Narrative Medicine Book Club: Magic Mountain, Week 2

Week 2: We are learning more about life at the sanatorium and getting a sense of the cast of characters. Castorp and his cousin eat lavish meals, take their “rest cures” in the terrifically comfortable balcony chairs, and we see Castorp beginning to be acclimatized to the life of being a “patient” without necessarily being aware of it (I’m guessing that very soon he will buy a thermometer). There are hints that this place works with different rules, perhaps, than elsewhere — Castorp’s cigar is disgusting to him as it never is, no matter how he tries to enjoy it. And the “Half-Lung Club”! Can someone who knows about how lungs work please explain to us how far-fetched (or not!) that whole thing is?? I appreciated what Castorp says about understanding; when his cousin says he will come to understand that “things are serious only down below in real life,” Castorp says, “I’m already taking a great deal of interest in all of you up here, and once one is interested, why then understanding follows as a matter of course, doesn’t it?” This seems so profound and true to me, and a very important message for out current moment — curiosity, interest, being the things that lead to understanding (and understanding, in so many situations, to peace). 

For Week 3: Read up to the section title “Politically Suspect” in Chapter 4. 

7 thoughts on “Narrative Medicine Book Club: Magic Mountain, Week 2

  1. Michele Reisinger

    It looks like the therapeutic pneumothorax and the “Blue Henry (Heinrich)” were real things! YIKES!
    “At the turn of the 20th century, the artificial pneu- mothorax (abbreviated PNX) became the treatment of choice in most severe cases of pulmonary tuberculosis. Also known as lung collapse therapy and therapeutic pneumothorax, PNX was unable to cure the disease completely, but it intervened in the disease process, slowing down its progression. However, from its inception collapse therapy was highly controversial due to the frequent complications associated with its use. On the one hand this “great benefit to mankind” (Nobel Archive [NA], nomination for Carlo Forlanini by Camillo Golgi in 1914) was put forward on multiple occasions for the Nobel Prize for Physiology or Medicine. On the other hand the pneumothorax needle was called “the most dangerous weapon ever placed in the hands of a physician” [1]. In the pre-antibiotic era there was no satisfactory alternative. In addition to the infamous spittoon, called “Blue Heinrich,” the pneumothorax device became a distinctive signature of medical culture and everyday life of the early 20th century. In Thomas Mann’s novel “Magic Mountain,” for example, a group of patients at a sanatorium in Davos, Switzerland, referred to themselves ironically as “fraction of half lungs” because they were being treated with PNX and whistling from their pneumothorax hole [2]. However, after the discovery of specific chemotherapy artificial pneumothorax fell into disuse, and by the beginning of the 1960s the method was seen as obsolete [3].”
    Retrieved from https://www.annalsthoracicsurgery.org/article/S0003-4975(15)00590-1/pdf

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  2. Thanks so much for elaborating on this rather
    Little known and now obsolete treatment. Any idea
    about what the purpose of the “hole” was? And what caused the whistle??? Please
    illuminate if possible. Thx

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    • Michele Reisinger

      Kitty, a pneumothorax is a “collapsed” lung. In current day for a severe case, we would puncture the skin and the pleura (the sac that surrounds the lung) and insert a chest tube. The tube is attached to a contraption that clears out the excess air that has accumulated in the pleural sac surrounding the collapsed lung and allows it room to expand again…In our story, Hermine’s lung has been purposefully collapsed (therapeutic pneumothorax) by Director Behrens to allow for healing of the TB infected lobe, and the hole remains in the pleura and chest wall. I imagine the whistle was made when she forced air (instead of whistling out from between pursed lips, it was pushed out from the hole in the chest). Sounds so completely barbaric! But then again, it’s not been that long ago that blood letting was used to cure many ailments, and epileptic seizures were considered possession by the devil…I wonder what things we do today in medicine that will be suspect 50-100 years from now!! I’ve been an RN since 1988, and I’m sure I could come up with a big list of outdated and suspicious treatments we did. I’m enjoying the book! On page 247!

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  3. Kitty Bateman

    Gee, thanks Michelle…
    No way would I have known
    that and it does illuminate
    the narrative. It is quite a read, isn’t it? Especially in the time of a pandemic.

    More to come…

    I

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  4. Bill

    Thanks, Michele, for illuminating this peculiar medical procedure. But what do you know anything about the “horrific” and “filthy” experience described later in the novel of the failed pneumothorax?

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    • Michele Reisinger

      Bill, I assume you are referring to Herr Ferge in the chapter “Danse Macabre”. That was disturbing!
      I found something on the net from a 1931 medical description of pleural shock…
      Retrieved from https://www.atsjournals.org/doi/abs/10.1164/art.1931.24.5.545?journalCode=art
      Basically, it states that with a pneumothorax puncture into the pleura, a patient could go into seizures, loss of consciousness, shock, and sometimes death – all this while you are awake under a LOCAL anesthetic while being HELD DOWN (in this case, by an assistant and a head nurse) – Yikes! And I believe this all happened up until the 1940s or 50s. The really effective TB drugs came in the 1950s – not that long ago!
      It seems that there were lots of Sanitoriums in the US as well as the high altitudes of the Swiss Alps. “In 1953…839 institutions with over 136,000 beds were fully functioning.”
      Retrieved from https://www.atsjournals.org/doi/full/10.1513/AnnalsATS.201509-632PS
      If you are not familiar with the work of Dr Paul Farmer, take a look at “Mountains Beyond Mountains” by Tracy Kidder. Dr. Farmer has done a lot of work worldwide with his organization Partners in Health, fighting against poverty and poor public health conditions that lead to TB outbreaks. He is a modern-day medical hero!

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      • william feldman

        “Yikes!” Sums it up very well! Yes it was Herr Ferge I was thinking of. Thanks much. Bill

        Sent from my iPhone

        >

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