Department of Nephrology and Rheumatology, University Medical Center, Göttingen, Germany (Spring 2015)
Thomas Mann, 1937
Originally intended as a novella, Thomas Mann’s (1875–1955) multilayered novel The Magic Mountain documents in fine detail the methods used to treat lung diseases and especially pulmonary tuberculosis at the beginning of the twentieth century. Mann’s protagonist, Hans Castorp, who intended to spend only three weeks in the sanatorium in the Swiss mountains but ended up staying there for seven years, was welcomed by a rather strange appearance:
“Why are you making such as face?’ he [Joachim Ziemsen, Hans’ cousin] asked. “She whistled,” answered Hans Castorp. “She whistled out of her inside as she passed. Will you have the goodness to explain to me how?” “Oh!” Joachim said, and laughed curtly. “Nonsense, she didn’t do it with her inside. That was Hermine Kleefeld, she whistles with her pneumothorax.”1
Castorp, a young engineer of remarkable usualness, felt utterly surprised and asked his cousin to explain these strange happenings.
“It’s a surgical operation, they often perform it up here. Behrens [the chief physician of the sanatorium] is a regular dab at it. When one of the lungs is very much affected, you understand, and the other one fairly healthy, they make the bad one stop functioning for a while, to give it a rest. That is to say, they make an incision here, somewhere on the side, I don’t know the precise place, but Behrens has it down fine. Then they fill you up with gas—nitrogen, you know—and that puts the cheesy part of the lung out of operation.”1
Joachim Ziemsen further explains to Castorp that the patients with artificial pneumothorax were in some way brought together by the procedure. In the sanatorium they were known as the “Half-Lung Club,” a handful of patients most affected by pulmonary tuberculosis and whose lungs needed rest to recover. The installed nitrogen had to be refilled every couple of weeks, yet the whistling Hermine Kleefeld needed to be filled up every week.
Mann was a keen observer of the incidents going on in those types of health resorts, as he had visited his wife Katia during her stay in a sanatorium in Davos-Platz in 1912. He finished The Magic Mountain in 1924 and had tremendous success shortly after its publication.
Treatment options for pulmonary diseases, especially for pulmonary tuberculosis, were quite limited at that time and the practice of artificial pneumothorax had gained popularity after its development in 1882, the same year in which Robert Koch discovered the tubercle bacillus. There was much discussion about who invented the procedure, yet credit must be given to Carlo Forlanini (1847–1918).2 This Italian physician pursued quite an interesting career, as he had been head of the dermatology department of Ospedale Maggiore in Milan, but remained interested in general medicine and was later named chair of clinical medicine at Pavia, his alma mater.
That Mann knew about artificial pneumothorax and described it in such detail is remarkable, since many of Forlanini’s peers had rejected it at that time. It was not until 1906, when the operation was ascribed to the American surgeon JB Murphy in the Deutsche Medizinische Wochenschrift, that Forlanini’s experience of 24 years earlier was published in exactly the same journal.2
The procedure, in the absence of better alternatives, undoubtedly helped many affected people. Yet even fifty years after the development of drugs against tuberculosis, the disease remains a major global health problem with almost nine million people affected worldwide.3 The United Nations Millennium Development Goal was to reverse the global spread of tuberculosis by 2015, but this was hampered by the growing number of multi-drug resistant (MDR) tuberculosis.4
Tuberculosis nowadays affects almost exclusively poor people living in poor conditions. This is in stark contrast to the way in which Europeans were already able to cope with the disease in early twentieth century, as in Mann’s pictorial description. Treatment for tuberculosis, even MDR tuberculosis, is now available and should be made available to all patients.
When faced with global health disasters, the International Community of States has shown reluctance to take immediate and effective actions. The latest Ebola outbreak in West Africa is another example. The number of people affected outside of Africa is small and only slightly bigger than a modern-day “Half-Lung Club.”5 Global health affects us all. Now is the time to descend from our inner “Magic Mountain” and help those who are most severely affected.
- Thomas Mann, The Magic Mountain, trans. H. T Lowe-Porter (London: Vintage, 1999).
- A. Sakula, “Carlo Forlanini, Inventor of Artificial Pneumothorax for Treatment of Pulmonary Tuberculosis.,” Thorax 38, no. 5 (May 1, 1983): 326–32, doi:10.1136/thx.38.5.326
- A. Zumla et al., “Tuberculosis,” New England Journal of Medicine 368, no. 8 (February 21, 2013): 745–55, doi:10.1056/NEJMra1200894
- I. D. Olaru et al., “Novel Drugs against Tuberculosis: A Clinician’s Perspective,” European Respiratory Journal, November 27, 2014, doi:10.1183/09031936.00162314
- “How Many Ebola Patients Have Been Treated Outside of Africa?,” The New York Times, July 31, 2014, http://www.nytimes.com/interactive/2014/07/31/world/africa/ebola-virus-outbreak-qa.html
, MD, is a resident physician in his last year of training in Rheumatology at University Medical Center in Göttingen (Germany). He graduated from medical school at the Heinrich-Heine University in Düsseldorf, Germany, in 2008 and worked in Berlin, Ecuador, and Mexico during internships. His current research interests include systemic autoimmune diseases, such as sarcoidosis and systemic lupus erythematosus.