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Under the Magic Mountain

FROM THE TB SANATORIUM TO MEDICAL TOURISM

An Alpine regime

In his influential commentary on Thomas Mann’s novel The Magic Mountain (1924), which appeared just a few years after the novel itself, the scholar Hermann Weigand called it ‘the epic of disease’.

We need to define terms. Mann’s novel is more accurately characterised as the epic of a disease, tuberculosis, a major disease that has accompanied humans throughout their history, at least since they started building and settling in cities. It is also, in the broader sense, an epic of illness—an ambitious attempt to show how the condition of being ill (a more subjective category than disease) was experienced in a particular culture at a particular time in its history.

In the nineteenth century, and not just in Germany, being tubercular was associated with being ‘interesting’—and making yourself interesting is the primordial Romantic impulse. The main character in the novel adopts the sick role with a sense of exaltation—and at times even election—that goes back to transcendental idealism and the supposition, first expressed by the poet Novalis, that illness might be ‘the means to a higher synthesis’. It is unsettling, then, that when seen from the ‘flatland’ (a code-word in the novel for ordinary existence) the same character comes across as a malinger who has jacked in his career in order to enjoy an institutionally coddled life on the mountain top where he will become a virtuoso in selfhood. In mere selfhood, one is tempted to add.

As Thomas Mann himself suggested, his hero Hans Castorp—a kind of dreamy Candide whose face, as with Voltaire’s famous fictional character, is ‘the index of his mind’—is on a somewhat paradoxical quest: he has to pass through illness to rediscover the ethics of normal life itself. That is a search we are all familiar with, one way or another: the magic mountain is no longer a retreat or social height; it is the familiar landscape, at least in the developed world, of a technological Eden with no more onerous a task than organising our entire lives. On the bottom rung of all this reorganising is a medical sociologist’s platitude: the healthier we become the more medicine we demand. In the words of Nikolas Rose: ‘like Hans Castorp upon his Magic Mountain, our stay in the sanatorium is not limited to a brief and terminable episode of illness. It is a sentence without limits and without walls, in which, apparently of our own free will and with the best of intentions on all sides, our existence has become bound to the ministrations and adjudications of medical expertise.’

When Mann began his novel, tuberculosis was at a significant juncture in its history: the discovery of the visible effects associated with an unknown type of electromagnetic radiation, X-rays, on the cusp of the twentieth century, had made it possible to detect with some accuracy early active pulmonary forms of the disease. Medicine’s therapeutic capacities, however, lagged decades behind its diagnostic accuracy: it was only after the Second World War that effective antibacterial treatments emerged for TB. But treatment is lengthy and not always well tolerated, and patients tend to stop taking their treatment on the first signs of remission. This abets the development of resistant forms. Even today, despite the newer drugs available to treat it, containment campaigns in many developing countries have only been partially successful and TB remains a major public health problem, not least in its multidrug-resistant forms: it is thought there are now more cases of TB worldwide than at any time in history. It has been calculated that fully about one-third of the global population has been exposed to the bacillus (although only a percentage of those exposed go on to develop the disease).

The Magic Mountain takes us to one of the few therapeutic options open to the better-heeled European patient of that time: a ‘change of air’ in the spa or sanatorium—what the Italians call villegiatura.

Going up into a mountain retreat was one of the growth sectors of Switzerland’s economy in the nineteenth century. From about 1860 to 1940, an Alpine regime of rest and rich food was thought to provide the best chance for recovery from TB, and for the body to work its healing ‘wisdom’. It was a policy that certainly isolated patients with active disease (who were spreading the infection through coughing or sneezing) from the general population, but it made for local environments that had high circulating levels of airborne bacilli. Indeed, the atmosphere of the Haus Berghof, on the Davos plateau, to which Mann in the opening pages of his novel propels Hans Castorp, is not quite as wholesome as it might seem. The thin mountain air, much as in the Bergfilme (mountain films) that were popular in the years of Weimar Republic and later promoted by the Nazis as the German answer to the Western movie, proves to be anything but pure and clean; it turns out to be a narcotic, heady and disorientating.

Hans, who has just passed his engineering exams in Hamburg, is travelling up from the ‘flatland’ into the mountains to visit his cousin Joachim Ziemssen, an aspiring soldier with established TB. He plans to go for a three-week holiday and ends up staying seven years: the Berghof wins him over in the way people sent out to the European colonies used to be accused of ‘going native’. In this rarefied atmosphere snow falls all year round and all days become ‘a continuous present, an identity, and everlastingness’. It is where the consumptives are confined, lying out in blankets on rattan deck-chairs to breathe the glacial air by day—the famous Liegekur—and retiring to their rooms to cough out their lungs at night. They live ‘horizontally’, as Joachim remarks to Hans.

This society in exile is a circle of the living dead or moribundi, yet to Hans its members seem frivolous and even disobligingly superficial: the foppish Herr Albin likes to upset his fellow diners by pressing a revolver to his temple and Hermine Kleefeld, a leading light of the Half-Lung Club—a select bunch of patients who have undergone a surgical pneumothorax procedure to collapse temporarily the affected lung—whistles at Hans ‘from somewhere inside’. When not being slothful and eating copious amounts of food—a typical gourmet meal would comprise a chaud-froid of chicken garnished with crayfish and stoned cherries followed by ice-cream and pastries in spun-sugar baskets—they indulge in an easy-going eroticism: the high-minded Hans at the outset of his stay is offended by the amorous sounds of the Russian couple in the next room ‘[whose] game had passed quite frankly over into the bestial’. In general, opting for the sick-role on the magic mountain seems to open the door on a life of constant good spirits and endless fun, not lucidity and depth about the human condition.

Perhaps being afflicted with TB, as all those nineteenth-century operas proclaim, was indeed an aphrodisiac.

How Hans becomes what he is

Improbable as it might seem to us, its present readers, The Magic Mountain started out as a short story, in fact as a pendant to Mann’s famous tale of disease and eroticism, Death in Venice. Mann had just finished work on that novella when he visited his wife Katia at Dr Jessen’s Waldsanatorium in Davos in May and June 1912, and told one of his correspondents that he was working on a new project, a ‘kind of countertext’ to the Aschenbach story. Both offer a journey out of humdrum life into a luxury setting, and explore an existentially threatening situation subsequent to falling in love. But while Aschenbach is degraded by deciding that illness should be a reason for his not escaping the stricken city, Castorp, as Susan Sontag notes in Illness as Metaphor, is ‘promoted’. ‘The atmosphere was to be that strange mixture of death and lightheadedness I had found at Davos’, wrote Mann, in his afterword to the novel. ‘There was to be an ordinary hero, in conflict between bourgeois decorum and macabre adventure […] Then the First World War broke out. It did two things: put an immediate stop to my work on the book, and incalculably enriched its content at the same time.’

Like the steam train that transports Hans Castorp from Hamburg to the mountain, Mann himself was travelling from the comfortable patrician world of his upbringing to a more uncertain future: ‘It takes place […] in the old days, the days of the world before the Great War, in the beginning of which so much began that has scarcely yet left off beginning.’ New possibilities are in the air (including having an upstart technician-engineer as the hero of a Bildungsroman, since it was still the case in imperial Germany that the professions open to the classically educated carried more prestige than engineering), but there is a certain reluctance about abandoning the old world altogether: bits of the old scenery loom out of the mist, deep chasms and bare peaks damp with mythic associations. And behind the old scenery we sense the self-consciously ‘representative’ writer who, on the outbreak of war, had been seduced by dreams of glorious service to the Fatherland, including what he called ‘armed service with the pen’. After it, ruefully aware of his romantic penchant for pessimism and apocalypse, Mann had tried to find a place in a world run by technically competent yet unexceptional men like his Engineer. As late as 1918 he had published his bulky collection of polemical essays Reflections of a Non-Political Man, a passionate defence of Germany’s participation in the war that goes so far as to identify his nation’s cause with Kant’s philosophy: as an arch-nationalist, he had argued against the liberal position of his own brother Heinrich, an enthusiastic Francophile. By 1922, Mann had completely changed his position, and gone public about his thinking on the matter—to the consternation of supporters and opponents alike. He had seen where it had led, all the talk of war as a rebirth of the spirit and an opportunity for Europe’s moral regeneration. He was now a supporter of democratic republicanism, even of accommodation with what Bertolt Brecht called the ‘bad new’ things. The Magic Mountain is, over much of its length, an oblique account of his conversion.

An aspect of the ‘good old’ things that Mann insists on taking with him is the classic humanism of German culture, of which Johann Wolfgang von Goethe is the emblem and figurehead. It is in Goethe’s early novella, The Sorrows of Young Werther, his story of an ardent soul and teenage suicide, that we find the origins of the descriptions of nature that break into Hans’ stolid consciousness: Stupendous mountains encompassed me, abysses yawned at my feet, and cataracts fell headlong down before me; impetuous rivers rolled through the plain, and rocks and mountains resounded from afar.’ Goethe’s protagonists—notably the titular lead of his second novel, Wilhelm Meister’s Apprenticeship—leave imprints all over Mann’s novel: Hans is still ingenuous, in the sense that his native wit and intuition have not been educated out of him: early in the novel the narrator calls him ‘this still unwritten page’. From being a rather feckless young man whose bedside reading material when he arrives at the Berghof is a technical book called Ocean Steamships, by the end of his stay he has acquired the kind of hermetic knowledge of ‘the innermost force that holds the world together’ that Goethe alludes to in the second book of Faust. In the spellbinding sphere of dreams and magic (‘Traum-und Zaubersphäre’), another phrase from the same play, anything can happen: image can become reality and reality mere image, and a young man of promise can lose his soul.

Up on the mountain new cases arrive and old ones leave, some of them from the mortuary: the other sanatorium in the region, the Schatzalp, somewhat indelicately carts the bodies of its dead patients down in sledges during the winter. A death is never announced to other guests on the mountains: that would be considered an indecency. There are incoming messages from the flatland; there are even occasional visitors, including, in an amusing interlude, Hans’ great-uncle (and guardian) James Tienappel, who pays a visit to the young man, after a year has lapsed, in order to persuade the lost sheep to return to Hamburg. Uncle James leaves in a hurry the next morning, apparently fearful of falling victim himself to the morbid charms of the Berghof. Uncle James ‘had become inwardly aware’, muses Hans later. ‘After only a week up here, he would find everything down below wrong and out of place […] It would seem to him unnatural to go to his office, instead of taking a prescribed walk after breakfast, and thereafter lying ritually wrapped, horizontal on a balcony.’ The magic mountain is no prison, but its atmosphere has a terribly warping effect on common sense.

In this grandiose natural setting, Mann compels Castorp to tackle the opposing forces that so preoccupied him in his own career as a novelist: reason and irrationality, health and sickness, dynamism and pessimism, conscious will and unconscious impulse, West and East. Few novels of this length have a simpler narrative schema. And, of course, everything happens in sevens: the magical number is one of Mann’s little jokes, and a major structural principle. It is evidence of Mann’s skill as a novelist that his huge symbolic superstructure is able to nurture a society of characters and offer a genuine portrait of the age. It is one in which a middling young man is compelled to become a genius, at least about himself; and he is obliged to discover it through being ill. He lives his life as an individual even while expressing the life of his epoch.

Hans Castorp is a psychological man, sick to the degree that he is unable to find any authority in his upbringing that might give a sense of direction to his life. Indeed, The Magic Mountain explores ways in which self-knowledge might be made social, a reversal of the old understanding that knowing one’s place comes about through obedience to family and community, to inherited tradition and the basic tenets of civility. Hans is, let us not forget, an orphan.

A negative epiphany

One morning Hofrat Behrens, the jovially cynical superintendent of the Berghof, tells Hans that he looks unwell—‘sine pecunia’, he adds twice, although he clearly has a vested interest in recruiting and retaining patients. Patients are free to leave the sanatorium, even against doctor’s orders; Behrens merely shrugs his shoulders at the news of disloyal departure, and lets his arms clap against his sides: he enjoys predicting the date of their likely return ‘to spend yet more earthly time at this pleasure resort’. Hans, as fascinated as he is alarmed, buys a state-of-the-art thermometer (which is ‘like a jewel’) and begins to record his temperature four times daily. In a rather innocent manner, Hans’ adoption of routine fever-measuring foreshadows our more technically elaborate obsession with self-monitoring: the classic injunction ‘know thyself’ is something we do with numbers these days, not words. Meanwhile, his cousin Joachim, the actual patient, chafes under his enforced leisure, and hankers to return to his flatland life in the army; Behrens—tongue not entirely in cheek—tells Hans that he’ll make ‘a better patient’.

On the point of embracing the possibility that he too might be ill, Hans meets the beguiling Russian, Clawdia Chauchat. With her blithe habit of slamming the dining room door, this ‘Kirghiz-eyed’ woman irritates him, and then starts to intrigue him. She is a free spirit who cares nothing for the kind of ordered reason that governs social conventions such as marriage, or even the proper running of the sanatorium. Her mysterious husband, who never turns up to reclaim her from the sanatorium, is an oil-engineer working at the centre of the then world oil industry in Daghestan, one of those ‘heavenly rose-gardens’ where Persia abuts on Russia in the eastern Caucasus. He is too busy siphoning the geological subconscious to appear in the novel: oil doesn’t just fuel the modern economy and provide strategic objectives in time of war, it is the ‘crude’ stuff that energises the magic mountain and the life of its characters.

It will take Hans months—seven in fact—before he can work up the courage to address Clawdia. And such a troubling influence cannot go unchallenged. Hans meets the man who will play down her attractions: Ludovici Settembrini. Though Hans thinks he looks clownish on their first meeting, Settembrini proves to have a sobering influence on him. He requests to be his tutor, the humanistic pedagogue who will admonish Hans regularly for his waywardness and urge him to return to his professional life. Settembrini, the great defender of Western liberalism, has no truck with the supposition that illness might make a person more interesting. ‘Disease and despair are often only forms of depravity.’ Perfectly well people, he warns Hans, have even been known to insist on staying on the mountain.

But Clawdia and the East prevail, and they overcome Hans at the moment that we see through him with the help of Behren’s X-ray machine—which Mann writes as a parody of the famous moment in 1896 when Wilhelm Röntgen first took an image of his wife’s hand with his newly discovered invisible electromagnetic rays. The doctor concludes that Hans has a ‘moist spot’ on his lung and scars from a childhood infection, the same pronouncement that Mann heard from his wife’s physician, Dr Jessen, on his brief visit to the sanatorium in Davos. Suddenly, it seems as if the mountain atmosphere is just as likely to bring out an incipient case of TB as it is to resolve an established one. Hans has a chance to show just how good a patient he can be. In the room housing the radiology apparatus he catches a glimpse of ‘what he never thought it would be vouchsafed him to see: he looked into his own grave’. The none-too-solid flesh can be penetrated—‘the flesh in which he walked disintegrated, annihilated, dissolved in vacant mist’—and its parts viewed as negative images quite separately from the living breathing body, and held up to the light for scrutiny. Hans has become exquisitely image-conscious, like the other patients of the Berghof who pass the time observing their ‘interior portraits’. They are not disturbed by what might seem the ultimate dehumanising experience: the ghostly aseptic images of their lung-fields—cavities full of shadows—have become a kind of consolation prize for their inability to grasp the reality of their bodily affliction.

Momentous epistemological changes are just around the corner. As Bettyann Holtzmann writes in her history of medical imaging Naked to the Bone, the X-ray undermined not only Victorian ideas of propriety and private parts, it affected ‘the self-perception of an entire culture’. On the front in 1914, radiologists worked in tandem with surgeons, using relatively primitive devices to localise bullets and shrapnel in soft tissue; and X-ray fluoroscopes entered civilian life not long afterwards, as a gimmick for fitting shoes. Since then, of course, imaging techniques have become ever more sophisticated, revealing first soft tissues, then, with the advent of ultrasound, nuclear magnetic resonance and positron emission tomography, the detailed internal structure and even metabolic activity of living tissues.

Yet which illness more visibly exposes the delusion of mistaking an image of a disease process for the true reality of the logos incarnate in the human form than tuberculosis—the cavitating disease? Hofrat Behrens might find the whole business of this new technology ‘spooky’ but he doesn’t react to the X-ray films in the same way as his patients. For him, the image is a sign that can be used to uphold his physical findings or confirm advancement of the disease: it is a demonstration. It is metaphor-free; it lacks any imaginative ‘after-image’. In the very best of cases, it ought to serve as the prelude to rational action. What his patients see in their X-rays is of a different order: for them the image-symbol is an evocation. It gives the old name for the disease an ironic twist: ‘consumption’ was thought to spiritualise the person even as it consumed the body, so that the inner glow of the soul could shine forth. It is an odd business, this idolising of X-rays…

Now that Hans can safely call the sanatorium his home, he is free to pursue his love interest. Madame Chauchat (her name is a double pun on the French word for whispering and her sexually alluring felinity) proves to be a seductive and elusive personality. To his vexation, she refuses to take his illness seriously. Settembrini, of course, detests her, seeing her as a telluric force that will disrupt the brotherhood of enlightened men. Yet the ‘wicked, riotously sweet hour’ Hans enjoys with her on Carnival night—seven years of hanging around a sanatorium for one hour of bliss—probes his pedestrian soul. He declares his love for her in the most stilted French (which the first English translator of Mann’s novels sensibly left in the original): ‘Let me take in the scent of your pores and brush the down—O human image made of water and protein, destined for the shape of the tomb: let me perish, my lips against yours!’ Hans verbally lays bare his soul, in the kind of purple prose only an engineer would drum up; and then he takes possession of her soul physically, in the form of his most ‘intimate’ possession, the X-ray plate of her lung. Clawdia leaves the sanatorium almost immediately after their night of passion, and Hans embarks on a long course of reading and studying.

The cure for heartbreak is a curriculum.

The battle for a soul

In Clawdia’s absence, Hans takes up the part of the medieval Everyman in a modern morality play. Settembrini and his new foil, Leo Naphta, a Polish Jew converted to Catholicism who has taken up lodgings in the village below the Berghof, become God and the Devil fighting it out for the young man’s soul—or mouthpieces for the antithetic arguments that convulsed twentieth-century history.

Many of their sermonettes do indeed offer ‘the great disputation on sickness and health’ that Mann hoped for his novel. According to Settembrini, the high-toned Italian liberal and Free-mason, the purpose of modern medicine is, through hygiene and social reform, to allow reason and enlightenment to triumph over all the contingencies of disease. To combat the sufferings of the flesh has a moral dimension to it, insofar as health will ultimately be identified with virtue. He reports, for instance, on the work of the League for the Organisation of Progress, the goal of which is nothing less than utopia: the total elimination of human suffering through total knowledge. ‘Famous European specialists, physicians, psychologists, and economists will share in the composition of this encyclopaedia of suffering, and the general editorial bureau at Lugano will act as the reservoir to collect all the articles which shall flow into it.’

This is outright niaiserie to Naphta. Nothing could be more detestable than a normalised ethics for living. True spirituality and freedom are bound not to an anodyne veneration of the healthy body, but to a stoic acceptation of bodily infirmity and suffering. Being human is to be ill. ‘Man was essentially ailing, his state of unhealthiness was what made him man. There were those who wanted to make him “healthy”, to make him “go back to nature”, when, the truth was, he never had been “natural”.’ Naphta, who sounds at times uncannily like a member of the Frankfurt School or even Michel Foucault, argues that the normal has always lived on ‘the achievements of the abnormal’. What counts is ‘iron allegiance, discipline, denial of the individual’ at the service of ‘the revolution of antihumane backlash’.

Naphta seems to have all the persuasive arguments, yet nothing he says ever suggests a man who means well, certainly not by young Hans Castorp, for whom his reasoning is often way above his head. Settembrini, on the other hand, is quick to notice that Naptha’s thinking proceeds essentially through ‘malice’.

When Clawdia returns to the sanatorium, it is in the company of her lover, Mynheer Pieter Peeperkorn, a retired colonial coffee-planter from the Netherlands. He is a gift of sorts from Clawdia Chauchat to her ‘little German Hänschen’, although he is hardly likely to think so at first. Peeperkorn is the fatherly but vital man whose role it is to teach Hans how to be a master of antinomies. Although Thomas Mann admitted he had modelled Peeperkorn on the German writer Gerhart Hauptmann, he seems in his embodiment of the sexual, the instinctual unconscious and the naturally religious to have stepped out of one of D. H. Lawrence’s more exotic novels: the eldest character in the book is a voluptuary of stupendous personality—‘though blurred’. This inarticulacy is no disadvantage. Hans is forced to admit that his soul-teachers are dwarfs beside Peeperkorn. His presence at their debates, which he mocks with a series of tics and gestures, makes their verbal skills seem trivial and unimportant. Peeperkorn’s mission at the sanatorium appears to be to make Hans aware of the ‘sacraments of pleasure’. He has a duty to feel. For brief moments, Nietzsche had written in his early work The Birth of Tragedy, we become ‘primordial Being itself, and feel its indomitable desire for being, and joy in existence’. Even Clawdia is outshone by the bombastic enthusiasms of this primitivist, whose shock-confession to Hans is his impotence—‘a cosmic catastrophe, an irreconcilable horror’. The vessel that spouts the gospel of health is cracked. To be impotent and a sexual mystic can hardly be a happy condition. And sure enough, a short time later, Peeperkorn takes his life on a picnic by a waterfall using a baroque little gadget containing poison. Soon Clawdia leaves the sanatorium for good and Hans is cast again into dudgeon.

This irruption of vitalist philosophy into the becalmed atmosphere of the Berghof is still not enough to make Hans quit the mountain. His explorations of the occult, in which he is encouraged by Behrens’ assistant, the ambiguous psychoanalyst Krokowski—who is described as an ‘idealist of the pathological’—bring him to another dark room and an apparition of his dead cousin Joachim dressed in a field uniform and wearing what appears to be a ‘steel pot’ on his head. It is a disconcerting vision which reverses the ‘enlightenment’ of the earlier X-ray room experience. ‘Hans Castorp liked the darkness, it mitigated the queerness of the situation. And in its justification he recalled the darkness of the X-ray room, and how they had collected themselves, and “washed their eyes” in it, before they “saw”.’ Called up by a medium, Hans mumbles his apologies to the wraith of Joachim—who so resembled him that they had been called the ‘Gemini twins’—and, in a Settembrini-like gesture, throws on the light.

Their frivolous desecration of the dead is over; and we sense that the magic of the mountain might just be starting to wear off.

An abrupt end is also in sight for the debating circle. After a general deterioration in the atmosphere at the Berghof (mirroring the conflicts in Europe that led up to the war), Settembrini and Naphta’s intellectual cut-and-thrust loses its gentlemanly tone, and sinks into nasty bickering, with the former accusing the latter of infamy—of ‘misleading unsettled youth’. A duel is arranged; but Settembrini casually fires his revolver into the air, refusing to shed blood, and offers his body to his rival. Naptha, enraged by Settembrini’s refusal to use his weapon, shouts ‘Coward!’ and shoots himself through the head. Death and the daemonic turn out to have been in cahoots. It is the novel’s climax—an episode entirely in the manner of that famously drastic classic German author Heinrich von Kleist—though it is hardly its resolution. The gunshot on the mountain signals the more famous one soon to ring out more than four hundred miles away in the flatlands: the Archduke Ferdinand’s assassination prevents Hans from eking out his life indefinitely at the sanatorium. The first rumblings of the Great War finally enter the novel, like chairs being toppled in a drawing room. In the final, film-like epilogue to the novel, we see Hans advancing over the mists of a battlefield, bayonet in his hand, humming to himself the Schubert song ‘Der Lindenbaum’ (The Linden Tree) that once besotted him in the Berghof. He had first heard it on the gramophone, another kind of machine brought in to lighten the lives of the Berghof guests.

Looking down from heaven

Mann’s conclusion is the most unsettling part of the novel, and not just because it falls in the shadow of the mountain of text that precedes it. His epilogue is a stilted delirium.

The first soldiers to go over the top in 1914 were the first victims of technological warfare, a horrifying inferno to be run under the guidance of the coolly functional engineer types Hans had actually trained to become. (Given his training in naval architecture, perhaps Mann ought to have placed his novice engineer in an office designing one of the advanced battleships the Germans were busily rolling down the slipways in an attempt to outdo the Royal Navy’s dreadnoughts.) And there is another realisation. For over seven hundred pages we have been preoccupied with Hans Castorp’s Bildung, his education—and what is its likely outcome? He is about to fall in the mud of a war that will not only nullify his existence but render the entire world of values that created him as archaic and irrecuperable as that of his Uncle James. The Great War certainly made it easier to die as an idealist than live like one: it was the turning point in the modern surge of cynicism about authority and superiors and people in command generally. Any writer who presumed to address warfare after 1918 would have to walk over dead bodies. Mann’s touchingly rhetorical farewell to ‘life’s delicate child’ is barely camouflage enough to prevent us from seeing that treading on corpses is precisely what they, hero and author, are both are doing in that final scene. It will also be noted that the young soldiers—those ‘feverish lads’—have the same flushed face as Hans in his heightened state on the magic mountain.

In the commentary he wrote in English in 1953 for the American edition of The Magic Mountain, Mann observed: ‘Such institutions as the Berghof were a typical pre-war phenomenon. They were only possible in a capitalistic economy that was still functioning well and normally. Only under such a system was it possible for patients to remain there year after year at the family’s expense. The Magic Mountain became the swan song of that form of existence. Perhaps it is a general rule that epics descriptive of some particular phase of life tend to appear as it nears its end. The treatment of tuberculosis has entered upon a different phase today; and most of the Swiss sanatoria have become sports hotels.’

While it is true that the discovery of streptomycin by Albert Schatz in 1943, the first effective pharmaceutical cure for TB, led to the closure on a massive scale of spas and sanatoriums, the phenomenon of leaving the ‘flatland’ for what might be called recreational medical treatments actually grew considerably. In some European countries these treatments are still funded by the national health systems. As the post-war French and German governments were the first to grasp, medical tourism could be seamlessly integrated into the macroeconomics of their respective national economies. These are the naturalistic ‘experiments in regeneration’ that Naphta ridicules in the novel. The word Mann used to describe the heightening of Hans Castorp’s personality—‘Steigerung’—now has its primary meaning in the economic field, where it denotes increased productivity. It was, in fact, one of Goethe’s key terms: intensification is what he saw as the propensity of organic phenomena to manifest themselves in ever more complex forms, to push skywards in ‘a state of ever-striving ascent’. Mann had perhaps not fully anticipated how grand bourgeois families would be replaced by mass consumers with a sense of entitlement and enormous appetites, after the libidinal revolution of the 1960s, for restorative leisure. This was a key element of Herbert Marcuse’s once famous notion of ‘repressive tolerance’, by means of which citizens are kept too busy with the delights of consumerism and demands of fashion to pay any attention to reforming society (itself a distraction from what Blaise Pascal claimed was the need to attend to the care of our immortal souls).

Under modern conditions, that delicious temporary sensation of being simultaneously above the fray, embedded in the elements (most pleasurably in the amniotic surround of a spa) or caught in a bubble of luxurious rarefaction, can be had collectively. It is not just German philosophers who get the chance to look down from heaven on the flatland far below. Now, as employees who have paid their medical insurance premiums, clients can ask their doctor to send them on a ‘cure’—to a place where they can partake in an atmosphere of the most gently enforced discipline, segregation and submission to orders from above, accompanied the while by a piped Haydn or Mozart quartet.

Visiting a spa or sanatorium is the equivalent in medicine of adopting the pastoral mode in the arts.

Committed now to nothing more than our well-being, our principal guides in the art of living are doctors, not philosophers. It is Settembrini’s ethics that prevail, even though the radical critique of medicine’s largely humane accomplishments is pure Naphta. The contemporary German philosopher Peter Sloterdijk—who once wrote an epic novel about the beginnings of psychoanalysis called Der Zauberbaum (The Magic Tree)—lists in the third volume of his massive phenomenological account of modernity Spheres, a book with something of the grand synoptic reach of Mann’s novel, the zones in our culture where we can find something of the magic mountain atmosphere: ‘Even where illness does not define the very modus vivendi, it remains in the background as a constant possibility: fitness scenes, wellness and diet regimes, the smoothly organised and inward-looking worlds of the spa towns, the balneological retreats and the high-altitude castles for coughers would be inconceivable without it.’ These are the various stations of the therapeutic good life. As an older Naphta avatar, Carl Jung, once wrote: ‘the gods have become diseases’.