8. On the influence of tuberculosis on Albert Camus’ The Plague, 1941-1947
And how it fulfils the plague symbol
In January 1942, in Algeria, soon after commencing work on his plague novel, Camus’ second lung became infected with tuberculosis. Until then, he had refused to be confined to a sanatorium. But the disease was spreading and his prognosis was so dire he reluctantly agreed, although it took until August of that year before he was stable enough to travel, and for his wife, Francine, a teacher, to finish the school term to accompany him. Together they received a travel pass, on medical grounds, to go to mainland France. This trip to Le Panelier – first introduced in the fourth instalment of this newsletter – was not, therefore, a vacation, but was prescribed as a medical necessity. From there Camus would travel down to Saint-Etienne every two weeks for pneumothorax injections, and then return to recover until his next treatment. After settling Camus into his schedule Francine returned to Algeria, for work. Camus was to follow after his course of treatment had concluded, but instead greater events intervened, the French border closed, and Camus became exiled in France, under Nazi occupation.
In the same notebook entry where on this day, November 11, 1942, he wrote ‘Caught like rats!’, Camus also referred to his tuberculosis which had conspired to make him travel there in the first place, and then to keep him exiled there: ‘Keep quiet, lung!’
It was, in turn, his illness that kept him from participating more immediately, and more fully, with the resistance during the period 1942-1944, his months punctuated by his repeated and monotonously scheduled visits to Saint-Etienne for treatment. But each time, he would then return alone to Le Panelier for two weeks of relative solitude, which he spent resting – and writing. His tuberculosis, which in 1939 had kept him out of the war, now kept him out of the resistance. But it did keep him writing. ‘Do not forget: illness and decrepitude,’ he noted in mid-1943. ‘There’s not a minute to be wasted – which is perhaps the contrary of “one must hurry.”’
Even before the border had closed, Camus was, in the first version of the novel, working on bringing in aspects of his experience of illness into some of the characters. In an early outline of the shady figure of Cottard, for example, Camus provides the following psychological sketch in his notebooks:
Psychosis of arrest. . . But at other times he felt that an ailment, some infirmity, would protect him just as much. And just as criminals used to flee to deserted places, he made plans to flee to a hospital, a sanatorium, a nursing home. . .
So he would turn to epidemics. Just suppose typhus, a plague – such things happen…
Thus that furrowed, shrivelled soul sought fresh waters in the desert and found peace in an ailment, a curse, and catastrophes….
But then, in late 1943, Camus recovered enough to move to Paris – instead of returning to Algeria, as originally planned – and he was eventually given the opportunity to put his skills as a journalist and editor to good use: he began work on Combat.
But this, too, quickly took its toll on his health. Six months working underground, and then six months working above ground, post-liberation, and already Camus needed, in January 1945, an enforced break from the newspaper, due to exhaustion and health reasons associated with his tuberculosis. It was during this month of recuperation – and for Camus such periods were also moments of contemplation – that he was presented with the petition to commute the death sentence of Robert Brasillach, and probably around this time he was free also to attend one of the purge trials. And so, in this way, his illness provided the immediate circumstances against which he came to make the decision to henceforth oppose the death penalty: in the reality of which he perhaps saw a metaphor for his own physical condition, and by extension, ours.
And then, in March 1946, Camus travelled by steamer to the United States, in part to give his lecture “The Human Crisis”. Once more, it was a bout of illness that provided the immediate context for the lecture. Four days before the lecture, on Monday March 25, he notes: ‘I go to bed sick in both body and soul, but knowing perfectly well that I will have changed my mind in two days.’ He is familiar with the rhythms of his own body, the ebbs and flows of his tuberculosis. On Tuesday: ‘Wake up with fever. Incapable of going out before noon.’ And later that same day, ‘devoured by fever and unable to do anything but go to bed.’ The next day, as predicted: ‘A little better this morning.’ And then, on Thursday March 28, in that period of lucidity that follows the breaking of a fever, Camus spent the day dictating and editing his lecture – in which he outlines his argument against political violence generally, and his argument for rebellion conditioned within limits; a rehearsal of ideas he will later that year expand in his series, “Neither Victims Nor Executioners”, and later still in his book, The Rebel, but which will also come to structure the final version of The Plague – a lecture which he then presented that same night. The notebooks which cover this brief period in the United States, and this particular constellation of ideas, also contains notes on the character of Tarrou, which he was at the same time still fleshing out.
It should not, therefore, be surprising that in writing a new novel during these years, 1941-1946, Camus was drawn to the metaphoric possibilities of an illness, a plague. In A Happy Death, as well as his first two collections of lyrical essays from the 1930s, he wrote about tuberculosis literally. In The Stranger, he wrote about the metaphoric elements of the illness, but without direct reference to it. In The Plague, he combined these two strategies. He introduces the idea of tuberculosis through deploying contiguous images, rather than declarative statements. For example, in the opening chapter, Rieux draws an association between the first signs of the yet to be diagnosed plague – the discovery of the first dead rats – and an unnamed illness of his wife: ‘It wasn’t the rat he was thinking of. That spurt of blood reminded him of his own worry. His wife, who had been sick for a year, was supposed to leave the next day for a mountain retreat…. Despite thirty years and the marks of her illness, this face always seemed youthful to Rieux...’ The ‘spurt of blood’, which triggers his association with his wife’s illness, reflects the coughing up of blood that is characteristic of tuberculosis. Her leaving for ‘a mountain retreat’ confirms this diagnosis, but without needing to name the illness directly.
Soon after, when we are introduced to Tarrou, he begins making journal entries about people’s reaction to this mysterious malady that is sweeping the town. He transcribes the following overheard conversation, regarding the death of a musician named Camps:
“Well, he’s dead.”
“After this business with the rats.”
“Really? And what happened to him?”
“I don’t know, a fever. And also, he wasn’t that strong. He had abscesses under his arms. He didn’t fight it.”
“But he seemed like everyone else.”
“No, he had a weak chest, and he played music with the Orphéon. All that blowing into a tube, it wears you out.”
“Oh!” the second one said. “When you’re sick, you shouldn’t blow into a tube.”
After these few indications, Tarrou wondered why Camps had joined the marching band against his best interests, and what profound reasons might have led him to risk his life for these Sunday parades.
Like Rieux’s wife, Camps’ illness is unnamed. But the descriptors used in reference to it recall tuberculosis: the ‘weak chest’, ‘a fever’, and the presence of ‘abscesses under his arms’, leading to death, is all relevant to tuberculosis. And then the ambiguity discerned between Camps’ individual illness and the equally unknown epidemic sweeping the town enables these tubercular references to become figuratively linked to the plague as well. It is unclear if Camps dies of plague, or of tuberculosis, which he seems to have had prior to the onset of the epidemic – a pre-existing condition.
It is in this context that we meet up with one of Rieux’s regular patients, an old Spaniard, suffering from asthma. The beginning of summer brings with it an increase in deaths related to this as-yet-unknown malady facing the town. The change in weather brings with it a certain malaise which falls over everyone in the town. But the old Spaniard greets the change in weather with enthusiasm. He draws on one of the myths regarding the treatment of tuberculosis (and asthma): that the dry, hot air is good for repairing the lungs. And this triggers in Rieux an association with ‘fever’, an image which he then expands to include the whole town:
“It’s heating up,” he [the old Spaniard] said. “Good for the lungs.”
Something was, in fact, heating up: a fever, to be precise. The entire city had a fever, at least that was the impression that dogged Doctor Rieux the morning he stopped by the rue Faidherbe…
The first part of the novel – from the appearance of the first dead rat, to the first dead human, and then, under the summer heat, the exponential growth in deaths which the municipal authorities can no longer ignore as being correlated to some epidemic – is concerned with introducing and identifying the plague. In the final pages of this first part, the ‘the squat bacillus of the plague’ is finally diagnosed. It is interesting to note that tuberculosis – caused by the ‘tubercule bacillus’ – is physically linked to plague, in that both are the result of certain bacterium (bacillus) infecting the body. The metaphorical connection between the two diseases is fixed by this physical link between them. In the 19th century, for example, when tuberculosis was more rampant, it was even considered ‘the white plague’.
Camus plays on this metaphorical ambiguity in his novel to delineate a form of literal plague in terms otherwise associated metaphorically with tuberculosis. As Dr Rieux states in the closing pages of the first part of the novel, in the scene when the plague has been identified by the authorities: ‘To be candid, I should say, however, that certain specific modifications of the microbe don’t coincide with the classic description.’ In the remainder of the novel these ‘specific modifications’ are exploited in order to bring the disease into closer accord with tuberculosis. For example, immediately following Rieux’s proviso, he states that this microbe is capable ‘of quadrupling the size of the spleen, of giving the mesenteric lymph nodes the volume of oranges and the consistency of porridge.’ Such swelling and knots of growth is also one of the symptoms of tuberculosis. In fact, the etymology of the ‘tuberculosis’ foregrounds this aspect of the disease, coming from the Latin tūberculum, cognate to tūber, a swelling or bump, a growth. This element of the disease is raised time and again throughout the novel.
Added to this is the fact that another ‘specific modification’ of the disease that inhabits the town is that it becomes pneumonic, air-borne, and is henceforth associated with the lungs. As the narrator states, regarding this new, deadlier variant: ‘Since the day before, there had been two cases of a new form of the epidemic. The plague was becoming pulmonary.’ Again: ‘The existing pulmonary forms of the infection multiplied in all four corners of the city, as if the wind kindled and fed fires in the lungs. In the midst of vomiting blood, the infected patients died much more quickly. The risk of contagion was greater with this new form of the disease. In truth, the opinions of specialists had always disagreed on this point. Just to be sure, health workers continued to breathe through masks of disinfected gauze.’
So the form of plague that inhabits the township of Oran becomes activated through the lungs, and is manifested in fevers, morbid swellings and coughing up blood. And it results in death. In other words, it is described in the same precise detail that Camus has previously used in his own writings to describe tuberculosis. Moreover, it is the same symptoms that Camus himself had been manifesting since he was 17 years old – the same age, incidentally, that Tarrou was when in the novel he claims to have first caught ‘plague’.
The structuring theme of separation in the novel also draws upon and pushes to its logical extension, the separation Camus suffered when he first contracted the illness in the early 1930s and was removed from his family home, and from the poor quarter of Algiers. The experience of being exiled in France during the occupation would only have recalled and exacerbated the memory of this earlier experience. Indeed, in the days before the closing of the border, with Francine already back in Algeria, Camus was already feeling isolated. ‘I am not the one giving up persons and things (I could not),’ he wrote in his notebooks, ‘but rather things and persons are giving me up. My youth is fleeing me; that’s what it is to be ill.’ But after the closing of the borders a few days later, this experience was shared by many others. Separation had become general.
Prior to the full Nazi occupation of France, when Camus was first sketching the initial outline of his novel, he wrote in his notebook: ‘Illness is a convent which has its rule, its austerity, its silences, and its inspirations.’ It was these aspects he began exploring in his initial draft. During the occupation, when he began drawing a more explicit link between the plague image and the literal war, when he turned to biblical references of pestilence and the sword, it is significant to note that most of the verses chosen combine these images with images of tuberculosis and consumption. For example, Camus noted a passage from Deuteronomy 28, which reads:
The Lord shall make the pestilence cleave unto thee, until he have consumed thee from off the land, whither thou goest to possess it. The Lord shall smite thee with a consumption, and with a fever, and with an inflammation, and with an extreme burning, and with the sword, and with blasting, and with mildew; and they shall pursue thee until thou perish.
After liberation, when Camus was revising his novel for publication, he noted a possible epigraph for the book, taken from Daniel Defoe – not from A Journal of a Plague Year (1722), as may be assumed, but from Robinson Crusoe (1719): “It is as reasonable to represent one kind of imprisonment by another, as it is to represent anything that really exists by that which does not...” Earlier, Camus pondered titling the novel “The Prisoners”. In the novel, he drew comparisons between monasteries and prisons, each reflecting the confinement undertaken by the whole town, but as compared to the confinement of a tubercular patient in a sanatorium.
The plague in the novel is therefore a symbolic plague, a form of tuberculosis writ large. And it was this image that probably motivated the initial idea to write a novel structured around this image in the first place. Camus’ initial conception of a ‘liberating plague’ in 1941, outlined against this background of more than a decade of his life being dictated by the disease, was drawn in the same sense as the later self-description of this chronic affliction as being a ‘fortunate illness’: as an awareness of the negative impacts of the disease, the severe limitations it imposed upon people, but in which he also acknowledged the possibilities it afforded them, and the interplay between both – and the concrete choices made within this interplay – which shapes the course of their lives.
This also outlines the basic plot of The Plague.
In September 1942, before being exiled in France, and while still working on the first version of The Plague, Camus made a note regarding Marcel Proust’s long novel, Remembrance of Things Past (1913-1927), which Camus thought was an ‘heroic and virile book’. Still at the beginning of his own composition, Camus was probably seeking some inspiration for the long writing journey ahead. He contributed the success of Proust, a fellow tubercular, to two conditions, which could perhaps also be read as applying to Camus himself:
1) by the perseverance of the creative will;
2) by the effort demanded of an invalid.
In January 1947, after having finalised The Plague, after several long years, but still some months before publication, Camus’ doctor sent him for three weeks of rest and recovery in the French Alps, to Briançon, around 2000 metres in altitude. His doctor had also decided to end Camus’ pneumothorax treatments. After four years, they had ceased to be effective, his lungs too damaged. ‘The pneumothorax I have had for four years was discontinued and could no longer be applied,’ Camus later wrote to Jean Grenier. ‘So I’m in a period of transition during which the lung does not benefit from the automatic protection, so to speak, of the pneumo, and increased precautions must be taken to strengthen what is normally called recovery.’
Sometime in March/April, 1943, while still in Le Panelier, during the first period of the occupation, Camus made the following note, regarding his experience of tuberculosis:
The sensation of death that is henceforth familiar to me; it is deprived of the aid of pain. Pain clings to the present; it calls for a struggle that keeps one busy. But foreseeing death from the mere sight of a handkerchief filled with blood is being plunged suddenly and effortlessly into time in a dizzying way: it is the fear of what’s ahead.
Several months later, in October 1943, in a laboratory run by Selman Abraham Waksman, in New Jersey, in the United States, a young researcher named Albert Schatz managed to isolate an antibiotic called streptomycin. The antibiotic was trialled on humans, as a treatment for pulmonary tuberculosis, during the period, 1946-1948. This was the same period within which Camus finalised his plague novel – in which Dr Castel works on developing, trialling, and rolling out his own fictional serum – the period in which the novel was finally published in France, and then, in 1948, appearing in its first English translation.
By November 1949, Albert Camus had started taking his first course of streptomycin.