Cures for Modernity

The Interwar Medical Theme: A Case Study

This book examines manifestations of the interwar medical theme through a case study of its appearance in Russian and Czech culture, or, more specifically, in literature and cinema produced in Russian in the Soviet Union and in Czech in Czechoslovakia. These two linguistic and cultural contexts were rich in medical storytelling and were well endowed with doctor-writers (doctors who are also writers),¹¹ had a shared intellectual and cultural history, and, on a geopolitical level, were both engaged in an elaborate process of reinvention that held the medical profession at its heart (these points will be discussed in more detail later in this introduction). As such, the Russian and Czech contexts represent heightened examples of the interwar period’s broader impulse for regeneration, whilst also providing a fruitful comparative study in their own right. Throughout the book, cinematic examples complement literary, reflecting and engaging with the changing ways in which messages were spread and people consumed stories in the first decades of the twentieth century. The book serves three interrelated purposes: first, its analysis and conclusions are intended to provide a frame of reference for scholars interested in examining the medical theme in these and other interwar contexts and media. Secondly, it is a contribution to the study of modernity and its discontents. Last, but by no means least, it is a comparative exploration of interwar Russian and Czech literature and cinema that will be of interest to students and researchers of these cultures, with or without a specific interest in the medical humanities.

Throughout my analysis, I unpack the different conceptions of health and unhealth that lie beneath the surface of each narrative. In each case, what constitutes a healthy modernity? Is it considered achievable? And, if so, what role are medical science and practice expected to play in its realization? While the medical theme in interwar culture was widespread and emerged from a shared cocktail of contributing circumstances and discourses, its manifestations were far from homogenous, even within individual linguistic, political or national contexts. Just as there is no single, precise conception of modernity, the idea of a modernity in a state of rude health is multifaceted, nebulous and open to manifold interpretations. After all, by its very nature it implies a rejection of an equally nebulous opposite: an unhealthy modernity. Further, my analysis asks what literary and cinematic portrayals of medicine can teach us about contemporaneous social attitudes to medicine, and about how these attitudes interacted with the wider philosophical, artistic and cultural discourses of the period. Throughout, as will be seen, a definite ambiguity emerges. Regardless of whether the works broadly display optimism or pessimism about the medical profession’s ability to bring about a state of health, they tend also to reveal a profound anxiety about the power it can wield over the individual body. Medicine is characterized throughout as both saviour and aggressor, often in the space of the same narrative. In addition, a picture emerges of a complicated interwoven relationship between medicine, art and politics, whereby all three can be understood to be engaged in the same transformative project of society and can therefore function both as metaphors for, and examples of, each other. The anxieties expressed about one tend to map onto the others, thereby revealing a deep-rooted sense of trauma about the very experience of modernity and the Modernist project.

Four thematic chapters follow this introduction, each of which analyses a sample of Russian and Czech literary and cinematic works on a specific aspect of interwar medicine and medical practice: from syphilis to nervous illness, and surgery to childbirth. In each case, my focus is the medical intervention involved, rather than the condition or physical state itself.¹² The chosen themes encompass the medical treatment of both mind and body and have all historically been used as ways of framing narratives of twentieth-century modernity. Taken together, they enable an examination of the cultural resonances of a broad overview of interwar medical science and practice, including bacteriology, epidemiology, neurology, psychotherapy and obstetrics, anaesthesia and the operative environment, and research into the scientific management of human reproduction.

Chapter 1’s focus is the treatment of syphilis, a disease that came into the interwar period with an existing cultural symbolism and a long history as a literary theme. Most recently, it had been a recurring feature of fin-de-siècle writing, in which it was often used as a way of expressing the idea that civilization was in a state of moral decline. Syphilis was a major public health concern in the interwar period and had also recently become widely diagnosable and treatable (the latter thanks to the development of a ‘magic bullet’ drug known as Salvarsan). It therefore makes a particularly interesting case study for the influence of bacteriology on the period’s literature and cinema.¹³ In this chapter, I argue that as syphilis passed into the interwar cultural climate, the influence of its extramedical connotations frequently came into conflict with the new medical, epidemiological and bacteriological understandings of the disease. The works analysed reveal that while syphilis retained its potency as a symbol of societal decay in the interwar period, its symbolism was reconfigured: in the new era of its treatability, writers and filmmakers could use the disease to identify barriers to regeneration, no longer just sources of degeneration itself. I also suggest that writers and directors engaged with the new syphilological developments because the promise of a ‘magic bullet’ drug appeared to speak to the post-war period’s deepest desire: that a panacea might be found for modernity’s ills.

Chapter 2 examines narratives that engage with the treatment of nervous illness, another significant interwar public health concern. At the time, nervous conditions were widely perceived to have the capacity to emasculate sufferers, render people ineffective members of society and to be inherited. They were also culturally synonymous with modern urban civilization since the stress of modern life was widely considered to contribute to nervous strain. Further, like modernity itself, nervous illness was a highly fluid concept, open to myriad different interpretations. In this chapter, I argue that, for all these reasons, imagery of nervous illness and its treatment provided a particularly suitable means for interwar writers and directors to examine, diagnose and treat the state of the modern world. The nebulous nature of the concepts of modernity and nervous illness meant that writers and directors could tailor their choice of nervous illness imagery to suit their particular vision for a healthy modernity. Relatedly, and each in their own way, the interwar writers and filmmakers examined here use nervous illness to represent a generalized and widespread crisis of human mutual relations and connections with the surrounding environment.

Chapter 3’s attention is on narratives of surgery, some of which are medically realistic for the era and some are, at least partially, fantastical. All of the chosen works explore ways of healing the ‘broken’ or ‘inadequate’ body, thereby engaging both with the interwar period’s immediate concerns of rehabilitating the war wounded and with wider ideas about forging a ‘new man’ for a new era. Particular attention is paid to narratives of transplant or skin graft surgery, of which the period produced many. Some of the scenarios described in the chosen works were at the forefront of contemporary scientific capabilities while others remained beyond the realms of possibility, but all reflect the transformative potential that modern medicine was understood to possess. Throughout, profound questions about ethics emerge from the narratives, many of which, I argue, extend beyond the surgical scenario to parallel broader questions about societal relations in a world that was changing quickly and dramatically. Many of the narratives suggest an anxiety about political fragmentation, for instance, that is manifested in depictions of bodily fragmentation. My analysis also shows that many interwar writers and directors used surgical scenarios as a means of dissecting a widespread sense of fear about the potential loss of self-identity in an increasingly deindividualized world.

The narratives in Chapter 4 differ from those in Chapters 1–3, in that they deal with a natural function of the healthy female body: childbirth. All of the works analysed within this chapter portray births in which medical intervention takes place at the point of either fertilization or parturition. As such, they all engage with opportunities provided by the medical revolution for human reproduction to become a process managed by forces beyond the individual female body. Childbirth became increasingly medicalized – and, in some cases, pathologized – over the medical revolution’s course. Each in their different ways, these works explore the contribution of science, medicine and technology to the birth of a new society. In the interwar period, childbirth became closely linked to questions of national regeneration, both literally (in that it provided new bodies for the state) and metaphorically (in the sense of giving birth to a new era). I argue that the writers and filmmakers use extended metaphors of medicalized childbirth as a means of discussing the pain, violence and trauma of society’s transition from the late fin de siècle to the interwar period. In the process, they explore whether the professions, beliefs and philosophies that feature in their works are ready to occupy positions of authority in society.

Collectively, the diverse literary and cinematic narratives that I have selected for analysis in these four chapters illustrate just how deeply the medical theme pervaded interwar cultural production. They also demonstrate that drawing inspiration from medicine was not the preserve of the adherents of any particular genre, artistic grouping or style. The selection includes, for instance, Realist and Naturalist works as well as avant-garde, and health education films as well as popular melodramas. Further, it is clear from the selection that using a medical scenario was not, in itself, sufficiently cutting edge to ensure the writer or filmmaker a place in cultural history: some of those whose work is included can be considered canonical figures, at least in their own cultures, while others are much more obscure. Finally, the selection shows evidence of the diverse sources of medical information from which the writers and artists drew inspiration. Many had recourse to their own professional medical knowledge and experience: Mikhail Bulgakov (1891–1940), František Langer (1888–1965), Vladimír Raffel (1898–1967), Vladislav Vančura (1891–1942) and Vikentii Veresaev (1867–1945), and the filmmakers Elizaveta Demidovich (1868−unknown) and Noi Galkin (1897–1950) were all qualified doctors alongside their creative practice. Other works are by non-practitioners, the widespread appearance of the medical theme in whose work demonstrates the era’s breadth of popular, rather than simply professional, interest in medicine: the writers Nikolai Aseev (1889–1963), Karel Matěj Čapek-Chod (1860–1927), Sigizmund Krzhizhanovskii (1887–1950), Boris Pil’niak (1894–1938), Andrei Platonov (1899–1951), Anna Maria Tilschová (1873–1957), Evgenii Zamiatin (1884–1937) and Vladimir Zazubrin (1895–1937), and the filmmakers Oleg Frelikh (1887–1953), Gustav Machatý (1901–63) and Leo Marten (1897–1961).

It is also important to emphasize that, as the chapter outlines above show, many of the narratives examined in this book explore conditions or scenarios that were focuses of interwar public health programmes. As such, they are about the health of both individual and collective bodies. By the interwar period, public health had undergone a process of professionalization that incorporated both medical and social scientific knowledge.¹⁴ During the interwar years themselves, preventative and curative methods became increasingly integrated and increasing attention was paid to the relationship of social factors to public health.¹⁵ The period also saw unprecedented international collaboration on matters of public health, such as in the work of the League of Nations Health Organization, which was provisionally founded in 1921.¹⁶ However, it was also an era in which the experience of the First World War had posed a serious challenge to the question of society’s right over individuals’ bodies. A related tension between optimism for the health of society as a whole and mistrust about its effect on individual freedom is felt in many of the narratives discussed.

In her thought-provoking Medicine as Culture, Lupton writes of public health that its ‘dialectic […] is that of the freedom of individuals to behave as they wish pitted against the rights of society to control individuals’ bodies in the name of health’.¹⁷ Versions of this dialectic pervade many of the narratives analysed, both in terms specifically of health, and on a wider political and philosophical level. Public health’s central relationship between the individual and the collective comes through in the themes and language of interwar culture, which reflects the fact that the medical revolution heralded the arrival of a new mode of language and observation as well as new forms of medical treatment. As Lawlor has observed, the ideas of contagion and infection that emerged from the language of bacteriology could legitimate the stigmatization of whole social groups, such as foreigners or the lower classes.¹⁸ In Zamiatin’s dystopian depiction of a highly technologized and collectivized society, My [We] (1920), for example, the protagonist uses a bacteriological metaphor to explain his relationship as a diseased individual to the wider collective body: ‘It may be, after all, that I am not a phagocyte, calmly going about its business of destroying microbes […]. It may be that I am a microbe.’¹⁹ When, as happens in the majority of the narratives examined in this book, this type of language is applied to persons suffering from a literal disease of public health concern, the boundary between the metaphorical and the literal is frustrated. The individual and collective bodies cannot function unproblematically as metaphors for one another, and the modes of blame and stigmatization that Lawlor identifies become peculiarly persistent, even where they may be unintended. Put more simply, late nineteenth- and early twentieth-century discourses of public health made it increasingly possible for discussions about the health of individuals to be mapped, to a greater or lesser extent, onto the period’s discussions about the wider health of society.

Regeneration: A Discussion

Regeneration is a word that has already made several appearances in this introduction. It will be a key term throughout this book and therefore demands some discussion. In this context, such a discussion needs to proceed from the other side of the same coin: degeneration, a term widely used and theorized from the second half of the nineteenth century and into the interwar period. Theories of degeneration were the counterdiscourse to the Enlightenment narrative of progress, which was increasingly questioned over the course of the nineteenth century.²⁰ They drew on Darwinian evolutionary theory but argued that humanity could devolve as well as evolve.²¹ The meaning of the word itself – degeneration – constantly shifted. It was a scientific theory but also a psychiatric diagnosis, a cultural condition and the basis of literary Decadence. Importantly, the potential for societal degeneration was not posited as a philosophical discussion point but ‘as an empirically demonstrable medical, biological or physical anthropological fact’.²² Even in many interwar narratives, the perception that degeneration was prosaic fact lies, often barely, beneath the surface.

As a psychiatric condition of the individual, mental degeneration encompassed a wide range of conditions, including nervous illness, alcoholism and other addictions.²³ It was considered to be inheritable and to increase in severity as it passed down through the generations. Thus, a mild condition such as neurasthenia in one generation was understood to have the potential to manifest itself three generations later in something much more serious, such as in prostitution, criminality or, finally, ‘insanity and utter idiocy’.²⁴ One of the foremost theorists of mental degeneration, Bénédict Augustin Morel (1809–73), saw it as an inheritable ‘pathological deviation’ from the human ideal.²⁵ He conceived of the human mind and body holistically, believing that the degeneration of one led inevitably to the collapse of the other.²⁶ Over time, the focus of the concept shifted from the individual to the collective.²⁷ The collective understanding was sociological rather than strictly medical and stemmed from anxieties about race, population and class, which intersected with concerns about changing conceptions of gender roles and sexual mores at a time when the issue of women’s rights was rapidly gaining pace and women were increasingly moving beyond the domestic sphere to claim a stake in public life. Falling birth rates, political unrest and urbanization, along with the ‘social pathologies’ of ‘crime, suicide, alcoholism and prostitution’ were widely considered a danger to the perceived superiority of the European races.²⁸ This thread of the discourse would be reworked in the early interwar period by, among others, Oswald Spengler (1880–1936) in Der Untergang des Abendlandes [The Decline of the West] (1918–23) and Paul Valéry (1871–1945) in ‘La Crise de l’esprit’ [‘The Crisis of the Mind’] (1924), both of which works had widespread influence on interwar philosophy, art and literature.

The discourse of degeneration also had a cultural strand, according to which many features of fin-de-siècle art and literature were taken as evidence of degenerative mental disorders on the part of the artists and writers who had created them. This was expressed with particular prominence in Nordau’s Entartung [Degeneration] (1892), the medicalized preoccupations of which resonate throughout the literature and culture of the late nineteenth and early twentieth centuries. Smith observes that Nordau was able to ‘pathologise the new art forms of the fin de siècle because a medical notion of disease ha[d]‌ become culturally transportable’.²⁹ Like Morel and Cesare Lombroso (1835–1909), another leading degeneration theorist and the dedicatee of Degeneration, Nordau had trained as a doctor and used his title to lend his works medical authenticity. Degeneration’s success has, in part, been attributed to its ‘novel application of science to art’ while the work has been described as ‘largely responsible for the medicalization of literature at the fin de siècle and beyond’.³⁰ Indeed, one scholar sees Nordau as exhibiting ‘a certain intuition about his time by situating the study at the intersection of contemporary medicine and literature’.³¹ When the combined medical, sociological and cultural strands of the discourse of degeneration passed into the late nineteenth- and early twentieth-century collective imagination, they created a culture imbued with a sense of impending doom: humanity was devolving morally, spiritually and physically; the West would soon be overtaken by the East; and the lower-class masses would rise up.

The interwar narratives analysed in this volume frequently engage with the imagery of degeneration, but they combine it with imagery of medical treatment. As such, they demonstrate continuity with the preoccupations of the fin de siècle but also reconfigure them. Their focus is less degeneration per se than its antidote and continuation: a culture of regeneration.³² As Lawrence and Mayer show, this term – better than any of its close synonyms – suggests the post-war period’s dual embrace of modernity and the spirituality of a lost age;³³ a simultaneous pull towards tradition and innovation. Unlike its predecessor, regeneration was not a theory with its own contemporary keystone texts. Rather it was an impetus that manifested itself variously across disciplines. The word carries a number of glosses, including rebirth, renewal, restoration, regrowth and re-creation. It has historically been used in the sense of spiritual rebirth, such as through baptism or a coming to faith, and also in the spheres of technology and science. Often, the lines between the spiritual and scientific or literal usages become blurred, such as in this example given by the Oxford English Dictionary: ‘The brambles figure centrally in the dramatic process of regeneration that Nature uses to reclothe her land after it is scarred.’³⁴ Here the natural regrowth of plants and vegetation is invested with a sense of spiritual healing; a return to order from chaos. Forms of regeneration that are associated with nature and spontaneity often take on a spiritual quality because they are out of human hands. Indeed, natural cycles, such as the seasonal regrowth of plants, exemplify the intransitive usage of the verb ‘to regenerate’: assuming conditions are favourable, regeneration occurs spontaneously. Also in this category is the biological phenomenon of animal regeneration, which was topical in late nineteenth- and early twentieth-century biological research.³⁵ In this usage, regeneration denotes ‘the formation of new tissue or cells; the natural replacement or repair of a lost or damaged part, organ, etc.; the formation of a new individual from part of an organism, often as a form of asexual reproduction’ (OED).

More relevant for the term’s application to the interwar period and to medicine specifically is the transitive usage of ‘to regenerate’, which emphasizes the potential for active human involvement. This implies a process of managed rather than spontaneous regeneration, such as in the concept of urban regeneration, whereby architects or urban planners set out consciously to alter an area’s appearance, infrastructure, reputation and sometimes even demographics. Medicine is exemplary of this: through surgery or medication, for instance, doctors bring about the managed regeneration of the human body. Even childbirth, which aligns more closely with the concept of spontaneous regeneration, becomes, at least partially, a managed process once it is a site of medical or pharmaceutical intervention. Another example is organ transplant surgery, which can be understood to make a natural function of some non-human animals available to humans. In Jaroslav Hašek’s (1883–1923) Osudy dobrého vojáka Švejka za světové války [The Good Soldier Švejk and His Fortunes in the World War] (1921–3), a conversation between the battalion’s occultist cook Jurajda and the telephone operator Chodounský demonstrates this. In response to comments by Jurajda, Hašek’s description of which is used as the epigraph for this book, Chodounský sums up the fascination of spontaneous biological regeneration for science, especially in the context of war: ‘[P]‌eople would have the time of their lives if they could do what the lizards could with their tails. Take war, for instance, when anyone’s head or other parts were torn off. How frightfully glad the military administration would be, because then there would be no disabled soldiers.’³⁶

Consideration of regeneration’s ‘re-’ prefix adds further nuance to the discussion since it can denote either a cyclical return to a past state or a completely new beginning in linear time. Both possibilities, as Ozouf observes, were part of the discourse of the French Revolution, with a desire for the ‘happy restoration of the alleged ancient constitution of France’ on the one hand, and an attempt literally to begin again in time manifested in the creation of the revolutionary calendar on the other.³⁷ One can also look here to Berki’s schema of ‘nostalgic’ (backward-looking) vs ‘imaginative’ (forward-looking) political idealism, which Megill has usefully applied to the immediate post-war period’s apparently opposing attractions of past and future.³⁸ Berki considers idealist politics – in both its conservative ‘nostalgic’ and radical ‘imaginative’ forms – abstract and unrealistic, and advocates instead for a carefully defined form of ‘political realism’.³⁹ His charge of abstraction and unrealism is echoed in Ozouf’s characterization of the desired total regeneration of the French Revolution as a product of ‘boundless philosophical ambition’ that set up ‘an endless debate about the boundary between the possible and the impossible’.⁴⁰ Questions of realism, idealism, the impossible and the possible hold significant relevance for the present discussion because neither a nostalgic cyclical return nor an imaginative new beginning is a realistic outcome in a medical scenario. Although phrases like ‘getting one’s old life back’ or ‘being given a new life’ are often used figuratively, medicine can neither return patients to a past state of health nor enable them to start completely anew. Instead, successful medical intervention bridges a gap and enables the continuation of a linear life. It has to connect past, present and future.