Henry’s severe illness and his difficulties accessing treatment prompted Green to contemplate the horrifying statistics of tuberculosis and the paradox of our extensive knowledge about it. More than one million people still die every year from this ancient disease; yet the bacterial cause was elucidated a century and a half ago, and effective treatments have been around since the 1950s. Barring eradication, the germs mutate and become resistant. Given dire living conditions, it spreads. Effective therapy can be prohibitively expensive. “The cure is where the disease is not, and the disease is where the cure is not” (p. 5). People die where cures cannot be obtained. 

History is woven though Henry’s story, but so are politics, culture, and economics: the discoveries, the 19^th-century romanticization of ‘wasting away,’ the hard realities of pharmaceutical development and delivery. Henry has survived, become healthy and an inveterate TikToker and youtuber. He even has an episode on the power of storytelling. But other people that we encounter through this tale have died. 

We still have tuberculosis because statistics de-personify it, and geography allows ignoring it. Green uses Henry’s story to invite us to ‘[t]hink about how rare and precious humans are, and how many of them you get to worry for and care about. Then if you can, find a way to multiply that 1,250,000 times’ (p. 189).  

The book flows easily in language that is clear and accessible, a tribute to Green’s experience in writing young-adult fiction. In the end, without denying the benefits of medical interventions, he calls for a focus on the real cause of tuberculosis: injustice—tolerated and unchallenged. ‘Ultimately,’ he writes, ‘we are the cause’ (p. 184).  

Everything is Tuberculosis: The History and Persistence of Our Deadliest Infection
John Green
New York: Penguin/Crash Course Books
2025
ISBN 9780525556572 

Web image created by Medhum.org

In Sophocles’s Oedipus Rex, a plague ravages Thebes as divine punishment for an unpunished crime—the murder of the eponymous king’s predecessor.

Two and a half millennia later, illness remains a metaphor in Robert Icke’s buzzy retelling of the Freud-genic tragedy, now on Broadway after a West End run last fall. Susan Sontag, who cautioned that portraying disease as a symbol of social decay can stigmatize patients, would likely disapprove. (Perhaps, apotheosized on Mount Olympus, she cursed Lesley Manville, who plays Oedipus’s wife and—spoiler alert—mother Jocasta, with an illness; Denise Cormier filled in when I saw the production.)

At curtain rise, on a stage-wide video screen, Oedipus (a charismatic and commanding Mark Strong)—reimagined as a politician on the cusp of electoral victory—tells a throng of eager reporters and supporters: “The civic body is ill. And that isn’t… chemicals in lakes—it’s us; we’re sick… The water got poisoned, and we got used to the taste.”

Economic inequality and xenophobia abound, as do rumors surrounding the death of Laius, the former ruler and Jocasta’s former husband. And so Oedipus promises to open an investigation. This off-script announcement exasperates his campaign manager and brother-in-law Creon (John Carroll Lynch), but Oedipus is steadfast in determining what happened. In Icke’s adaptation, probing the metaphorical plague is less a divine mandate and more a political act of narrative control. And, as Oedipus doubles down on transparency, what he uncovers about a fateful crossroads unravels his sense of self.

The truth of Oedipus’s identity is old news for most viewers, and we know that he is going to win. Yet Hildegard Bechtler’s set—an office with a hodgepodge of furniture, TV screens, and a clock counting down until the release of the election results—cultivates a palpable sense of uncertainty.

The successful set embodies Mikhail Bakhtin’s notion of the chronotope, or the inextricable fusion of time and space in literature. The literary theorist cites the road as one example of a chronotope. Social divisions such as class, nationality, and religion collapse, and time unfolds unpredictably through chance encounters rather than routine.

In Oedipus, as election night comes to a close, movers strip the campaign headquarters bare, transforming the space into a chronotope that mirrors how our hero is stripped of everything he once believed about himself. The ticking clock heightens the temporal pressure, heralding the landslide victory while portending the inexorable revelation that Oedipus did what every little boy dreams: killed Dad and married Mom.

Bakhtin also argues that chronotopes allow abstract ideas about philosophy, society, and cause and effect—say, the limits of free will and the illusion of power—to “take on flesh and blood.” Oedipus highlights the vital role chronotopes play in narratives, even if the coda transports us to the start of the campaign, undoing everything.

And even if much of the script doesn’t sparkle. For instance, Jocasta telling Oedipus “You’ll be the death of me” and calling him “baby boy” feels heavy-handed. Modern updates to Oedipus’s family dynamic have mixed success. The parts of adoptive mother Merope (Anne Reid) and daughter Antigone (Olivia Reis) are a welcome addition and expansion, respectively, bringing understated humor and wisdom. On the other hand, Icke casts one of Oedipus’s sons, Polyneices (James Wilbraham), as gay and the other, Eteocles (Jordan Scowen), as unfaithful. This framing raises an uneasy question: Are we meant to read queerness as a moral transgression on par with infidelity or incest? (Sontag, who was bisexual, probably wouldn’t be thrilled by this either.)

Icke’s greatest writing, however, is Jocasta’s hesitatingly revealed, harrowing backstory: She was only 13 when Laius raped her and forced her to abandon the resulting child. Jocasta recalls the delivery in visceral detail: the fluorescent lights of the hospital, the newborn Oedipus’s mucus-slick body. But she is denied the opportunity to share her traumatic account on her own terms; in his relentless quest for answers, Oedipus forces her long-hidden narrative, precipitating the discovery of their true relationship.

Narrative medicine emphasizes that this kind of listening can be destructive to both patient and listener. Indeed, Jocasta kills herself, and Oedipus gouges out his eyes with her heels. (Not very healing.)

Some narrative humility would have served Oedipus well. As Sayantani DasGupta writes, “narrative humility acknowledges that our patients’ stories are not objects that we can comprehend or master, but rather dynamic entities that we can approach and engage with, while simultaneously… engaging in constant self-evaluation and self-critique about issues such as our own role in the story.” With greater narrative humility, Oedipus might have better seen Jocasta—and himself.

Icke’s Oedipus teaches us that listening must be humble, ethical, and emotionally attuned; had it been so, perhaps the drama’s seemingly inevitable ending could have been averted.

Oedipus, through Feb. 8 at Studio 54 in New York; oedipustheplay.com.

Bakhtin, Mikhail. “Forms of Time and of the Chronotope in the Novel: Notes toward a Historical Poetics.” The Dialogic Imagination: Four Essays by M.M. Bakhtin, edited by Michael Holquist, translated by Caryl Emerson and Michael Holquist, University of Texas Press, 1981, pp. 84-258.

DasGupta, Sayantani. “Narrative Humility.” The Lancet, vol. 371, no. 9617, 2008, pp. 980-981. thelancet.com/journals/lancet/article/PIIS0140-6736%2808%2960440-7/fulltext

Web image from Sonia Friedman Productions Limited.

Although his story opens with the establishment of the Johns Hopkins Hospital in 1876, Barry immediately takes a detour into the history of medicine dating back to Hippocrates, and traces the history of medical/scientific thought from Ancient Greece to the end of the 19^th century. He then introduces a series of physicians, scientists, and medical researchers who will play their parts in the story of the pandemic (this first section is called “The Warriors”) and outlines their training, research, and interactions.  

It isn’t until page 91 that he takes us to the rural Kansas county in which the story of the pandemic begins. For although it was called the “Spanish Flu,” that was actually an eponym of convenience; in fact, the first cases of pandemic flu seem to have arisen on the American prairie. However, newspaper reporting on the new pandemic was felt by the Allies and Central Powers alike to be contrary to the public interest (the war was still raging), so it was left to neutral Spain, whose king had come down with the disease, to publish the early reports. In this section, “The Swarm”, Barry also briefly reviews the basic (not to worry, very basic) microbiology of viruses and the history of some prior pandemics. He follows this with the section called “The Tinderbox,” in which he traces the events leading up to the entry of the United States into World War I, and the importance of that war and the political and social conditions surrounding it in the history of the pandemic. From here on in the influenza itself takes center stage; in sections called “It Begins,” “Explosion,” “Pestilence,” “The Race,” and “The Tolling of the Bell,” the rapid and lethal course of the pandemic is described in gripping (no pun intended) detail. The last two sections discuss the scientific advances (and some false starts) brought about by the cadre of researchers working day and night to tame the outbreak, and then Barry finally turns to the retreat of the virus and ultimate end of the pandemic. The book ends as it began, returning to the stories of the individual men and women of science who engaged in the battle to beat the disease of which it had initially been said by many that “[t]his was, after all, only influenza.”  

For anyone seeking to understand the 1918 influenza pandemic not only from a scientific and medical historical standpoint, but also with an appreciation of the political and sociocultural milieu in which it took place, you can’t do much better than Barry’s work. It is not short—it clocks in at 461 pages, with another nearly 40 pages of endnotes and a 20 page bibliography—but it is well-paced and reads smoothly; the narrative carries you along, a testament to the author’s writing style. Barry succeeds in putting a human face on the pandemic and creates a mental image of the horror of pandemic disease which can stand up alongside those we have of the Black Death of the mid-fourteenth century, with which it is often compared. For those of us who know the flu as a seasonal visitor, (for most of us a major annoyance, but nonetheless a disease that kills tens of thousands each year), the images of massive and rapid death—villages abandoned except for piles of corpses, trains that “left one station with the living…[and]…arrived with the dead and dying”—seem surreal. Barry paces the book in such a way that one can almost hear the stopwatch ticking in the background; The Great Influenza is scientific and historical reporting done with great attention to detail and to getting the medical facts right, but it is reporting done with a novelist’s flair.  

Even as the pandemic begins to recede, leaving in its wake not only the dead but those living with its sequelae, such as post-encephalitic syndromes (the Woodrow Wilson/Treaty of Versailles anecdote is particularly striking), the helplessness of medical science is reaffirmed; the pandemic recedes of its own accord, because the virus mutates to less virulent forms, and the very large number of those who have survived helps to create herd immunity.   

In the book’s Afterword, added in 2018, the author discusses and compares influenza pandemics which followed the 1918 experience, talks about some of the antiviral drugs introduced over the years and how they work, and speculates about what the next great influenza pandemic might look like and how it might be prepared for. His concern was prescient, although it would be a coronavirus, rather than influenza, that would cause widespread death and societal disruption. In fact, one of the most jarring aspects of this story is the fact that, if one changes the dates and the names, the tale bears an uncanny resemblance to the COVID-19 story, right down to the attempts at minimization by the government and even the isolation and victimization of an ethnic group (in 1918 the Germans, who were the enemy in the world war, rather than Asian-Americans, as it would be during COVID).  

The Great Influenza is a detailed, highly readable, and sobering account of an episode which demonstrated once again that despite what we may think, we are not the masters of the world in which we live, and that a microbe could rapidly kill on a devastating scale and upend society—again—and there was initially little that could be done to stop it.  

THE GREAT INFLUENZA: A Story of the Deadliest Pandemic in History
John Barry 
Penguin Books, New York, 2004 (reissued with new afterword, 2018)
461 pages 

A previous version of this review was published in the NYU Literature, Arts, and Medicine Database.
Web image by Medhum.org

As the founder and director of the Centre for Health Humanities and a professor of English at the University of Reading, UK, Andrew Mangham, Ph.D., has published extensively on medicine and Victorian literature. His books include Violent Women and Sensation Fiction: Crime, Medicine, and Victorian Popular Fiction (Palgrave, 2007) and Dickens’s Forensic Realism: Truth, Bodies, Evidence (Ohio State University Press, 2016). Mangham and I exchanged questions and answers via email concerning his book, The Science of Starving in Victorian Literature, Medicine, and Political Economy (Oxford University Press, 2020).  

1, How did you arrive at the topic of your monograph? What led you to research the intersection of Victorian literature, medicine, and political economy? 

It was a bit of a circuitous route actually. At the institution where I teach, there is a key research strength in food science and food security. A few years ago, this was highlighted as an area of research focus within the University, and this got me thinking about what it was that the Victorians could bring to the table, as it were, on the question of modern food security. We’re all very familiar with the idea of the starving Victorian pauper, but I wondered what political and philosophical work this idea or image was doing on the ongoing issue of food inequity. This then set me thinking about how nineteenth-century medicine responded to the problem. Some preliminary research taught me that there was a plethora of medico-physiological works on starvation as a material phenomenon. I also noted that this side of the question had been overlooked by modern scholarship, which has tended to focus on political economy as the Victorian science of hunger. What I found, however, is that medicine spoke in very different ways about hunger and—if anything had a bearing on the birth of social problem realism as the genre of the ‘Hungry Forties’—it was this material, medical, scientific focus set against the consequentialist thinking of political economy. 

2, For readers unfamiliar with The Science of Starving, briefly sketch your main contention. Why does your study deserve attention? 

My main contention is that, in the long nineteenth century, there emerged a science of starving in which specialists in medicine and physiology spoke about what happens to the body when we starve. The realities of this process were stark and shocking, and they countered the notion, formulated mainly in the works of Thomas Malthus but swiftly adopted as ‘fire-and-brimstone’ gospel by politicians, social reformers, and authors of statutes, that those who starve are intended to do so by nature—that it is only ‘natural’ that famines sweep away large numbers of people. This propagandizing interpretation of Malthus converted the poor into a mass of immoderate and reckless burdens on the State. The physiological focus on starvation as a harrowing condition which affects individuals helped counter the conservative ideology, and it inspired the social problem fictions of Charles Kingsley, Elizabeth Gaskell, and Charles Dickens, which also take individual subjectivities, ways of interpreting poverty, and reactions to social injustices as key points of focus. Taken in conjunction, literature and medicine show us a world in which the well-meaning ideas of Malthus were exploited and warped into something much more sinister; they also show us the ways out of the problems the ideology has posed for us by returning to a consideration of the individual, the connections between people, and the material realities of modern life. 

I would argue that the book deserves attention on two major counts. First, it gives us a new context in which to read Victorian social problem fiction—a context in which we have an explanation for the emergence of realism as a socially-aware, politically-driven mode of writing. Looking at the forgotten context of Victorian food science, we see a lot of familiar and unfamiliar narratives in new light. Secondly, the book—and perhaps the most important issue—deserves attention because its questions are still with us. The conservative interpretation of Malthus has fed into and justified neoliberalism—a political approach tried and failed since the 1980s, and now enjoying a resurgence in the UK. At the heart of the neoliberal ideal is the idea that the many cannot be trusted to handle money and that economic responsibility is rightly placed in the hands of the elite few. The idea is that this will lead to a trickle-down effect, where the many will benefit from the successes of the few. The truth, as we see in the bloated account-books of internet trading companies for instance, is that wealth placed at the top tends to stay there, with some individuals now wealthier than some countries. My book can’t tackle all aspects of this issue, but it does show us where the idea of the ‘immoderate mass’ comes from; how it has justified political disenfranchisements of the poor for centuries, and that there is a more humane approach which concentrates on the experiences and the needs of individuals.  

3, Describe your research methodologies for this book. You use the first chapter to stage the broader historical context, describing the major theories of political economy and medical understandings of hunger, digestion, and gastrointestinal anatomy. Your subsequent chapters then situate medical texts alongside examples of Victorian fiction. What is your larger methodology? 

I suppose my methodology could be identified as a kind of new-historicism, where the powers and meanings of literature are best understood when we pay attention to their original, historical and social, contexts. But this isn’t a straightforward process of identifying where an author picks up his or her ideas. I try to read literature as actively involved in the shaping of history; ideas may begin in medicine and/or political economy, for instance, but they are soon transformed and made to do something special when they work their way into works of fiction. What this work is depends on the styles and objectives of individual authors, but it is certainly the case, I think, that ideas become bolder when they are explored in works of fiction. Zola famously had the idea that the novel was an experiment—a trial of ideas and concepts—and I think that whether an author intends it or not, their work tests the meanings, potentials, and limits of ideas within a certain historical timeframe. I therefore think it’s important to read the fiction produced by any time period we are seeking to understand fully, to go back and to see how and why ideas first emerged through the ways they are tested and dissected in the form of fiction. 

4, Some readers might naturally assume a kind of intrinsic rivalry between art and medicine, fiction and scientific rationalism. Yet your book emphasizes that Victorian writers neither snubbed medical science nor regarded it as antithetical to their literary ambitions. Why is it important that these writers transcended disciplinary borders? 

It’s important that the field of ‘literature and science’, which has become quite busy in recent years, moves away from the idea of the two cultures—the notion, that is, of warring approaches to interpreting the world. This is a modern idea, forged in the twentieth century, and is not actually representative of the work science or literature does. To those of us who spend any time with the ideas of science and/or medicine, we’re used to seeing how the intellectual work involved here is no less beautiful or imaginative than the ideas of fiction and poetry. Similarly, we can point to authors whose work has all the hallmarks of scientific rationalism. It is important to see how writers transcend their so-called disciplinary borders because this shows us how ideas evolve when they are passed from specialism-to-specialism; it also shows us how ideas were never meant to be confined in disciplines. Appreciating the true interdisciplinarity of how ideas work opens up a world of possible collaborations and curiosity.  

5, Writers, as you show, were certainly influenced by the era’s medical texts, but were physicians reading the works of these literary figures? In other words, was there a mutual exchange of influence and recognition between Victorian physicians and writers? Were physicians aware of their impact on shaping the literary texts you examine? 

Yes, certainly. This question could have formed the basis of another book—volume 2 perhaps. We know that medical figures read fiction—there is a famous account of the physiologist and surgeon Benjamin Brodie reading The Pickwick Papers in his carriage between consultations; other medics saw literature as crucial to the kind of work they did. The surgeon Anthony Carlisle perceived there to be similarities with the progress of illness and/or injury and the progress of a story. He is thought to have written a gothic novel. For other medical and scientific figures, literature was a ‘switch off’ activity. We have accounts, for instance, of Charles Darwin and Richard Owen reading Dickens in the evenings. In later psychological texts of the period, Dickens’s characters are often held up as case studies of complex conditions like dementia. Whereas we have an obvious written record of medicine’s influence on literature (we can look at specialist language working its way into fictional plots), proving the inspirations in the opposite direction is more challenging, but I wonder whether the evidence is less ‘tangible’. I think the centrality of narrative in case studies and accounts of experiments, for instance, owes much to the powerful example of literature; I also think questions of causation, biological determinism, psychological wellness or aberration have their roots in the long social and psychic studies of the novel. 

6, While these writers used medical language to ground their plots and characters in the materiality of poverty, one wonders if these descriptions would have eventually desensitized readers to the shock of starvation’s physical dimensions. That is, did the language of medical science and physiology become subsumed into what later readers may have recognized (and disparaged) as sentimentality? Did the language of physiology eventually lose its trenchancy as it became an established feature of these Victorian writers’ works? 

It’s a good question. Certainly, in respect to the long nineteenth century, I think the science of poverty offered something of a stimulant to ways of reading which had become desensitized. We often hear of social-crusade literature, or poverty tourism in the nineteenth century, as intending to jolt the Victorian reader with confrontations from a world they had chosen to ignore, or which their middle-class existences sheltered them from; but by the 1840s, the world of letters, politics, and social reform were overwhelmed with newspaper reportage, government blue books, and philanthropic pamphlets. Writings about the stock figures of the starving mother and child, for instance, were very common and it’s unlikely that these would have had the confrontational power it would be all-too-easy to ascribe to them when read out of context. In the nineteenth century, however, physiology was relatively new; people were used to medicine as the treatment of the sick, and to anatomy as the study of bodies, usually dead ones, but the science of life—the science of the processes of life—was relatively fresh. This new science had new things to say about hunger—how it operates, what causes it, and how it proceeds if it is unchecked. I think this did emerge into something confrontational, something which had a powerful political ballast. I think it still does.  

7, Readers might consider the extent to which illustrations—in Dickens’s writings, specifically—also worked to visually articulate the language of physiology. For example, John Leech’s illustrations in Dickens’s Christmas Carol depict the children “Innocence and Want.” These child figures are gaunt, shivering, and spectral; their clothes are tattered. Are readers to understand these illustrations as also reflecting Dickens’s broader efforts to draw on medical science to ground material representations of starvation? 

Yes, I think so. ‘Ignorance and Want’ was an image I originally intended to include in the book but left it out in the end because it will be very familiar to a lot of my readers. We know that Dickens exerted a pernickety attention to detail when it came to his illustrations and, as John Leech set about creating the engraving, Dickens would have overseen the process closely. What’s interesting about this image is the fact that it is set in London and yet has a mill in the background, which would have been more identifiable with an industrial town like Manchester. This is an obvious nod to the industrial context—how the inequities of the profits of capitalism result in ignorance and want. The image pays particular attention to bodies in a way that echoes how the literature develops what Terry Eagleton has called ‘corporeal materialism’; in the contexts provided by the spectacle of starvation, skinny, gaunt and raggedy bodies spoke a radical, political message against the status-quo. 

8, At the time these writers were drawing on medical science to recalibrate literary representations of starvation and poverty, did the era’s readers and literary critics observe, even minimally, this changing perspective? Did book reviews, for example, detect this shift in language and representation by responding to or critiquing its efficacy? If not, what may have accounted for this critical oversight? 

Reader response is a difficult thing to measure, but reviews are an interesting insight. These differed wildly and depended, of course, on the politics of the reviewer and the magazine or newspaper they were writing for. There certainly was an acknowledgement of the social aspects of the literature and some account of the realism as well. I think that the radical qualities of the literature can be seen in just how often it raises the heckles of a conservative reviewer. It was not uncommon, for instance, for authors to take umbrage with the dogged materialism of an author like Gaskell (which is not an entirely accurate summation—she was very much interested in religion, spirituality, and feeling); Kingsley was also taken to task for his focus on bodies—unseemly, some said, in a man of cloth. And Dickens himself was attacked for the unrelenting nature of his focuses on the poor—for his seeming preference for the characters and situations of low life. Not many critics saw this—at the time—as part of a new way of thinking about poverty, but it’s certainly the case that materialism had long been associated with radicalism. Those readers who appreciated these authors often spoke of their truth and their accuracy and I think this is part of a larger, cultural (largely unspoken) acknowledgement of the powers of social problem realism. By the time we get to the next wave of social problem fiction—Arthur Morrison, George Moore, George Gissing—we’re in different territory and there is, I think, a more critical and analytical reflection on corporeal materialities.  

9, Historians of medicine, political scientists, and literary scholars will certainly note the importance of The Science of Starving. Aside from these readers, what do you want your research to convey to today’s medical students and practicing physicians? 

I’m fairly happy leaving medical students and practicing physicians in peace. They do extraordinary work and don’t need me to tell them how to make their work more humane or socially responsible. Politicians, on the other hand, I’m very happy, in the words of Dickens, to ‘fall upon’. The emergence of the far right, the zombie-like persistence of neoliberalism, and general intolerance among conservative politicians are all things which suggest that some of our civil servants might take a leaf out of the book of the nineteenth century. I would love it if my research could convey to some individuals that consequentialist thinking, knee-jerk policies, and political essentialisms have all been tried and tested, have failed, and done irreparable damage. One thing the authors of fiction and the pioneers of science and medicine have taught us is the power of thought—the importance of keeping an open mind and being willing to abandon ways of thinking whose fixedness is preventing us from growing as individuals and societies. We can learn a lot by looking to the past and we need these lessons more now than ever. 

Andre Mangham’s most recent book is We Are All Monsters: How Deviant Organisms Came to Define Us published in February 2023 by MIT Press.  

An earlier version of this interview was published in the NYU Literature, Arts, and Medicine Database (Litmed).
Web image from The Cleveland Museum of Art

The Science of Starving in Victorian Literature, Medicine, and Political Economy  by Andrew Mangham 

Sebastian Galbo Jun 2, 2025

A compelling study of how Victorian writers used medical science to expose and challenge political economy’s misconceptions about starvation.

Undergirding Victorian-era political economy was the influential work of the British cleric-economist, Thomas Malthus, and the rise of statistics. Malthus’s well-entrenched theories maintained that starvation, or large-scale famine, was a natural (and therefore inevitable) response to overpopulation. “In Malthus’s thinking,” Mangham clarifies, “hunger is the greatest tragedy in human economics: in the worst of times it rises up as a horrible check on those nations whose resources have been overrun by improvident birth rates” (1). These theories further solidified within religious contexts, which produced the peculiar notion of “salutary starvation” (26) or “the providential law of starvation” (30)—an understanding of famine and other disasters as just consequences for exceeding the material capacities of God’s “natural system” (26). Malthus’s theories, imbued with religious interpretations, were pernicious and far-reaching, seeping into how the British government and affluent classes viewed and (mis)understood poverty.  

Mangham also maintains that Malthus’s theories were augmented by the emergence of statistics during the first several decades of the century, which enabled the government to measure and evaluate epidemiological patterns, demographic data, and other information about human populations (53). He notes that while statistics were used to collect data about starvation, the data were frequently presented in ways that skewed the prevalence of malnutrition, food scarcity, and diseases and mortality rates related to starvation (56). Using a range of literary and primary sources, Mangham underscores that support for statistics was far from monolithic, that for all the scientific certitude that government officials invested in the discipline, there were critics who vociferated about how statistics were often reductive representations of human experience. In other words, masses of tabulated numbers created a cold, mathematical distance between government authorities and those human lives suffering starvation (56–57). Overall, Mangham outlines a bleak picture of Victorian political economy and its views of material privation. 
 
For Mangham, then, one of the most injurious consequences of political economy was its failure to observe starvation (and its manifold health complications) as a material, indeed physiological, experience. As noted, political economists viewed starvation as anything but a form of bodily suffering, using theories instead to explain the naturalness and necessity of hunger and thus blaming the poor, not government and industry, for their problems (31).  

While political theorists were preoccupied with these explanations, Mangham traces the era’s concurrent developments in medicine that examined the physiology of hunger and digestion. The gastrointestinal research of the Italian Lazzaro Spallanzani influenced Victorian physicians, namely John Hunter, Charles Thackrah, George Henry Lewes, Thomas Southwood Smith, and others, who sought to describe the anatomical workings of the stomach and explain the bodily sensations of hunger (36). Against this backdrop, Mangham argues that Charles Kingsley, Elizabeth Gaskell, and Charles Dickens—united in their “antipathy towards Malthusianism” (17)—recognized the power in articulating starvation using physiological terms, and turned to science to limn “. . . the material sufferings of the starving and, more importantly, on detailed analysis of what it means to go hungry and to observe and to write about it in a way that seeks to be truthful” (16). In chapters that individually examine each author’s literary works (among them Kingsley’s Yeast, Alton Locke, and Two Years Ago; Gaskell’s Mary Barton, North and South, and Sylvia’s Lovers; and Dickens’s Bleak House and others), Mangham demonstrates how “. . . physiological ideas offered both an alternative way of thinking about hunger and an exploration of the ways in which it might be interpreted” (47). This volume’s close readings of these authors’ various novels, journalism, and speeches reveal that medical science offered a language that could undermine theories that misunderstood human starvation and the sociopolitical conditions that perpetuate it.  

Mangham’s study traces compelling connections among nineteenth-century political economy, medicine, and literature, demonstrating that writers looked to science for inspiration to critique feckless government policy and represent the concrete physicality of hunger. If writers could emphasize that impoverished people experiencing starvation were undergoing an “unnecessary, unjust, and unnatural” process, their stories could begin to demystify for readers the opposite claims of political economy (18). Kingsley, Gaskell, and Dickens used new science to depict not only physiologically accurate but also humanized renderings of the poor and Mangham provides close readings of novels to emphasize how these authors used physiology’s vocabulary to describe the material dimensions of poverty, which enabled them to push back against the theories of political economy. It is not that Victorian writers resorted to stale clinical language, but instead worked in confidence, knowing that what they represented in their narratives was grounded in scientific fact. Mangham’s analysis shows how literature and medicine intersected in ways that produced trenchant critiques of government policy. 

The Science of Starving in Victorian Literature, Medicine, and Political Economy
Author Andrew Mangham 
Publisher Oxford University Press 
Place Published United Kingdom 
Edition 2020 
Page Count 240 

An earlier version of this review was published in the NYU Literature, Arts, and Medicine Database (Litmed).
Web photo from The Cleveland Museum of Art 

Interview with Andre Mangham

Sebastian Galbo Jun 2, 2025

Andrew Mangham explores how Victorian literature, medicine, and political economy intersected to shape powerful narratives about hunger and poverty.

Kairos is the claustrophobic story of an affair between a 19-year-old woman and a married man more than 30 years her senior. Nothing unique in that situation. But this clandestine relationship unfolds against the backdrop of the last years of the German Democratic Republic before the sudden collapse of the Berlin Wall. This too is familiar territory — from novels like John LeCarre’s The Spy who Came in from the Cold and Ian McEwen’s The Innocent to popular movies like The Lives of Others. What makes Kairos different from anything that I have read about this period is the microscopic view it provides of the dysfunctional relationship between Katharina and Hans and the larger vision of reality that emerges. 

Their initial meeting is a completely chance encounter on a bus in Berlin as they shove to board it and escape the rain. They spy each other immediately and within a few pages are sleeping together. Hans is a married broadcast journalist who seems to have found a secure niche for himself despite state control of the press, while Katharine is a student in theater arts. Literary May-December romances are not uncommon, but the rushed and secretive meetings between the two lovers quickly move into less comfortable terrain. Katharine becomes increasingly insecure and less assertive in her interactions with Hans. Violent sadomasochistic behavior intrudes into their space, and Hans becomes more domineering and demanding. This is not a fuzzy tale of two star-crossed lovers who pine longingly for one another; this is obsessive territory. Over time, distrust and suspicion and mutual cruelty invade the lovers’ trysts. When Katharine leaves Berlin for a period of academic study in Frankfurt, it triggers exaggerated accusations of betrayal by Hans. He blames Katharine for being unreliable and not fully committed to their relationship and calls into question her loyalty to him. There is lots of sex and coded signals and furtive meetings to avoid detection by Hans’ wife and son. But the mood becomes chillier and more tense with each turning page. Eventually, the political uprising across Germany and Eastern Europe ruptures the novel’s narrow field of vision and alters the contour of their illicit relationship.  

The novel is bracketed by two efforts at historical reconstruction, accomplished by mining written records from the period. This highlights the power of literary narratives to frame our lives, something that Kairos accomplishes so successfully. The plot is spare but Jenny Erpenbeck has created a novel that is very thick with the lives of the two characters, and it is that richness of texture and intimacy, disturbing as it might be, which causes the book to reverberate in your memory long after you put it down. 

Why is that? What Kairos accomplishes better than other books I have read in recent memory is its ability to bring to life the impact of our social and political environment on our inner lives. The tautness of Erpenbeck’s writing, the novel’s ominous and suspicious atmosphere, are a direct reflection of what it might have been like to live in East Germany after the Iron Curtain descended and the Berlin Wall was erected. The East German domestic spy service, the notorious Stasi, infiltrated everyday life. Anyone could be an informer and everyone could be informed on. Petty offenses against the Communist party, minor disagreements between colleagues about policy, and trivial comments among friends about current affairs could quickly escalate into charges of treason, of being an enemy of the state. No one knew exactly what could provoke a summons to a closed room interrogation and a prison sentence. 

 It is in this stultifying environment that Katharine and Hans’s relationship takes shape and it is against this sweeping historical background that we confront and must try to understand their thoughts and actions. Katharine is young but seems deadened by life on the dreary East German side of the Berlin Wall with its brutalist architecture and its color spectrum ranging from shades of gray to shades of gray. For her, even a destructive relationship with an older man, a spiteful and hurtful one at that, may have provided a glimmer of hope for a “real” life. Hans has survived under the Communist regime and achieved a modicum of fame and fortune. But we can only speculate on the cost. Erpenbeck makes it clear that the price was high. The humanity of both main characters has been stunted by their reaction to living in a police state and by internalizing the distrustful depersonalizing actions of the government’s internal espionage apparatus. I suggest that Erpenbeck’s accomplishment is to show how the political environment can influence personal patterns of behavior. 

How would we have held up if forced to live under such conditions? Would one have had the courage to speak truth to power or would one have hunkered down, kept a low profile, and avoided confrontation with the state? What would we have resorted to in order to protect ourselves and our job, family, and friends? Could we have maintained our humanity and dignity? Katharine and Hans lived with these unbearable dilemmas every day and their personalities were gradually warped under the relentless pressure.  

It is easy to devalue the lives of others living in the former East Germany or Soviet Union, or current China or Iran, where men and women are forced to remain in countries that interfere with the freedom to think and express oneself and where every thought and action is under surveillance. But it would be a mistake. We should not lose sight of external factors in this country that threaten our individuality and our humanity. Whether it is political uniformity and social tribalism or blind use of the tools of artificial intelligence, we too must recognize and address the social forces that could impact on how we interact with the world and behave to one another. Like the Stasi in East Germany, these forces have the real potential to diminish our stature as moral agents.  

Neither main character in Kairos is easy to identify with and it is hard to muster sympathy for the plight of either one. But our distaste for Katharine and Hans is tempered by the knowledge that their souls have been distorted, damaged almost beyond repair, by a state that has flattened the complexity of human individuality into a file of incriminating notes based on informer reports. I suspect it may be especially hard for a woman to read this book and suffer along with Katharine as she is manipulated and physically and psychologically abused by Hans. But one cannot escape the reality that Hans too is a victim. Quality literature like Kairos does not aim to rationalize human behavior. What it can do is contextualize fictional characters and in doing so make us understand what some of our fellow human beings are going through a little bit better and with a little more sensitivity. 

Winner: International Booker Prize 2024

A Q&A with Jenny Erpenbeck and translator Michael Hofmann

KAIROS 
Author: Jenny Erpenbeck 
Publisher ‏ : ‎ New Directions; First Paperback Edition (May 14, 2024) 
Hardback: 2021, Penguin Verlag 
Paperback: 304 pages 
ISBN-10 ‏ : ‎ 0811238539 

Photo by Lucy Bruell

What makes The Magician so unique as a novel is its depiction of writing as an all-encompassing creative activity that consumes the author’s full psychic energy and that emerges out of his personal struggles as an individual. It would be impossible to affix The Magician to the back cover of all editions of Buddenbrooks or The Magic Mountain. Tóibín offers more than a page of scholarly references to help a reader gain background knowledge about Mann, his life, and the times. But if you are interested in what it might have been like for Thomas Mann to compose these monumental works, Tóibín’s book might offer the best entry point into Mann’s artistic mind and his creative persona.  

The novel covers the full panorama of Mann’s life, from his somewhat pampered childhood in Lübeck, Germany, to his final years spent in the German expatriate community of Los Angeles. The writer’s camera is laser focused on ground level details and refuses to zoom out to the big picture and lose its granular tone. The texture of the bourgeois lifestyle of the Mann family is captured in all its minutia including rowdy family meals, community engagements, and professional insults. One can almost feel the temperature rise and the climate change as Mann and his family move from Munich to Princeton and finally to Pacific Palisades. Mann exerted very tight control over his daily routine and one senses his absence on the page as he withdraws to his private study every morning after breakfast to write without any interruptions. We are excluded from this sanctuary just like his wife and children as they waited for him to emerge after lunch for his afternoon walk and some playtime with them.

Mann was more than a prominent novelist. He was a winner of the Nobel Prize in Literature in 1929, globally recognized and one of the most famous personalities of his time. He hobnobbed with dignitaries and the leading figures of the pre-World War II era, including Einstein and FDR. They parade across the pages of the novel with all their foibles and idiosyncrasies. Tóibín details Mann’s tempestuous relationship with Agnes Meyer, a leading figure in high society along the New York-Washington DC corridor. I had to look her up to learn that she was a well-known journalist and civil right activist and Katherine Graham’s mother to appreciate her impact on the world during the 1930s and 40s. 

The most striking feature of the book is the intimate recounting of Mann’s tortured struggles with his sexual orientation, which infiltrated his fiction from the very beginning of his career. He never denied his homoerotic longings and Tóibín delicately describes the many occasions during his long life when Mann was overwhelmed with desire for a particular man and his secretive attempts to act on his cravings. But he was a man of his era and was forced to submerge his identity as a gay man most of the time. The emotional cost of a life lived closeted on the one hand, and as the married father of six children on the other, is readily apparent. Reading The Magician motivated me to reread Death in Venice and made me realize the courage it must have taken for Mann to portray Aschenbach’s tragic story in such complex but precise prose, to reify his own emotional turmoil without sanctimony or defensiveness. Tóibín’s prose is the ideal conduit to channel the roiling interface between the Mann of the larger world and the inner literary mind of a flesh and bones historical human being. 

The Magician is an engrossing reading experience that also has special salience for followers of the MedHum website, which explores the role of the individual in a changing society. A key element that drives the narrative forward is Mann’s engagement with the political developments in Germany over the long period spanning from the lead-in to World War I, to the outbreak of hostilities in August 1914 and again in September 1939 and the devastating war years, and ending with the rebuilding of his native country. At the start, Mann saw himself as heir to a tradition of German intellectual excellence and nobility. He took great pride in his country and patriotically defended the decision to go to war against France, Britain, and Russia in August 1914. However, he recognized the dangers posed by the Nazi seizure of power and openly decried the degradation of public life. Mann felt the Nazi destruction of the German cultural heritage as a personal betrayal. Mann recognized early on the brutality of the antisemitic legislation and the attacks on his Jewish colleagues. He was forced to weigh loyalty to country against the defense of universal humanistic principles and he struggled to find a path forward between these competing ideals.  

As Hitler rose to power, were Mann’s instincts right that this would bring calamity to Germany, or should he have had trust in his fellow citizens that things would right themselves? How much could Mann rely on his interpretation of unfolding political events and his prediction of what the future would look like? Once the Nazis consolidated their dictatorial control of the Reich and set out on a course for total war and extermination of the Jews, should Mann have been a strident and outspoken opponent of the regime or should he have worked more discreetly behind the scenes? Should he have remained in Germany and risked his own life and the safety of his family, especially his wife’s Jewish relatives, or sought refuge in America, where he could serve as a champion of cultural enlightenment and world peace? How does one weigh the facts and decide on an effective course of moral action? How does one choose among imperfect options? 

Like all of us, Mann was forced to anticipate events and make painful decisions—decisions that would play out over time and have consequences for others– in real time and with only partial or inaccurate data. Much like the case with physicians and other health care professionals, most of these decisions will work out well, some will be imperfect, and a few will even be wrong. Tóibín’s novel, history as fiction, vividly illustrates the human predicament of living while moving forward with uncertainty and anxiety because full clarity only comes in retrospect — something that doctors understand because they experience it nearly every day in encounters with their patients.  

The Magician – Reading by Colm Tóibín & Conversation with Friedhelm Marx at the Thomas Mann House 

The Magician: A Novel 
Colm Tóibín 
New York: Scribner, 2021, 512 pages  

Photo of Thomas Mann generated from Wikicommon Photos

The renowned English social realist and portrait painter, Luke Fildes (rhymes with “childs”), created The Doctor in 1891 after Henry Tate commissioned a painting from him for his new museum, the Tate Britain. The subject of the painting was Fildes’ choice. Despite a poor reception among art critics when it was first exhibited, the painting quickly became iconic as the physician ideal. Over its 133-year history, the painting has been used for a variety of purposes, including inspiration, education, propaganda, and politics. During that time, the ways in which the painting represents the physician ideal changed. We talk about these aspects of the painting with Hannah Darvin from Queen’s University in Kingston, Ontario, Canada. She has conducted extensive research into the painting and its creator.

Links
Image of The Doctor from the Tate Britain Museum.
About Hannah Darvin at Queen’s University.
Hannah Darvin’s description of her research for the Harvey Cushing/John Hay Whitney Medical Library at Yale University.
John Brewer Eberly’s diptych rendering a modern version of The Doctor in which computer technology is interjected between doctor and patient. 

Feature image from Wikicommon

Cold Eye, Warm Heart: Medicine and Anton Chekhov  

Jack Coulehan Aug 6, 2025

A moving portrait of Anton Chekhov, whose dual life as physician and writer reveals the deep interplay between healing and storytelling.

The Center for the Study of Tobacco in Society is ready for the 2024 Election. Check out their new exhibit: A Vote for Cancer: Tobacco Advertising and Presidential Elections and read an interview with the Center’s founder, Dr. Alan Blum, in conversation with Jack Coulehan.

Tobacco was America’s first cash crop and a mainstay of the US economy for 300 years. So it’s no surprise that manufacturers of cigars, chewing tobacco, and cigarettes have had a presence in presidential and other electoral campaigns since the mid-19th century.

The first Presidential campaign buttons appeared in 1896 – promoting Republican William McKinley and Democrat William Jennings Bryan — and were given away by Liggett & Myers Tobacco Company to promote its Sweet Caporals cigarettes. By the mid-1900s, cigarette advertisers would distribute whimsical presidential campaign buttons featuring advertising icons such as Philip Morris’s bellhop Little Johnny and Brown and Williamson’s Willie the Penguin. The button gimmick culminated in RJ Reynolds Tobacco Company’s nationwide “Vote for Joe” advertising campaign in 1992 for its cartoon character Joe Camel.

Toward the close of the 20th century, the combination of restrictions on cigarette advertising and the approval of political action committees by Congress enabled cigarette makers to donate directly to Presidential candidates and lessened the need for cigarette product advertising.

Alan Blum, MD
Introduction to A Vote for Cancer: Tobacco Advertising and Presidential Elections

Interview with Alan Blum

Jack Coulehan Oct 24, 2024

The battle against smoking evolved from awareness campaigns to challenging a profit-driven industry, using humor, irony, and persistent activism to drive cultural change.