausible evidence by the enumeration of many cases which apparently have been influenced by these agents.

Having referred to alcohol and opium as being among the agents which occasionally release the secondary personality and lead to strange and fantastic flairs of genius, we should digress for just a moment in order to call attention to the fact that the alcoholic or the drug addict always pays a frightful price. Among the literary geniuses who have been addicted to alcohol and opium we might mention De Quincey, Coleridge, Edgar Allan Poe, Gabriel Rossetti, James Thomson, Elizabeth Barrett Browning, Swinburne, and Francis Thompson. Two of these, Edgar Allan Poe and James Thomson, "died in the gutter." Another, Francis Thompson, was rescued from the streets in London in an almost dying condition. Jeannette Marks states that two of the remaining five "made ineffectual struggles to get free. And one made no struggle at all but quietly closed the door of his house upon the world.… One was made well by a great love, another by a great friendship. But of De Quincey, Coleridge, Poe, Rossetti, James Thomson and Francis Thompson, is recorded both physical and mental shipwreck."

We are now concerned with the alleged influence of the toxins of the tubercle bacillus. After allowing for the increased mental activity which is apt to accompany enforced physical rest and the fear of impending death, many students of tuberculosis have expressed the belief that there is a decided excitation of the mind with increased capacity for creative accomplishment and that this excitation is due to toxic agents manufactured by the tubercle bacillus. Even though we question the intangible conception of a dual personality and the unproved theory of a psychic stimulant among the toxins of tuberculosis, it must be admitted that we have not reduced the number of exceptional minds in conflict with the disease.

During the past few decades the tubercle bacillus has inspired much investigative work, including that of the Research Committee of the National Tuberculosis Association. This Committee has been particularly interested in the chemical composition of the tubercle bacillus. Through the Committee's various assignments to carefully selected workers in well-chosen laboratories, many interesting observations have been made, and some significant facts have been established. If there is a chemical factor possessing the power of mental excitation, the continuation of these investigations may ultimately lead to its discovery and identification.

In the meantime, we must agree that the present evidence of such a stimulus is founded wholly on the clinical observations of those who have witnessed the strange phenomena of mental excitation in many individuals suffering from tuberculosis. While we await the proof of a stimulating toxin, all well-informed physicians who think in terms of tuberculosis will recognize the genuineness of past observations with reference to unusual psychic phenomena in those already endowed with exceptional mental qualities, and the majority of them will continue to attribute such phenomena to compensatory efforts on the part of the patient to meet the insistent demands of a dread disease, to defeat the annulling vision of approaching death, and, in some, to disguise a consciousness of the dismal truth.

In addition to this brief summary of opinions expressed in semiscientific and popular writings, attention is called to the fact that textbooks on tuberculosis recognize the profound influence of tuberculosis on the nervous system. In some of them the surprising euphoria accompanied by a desire for creative accomplishment is frankly discussed.

Dr. Maurice Fishberg in his book on Pulmonary Tuberculosis says: "As an exquisitely chronic disease, phthisis is accompanied by many morbid manifestations of the nervous system; in fact, nearly every symptom of the disease is often influenced by the effects of the tuberculous toxins on the nervous system. The neurotic phenomena may make their appearance immediately at the outset, in some they precede the actual onset of phthisis, while most confirmed consumptives have a psychology peculiarly their own, and show symptoms of nervous aberration which cannot escape the vigilance of the observant physician."

Under psychic traits he adds: "Many tuberculous patients show a remarkable change in their mental traits and character, a disturbance in their emotional life and a striking divergence from their previous customs, habits, affections, and tastes. In some, this change precedes the evident onset of the disease, in many it appears synchronously with the symptoms of active disease; it may ameliorate with each improvement, and aggravate with each acute exacerbation." He goes on to say: "Engel points out that the original, innate temperament or character of the individual becomes strikingly pronounced in the chronic consumptive: The pessimist suffers from marked despondency; the optimist becomes unreasonably hopeful of the ultimate outcome, etc. These phenomena may be explained by the discordance between the subjective feelings of the patient who is not as disabled as the objective findings of the physician would lead to expect. The mental make-up of the patient depends greatly on his physical condition which, in tuberculosis, is subject to great oscillations; aggravations and improvements coming and going quite unexpectedly. The mental traits per se do not change, but such traits as were characteristic during youth but, as a result of education, training, and the vicissitudes of life, have been suppressed, reappear boldly, unhindered by conventionalities."

Discussing euphoria and euthanasia, he says: "Optimism, despite many evidences of progressive disease which saps the body, is frequent; only a copious hemorrhage, or, more rarely, a spontaneous pneumothorax, will terrify the average tuberculous patient. Otherwise, all the symptoms amount to little or nothing.… It is often astonishing to behold the sinking man make plans for the future, engage in new enterprises, plan long voyages not for a cure, which he believes he has almost attained, but for pleasure or, as I have seen, arranging for his marriage a few days before his death."

Referring to patients with advanced tuberculosis, Dr. Fishberg says: "His bright eyes with dilated pupils, which are at times contracted unilaterally, the flushing cheeks, the keen intellect which is so often met with among those who before the onset of the disease were rather dull in this respect, coupled with a flickering intelligence which brightens up suddenly for a few hours, but is soon followed by mental depression or fatigue, bear close resemblance to the average person who is under the influence of moderate doses of alcohol, or a narcotic drug.

"In tuberculous patients, particularly young talented individuals, it is noted that for weeks or months, now and then, they display enormous intellectual capacity of the creative kind. Especially is this to be noted in those who are of the artistic temperament, or who have a talent for imaginative writing. They are in a constant state of nervous irritability, but despite the fact that it hurts their physical condition, they keep on working and produce their best work.…"

He quotes Létulle as having said: "They astonish everybody with their mental and intellectual activity; their memory, their quick judgment, their delicate reasoning powers are of incomparable amplitude."

Dr. Robert H. Babcock in Diseases of the Lungs says: "The one peculiarity of the consumptive which probably strikes the observer most forcibly is his hopefulness, the spes phthisicorum of the ancients. This is not usually seen, or at least is not pronounced, in the beginning of the disease, but late in its course, when it is only too apparent to his friends that death is not far off, the consumptive is possessed with a belief in his speedy recovery. He not only talks hopefully of his condition, but actually makes plans for the future which to his friends are absurd and distressing. It is this sanguine expectancy which makes the bedridden consumptive so ready to undertake journeys to some vaunted resort."

Dr. Sherman G. Bonney did not believe that the byproducts of the tubercle bacillus could cause a toxic excitation of the mind, but in his textbook, Pulmonary Tuberculosis and Its Complications, he admits that "there is a vast difference in the degree to which pulmonary invalids retain their nervous energy.… Some exhibit an astonishing vitality almost to the very end, although their physical strength may be very seriously impaired."

From the above discussion it is obvious that the proper understanding of the psychological phenomena accompanying tuberculosis requires careful reasoning with skilful integration of the known factors and conservative consideration of the unknown.

It is well to remember that every person suffering from tuberculosis presents individual problems. In each case the hereditary factors are distinctive, and the individual's reaction to disease and other external influences is conditioned by these factors—the fundamental traits of character. Though the sum-total of life is to be found in the hereditary and the environmental factors, it is obvious that the range is so wide, the possibilities so varied, that there is no formula which will fully interpret behavior at any period in a person's life. The tubercle bacillus has its own individual characteristics, and the response to its presence in man is to some extent dependent upon the strain or the virulence of the invading bacillus. The behavior of the bacillus and the progress of tuberculosis are greatly influenced by the temperament and constitution of the person infected and the environment in which he lives. Finally, the psychology of the individual suffering from tuberculosis may vary with the acuteness or chronicity of the disease, the stage it has reached, and in some the periods of quiescence and activity.…

To mention briefly the work of all the creative minds influenced by tuberculosis would mean the accumulation of sufficient data to fill a series of thick volumes. The following incomplete list, chosen from the field of literature alone, will immediately bring a realization of the close relationship of this disease with creative effort and accomplishment. While the diagnosis cannot be verified in many of the persons listed, the available clinical evidence seems to warrant their inclusion. It is interesting to note that they nearly all lived before the discovery of the tubercle bacillus, before early diagnosis was possible, and before toxemia was limited by modern management.

Milton, Pope, Shelley, Voltaire, Hood, Keats, Walt Whitman, Elizabeth Barrett Browning, Francis Thompson, Goethe, Schiller, Molière, Channing, Mdrimde, Thoreau, Descartes, Locke, Kant, Spinoza, Beaumont, Samuel Johnson, Goldsmith, Sterne, De Quincey, Scott, Leigh Hunt, Jane Austen, Charlotte, Emily, and Ann Brontd, Stevenson, Balzac, Rousseau, Washington Irving, Hawthorne, Gibbon, Kingsley, Ruskin, Emerson, Cardinal Manning, Lanier, Marie Bashkirtseff, Robert Southey, Westcott, Georges de Gudrin, David Gray, Amiel, John R. Green, Robert Pollok, Hannah More, James Ryder Randall, N. P. Willis, John Addington Symonds, Stephen Crane, Katherine Mansfield, Paul Laurence Dunbar, Eugene O'Neill, Novalis, Klabund, Tchekov, Llewelyn Powys, W. E. Henley, William Cullen Bryant, John Greenleaf Whittier, Maxim Gorky, Feodor Dostoevski, Aubrey Beardsley, Eugene Albrecht, Beranger, Richard Lovelace, George Ripley, Blackmore, Joseph Rodman Drake, Kirke White, Adelaide Ann Proctor, Henry Timrod, H. C. Bunner, John Sterling, Havelock Ellis, and John Millington Synge. Cicero has also been listed among those who may have suffered from tuberculosis.

Even this limited list opens a field for interesting studies in the realm of psychology conditioned by affliction and places before the biographer the intriguing trend of genius through its difficult course in defiance of disease.…

Dan Latimer

SOURCE: "Erotic Susceptibility and Tuberculosis: Literary Images of a Pathology," in MLN, Vol. 105, No. 5, December, 1990, pp. 1016-31.

[In the following essay, Latimer observes that in works by such authors as Thomas Mann and Edgar Allan Poe characters afflicted with tuberculosis are associated with erotic and artistic qualities.]

What is striking about tuberculosis as a disease—in contrast to other important disease representations—syphilis, let's say, or leprosy—is that tuberculosis gets remarkably good press from writers of belles lettres—especially in the first two-thirds of the 19th century. Rend and Jean Dubos characterize this literary treatment as "perverted sentimentalism," and indeed, considering the nastiness of the disease and its ubiquity, it is hard to imagine at first why permanent diarrhea, ceaseless coughing, spitting up of yellow phlegm then bright red blood, having a grotesquely swollen neck after the lymph nodes have bagged a few of the circulating bacilli, not to mention the night sweats, fever, sleeplessness, opium addiction, emaciation, sunken chest, and clawlike hands—it is hard to imagine how the disease could have been romanticized at all. Nor was it exactly the privilege of the few to have it. In the 19th century, according to Dubos, one-half of the population of England suffered from it with varying degrees of severity. At the beginning of the 20th century, practically all Americans were tuberculin positive, that is, had been exposed at one time or another to the disease. In the first half of the 20th century, it killed 5,000,000 people in the United States, and in 1952, the date of The White Plague, Dubos calls it still the greatest killer of those between 15 and 30 years of age. Fifty million were still suffering from it world-wide in 1952, and of those it killed three to five million every year.

The disease, it seems, has always been around. There are Egyptian skeletons from 1000 B.C. with bone lesions, and there are neolithic remains showing signs of spinal curvature, both hallmarks of tubercular infection. But there have been epidemics, periods when the disease was far worse than at other times. In the middle of the 17th century, there was a mini-epidemic in England, though the disease was rare in the country districts. Twenty percent of total deaths were attributed to it. The disease then declined spontaneously to 13 percent of total deaths around 1715, at which point tubercular mortality began again to rise. At the end of the 18th and beginning of the 19th centuries, the mini-epidemic was replaced by a very major one. Then around 1850, the mortality of the disease began to decline gradually of its own accord—before medicine had really figured out what to do about it, whether even it was infectious or not, whether the patient should relax or rough it (as in Mark Cook's wilderness cure), breathe fumes of cow dung or go into the mountains, before Koch had determined that a bacillus caused the disease, and certainly before streptomycin was used against it—not really as a cure, it turns out, since the bacillus lives a long time in dead tissue, through which blood, hence anti-bacterial drugs, cannot circulate.

Mortality declined for several reasons, but the spontaneous decline was probably due to the ubiquitous exposure, the melancholy absence of progeny from those who had been susceptible and had died young, on the one hand, and, on the other, the resistance put up by the bodies of everyone else who did survive it—all rather a Darwinian answer to how epidemics decline on their own. Within this period of gradual decline, there were other periods when mortality shot up aberrantly, even among those groups known previously for considerable resistance. Tuberculosis mortality always rises during times of social upheaval and disruption, during wars and revolutions, when life is unpleasant and stress is high. During the Prussian siege of Paris in 1871, for instance, tuberculosis deaths rose. Eastern European Jews from the ghettos, whose mortality from consumption was low compared to the general population, soon had a worse mortality rate than the general population once the pogrom-like activities of the post-World War I period were under way. Denmark, which was not involved in World War I—neither fighting, nor occupied—but was surrounded by mutually hostile neighbors, had an increased mortality rate. For Dubos, the reason was in part at least that Denmark's own consumption of animal protein was disrupted by heavy sales to England during the war. Mortality declined again once submarine warfare disturbed the meat shipments on the high seas. This relation of animal protein intake to resistance to tuberculosis is supported by the high mortality among vegetarian African tribes (the Akikuyu) as opposed to such meat eaters as the Masai.

Dubos's theory on the causes of the great epidemics of tuberculosis rests mainly on the spreading industrial revolution, in particular the era following Marx's so-called "primitive accumulation," the most rapacious era of early capitalism. Of course Dubos emphasizes the unhealthy living conditions of the workers driven off the land, out of the loveliest villages and into the hellish tenements of new industrial towns, with their night shifts, child labor, and bad nutrition; and, appropriately enough, we find Dubos quoting extensively, and by the way anonymously, from Capital here (though the less threatening Engels does get a fleeting mention). A propos of nutrition, one textile manufacturer noticed that the flying fingers of his working girls slowed down after breakfast, so he forbade them breakfast in order to make them, he thought, more alert. Soon sagging surplus value was the least of the problems they and their boss had. In fact, the tuberculosis epidemic was probably the first big price the middle class had to pay, Dubos says, for its capitalist revolution. It was not just the exploited employees who were dropping like flies; the bourgeois gentleman, after a hard day of making others work for him, would come home himself puffing out little toxic clouds of bacilli. This explains why the leisure classes also died from the disease, despite their ample board and enviable idleness.

But it was not just the physical living conditions, the dust, the smoke, the crowded and stuffy rooms of industrialized cities that got the epidemic going. It was also, Dubos says, a matter of the mind—the psychic disruption of the worker as he or she was torn away from a world which, in spite of its poverty, was one where the worker had felt at home and secure to an extent, one where ancestral values were clear, where one was close to the land, and had a comprehensible place in a family and a community. The new urban life offered unusual new cruelties and solitude, and certain hopelessness as well, and consequently vice, including alcoholism and other chemical substitutes for a natural sense of well-being.

This connection between a disrupted psyche and a disrupted soma is something the theoreticians, as well as the poets, of tuberculosis make much of. Dubos mentions without apparent skepticism the statements of physicians who wrote of severe emotional dislocations as preceding the onset of tuberculosis in practically all their patients. Thdophile Laennec, an early student of the disease, inventor of the stethoscope, and therefore of "mediate auscultation" in the examination of tubercular patients, said that unsatisfied desires, nostalgia, and passions of profound melancholy can and do lead to the onset of the disease. Such emotions can and do proceed from financial difficulties, unhappy love affairs, and family tragedies. Thus it was said that Keats's case of miliary consumption was brought on by Fanny Brawne or some bad reviews of Endymion. I cite only by way of illustration, and not as evidence, Thomas Mann's fictional treatment of Hans Castorp in The Magic Mountain (1924). Castorp's "disease" manifests itself at the same time that some long-buried memories of a boyhood attachment to Pribislav Hippe return during a strenuous walk around Kurort Davos. This attachment had only been a matter of a borrowed pencil, an exchange of a few words, and the preservation of some sacred fetishistic pencil shavings. But by the time Castorp gets back to the Berghof, he is in a state of nervous prostration and is spattered with his own blood. He sinks into a chair just in time to hear Dr. Krokowski explain to a roomful of smouldering female patients that the power of repressed desire always returns in the form of disease. This diagnosis also helps explain Castorp's cousin Joachim's difficulty in getting well, since he is desperately enamored of the young Russian woman Marusja in the Berghof but remains faithful to what he considers his military duty. For Castorp the pencil itself returns, along with Hippe's epicanthic eyes and a new opportunity for love, in Clavdia Chauchat on Walpurgis Night. "Don't forget to bring me my pencil," she says, as she repairs to her bedroom, an exciting if confusing moment for the reader, if only because it emphasizes what really has been clear all along, namely that those who are diseased supposedly because of erotic repression are nevertheless erotomaniacal. One can cite the "unmanierliche" Russian neighbors of Castorp early in the novel who make love noisily and incessantly, as well as the Dionysian entourage of Mynheer Peeperkorn to whom Chauchat (the "hot cat") later becomes attached. The orgies of the Berghof are joined by way of allusion in this text to Faust's orgies on the Brocken with witches as well as the medieval sojourn on the Venusberg by Tannhauser. Responsibility in Castorp's case is in the flatland, the mercantile world of buying low and selling high, of regular work, of family, and of the unreflecting accumulation of solid property. Eventually responsibility appears as the defense of the fatherland during World War I, a responsibility which Castorp accepts after years of self-indulgence. Irresponsibility is, on the other hand, quite pleasant—a matter not only of erotic experimentation, but of letting go in other ways, in lying around with a low-grade fever reading, thinking, eating massively five times a day (including six-course lunches), having lovely conversations, and cultivating the soul.

Before coming back to Thomas Mann and the suspicious vacillations and waverings of Tristan (1902), I would like to take a turn through Dubos again if only to suggest that Mann's vacillations are typical of the contradictory representations of the disease in the years leading up to Mann's fictional accounts. We cited Laennec's position that repressed desire pops up as tuberculosis, a point reiterated by the lecturing lecher of The Magic Mountain, Krokowski. What of the other chord, sounded just as often, just as insistently in Mann, that sickness and orgiastic sexuality are two sides of the same self-abandonment? And if this sexual sickness is one that leads to death—think of the terminal relaxation of Aschenbach on the Lido in Venice after he had caught a different, but just as deadly, disease chasing along the canals in pursuit of Tadzio—why is Mann just as likely to make sickness attractive as he is to be censorious about it? When the disease was so common and emerged from an abused proletariat, how did it become in the iconology an aristocratic affliction? When it was so revolting (phlegm and bloody hemorrhages), how did it become the sign of a refined, ethereal nature? Why was Elizabeth Barrett Browning, in Italy for her own consumption, overheard to say, "Is genius, then, only a matter of scrofula?" One might mention that the disease could have been more revolting if the ulceration caused by the extreme toxicity of the bacillus in the moist tissue of the brain, lungs, intestines, even the royal anus in the case of Louis XIV—if this ulceration had been visible, or less disguisable in the case of scrofula by high collars and fashionable neckwear, it would have been less easy to associate tuberculosis with love. As it was, the poets, whose whole gift, Aristotle says, consists in making certain lies plausible, had an all too easy time of it (Poetics XXIV).

One curiosity of the taste of the time involved, says Dubos, a change in what was considered attractive in women. Or was this change in taste a matter of necessity thanks to the universality of consumption? In any case, the revolutionary female of 1789, boisterous and lusty, had given way to the vaporous, languishing, delicate, diseased—sometimes even deceased women—of Edgar Allan Poe. Poe's heart leapt up when his wife Virginia would pause during her recitals at the piano while bright red blood ran down the front of her white dress. Nothing was more thrilling to the men of the time. William Cullen Bryant said a dead beautiful girl was the most poetic of themes. Women wore white muslins to look even more consumptive than they already were. They blanched their faces with whitening powders. Pre-Raphaelite painters preferred tubercular women for their models. One such model was the renowned Elizabeth Siddal, a pale redhead with long thin limbs, a cadaverous physique, and a red, sensual mouth. She became Rossetti's wife and a favorite model for everyone from Burne-Jones to Millais. The painters loved to make her lie in a tub of lukewarm water, though at times it was considerably colder than that, while they pretended that she was Ophelia. She died in 1862 at the age of 30 of a laudanum overdose, laudanum being the drug of choice of the time, a mixture of alcohol and opium, just the ticket for diarrhea and a hacking cough. Jane Burden was the woman with whom William Morris afflicted himself (in 1859). She was tubercular, inconstant if not wildly so and sported the same body type as Elizabeth Siddal.

A few years earlier, love and death had already been joined in the feverish example of Marguerite Gauthier, the dame aux camglias, and courtesan friend of Dumas, fils. After she died at the age of 23, it became fashionable for young lovers to seek the blessing of her spirit by bringing camellias to her grave in Paris. Camille, translated into English had a great success in New York, and Verdi's La Traviata (1853) it seems, never leaves off drinking, dancing, copulating, and being free. Henri Murger gave his tubercular flower girl-girlfriend eternal life in his Scenes of Bohemian Life (1849). When Murger put pen to paper, Mimi was scarcely cold, having died only the year before. Puccini's popular opera, La Boheme (1896), is based, of course, on the text of Murger. So compelling was the sexy image of this disease that the Goncourt Brothers, despite their professed realism, were unable to resist a certain romanticization of the sickness in their novels. Dubos mentions the Goncourt novel of Madame Gervaisais (1869), whose seraphic seductiveness increases with the progress of her disease. Germinie Lacerteux (1864) is an even better example for our purposes here, if we say that our main purpose is to trace the supposed relationship of sex and disease. Germinie is a working-class woman whose frantic erotic excesses—frantic at least for the Goncourts—and her inordinate love of alcohol sentence her to certain pulmonary hemorrhage and death. In this novel, the association of sexual freedom with the grave seems so suspiciously like punishment, in fact, that one thinks of Fontane's Effi Briest (1895), another adulteress with lung trouble. For Germinie, though, the need for punishment seems to come less from the central character, as in the Fontane novel, than from the authors, who are clearly appalled by the notion of a woman sleeping around and getting away with it.

Germinie needs to get drunk to let go, needs a Liebestrank, or at least a Liebesgetrank, much like Castorp, whose desire is also abetted by its translation into a language other than his own. He drinks punch and speaks French to seduce Chauchat. Not that most 19th-century consumptives needed to get drunk to be amorous, since they were almost invariably drunk already. Dubos says that it is safe to assume that every consumptive became an opium addict. Opium generates unnatural brain states. So does fever, also part of the consumptive's lot. Dubos mentions that there is a theory that consumption produces in its victim a microbial toxin, which gives the opium-eating, fever-ridden patient an extra jolt of giddiness. Whatever caused it, it made the consumptive wild, restless, hyperactive, and visionary. Activities suggesting such wildness were widely regarded not only as the result of consumption but also as its cause. One could contract tuberculosis both while sitting in the ratinfested gutter clutching one's gin bottle and while whirling about in a ballroom sipping champagne with Violetta. Indeed, waltzing itself supposedly lubricated the slippery slope to disease, though whether it was as dangerous in this regard as the polka morbus is hard to tell. These are the activities of city life, in any case, and consumption was in its inception a disease of the cities. Whatever happened in the cities was perverse and unnatural and likely to upset healthy equilibrium.

If one was sick, then, one was precipitous, hectic, intoxicated. As Stevenson tells us, though, in "Ordered South," strength is soon at an end, even while restlessness remains. The consumptive is therefore necessarily focussed on indoor sports or even sublimations into mental activity of his (or her) natural drives. One can suppose, therefore, a metaphorical leakage between the patient's fever to the idea of a consuming fire, that seemed to burn the patient up from within, and then to the brightness of intellectual achievement. The mental restlessness of the consumptive was a sign of genius. Sidney Lanier, bard of the Chattahoochee, believed his creativity was encouraged by his disease. He was shocked to find Walt Whitman perfectly healthy. The Goncourt brothers were similarly disappointed in Victor Hugo, who would have been a much better poet had he been a physical wreck like Heine or indeed like themselves. The characteristic fire of the consumptive was noted in ancient times by physicians like Aretaeus, who called it spes phthisica, "consumptive hope". It manifested itself as a race with death, a hectic drive toward achievement or experience before the disease had burned itself out and the consumptive up. Stevenson's productivity is often mentioned as an example of spes phthisica: A Child's Garden of Verses (1885), Dr. Jekyll and Mr. Hyde (1886), and Kidnapped (1886) were all written under these hectic conditions. But it is hard to imagine such works being produced by a consumptive who had only the disease, and no talent, to help him along. Nevertheless intellectual sensitivity and culture were linked with the disease as irresistibly as were unconventionality or hypersexuality. Any one of these linkages would bring us back again to Thomas Mann, but it is surely the first, the alliance between art and disease, that opens the path to Tristan (1902). Or is it?

Hypersexuality does exist in the story, of course, but it is characteristic of the healthy Kleterjahn, whose name suggests a dialect word for "testicles." It is he who is discovered, compromisingly, with the maid in the hall of the sanatorium Einfried practically the instant he has checked his wife in as a patient there. It is not surprising that he has chosen as his son Anton's nanny a woman of "exuberant figure" and "swelling hip." She is the woman regarded by Spinell with revulsion as she takes the Kloterjahn baby, another relentless man of action and instinct, for an airing in the garden. Kloterjahn pare is robust of whisker and appetite, devouring an English breakfast every morning with an English family he discovers staying—though they are apparently quite healthy—at Einfried. His overall Anglophilia suggests simplicity and absence of any neurotic tendencies. He is a solid businessman and frankly rapacious. His gaze is open and direct. His eyes are blue with pale lashes; he is short, solid, sociable, and noisy. He is contrasted with Einfried's resident author, Detlev Spinell, who is quiet, solitary, and looks a bit like an undertaker with his lanky, dark form and black coat with tails. When he stands at the piano in the light of the two candles and beckons to Gabriele to play, it is as if he is inviting her to her own coffin. Mann insists on the association of his name with the thorny crystalline mineral "spinel." But the name also suggests Spinne, "spider," as well as Spindel, the bobbin which gives death to Dornroschen. Spinner, "madman," may also be part of the name's resonance. His "deer-like brown eyes," his "gentle" expression and beardless face suggest either feminization or total lack of sexuality. The eyes cannot bear to search out much reality, the defects of which are only too abundant, he says. He prefers his fantasy, his mental impression, to the tangible and actual. Consequently he transforms the image of the young Gabriele in the garden with her six girlfriends into a Pre-Raphaelite hortus conclusus, a garden "wild and overgrown," with crumbling, mossy walls, and a fountain bordered by lilies. He has the girls, like fairytale figures, singing instead of crocheting and sharing recipes for potato pancakes, which, according to Kloterjahn, is what they were really doing. Spinell places a little golden crown on Gabriele's head which was not there in reality but which in her increasingly pathological "self-satisfaction" and self-absorption she comes to believe in. When Kloterjahn bursts from the shrubbery to tear her away from the artistic father and girlfriends, Spinell sees the event in Tennysonian terms, and Gabriele as a German lady of Shalott also used, in her weaving, to indirect, reflected contact with the outside world who rises to look directly at her knight, and is crushed by reality. Similarly her tapestry, her web of art, unravels, her mirror shatters, and she dies. We are told several times that Gabriele's eyes have a slight tendency not to look directly at things: "sie zeigen eine kleine Neigung zum Verschiessen."

Spinell's decadence, his lack of fitness for life, the impaired nature of his appetites are signalled by his "carious" teeth. His sleeping late would be another sign of decadence, at least for the businessman, for whom the daylight hours are sacred for "getting ahead." It is precisely the day which is rejected for night and love in the piano score of Wagner's Tristan and Isolde (1865). Day separates the illicit lovers, who then are reunited at night. No doubt the sacredness of night gives us the principal motivation for Gabriele's opening her forbidden concert with Chopin's Nocturnes as well—Chopin, of course, another consumptive.

One positive thing can be said about Spinell's irresponsible behavior in this scene: he does have a sense of the beautiful. He does bring Gabriele (the music-making angel) back to her true artistic nature, tears her away from her reluctant respectability, her healthy child, her priapic husband, indeed from life itself in all its banality, and redevotes her to art and beauty, for which we are told she has an extraordinary talent. To cultivate the beautiful is to be a dreamer, someone who is impractical and self-absorbed. Spinell, who hates the practical, the useful, manages "to rouse in her a quite novel interest in her own personality" (eine seltsame Neugier, ein nie gekanntes Interesse filr ihr eigenes Sein). She nourishes "secret thoughts … about herself." She finds herself mildly intoxicated during these pensive moods when she is "a little affected, self-satisfied (selbstgefallig), even rather self-righteous (ein wenig beleidigt)." This intoxication is nothing compared to the massive drunkenness of Wagner's piano score, the Liebestrank which she and Spinell share. After she has played the second act duet and has paused with a question about the text, Spinell explains to her what it means for the lovers to say "Even then I am the world" (Selbst dann bin ich die Welt). It seems the perfect phrase for what she has become now, self-fulfilling, self-sufficient, the imaginative source of her own reality, all dissonant elements of the real world banished for the secret delights of the night of mystic death and love. The duet in question (from Wagner) begins,

O sink' hernieder,
Nacht der Liebe,
gieb vergessen
dass ich lebe;
nimm mich auf
in deinen Schooss,
löse von
der Welt mich los!

(Descend,
O night of love,
let me forget,
that I live;
take me
in your lap,
release me
from the world!)

This beauty that she produces is her death, of course, because it is precisely her disease which feeds her artistry. She would not be so talented, in the logic of consumption's interpreters, if she were not so ill. Her physique, too, with its ethereal, white, translucent fragility is precisely the otherworldly "muslin beauty" of Virginia Poe or Elizabeth Siddal. The "red, sensual mouth" of Siddal is here "beautiful and wide," with "exceedingly sharp and well-cut contours." Under Spinell's influence, she drops her knitting in her lap, dreams, wastes away, and dies from the massive aural orgasm of the Liebestod. This is all so obvious that it is perhaps a pity to have the narrative—actually, Spinell—also make the point that Gabriele dies not of art but of reality, das Respektabelste, her husband and child—dies from being torn away from her magic musical garden in Bremen, from her fountain and lilies, and perverted from her true nature by the plebeian gourmand, Mr. Testicles. It can't be that she dies of both, but, of course, she does. Mann as usual is reluctant to take too unequivocal a position.

There may be another reason that she dies, as well. What, besides mutual hatred of reality and love of beauty, is the true relationship between Gabriele and Spinell? What else does the dubious Spinell encourage in his protegee? We mentioned her "self-absorption" and "self-satisfaction," her refusal to consider her own "bodily welfare" when she takes up Wagner's music. There is the mysterious allusion to self-sufficiency in "Even then I am the world," explained by Spinell to Gabriele but not to the reader. The nature of the love between Spinell and Gabriele is an artistically mediated one, a love of distance, indirection, and images. He bows to her from a safe distance of twenty feet; he is speechless, his shoulders are heaving with (one assumes) genuine emotion. His devotion to her "lifts her up on billowy cushions of cloud," away from himself and away from all earthly impurities.

The clearest hint of the nature of their relationship comes in his reasons for being in the sanatorium in the first place. He is having himself elektrisiert. His powers have drained away. He needs charging up again. Such was one medical remedy for exhaustion at the time. He explains, paradoxically, that what has brought on this exhaustion is sleeping late. He has a bad conscience. He refuses to be useful. He leads an unhealthy life, troubled by a sense of his own futility. His "whole inner life … his way of working is … frightfully unhealthy, undermining, irritating (aufreibend)." It is unhygienic, undisciplined. He had gotten to the point of being "wund und krank," sore and sick; the condition has advanced to such an extent that there is not a healthy spot anywhere on his person (kein heiler Fleck an [ihm]). He came to Einfried for a counterirritant, to be forced to get up early, to take cold showers, to take healthy exercise in the garden. The ladies to whom he is speaking give a name to his way of life. Perhaps they are trying to characterize him as an ascetic when they use the term Selbstuberwindung, "overcoming" or "controlling" himself. On the whole, they think he is too hard on himself; he frets, torments, abuses himself too much:

—Sicher gramen Sie sich zu viel.

—Ja, ich grame mich viel.

We know by now, or ought to, thanks to the retrieval by Sander Gilman of the medical literature of Europe, and therefore the discursive context of belles lettres heretofore considered self-sufficient and exclusive, how to recognize representations of sexual pathology. In this regard, it is hardly a good sign that Spinell is a Langschldfer; always lying in bed late leaves the door open for any number of pathologies to develop, which would then show themselves physically as emaciation, lethargy, fleshy lips, attenuation of powers, and melancholia, which can advance even to the horrors of Uranismus or madness. I quote from Richard von Krafft-Ebing, Psychopathia Sexualis:

Die geistige Liebe dieser Menschen [die Uminge] ist vielfach eine schwarmerisch exaltierte.… Es bestehen Neurosen (wie Hysterie, Neurasthenie …). Geweckt und unterhalten wird sie [die Neurasthenie] durch Masturbation oder durch erzwungene Abstinenz.… In der Mehrzahl der Falle finden sich psychische Anomalien (glanzende Begabung fuir schone Kunste, besonders Musik bei … originarer Verschrobenheit) bis zu ausgesprochenen psychischen Degenerations-zustanden (Schwachsinn, moralisches Irresein).

The spiritual love of these people [he's speaking of homosexuals] is usually an enthusiastic exalted one.… Neuroses (like hysteria, neurasthenia) arise. … Neurasthenia is awakened and sustained by masturbation or through forced abstinence.… In most of the cases one finds psychic anomalies (a splendid capacity for fine arts, especially music, along with peculiar perversity) to the point of marked psychic conditions of degeneration (imbecility or moral delirium).

To be mad, to be a woman, to be a child, as we can learn from influential physicians like Dr. Paul J. Mobius, is all part of this pathology. (See Uber den physiologischen Schwachisnn des Weibes, fifth edition, 1909, pp. 17, 21). And Spinell is a child, a degenerate baby (ein verwester Saugling). He has no beard on his round, white, bloated face. He has the soft, doe-eyed gaze of a woman, oblique and indirect. His handwriting is full of gaps and nervous quavers (Zittrigkeiten), according to Herr Kloterjahn. But what of this Verwesung, this degeneration, nervousness, and neurasthenia? It is not enough to recognize that Spinell, who characterizes himself as weak and vengeful, the creature of Geist und Wort, is most probably a Jew, having been identified by Dr. Leander as coming from Lemberg (Lvov) Galicia, in other words, where "… das jüdische Geblüt vorzuglich gedeihen soll," according to that exemplary student of the Jewish guests of the Austrian Monarchy, Joseph Rohrer. One does not have to get too far into George Beard's Sexual Neurasthenia (1884) or Max Nordau's Degeneration (1892) to see that the cause of Spinell's decay, nervousness, and regressive appearance would have to be the nature and frequency of his sexual emissions. Given all these other pathologies, one would hardly be taken aback to discover that Spinell was also Jewish. How else besides general degeneration to explain the attenuated novel with the deeply confusing cover which can be read in a quarter of an hour? Or the fact of his own self-absorption in always reading it? Or the extraordinary number of letters that leave the sanatorium to find no response at all in the outside world? Perversion is no doubt Dr. Leander's diagnosis as well, for that, and not the normal dislike of the man of science for the artistic Schwarmer, would explain Leander's unrelenting contempt for Spinell.

It is as professor of perversion that he infects Gabriele as well, about whom it is probably not enough to say that she becomes a sublimated version of what he is on the physical level. We have mentioned her gaze and her languid, exhausted, translucent form. Her hands are mentioned just as often as Spinell's and are one aspect of their direct kinship. Hers are beautiful and white. His are white and finely shaped. Hers are in her lap more than they are anywhere else. When we first see her, "ihre schonen blassen Hande … ruhten in den Schossfalten eines schweren und dunklen Tuchrockes." At the piano after she finishes playing, her hands drop naturally to her lap, die Hande im Schosse. It is an image of her self-absorption and self-sufficiency: Selbst dann, o Wunder der Erfullung, selbst dann bin ich die Welt. But the best image of the mediated eroticism she and Spinell share is the repeated foaming up under her laboring hands of the dark musical passion, the masslose Befriedigung, unersattlich wieder und wieder, of Wagner's music.

A curious aspect of the story, though, is the way that Mann, the artist allows his diagnosis of Spinell and Gabriele to indict art itself. It is of course true that Wagner, a special favorite of almost all educated homosexuals, according to Dr. Magnus Hirschfeld, is parodied in Mann's style ("Denken und Duinken versank in heiliger Dammerung"); Einfried, the house of the sick, sounds like Wagner's villa in Bayreuth, Wahnfried. Spinell is not a real artist. The circuit of passion that flows between Spinell and Gabriele is not a strictly physical one. The mediated orgasm of the Liebestod is very far removed from the love recommended by Gottfried von Strassburg whose lovers do not play the prude but cure their sickness, Lameir, with the remedy of each other, ridding themselves thereby of a host of ills and sorrows. "This death suits me well," says Tristan jauntily,

ine weiz, wie jener werden sol:
dirre tot der tuot mir wol.
(12,494-12,498)

Instead of the love that heals, we find in Mann the love that kills. Should we say then that not all art, but only its perverted versions in Wagner and Spinell, are being called into question? Perhaps only life-denying forms of art are included here?

We could say that only if Mann did not show such a favorable inclination toward life-denial himself. It is hard not to see the enthusiasm with which he paraphrases Wagner's musical ideas. Surely it is a measure of his self-hatred that Mann identifies the perverse love between Gabriele and Spinell and its supposed consequences of disease and death with a genuinely breathtaking musical score, with art, beauty, indeed with composition itself, the dubious activity which consumes most of Spinell's average day "so hasst man im anderen nur, was man nimmer sein will, und doch immer zum Teile noch ist," as Otto Weininger puts it so well in Geschlecht und Charakter (1903). Mann gestures by implication toward the source of art in disease, a point which he seemingly never tires of making, nor would he exclude his Ōwn art from the indictment-Tonio Kröger's background comes quite close, after all, tq Mann's own, and the point of that novella, too, is that Tonio is an artist because he is intimately acquainted with abnormality, perhaps even with criminality. It is consequently justifiable to say that the clearly satirical elements of the Tristan novella do not exhaust its range. Spinell parodied is still not completely ridiculous. What he loves is beauty, while Kloterjahn only loves beauty's medium. Life defeats Spinell in the person of Klöterjahn and his robust son, and Spinell has to withdraw from the field the battle. But it is not a graceless retreat. Despite some appearances to the contrary, then, it is not impossible to count Thomas Mann among those belles lettrists who—perversely for René Dubos—speak favorably of disease and death as sources of art and beauty. Such words of praise for disease would, after all, only be a measure of Mann's self-love.