Hektoen International

A Journal of Medical Humanities

“Breath of life you’ll be to me”—The portrayal of tuberculosis in the opera La Traviata

Judith Wagner
Munich, Germany

Maria Callas in La Traviata

The white half-round of the stage is illuminated with an eerie blue light. The only prop is a large clock on the right-hand side. A dark figure is seated beside it. The door on the left opens and the heroine—clad all in red—enters the stage. Strings accompany her appearance with a low doleful melody. Weakly, she stumbles towards the clock—noticing with horror that its hands are moving slowly but inexorably forward. Exhausted, she lets herself drop beside the somber-looking man, staring at him imploringly. He rises and hands her a white camellia: a symbol of youth and beauty, but—at the same time—of imminent decay. By the end of the third act, she will have drawn her dying breath, defeated by the agonies of consumption.

The prelude of the highly-acclaimed 2005 production of La Traviata in Salzburg splendidly creates the atmosphere for the rest of the opera: beneath the surface of youth, beauty, and savoir vivre there lurks an undercurrent of disease and death. Next to the principal female character—Violetta—an illness takes center stage: tuberculosis.

La Traviata: a tragic love story

La Traviata—Italian for ”the fallen woman“ or “the lost one”—is based on the novel The Lady of the Camellias by Alexandre Dumas, fils. The opera by Giuseppe Verdi premiered in Venice on March 6th 1853. The setting is Paris and its vicinity at the beginning of the 18th century. The central character—the courtesan Violetta Valéry—meets the young Alfredo Germont, a long-term secret admirer, at a glittering Parisian party, where he confesses his love to her. Touched by his sincerity, she promises to meet him again. At first, skepticism prevails: romance with Alfredo would not only be incompatible with her current lifestyle and her longing for independence, she also knows it to be doomed from the outset. Suffering from tuberculosis, Violetta feels death approaching. Nonetheless, she ends up accepting Alfredo’s courtship. They spend a few carefree months at a country house near Paris. First cracks appear in their blissful togetherness when Alfredo discovers that Violetta has pawned her possessions to support their existence. He sets off to Paris to settle matters. During his absence, the appearance of Alfredo’s father spells doom: worried about his family’s reputation, he asks Violetta to forsake her lover. With a heavy heart, she complies. Having written a farewell note to Alfredo, she leaves for Paris. Upon finding the note, Alfredo suspects that Violetta has taken up her old life. Resolved to confront her, he finds her at a party accompanied by a former suitor—Baron Douphol. In a passionate encounter, Alfredo demands that Violetta admit that she is in love with Douphol. Feeling obliged to adhere to the promise given to Alfredo’s father, she affirms. In blind rage, Alfredo renounces his love to her and throws bundles of money won in a recent game of cards at Violetta’s feet. Appalled, the guests—including his newly-arrived father—rebuke Alfredo. Feeling remorseful about his role in the imbroglio, Alfredo’s father reveals the truth to his son—Violetta’s rejection has been a sacrifice made out of love for Alfredo and his family. Contrite, Alfredo rushes to her deathbed. Violetta utters hopes of returning to the serene country life with her lover. But her illness is merciless: after a brief resurgence of vitality, she falls dead at her lover’s feet. 

Tuberculosis: Affliction of the artists, plague of the poor

Tuberculosis was a common motif in 19th century art. Writers and visual artists devoted themselves to the portrayal of consumption such as Victor Hugo in Les Misérables and Edvard Munch in The Sick Child. But also opera composers attended to the phthisic: besides La Traviata, La Bohème by Giacomo Puccini is a well-known example.

During the 18th and most of the 19th century, a romantic perception of tuberculosis prevailed: its etiology unresolved, it was considered a sign of deep sensibility—the disease of the artists, bohemians, lovers. Their delicate, pale, and fragile feature was considered a characteristic of the disease to such an extent that the poet Théophile Gautier wrote: “I could not have accepted as a lyrical poet anyone weighing more than ninety-nine pounds.”1 The concept of tuberculosis changed during the latter half of the 19th century. Spreading rapidly throughout all parts of the population, the ailment lost its aura of exclusivity. It became associated with squalor and poverty as it began to dominate the crowded working class settlements spawned by the Industrial Revolution. When Robert Koch identified Mycobacterium tuberculosis as the causative agent of consumption in 1882, medical measures replaced artistic relief. The cold reality of sanatoria, x-rays, surgical instruments and—ever since the 1940s—antibiotics ousted romantic glorification.

La Traviata: Tuberculosis as a romantic disease

Why was tuberculosis so appealing for artists as to populate their works with consumptive heroes and heroines? What is it that made this particular affliction more befitting a 19th century dramatic character than, say, typhoid, diphtheria, or cholera, other common diseases of the time? Four aspects come to mind rendering consumption a perfect projection screen for the sentiments of the unfolding late modern period: exclusivity, esthetics, metaphor, and drama.

Exclusivity. In the 19th century, tuberculosis was closely associated with sensitivity, creativity, and youthful ardor. With death looming around the corner, the consumptive as displayed in the arts lived life to the fullest, scraping madness while abandoning himself to poetic prolificacy or indulgence of the earthly pleasures. Doomed and favored at the same time—consumed “by ardour…leading to the dissolution of the body”2—the afflicted became secret idols of their contemporaries. With a long list of famous sufferers, it was generally believed that tuberculosis and genius were connected.3 The author of the literary basis of La Traviata, Alexandre Dumas, fils even stated: “It was the fashion to suffer from the lungs; everybody was consumptive, poets especially; it was good form to spit blood after any emotion that was at all sensational, and to die before reaching the age of thirty.”4 Partying wildly with the rich and famous, coveted by the men, envied by the women, beautiful beyond comparison, Violetta epitomizes the phthisic character. In the first act , Verdi has her spell out her feverish quest to clasp the full abundance of life:

“I give myself to pleasure, since pleasure
is the best medicine for my ills.”

“Everything in life is folly,
except for pleasure.”

“Forever free, I must pass
madly from joy to joy.
My life’s course shall be
forever in the paths of pleasure.”

Esthetics. Along with the air of exclusivity, we find a distinctive aestheticization of tuberculosis. The emaciated young man and the languid young woman became the ideal of beauty throughout much of the 19th century. Dubos’ account of the “white plague” features an episode Tom Moore confided to his diary. While paying a visit to his fellow poet Lord Byron, the latter told him: “I should like to die of a consumption.” “Why?” asked his guest. “Because the ladies would all say, ‘Look at that poor Byron, how interesting he looks in dying!’”4 Furthermore, the consumptive often depicted with shiny burning eyes and flushed cheeks, feverishly illuminating the patient’s pallor precisely resembled the portrayal of the prototypical ardent lover. Therefore, features marked by the stigma of tuberculosis would have been deemed more than appropriate for the opera’s passionate heroine by Verdi’s contemporaries. Consequently, Violetta describes herself as the pale beauty whose cheeks are suffused by the glow of an internal fire:

How pale I am! (Act I)

Watchful though I never knew it,
he came here while I lay sick,
awakening a new fever,
the fever of love, …
(Act I)

…the roses of my cheeks are already fading. (Act III)

Metaphor. Consumption most commonly presented as pulmonary tuberculosis. Hence, the threat of asphyxiation would permanently loom over the afflicted like a sword of Damocles. “Breath” has always been a strong metaphor for “life”—and this symbolism also surfaces throughout La Traviata:

of love which is the very breath
of the universe itself –
(Act I)

Let him know the sacrifice
which I made for love –
for the very last breath of life
will be for him alone.
(Act II)

My very breath of life, sweet
pulse of my heart!
(Act III)

However, the theme of breath and breathlessness is not limited to the libretto. The musical score reinforces the sensation of dyspnea. The sparsely orchestrated Prelude, the halting figures in the orchestra accompanying Violetta’s monumental aria “Addio del passato” (Farewell, happy dreams of the past) suggest her struggle to breathe5—a struggle infusing the audience with existential, primordial fear. The stage is now set for consumption’s grand entrance—the dramatic final moment.

Drama. It is the moment of arrosion of pulmonary blood vessels, the instance of the phthisic coughing up torrential gushes of blood as an outward manifestation of inward destruction. A paradoxical terminal euphoria—known as spes phthisica—gives rise to an ultimate defiance of fate. In a dramatic gathering of strength, Violetta’s voice soars up to the climactic high b flat in the Finale of La Traviata.

After that, she collapses. The stage turns dark, the curtain falls—the hands of the clock have stopped turning.


  1. David M. Morens. “At the Deathbed of Consumptive Art.” Emerg Infect Dis. 8 (2002): Accessed January 30, 2015.doi: 10.3201/eid0811.020549.
  2. Susan Sontag, Illness as Metaphor and AIDS and Its Metaphors (New York, NY: Picador, 2001), 20.
  3. Mindy A. Schwartz, „Tuberculosis – a journey across time“, Hektoen International (2009), accessed January 30, 2015, http://hekint.org/index.php?option=com_content&view=article&id=609:tuberculosis-a-journey-across-time&catid=72:infectious-disease&Itemid=716.
  4. René J. Dubos and Jean Dubos, The White Plague: Tuberculosis, Man, and Society (Rutgers Univ Pr, 1987), 58/59.
  5. “Opera in depth – La Traviata – Musical Analysis”, Opera Lively, accessed January 30, 2015, http://operalively.com/forums/content.php/166-Opera-In-Depth-La-Traviata-5-Musical-Analysis-opera.

JUDITH N. WAGNER, MD, graduated from Freiburg University in 2004 after studying in Freiburg (GER), London (GB), Mendoza (ARG), and Boston (USA). From 01/2005 to 01/2014 she has been working in the Department of Neurology, Klinikum Grosshadern, University of Munich, Germany. Currently, she is completing a psychiatry rotation with the Max Planck Institute for Psychiatry in Munich. Supported by a DFG (German Research Community) grant, she spent one year (2012) at the Favaloro Foundation in Buenos Aires, Argentina, investigating the spatial orientation in patients with Pisa syndrome.

Highlighted in Frontispiece Volume 7, Issue 4 – Fall 2015

Fall 2015



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