But Mimì’s tragic demise isn’t a medical documentary: it’s depicted in the context of a cultural and artistic tradition in which a wide range of diseases—whether of the body or of the mind—carried powerful symbolic meanings. Inﬂuenced by the legacy of Italian opera as well as by Wagner, Puccini was intimately familiar with the sudden madness of Donizetti’s Lucia of Lammermoor, the innocent sleepwalking of Amina in Bellini’s La Sonnambula, and the mysteriously festering “wound” that torments Amfortas in Parsifal. Susan Sontag, in her landmark deconstruction of the use of “illness as metaphor,” observed that “sickness has a way of making people ‘interesting’—which is how ‘romantic’ was originally deﬁned.”
Puccini’s own fragile heroine Mimì takes her place as the last in an iconic lineage of nineteenth-century operatic heroines who suffer and die of tuberculosis (TB), following Verdi’s Violetta in La Traviata and the fatefully music loving Antonia in Offenbach’s Les Contes d’Hoffmann. That lineage entailed a romanticized depiction of what was, after all, a horrifyingly commonplace condition in Europe at that time, accounting for up to one in six deaths in France by the early twentieth century.
Such “romanticizing” is a complex, many-layered phenomenon. Sontag points out that by the nineteenth century, the model of disease as a “punishment” for transgressions had been reﬁned into the idea that disease “expresses character.” TB in particular was portrayed as “the disease that makes manifest intense desire; that discloses, in spite of the reluctance of the individual, what the individual does not want to reveal.” Speciﬁcally in terms of female sexuality, “having TB was imagined to be an aphrodisiac, and to confer extraordinary powers of seduction.”
In a fascinating essay for the journal Emerging Infectious Diseases titled “At the Deathbed of Consumptive Art,” the epidemiologist David H. Morens explains that artistic depictions of the disease sought to make sense of such a widespread phenomenon “in popular terms, ﬁrst as romantic redemption, then as reﬂection of societal ills”—all the more because “medicine had little to offer anyway.” The ﬁnal suffering of the courtesan Violetta Valéry becomes transﬁgured by Verdi’s music, transforming what was a shocking realism for contemporary audiences into a cathartic experience.
Dr. Deborah Gold, Chief of Infectious Diseases at Kaiser Permanente San Francisco, describes the medical reality of the disease: “Tuberculosis is an airborne bacterial infection that begins in the lungs and can spread to any part of the body—the brain, skin, spine, liver. When left untreated, the disease may cause an overwhelming inﬂammatory response resulting in intractable fevers, chills, night sweats, and dramatic weight loss. In the era before medications were available to treat TB, some of those infected literally withered away; hence the common name for the disease, consumption.”
By the time Puccini composed his version of the stories based on the earlier Parisian characters brought to life by Henri Murger (who himself died of TB in 1861), a medical breakthrough had occurred. In 1882 the microbiologist Robert Koch announced his discovery of the causative bacterial agent of tuberculosis. Does the new awareness of TB as highly contagious explain Rodolfo’s behavior in wanting to break up with Mimì? Is his guilt-ridden claim—“I’m the reason that this fatal illness is attacking her”—in fact a projection of his fear that he might contract the disease? In depicting Mimì’s situation, Puccini and his librettists emphasize the stark reality of her poverty. While the cause of her disease (never actually mentioned) was now understood, there still was no cure. Even Violetta has a doctor to comfort her, but Mimì must rely on the kindness of her friends. “Opera and tuberculosis have entered a new era, recognizable today, in which tragedy is seen as experiencing loss but is not understood in an artistic or philosophical sense,” writes Morens. Even more: “Mimì dies surrounded by a philosopher, a poet, a painter, a musician, and a singer—the arts had become powerless against tuberculosis.”
TB is curable today because of medications developed after the Second World War. Before that time, there was only palliative treatment for the disease, and sufferers were sent away to sanitaria for relaxation and fresh air—as in the setting for Thomas Mann’s epochal novel The Magic Mountain (1924). “In reality, a diagnosis of tuberculosis, even in the early days, was not necessarily a death sentence and patients were known to improve” says Gold.
Yet despite modern advances, tuberculosis is far from eradicated. “It’s such a huge worldwide problem that is most prevalent in the developing world. That being said, the rate of TB in San Francisco County is the highest in the state, and is one of the highest rates in the country. Most of the cases occur in individuals who were born in countries in which TB is endemic,” according to Gold. “TB is often latent and those infected may not suffer any symptoms. If the infection does become active, it is usually easily diagnosed and is often curable. We rarely see people dying of TB in the developed world.”
San Francisco Opera thanks Dr. Gold and the staff at Kaiser Permanente for contributing to this article. Kaiser Permanente has been a Corporate Sponsor of San Francisco Opera for eight seasons. Their support of the Company’s free, annual Opera in the Park concert has been a wonderful gift to countless opera fans.