Tuberculosis and the narrative: Blechers Scarred Hearts

In any case... in any case... what can a man do with his body?1

Introduction

The aim of the present essay is to analyze the manner in which Max Blechers

autobiographical novel Scarred Hearts renders tuberculosis within the margins of a

certain nosological and metaphorical reservoir of motifs concerning this illness and

will also tackle the conjecture between narrative and medicine. My hypothesis is that

tuberculosis medical and literary imagery are strongly intertwined and that there are

several recurrent motifs that can be found in the illness narratives concerned with

this very malady. In order to argue my point, I will engage in a close-reading analysis

of Scarred Hearts, alongside some references to Sontags cultural commentary on

tuberculosis. This essay will focus on the following matters that can be discussed in

regards to Max Blechers novel: what is the relationship between autobiography and

the medical narrative; how is the subject outlined in the case of a novel that

fictionalizes illness; how is the illness portrayed, in regards to somatic/psychological

aspects of the experience, and the relationship between the ill person and the medical

staff.

Biography

Max Blecher is a Romanian writer of Jewish origin, born in 1909. After

receiving the baccalaureate, he started studying medicine in Paris. However, he was

diagnosed not long after (in 1928) with spinal tuberculosis and abandoned his

studies. He went for treatment in multiple sanatoriums, one being Berck-sur-Mer.

1Max Blecher, Scarred Hearts, Old Street Publishing, London, translated by Henry Howard, first
published in Romanian in 1937, 121.
For the next 10 years, until his death in 1938, he was immobilised in bed and lived in

constant pain and suffering.

His published work comprises a volume of poetry from 1934 - Transparent

Body; Adventures in Immediate Unreality 1936; Scarred Hearts in 1937, and his

last work was published posthumously, The Illuminated Burrow: Sanatorium Diary

in 1971.

Autobiography

While in the case of Scarred Hearts we dont have such an honest and self-

explanatory subtitle as in the case of The Illuminated Burrow: A Sanatorium Diary,

neither such a candid confession of depiction of real events as the latters first

sentence: Everything I am writing was once real life2, we can infer easily that this

novel carries an autobiographical stance, after taking into account the biographical

aspects presented above.

The plot of Scarred Hearts evokes Thomas Manns The Magic Mountain,

aspect I will come back later to young Emanuel suffers of tuberculosis, particularly

Potts Disease, he has to go to a sanatorium in Berck, where he falls in love, he

witnesses several new friends dying, and leaves the place after months of extreme

suffering while wearing a plaster cast that leaves him almost as an a corpse, as he

thinks at a certain point: That was where the paradox lay: in existing, and yet not

being <fully alive>.3 The novel is visibly built-up as a case: there is a problem with

the main character of the story, he goes to specialists to find out what it is, he is given

2 Max Blecher, ntmplri n irealitatea imediat. Inimi cicatrizate. Vizuina luminat. Corp
transparent [Occurence in the Immediate Unreality. Cicatrised Hearts. The Illuminated Burrow],
Aius, Bucureti, 1999, 233.
3 Blecher, op.cit., 43.
a diagnosis and a prescription, he gets treatment and the story ends with the

perspective of another place where he should get treated.

While the novel is written in third person form, what is striking from the start

is the richness of details and the intricate web of Emanuels interior life depicted

through indirect speech, which effortlessly proposes this novel as an autobiographical

one, since through every sentence uttered by the character, through every thought

passing Emanuels mind, the voice and life of Max Blecher is heavily visible. Such a

moment where the auctorial voice bursts is the beginning of the first chapter (which

depicts the X-ray procedure he goes through): several artistic images make the

experience almost tactile through the appeal to all the senses: the air smelt faintly of

pharmaceutical products and burnt rubber4; A light bulb flickered feebly on. The

room was cluttered with medical equipment5; for fear (that) brushing against

(electrical wires) would unleash a formidable discharge of thunder and sparks6; The

cold, sharp contact with the tin surface on which he lay down...7, etc. This is how

Emanuels experience with his tuberculosis and everything surrounding it is carried

throughout the novel with a lot of attention to details, details that can be so

exhaustively familiar only to someone who experienced the illness themselves.

Apart from an obvious stylistic/literary choice, what can be the reason of

interpelling ones illness story through a third person narrative? I argue that this

manner of writing about personal experience with illness is a way of coping with the

ever-present reality of the malady. After the visit to the doctor, Emanuel feels that in

the interval spent shut inside the doctors office, the world has become strangely

diluted ... He, Emanuel himself, was no more than a mass of meat and bones,

4 Idem, 1.
5 Idem, 3.
6 Ibid.
7 Ibid.
sustained only by the rigidity of a profile.8 What a third-person narrative does in this

case is to preserve in part the alienating experience of the illness (when one does not

recognize himself anymore in the body inflicted by illness). At the same time, the

impersonal touch of the third-person narrative makes everything seem improbable,

distant this happens to someone else, it cant happen to me. I dare say that by

using the third-person narrative, tuberculosis and the somatic/psychological

experiences with illness are not only put in the drawer of possibility and also, by

making the nuance of the narrative impersonal, the author feels more in control of

what happens with his character. Another plausible interpretation would be the

creation of a certain taboo atmosphere around the tuberculosis, following Sontags

idea: Contact with someone afflicted with a disease regarded as a mysterious

malevolency inevitably feels like a trespass; worse, like the violation of a taboo. The

very names of such diseases are felt to have a magic power.9 Indeed, the illness that

inflicts Emanuels body is only twice named in the entire book, at the beginning, by

the doctor who did the X-Ray: Its called Potts Disease ... Spinal tuberculosis10 and

by Doctor Ceriez at the sanatorium. The rest of the instances where Emanuels

condition is talked about are gruesome descriptions of pestilence and disintegration:

your abscess was filled to the brim11 same illness as me... an eroded vertebra12, etc.

Scarred Hearts is an autobiographical novel, containing the memories of the

tubercular author in Berck-sur-Mer. However, it is impossible to guarantee that a

certain amount of fiction did not permeate the narrative by choosing the third

person and the free indirect speech, the author allows an amount of uncertainty

regarding the details of the story. It is important to think about how we manage such

8 Blecher, Scarred Hearts, 13.

9 Idem, 6.
10 Scarred Hearts, 7.
11 Idem, 20.
12 Idem, 30.
fictionalized accounts of malady what do we consider as real and what is fictional?

In What is an author?, Foucault argues that Becketts indifference (What matter

whos speaking?) is the ethical principle of contemporary writing, also stating that

the author is not the insertion of a subject into language, but rather creating an

opening where the writing subject endlessly disappears.13 I think that a third-person

narrative of illness like Blechers novel creates this very space where the subject

disappears.

What we deal with in the context of a fictionalized account of illness that also

has autobiographical roots is an inverted equation regarding the self and the

narrative. Paul De Man intuited this reversal in Autobiography as De-facement

when he stated that while we assume that life produces the autobiography as an act

produces its consequences, but can we not suggest, with equal justice, that the

autobiographical project may itself produce and determine the life...?14 Thus, the

internal rules of autobiography may determine the way in which the subject is

constituted, even more so in the case in which the trigger of the autobiographical

effort is something as alienating as illness. In Illness and Autobiographical Work:

Dialogue as Narrative Destabilization, Arthur Frank states, in the same manner,

that illness memoirs are performative since they create the self they claim as their

origin.15 Using Bakhtins theory, he goes on to argue that the self that is claimed

through these illness memoirs is dialogical, including thus the voices of others. What

is Max Blechers use of the third person narrative if not this very inclusion of the

voices of others through a pronominal nuance that makes the story no ones and

everyones at the same time? I dare say that the way in which Blecher outlines the

characters in his story, the empathy shown to their bodily inflictions and the fine
13 Michel Foucault, Aesthetics, Method, and Epistemology, New York, 1998, 206
14 Paul De Man, Autobiography as De-facement, Modern Language Notes, 1979, 920.
15 Arthur W. Frank, Illness and Autobiographical Work: Dialogue as Narrative Destabilization

Qualitative Sociology, Vol 23, No 1/2000, 135.

attention given to their stories/ personal traits makes this narrative effort a collective

one regarding the voices heard.

The magic sanatorium

While Emanuels sorrows and experiences resemble Hans Castorps, I want to

make some points about how this novel differs organically from The Magic

Mountain. Firstly, as argued above, Scarred Hearts is heavily autobiographical.

Thus, the depiction of the exiled young tubercular in the picturesque south of France

is not an epigonic effort, but an autobiographical one. Secondly, there is a very

important difference about the manner in which the pulmonary tuberculosis and

spinal tuberculosis are rendered and perceived. There is a certain monopoly of

pulmonary tuberculosis in the collective imagery when one talks about

tuberculosis, the general reaction is the fact that everybody understands that there is

something wrong with the lungs, as Sontag notices as well TB is understood as a

disease of one organ, the lungs.16 Hence, there is a certain spiritual, ethereal nuance

attached to pulmonary tuberculosis, leading to an aestheticization of the ill body

through the illness, as Sontag goes on to say: For over a hundred years TB remained

the preferred way of giving death a meaningan edifying, refined disease.17 Sontag

also tackles this monopoly of pulmonary tuberculosis in terms of poetical imagery

and how the symbiosis between body and art is carried through a process of creating

almost a mythology of tuberculosis: myths about TB do not fit the brain, larynx,

kidneys, long bones, and other sites where the tubercle bacillus can also settle... TB

16 Susan Sontag, Ilness as metaphor, Farrar, Strauss and Giroux, New York, 1977, 11.
17 Idem, 16.
takes on qualities assigned to the lungs, which are part of the upper, spiritualized

body...18

However, Blechers entire book is immersed in a putrid corporeality of disease:

an abscess that overflows with puss, an amputated leg that looks like a bouquet of

roses in the hands of the nurse coming out of the operating room, the dirt under the

plaster cast that causes irritation and maddening itching, etc. This is why I argue that

Blechers take on TB is a very interesting one in the context of how the imagery of it

was built in the literature of the time, more so considering the fact that it depicts a

form of TB that Sontag admitted is not easy to spiritualize Potts Disease, spinal

tuberculosis.

Sontag argues that Hans Castorp, the bourgeois par excellence, suffers a

mutation, an individualization through the illness19, whereas Emanuel confesses a

certain loss of individuality in the sanatorium, since everybody suffers more or less

from the same body inflictions as him, with same plaster stigmata: He was part of the

fellowship of illness, the fellowship of the plaster cast...20 Hence, I conclude that

while Manns novel must have been read by Blecher, the similarities are rather

coincidental, since the latters novel is based on his life and experiences and the bits

of fiction are also designed in a manner in which the autobiographical effort prevails.

Doctors and the illness

It is interesting to look at the way in which the discourse about tuberculosis is

managed throughout the novel in regards to the relationship with the medical staff.

Everything is under a rather paradoxical attitude towards the knowledge and

capabilities of the physicians. It starts with a certain monopoly of the medicine in the

18 Idem, 18.
19 Sontag, 30.
20 Blecher, 41.
process of dealing with illness: the name of Emanuels infliction is only twice uttered

in the novel, and each time by a medical authority. Every time this

diagnosis/designation happens there is a certain dispersion of doubt and/or fear:

Everything seemed entirely clear now that this erosion had its own scientific

name21; The doctor calmed him down with scientific and medical arguments.22 This

seems like a naive, complete trust in everything that can be scientifically/medically

designated the popular idea that the discovery of the diagnosis makes the cure

finding rather easy. This amazement with the medical knowledge has another side, as

well the annoyance of not being told everything that goes on with his body: He

became irritated then by the thought that behind that indifference lay a perfect

knowledge of his illness.23

However, Emanuels entire experience with the medical staff is also protruded

by mystery and fear, paradoxiacally. The first chapter of the book comprises the

gloomy parallel reality of the his encounter with medical apparatuses, such as the X-

ray chamber - an odd arrangement in which Emanuel is almost an object to be

studied. First, he has to stay in a waiting room that resembles the Purgatory: so quiet

and dark, that if he had been compelled to wait there for eternity, Emanuel would

have had no objection.24 The imagery used for his contact with the medical expertise

is in an eschatological, punitive register, just like a descending dantesque itinerary

the X-ray chamber resembling Hell: So many electrical wires... that Emanuel stood

doubtfully... for fear that entering... would unleash a formidable discharge of thunder

and sparks25; The darkness buzzed in his ears26. This punitive arrangement is

carried on by the material gruesome reality of his abscess after discovering the

21 Idem, 7.
22 Idem, 12.
23 Idem, 20.
24 Blecher, 2.
25 Idem, 3.
26 Idem, 4.
decayed vertebra, the doctor shows Emanuel a thick round swelling on his abdomen,

smooth and well-defined like an egg that had grown beneath the skin near his hip.

(Its enormous, thought Emanuel, thoroughly frightened.)27

However, the tone changes after the doctor encourages the disheartened

Emanuel and says that he does not accept any fee from students. In this moment,

Emanuel thinks of throwing at the feet of the doctor. It is interesting how the outward

gratitude shown by Emanuel echoes internally in a sort of hieratic celebration: Thank

you, Doctor. Thank you! (Hosanna! Hosanna!).28 We can see here a certain

amazement concerning the medical staff at work, amazement that turns into a

veritable morbid curiosity while Doctor Bertrand punctures his abscess later in his

room: What was taking place down there in his flesh? What was the doctor doing?29

The answer to this curiosity is once again an exaggeratedly material and pestilential

presence a jar of puss that was extracted from his abdomen, jar that will be left on

his table and which he will contemplate in the light of the dusk.

Once he arrives at Berck, the relationship with the medical apparatus and

medical staff changes in a way, since this is considered to be a place for leisure, as his

father emphasis on the fact that his cure is definitely at Berck, since The patients lead

normal lives in sanatoria set up like normal hotels; you wont even think of yourself

as being ill.30 The change in the spatial arrangement was a commonplace regarding

the treatment of tuberculosis, as Sontag argues: The TB patient was thought to be

helped, even cured, by a change in environment. There was a notion that TB was a

wet disease, a disease of humid and dank cities. ... Doctors advised travel to high, dry

placesthe mountains, the desert.31 Berck-sur-Mer seems to be a place that is

27 Idem, 10.
28 Ibid.
29 Idem, 19.
30 Blecher, 22.
31 Idem, 15.
specialised in illness as, particularly, in illnesses concerning the bones. When going to

Berck, Emanuel notices in the train the fact that everybody is going to the

sanatorium, since the discussions are only about sickness and everywhere around

him he sees bandages and decay. He is approached by an old lady that seems quite

illness-savvy and asks a crucial question: Where does it hurt? Here...? Here...?32 I

think that this is a key-moment of the novel, because it brings together the most

important aspects concerning illness. Firstly, the morbid curiosity. There are

countless instances in the book where the ill body is subject to curiosity and avid gaze

mostly when an accelerating sense of decaying and ruin is involved. Secondly, the

corporeal disfigurement through illness and pain. And thirdly, a certain pragmatic

pin-pointing of the illness in a certain area of the body, that comes in contrast to the

older tradition of the body as a whole, as Foucault notices in The Birth of the Clinic:

This new structure is indicated ... whereby the question: <What is the matter

with you?>... was replaced by that other question: <Where does it hurt?>, in which

we recognize the operation of the clinic and the principle of its entire discourse. 33

Berck-Sur-Mer is something between a clinic and a hotel, since a very capitalist

logic is at work, illness being its prime material. The staff at the sanatorium is very

affable, but Emanuel notices quite early the machinations of the seemingly nice nurse

Eva, for example, who liked to become intimate with the patients and affect

friendship. But on the other hand, she gossiped about them all to the doctor34. When

Quitonce lived his last moments, it was clear for him that Eva is only nice in order to

make him give her his gramophone after his death which is certified after he passes

away Eva is terribly furious when she finds out that she didnt get the

32Idem, 26.
33Foucault The birth of the clinic, Routledge, Taylor and Francis Group, 1976, 3.
34Blecher, 71.
gramophone.35 This cynical attitude towards patients/clients is carried in this fashion

thorough the story even though the medical staff is professional, they lack basic

humanity, as Emanuel feels like an object in certain moments: The nurse and the

doctor turned him on his back. The manoeuvred him like a lifeless mannequin36,

hes dressing me exactly like he would a corpse.37

Some other instances where the medical staff was described and commented

on in the novel is for example when Isa is on the verge of death, but everyone is silent

about her condition reminding me of Sontags observations regarding the way in

which the medical letters are sent in a discrete fashion, in case the sick person is

unaware of his/her illness38.

Another interesting aspect I found in the novel is the description of a certain

odd addiction of old patients, now healthy, with the medical atmosphere at Berck

Solange by example. After living in the sanatorium and curing their illnesses, some

people never actually leave, since: Berck is more than just a town for invalids. Its a

very subtle poison. It gets into your blood. 39

One last question is left to be answered: how is tuberculosis portrayed on a

cultural, psychological scale? Up until now we tackled the corporeality, often

pestilent, of the disease, but how does one see it in the broader sense?

Sontag starts her analysis on TB by talking about a certain attainment of a dual

citizenship through illness: Everyone who is born holds dual citizenship, in the

kingdom of the well and in the kingdom of the sick.40 Young Emanuel views illness in

the same blurry, double optics after going to the sanatorium: his illness was no

longer a simple matter of an abstract phrase, <being ill> as opposed to <being

35 Idem, 127.
36 Idem, 73.
37 Idem, 36.
38 Sontag.
39 Blecher, 75.
40 Sontag, 3.
healthy>. He felt as if he had joined the ranks of a military hierarchy.41 Regarding the

maladive hierarchy, Quitonce seems to be the absolute recipient of illness there is a

certain glory even in his complete decay and emasculation. He used to pose in

pornographic material in his youth, thing he would brag about during his last

moments, completely weakened and mutilated by illness. He exclaims, in the same

hierarchical logic of illness I mentioned above: I am a specialist... In my career as a

patient I have surpassed dilettantism. I have become a professional. To which,

Emanuel answers that Quitonce is a hero, rather than a professional42, remark that

allows Quitonce to say one of the most piercing things in the entire work, about the

negativity of the heroism of illness:

In the space of one year, an invalid expends exactly the same amount of

energy and willpower one would need to conquer an empire... Except that he

consumes it in pure loss. That is why the invalids could be called the most negative of

heroes.43

Another aspect regarding illness and its portrayal in the novel is its

deceptiveness Quitonce and Isa seem to feel better for a while and give signs of

recovery, only to surprise everyone with their deaths. Sontag also talks about this

aspect in her work: But it is characteristic of TB that many of its symptoms are

deceptive ... and an upsurge of vitality may be a sign of approaching death. 44

Quitonce dies in a fit of laughter, Solange tries to commit suicide, Tonio is

exaggeratedly jealous when Madame Wadenskas so-called cousin arrives and tries to

spy on her to discover if she cheats on him... There is a hysterical display of emotions

everywhere in the novel. What illness seems to be doing to its recipients is a certain

intensification of internal life over the external one. Sontag argues that TB always

41 Blecher, 41.
42 Idem, 83-84.
43 Blecher, 84.
44 Sontag, 13.
had pathos. Like the mental patient today, the tubercular was considered to be

someone quintessentially vulnerable, and full of self-destructive whims.45

Another aspect to be taken into account while discussing the imagery of TB is

its link to genius, to superior knowledge. Emanuel is not the archetypal romantic

genius, however, his emotional insight is quite refined and also, illness seems to give

access a dignified version of the self, even at the cost of various bodily inflictions, or,

better said, because of them. TB works as a necessary scourge that allows its recipient

to access superior knowledge, not in a medical sense, but in a diaphanous, mystical

way. Sontag also writes about this: ...the clich which connected TB and

creativity...46

The end of the novel finds Emanuel leaving Berck in search for a healthier

place and this extreme mobility of the tubercular is another poetical trope

concerning this illness, as Sontag argues: the myth of TB ... supplied an important

model of bohemian life, lived with or without the vocation of the artist. The TB

sufferer was a dropout, a wanderer in endless search of the healthy place.47

Conclusion

The novel is protruded and based on illness, but the actual medical

information is kept at a minimal scale and it pertains mostly to the functional and

collective mythology concerning TB that was available in the first half of the 20th

century. Even if heavily aestheticized, Max Blechers account on his illness through

the voice of Emanuel offers valuable information about the construction of the case

during his time and about the way in which the relationship between the sick person

and the medical personnel/ medical knowledge available was taking place. As I

45 Idem, 64.
46 Sontag, 32.
47 Idem, 33.
argued before, the novel has loosely the structure of a medical case problem

diagnosis prescription details about the treatment. However, the mastery of

Blechers work resides in the empty spots left by this structure, spots that are filled

with a very honest and striking account of illness his (through Emanuels voice) or

others. While the way in which the medical staff treat the patients might be

dehumanizing, this honest outline of raw emotions and fine attention given to even

the smallest details of patients life create a context of narrative empathy. As Didi-

Huberman puts it: This is the crucial phenomenological problem of approaching the

body of the Other and of the intimacy of its pain. It is the problem of the violence of

seeing in its scientific pretensions to experimentation on the body.48

Bibliography

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--- ntmplri n irealitatea imediat. Inimi cicatrizate. Vizuina luminat.

Corp transparent [Occurence in the Immediate Unreality. Cicatrised Hearts. The

Illuminated Burrow], Craiova, Aius; Bucureti, Vinea, 1999.

De Man, Paul, Autobiography as De-facement. Modern Language Notes, 1979.

Didi-Huberman, Georges, Invention of Hysteria - Charcot and the Photographic

Iconography of the Salpetriere, The MIT Press, Massachusets, 2003.

Foucault, Michel, Aesthetics, Method, and Epistemology, New York, 1998.

---- The birth of the clinic, Routledge, Taylor and Francis Group, 1976.

48Georges Didi-Huberman, Invention of Hysteria - Charcot and the Photographic Iconography of the
Salpetriere, The MIT Press, Massachusets, 2003, 8.
Frank, W., Arthur, The wounded storyteller: Body, Illness, and Ethics. The

University of Chicago Press, 1995.

---- Illness and Autobiographical Work: Dialogue as Narrative

Destabilization Qualitative Sociology, Vol 23, No 1/2000.

Sontag, Susan, Ilness as metaphor, Farrar, Strauss and Giroux, New York, 1977.