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Bulletin of the History of Medicine 74.3 (2000) 458-494

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The Disease of the Self: Representing Consumption, 1700-1830

Clark Lawlor and Akihito Suzuki *


Susan Sontag's now-classic Illness as Metaphor presents a compelling analysis of the paradoxical nature of the disease that was variously called consumption, phthisis pulmonalis, and, later, tuberculosis. Comparing the disease with cancer, she noted a stark contrast in the metaphors generated by the two fatal diseases of modern times: while cancer stood for negative values, consumption served as a metaphor of essentially positive attributes, such as heightened beauty, refined sensibility, and artistic creativity--La Traviata, The Magic Mountain, and John Keats being obvious examples. Or, as Sontag has succinctly put it, "As TB was the disease of the sick self, cancer is the disease of the Other." 1 Her perceptive work has done a great deal to stimulate both medical and literary historians to approach diseases in the past from the perspective of the subjective experience, images, metaphors, and mythologies, supplementing studies of the objective frameworks of medical discoveries, therapeutic breakthroughs, and disease mortality. [End Page 458]

Partly following Sontag herself, and partly influenced by Foucault, many practitioners of the new cultural history of disease most commonly use the concept of the Other as its central analytical tool, while others direct their attention to the Self. 2 The leading proponent of the former historiography has been Sander Gilman, whose works on madness, race, sexually transmitted diseases, and so on have been pioneering the field of the iconology of diseases. Particularly in his Difference and Pathology and Disease and Representation, Gilman has shown how societies and individuals attempted to draw the boundaries between Self and Other by projecting their various anxieties onto sufferers of certain diseases. 3 The abjection of diseases, it is contended, not only dispelled the specters of physical and mental pollution, contamination, and dissolution but also consolidated racial, class, and gender categories. Gilman and others focus on the historical processes of stabilizing one's identity by stigmatizing these diseases as the Other. This conceptual framework seems very effective when applied to certain diseases of a virulent nature such as syphilis, madness, and AIDS, which are Gilman's main examples. Similarly, lethal epidemic diseases such as plague and cholera sit well with this model, for they were often regarded as an alien visitation from outside the community. 4

On the other hand, diseases of the Self are more commonly found in certain diseases of a relatively mild nature, which were sought after as badges of the social and cultural distinction of the sufferers--George Cheyne's English Malady was the disease of the affluent and sensible, and gout in the eighteenth century suggested the aristocratic pedigree of the sufferer. 5 Rather [End Page 459] than being expelled to the other side of the boundaries, these diseases were integrated as vital and positive components of the Self. In other words, people anchored at least part of their identity in them, being ready to live with their unpleasant and occasionally agonizing symptoms.

In these typologies of the cultural meanings of diseases, consumption presents an interesting and apparently paradoxical case. Although it was lethal, and indeed the major killer in the eighteenth and nineteenth centuries, its romantic allure has long been noted not only by Sontag but also by medical and literary historians, and by patients themselves in the past. 6 Although there are some situations in which consumption stood for the Otherness of the patient--as in Kafka's tuberculosis and Jewishness, or the more generalized instance of the lower classes--Sontag is right in that it was less abhorred than dreaded, and the "dreaded disease" (whether real or imaginary) was, at the same time, more likely to be embraced into the inner identity of the sufferers. 7 As we shall see, such a stark opposition between one disease as a dangerous exteriority and another as a positive interiority in relation to the individual is in some senses false: no man, or disease, is an island. Consumption...