Dostoyevsky and Consumption

Tuberculosis, commonly known as “consumption” in the 19th century, is an airborne disease that often caused inevitable, albeit slow, death in afflicted individuals of Dostoevsky’s time. The disease was widespread particularly among the poor, with a mortality rate of 400/100 000 individuals in Russia at the end of the 19th century (Yablonski et al. 372). The disease claimed the lives of his mother and first wife, which may have inspired depictions of consumption in his novels (Lantz 105, 106). Written in the latter half of the 19th century, both Crime and Punishment and The Idiot mark the 19th century transition between romantic and realist portrayals of consumptive characters.

What Is Tuberculosis/Consumption?

Diagram: common symptoms of tuberculosis

Today, tuberculosis is understood to be a contagious illness caused by mycobacterium tuberculosis which most commonly manifests in lung tissue damage (Ducati et al. 697, 700; Frith 29). Transmittal is primarily effected via airborne particles, exhaled or coughed up by the infected. In healthy individuals, the bacteria can remain in latent form for decades without adverse effect. Active disease onset is (as exhibited in Dostoevsky characters such as Katerina Ivanovna and Ippolit) often a lengthy process, typically characterized by fatigue, fever, weight loss, chest pain, difficulty breathing, and coughing fits (Ducati et al. 703). So long as tuberculosis is diagnosed prior to advanced stages, modern treatments such as bactericides and chemotherapy are highly effective (Ducati et al. 706).

While scientific understanding and treatment of the illness has progressed in leaps and bounds since Dostoyevsky’s time, the WHO reported in 2006 that the illness continues to kill more people per annum than AIDS and malaria combined—with 98% of its victims located in developing countries, among populations lacking proper sanitary measures and treatment access (Ducati et al. 703).

Historical Understanding of Tuberculosis

Archaeological remains provide evidence of tuberculosis dating back to Ancient Egypt, and ancient Chinese and Indian texts describe outbreaks featuring its symptoms (Ducati et al. 698; Frith 29). One of the first clearly identifiable descriptions of tuberculosis—known at the time as “phthisis”—comes from Hippocrates, who characterized it as the most widespread disease of the era, and generally fatal (Frith 29-30; Sakula 247). Between his time (460 BC to 370 BC) and that of Greek physician Claudius Galen (174 CE), the concentration of the disease within families was recognized, though the medical community was divided over whether this was due to hereditary factors or contagion. Prescribed treatments included healthy food, clean air, bloodletting, and sea voyages (Frith 30).

The first usage of the term “tubercles” to describe nodes in phthisis-ridden lungs, which in later stages progress to ulcers, is attributed to Sylvius de la Boë of Amsterdam, circa 1679 (Frith 30). Around the 18^th century, “consumption” became commonly used as a lay term for phthisis, with the debate over hereditary condition versus contagious infection ongoing (Frith 30).

Consumption grew to become the leading cause of death in Europe by the close of the 19^th century. Its presence (to varying degrees) across all levels of society, especially among young adults, and including celebrity victims such as Chopin, Paganini, St. Francis of Assisi, Charlotte Bronte, John Keats, Lord Byron, contributed to a cultural romanticization (see "Romanticism vs. Realism") of the disease which shaped the epoch’s art, literature, and beauty standards (Ducati et al. 698; Frith 32).

In 1865—while Dostoevsky was writing Crime and Punishment, wherein Sonya cares for her consumptive mother at close quarters without expressed fear of catching her illness—Jean-Antoine Villemin’s experimentation with animals first demonstrated that consumption was definitively contagious (Frith 33; Sakula, 247). In 1882, the year after Dostoyevsky’s death, German Robert Koch isolated the bacteria responsible for tuberculosis. News of this discovery rapidly made its way across Europe and Russia, demystifying the disease’s origins, eroding its romanticization, and paving the way for the mid-20^th century development of effective antibacterial treatments (Sakula, 248-249, 251; Yablonsky et al. 372).

The Influence of Consumptive Individuals in Dostoyevsky’s Life

Dostoyevsky’s mother Maria Fyodorvna Dostoevskaya died of tuberculosis in 1837, when Dostoyevsky was fifteen (Lantz 106). Although he had a distant relationship with his parents due to a boarding school education, his mother instilled in him Russian religious ideals and values that influence many of his works (Lantz 106) (Mochulsky 10).

After seven years of marriage, Dostoyevsky’s consumptive first wife Maria Dimitrievna Isaeva died in 1864. While volatile and unhappy, their relationship was a loving one as they bonded over their shared suffering - Dostoyevsky being epileptic and Maria ill with tuberculosis (Lantz 105). Upon her death, he remarks:

"She loved me boundlessly, I loved her without measure too, but she and I did not live happily. She was the most honest, most noble, and most magnanimous woman I've ever known in my whole life. When she died - though I was tormented, seeing her dying, though I appreciated and was painfully aware of what I was burying with her, I could not at all imagine how painful and empty my life would become..." (Lantz 105)

Katerina Ivanovna in Crime and Punishment and Nastasya Fillipovna in The Idiot are commonly believed to be based on Maria. Like Maria, Katerina is a consumptive widow with a genteel upbringing who performed a dance before the nobility of her town in her youth (Lantz 106) (Mochulsky 158). Her marriage to the destitute Marmeladov parallels Maria’s marriage to her first husband, who formerly held respectable positions but fell into poverty and debt (Lantz 106). Such circumstances illustrate how far Maria has fallen both socially and financially. Maria’s wounded sense of pride, a coping mechanism for her suffering, is exemplified through Katerina’s proud and erratic behaviour. Similarly, Nastasya Fillipovna’s capricious and egotistical traits are a reaction against her depressed social status as a noble-born who has been corrupted (Lantz 106). Myshkin and Rogozhin’s night with Nastasya’s corpse was also inspired by Dostoevsky’s experience of writing beside Maria’s corpse after she passed away from tuberculosis (Mochulsky 260).

Romanticism vs. Realism

As the artistic milieu of the 19th century shifted from Romanticism to Realism, literary depictions of consumption evolved from glamorous, delicate characters to more accurate illustrations of the horrific suffering the disease entails (Porto 1). In the 18th and early 19th centuries, artists portrayed consumptive individuals as both aesthetically attractive due to their pale complexions and slender physiques, as well as spiritually transcendent, approaching the sublime while deteriorating ethereally. In a way, the disease was a status symbol:

Fading Away, a photograph by Henry Peach Robinson (1858) depicting a staged scene in which a dead consumptive girl is surrounded by her family. The serenity of this scene is consistent with the early-19th-century notion of Tuberculosis as a Romantic disease.

"It was a badge of refinement, it was very nearly a polite accomplishment. And if you contracted it, it led your friends not to mourn your early death so much as to venerate you as one marked out for a fate of special distinction.” (Caldwell 20)

The Romantic poet Lord Byron also reportedly remarked, “I look pale. I should like to die of consumption...because ladies would says - how interesting he looks in dying.” (Byrne 94)

Despite its fashionable connotations in wealthy social circles, consumption was an epidemic among the working class. Their susceptibility to the disease was due to a culmination of poverty, malnutrition, and overcrowding - factors closely linked to the Industrial Revolution.

“The disease picked out and killed a few Princes and it carried off more than one bejewelled, tender-hearted courtesan; but it slaughtered the poor by the million.” (Dormandy 73)

The irony was not lost on artists of the late 19th century, including Dostoyevsky, for whom tuberculosis was an indicator of socio-economic injustice rather than spiritual refinement. Scientific study of the disease further eroded much of the mystique that once appealed to the upper class (Porto 3). As a result, the literary glorification of consumption was replaced with horror - evoked not only by realistic descriptions of the frightening symptoms, but also by the abject social conditions in which the disease is situated (Porto 3).

Consumptive characters in Dostoyevsky’s novels, written in the mid- to late-19th-century, exhibit both Romantic, and to a larger extent, Realistic traits. In Crime and Punishment and The Idiot, the graphic detail to which Katerina Ivanovna and Ippolit respectively suffer long, painful, and delirious deaths - considered controversial at the time - is a Realist innovation that would not have been found in Romantic literature. Another feature of Realism is the consumptive individual’s circumstances of poverty and misfortune, as is the case for Katerina. Dostoyevsky also shows the stigmatization of the disease, as well as its social preconditions, through society’s lack of empathy for Katerina.

However, Dostoyevsky’s depictions of their consumptive experiences also contain Romantic undertones. The theme of suffering as a means of achieving the sublime, prominent in several of Dostoyevsky’s works, fits the Romantic trope of consumption as a divine illness. Despite Katerina’s and Ippolit’s vulgar characterizations, their suffering is an avenue for engaging with the divine. For instance, a priest “bowed his head and said nothing”, showing holy reverence to Katerina after she showed him her blood (Dostoevsky 152) (McLaughlin). Blood imagery also evokes the Holy Communion of the Orthodox Church, an initiation rite that involves wine as a representation of the blood of Christ. According to McLaughlin, the symbol of blood as initiation is exemplified by Raskolnikov’s charitable impulses following encounters with Katerina. For Ippolit, his physical deterioration corresponds with a spiritual progression from nihilism to a pursuit of divine meaning, culminating in his realization of the positive contribution he could have made to the world if he lived.