Spinoza and Tuberculosis: His Disease and Devotion

[Tuberculosis can be a difficult disease to diagnosis. The following is working under the assumption that the diagnosis of “phthisis” for Spinoza’s long-running pulmonary problems is best understood as the disease tuberculosis.]

The Influence of Disease

It is interesting that of all the influential facts we seem to have about Spinoza’s life, his tuberculosis may be neglected only as much as his lens-grinding has been. Very little of how debilitating this disease can be, nor its chronic nature seems to be considered when framing a picture of Spinoza’s motivations for life decisions. At most his tuberculosis, called in biographies “phthisis” (its name derived from Greek) gives us a remote picture of a man made weak and coughing at times. Then there is the oft repeated, unsupported, yet romantically satisfying thought that he died not only of his TB, but also from inhalations of glass dust from his lens-grinding. The facts of the disease seldom seem to enter into the explanations for Spinoza’s decisions and life turns.

Spinoza’s early biographer Colerus tells us that Spinoza had been suffering from tuberculosis for more than 20 years when Spinoza died at the age of 44, in February of 1677:

Spinosa was a Man of a very weak Constitution, unhealthy and lean, and had been troubled with a Pthysick above twenty years, which oblig’d him to keep a strict course of Dyet, and to be extreamly sober in his Meat and Drink. Nevertheless, his Landlord, and the people of the House did not believe that he was so near his end, even a little while before he died, and they had not the least thought of it.

If we track backwards, this would place the first bout with tuberculosis very close to the date of his father’s death (March 28, 1654), and his taking over of the family firm (September 1654). Spinoza’s step mother, Esther, died only five months before his father did (October 14, 1653), after a year of serious illness, itself a year after Spinoza’s own sister Miriam had died. Tuberculosis is a highly contagious disease when symptomatic, (if living 24-hours-a-day exposed for two months it is estimated that you have a 50% chance of being infected).

To more fully picture the condition, the symptoms of active tuberculosis include:

– A cough which may last three or more weeks and may produce discolored or bloody sputum
– Unintended weight loss
– Fatigue
– Slight fever
– Night sweats
– Chills
– Loss of appetite
– Pain with breathing or coughing (pleurisy)

That Spinoza may have contracted tuberculosis from his father (or other family members), and may himself have become symptomatic in the year 1656 or so is not something that many people have considered. (To his credit, Nadler does momentarily bring up the idea that Spinoza may have suffered from the same thing that killed his step-mother (Spinoza: A Life, 155); why he notes the step-mother and not his father I do not know. These are years that we have very little historical record of, and a struggle with the illness may very well be a reason for this (the highest risk for developing of the disease is in the first two years after infection). When Spinoza applied for orphan status in March of ’56 (two years after his father died), and when the cherem is read against him in July of the same year, removing him from the community, having failed to pay the family firm’s imposta tax, he may indeed already have been tubercular, and perhaps even seriously so. This would make his excommunication something of a quarantine, not only of ideas, but also in a vividness of metaphor, of body and illness. A cutting off of an already diseased limb. We really need not go that far, though it should be considered. We have had such a variety of motivations projected onto Spinoza and his situation at this time, from Jonathan Israel’s thought that Spinoza was during this period attempting to be excommunicated by being outrageous simply to climb out from the burden of onerous debts, to Wim Klever’s notion that Spinoza at this point was so invested in his political and spiritual education with Van den Enden, long broken from the community, the excommunication was but a trifle. Either of these may be so, but if Spinoza had by now become symptomatic, his illness certainly would have played into his inability to run the firm to profit, or more significantly, his desire to no longer conduct that kind of vigorous business or to remain in the community of his youth. No matter the thesis for his excommunication and his change of attitude towards the values in life, the facts of an onset of a lethal diseased that might have killed many of his family members certainly would play an informing role.

Chekhov’s Example

Tuberculosis does not always head in a straight line, by my understanding. It can be recurrent. Chekov, for instance, who like Spinoza also suffered from the disease over a twenty-year period. A first onset expressed itself in an initial bout of fevers in December of 1883, and then three days of coughing up blood a year later in December of 1884. It was not until six years after these, from the strain of trans-Siberian travel, that again the disease seemed to surface, much more forcefully. Chekhov, like Spinoza, died in his 44th year, at the peak of his intellectual and creative powers. [Citing “Chekhov’s Chronic Tuberculosis” (1963), by Brian R. Clarke]. This is how one medical information website describes the nature of the disease’s chronic mechanism:

In addition, TB can spread to other parts of the body. The body’s immune (defense) system, however, can fight off the infection and stop the bacteria from spreading. The immune system does so ultimately by forming scar tissue around the TB bacteria and isolating it from the rest of the body. Tuberculosis that occurs after initial exposure to the bacteria is often referred to as primary TB. If the body is able to form scar tissue (fibrosis) around the TB bacteria, then the infection is contained in an inactive state. Such an individual typically has no symptoms and cannot spread TB to other people. The scar tissue and lymph nodes may eventually harden, like stone, due to the process of calcification of the scars (deposition of calcium from the bloodstream in the scar tissue). These scars often appear on x-rays and imaging studies like round marbles and are referred to as a granuloma. If these scars do not show any evidence of calcium on x-ray, they can be difficult to distinguish from cancer.

Sometimes, however, the body’s immune system becomes weakened, and the TB bacteria break through the scar tissue and can cause active disease, referred to as reactivation tuberculosis or secondary TB. For example, the immune system can be weakened by old age, the development of another infection or a cancer, or certain medications such as cortisone, anticancer drugs, or certain medications used to treat arthritis or inflammatory bowel disease. The breakthrough of bacteria can result in a recurrence of the pneumonia and a spread of TB to other locations in the body. The kidneys, bone, and lining of the brain and spinal cord (meninges) are the most common sites affected by the spread of TB beyond the lungs.

“experience had taught me”

At the very least, if Spinoza was showing symptoms of the disease as early as 1656, as Colerus’ very rough estimate would place them, Spinoza’s life decisions to not pursue wealth, but rather a life of philosophy, must be cast in a slightly different psychological light. Spinoza writes of his change of mind in The Emendation of the Intellect:

After experience had taught me that all the usual surroundings of social life are vain and futile; seeing that none of the objects of my fears contained in themselves anything either good or bad, except in so far as the mind is affected by them, I finally resolved to inquire whether there might be some real good having power to communicate itself, which would affect the mind singly, to the exclusion of all else; whether, in fact, there might be anything of which the discovery and attainment would enable me to enjoy continuous, supreme, and unending happiness.

I say “I finally resolved,” for at first sight it seemed unwise willingly to lose hold on what was sure for the sake of something then uncertain. I could see the benefits which are acquired through fame and riches, and that I should be obliged to abandon the quest of such objects, if I seriously devoted myself to the search for something different and new. I perceived that if true happiness chanced to be placed in the former I should necessarily miss it; while if, on the other hand, it were not so placed, and I gave them my whole attention, I should equally fail (Elwes translation).

This is thought to have been Spinoza’s earliest philosophical text, before the Short Treatise, Shirley placing its composition between the years 1657 and 1660. What, we may ask, was this “experience” that has taught Spinoza the futility of social life, the uncertainty of “fame and riches”. Are these generic experiences that all of us would have, or perhaps the particularities of watching his father die in tubercular fashion, after a life of substantial monetary and honorific gain? Or, more jarringly, was it the onset of the same disease, the same coughing up of blood, that he had seen his father and his step-mother succumb to? This would certainly have a life-turning effect. Spinoza continues in the opening of the Emendation, actually referencing the analogy of fatal illness and remedy as the very mode of his decision making:

For I saw that my situation was one of great peril and I was obliged to seek a remedy with all my might, however uncertain it might be, like a sick man suffering from a fatal malady, who, foreseeing certain death unless a remedy is forthcoming, is forced to seek it, for therein lies all his hope (Shirley translation).

Is this just a proximate reference, or is Spinoza speaking literally of his own onset of illness?

We see no evidence for debilitation in April of ’55 in the record of Spinoza’s subpoena and physical confrontation with the Alvares brothers. He is struck so hard his hat comes off, something which might afford a reference to physical weakness, but none is mentioned. In fact, from the vague description it seems that only the hat seems worse for wear, leaving the impression of a firm man. And in ’58, from Fra Tomás’ 1659 report to the Spanish Inquisition, we find Spinoza to have a handsome face “de buena cara” with light, clear, but perhaps pale skin, blanco. This would seem to put him in good health. The only thing I would mention is that in this report there is great contrast given between his very dark hair and eyes, and the paleness of his skin. Prado, in whose company Spinoza is in, has a “brownish” complexion on the other hand. While he may have been in good health at the time, the paleness of his skin may have been due to some convalescence. In 1659 he is described by another informant for the Inquisition as having a “well-formed body, thin, long black hair, a small moustache of the same color, a beautiful face”.

Yet as we have seen from the example of Chekhov, an attack of tuberculosis does not necessarily leave one debilitated for life. The body’s immune system can indeed isolate the infection, and return one to health, even robust health, only to be susceptible to the disease later, at times of great stress or weakness. Assuming that his disease was that of tuberculosis, one cannot conclude that Spinoza’s health was never robust, as some have thought.

The Beginnings of “Isolation” and a Conserve of Roses

A great deal of investigative imagination and analysis has gone into the question as to why Spinoza left Amsterdam for the much more quiet Rijnsburg in 1661. Gullan-Whur suspects that something had frightened Spinoza in a way that the excommunication had not, perhaps something to do with the Spanish Inquisition. Perhaps an increasing pressure from Dutch authorities and Jewish reaction made it unsafe for Spinoza to continue his Amsterdam life, some feel. And there is the account of a knife attack outside the theatre, if it is to be believed. Alternately, some think that he went to Rijnsburg to be closer to the Collegiant movement. Spinoza’s very good, generous friend Jarig Jelles bought a large new house on the Herengracht in Amsterdam in 1660, but Spinoza did not move in. First he moved to near  “near ” Ouderkerk, and then to Rijnsburg near Leiden’s university. Why? It is mentioned that his move towards isolation was so that he could be away from distractions from friends, so that he could concentrate on his work, and this is no doubt true. But is it too much to notice that his withdrawal from friends and the air of the city may have been really a question of health? Was it not that tuberculosis struck him again, and it is was in full view of his mortality, and even questions of contagiousness, a theoretical need for fresh air, that brought him to concentrated isolation?

By September 1661 he writes to Oldenburg that his Short Treatise, (one may say his most overtly spiritual work) is still a work in progress. There is no hint of his illness in their correspondence. In the winter of ’62/’63 he has the company of Johannes Caesarius, who is living with him, helping him in a none-too-satisfactory fashion with the geometrical treatment of Descartes’ philosophy. Gullan-Whur reads Caesarius to be Jan Casier, a student of Van den Enden’s school, now a young, Dutch Reformed ordinand (1642-77). As a collaborative biographical note of perhaps significant correspondence during this period, Adriaan Koerbagh, Spinoza’s friend and comrade in spirit of the same age, had received his doctor of medicine from nearby Leiden University in 1659, with a dissertation on the causes of Tuberculosis, Disputio medica unauguralis de Phthisi. In 1661, the year that Spinoza moved to Rijnsburg, Koerbagh became a Doctor of Law, again at nearby Leiden, and in Koerbagh’s later political trial he admits that he had discussed philosophical matters with Spinoza numerous times in the years 1661-63. Having conducted a study of the causes of tuberculosis, one wonders if Koerbagh had ever seen Spinoza as a patient. Or if Adriaan himself had tuberculosis which weakened him (as he would died only within a few months of being sentenced to prison and hard labor in 1669). Along this thin line of argument, is it a coincidence that a conserve of roses is the only conserve mentioned in Koerbagh’s Bloemhof  (1668). The suppressed Bloemhof  was a 672 page dictionary of terms written by Adriaan and his brother, meant to demystify the use of foreign phrases and technical jargon, putting into the vernacular the verbal obfuscations by which eclesiastical, medical and legal “experts” carried out much of its authority over the common man. In June 1665 it is for a conserve of roses that Spinoza says he is waiting (Letter 28), writing to the physician Johan Bouwmeester who was an intimate of Adriaan Koerbagh. Spinoza had visited his friends in Amsterdam earlier in the year, and during his visit to the city he seems to have suffered a recurrence of his tuberculosis:

At the same time I also expected some of the conserve of roses which you promised, although now for a long time felt better. On leaving there, I opened a vein once, but the fever did not abate (although I was somewhat more active even before the bloodletting because of the change of air, I think). But I suffered two or three times with tertian fever, though by good diet I have at last rid myself of it and sent it packing. Where it went I know not, but I don’t want it back.

At this time Spinoza has just moved from Rijnsburg to Voorborg near the Hague. Likely having finished first drafts of parts I and II of a then tripart Ethica, he makes a break and begins his work on the Politico-Theological Treatise. Spinoza distinctly associates the “air” of Amsterdam with the onset of his illness. It would appear likely that this causal belief was consistent in his life, and thus part of his reason for moving out of Amsterdam in the first place. One can also ask, something I’ve not seen considered, was the renewed attack of his disease in some way linked to the much discussed break from the Ethics, and his turn to political issues of the day?

Voorburg, Not So Quiet

At this point I would like to take up some of the psychological criticism aimed at Spinoza by his biographer Gullan-Whur. In making her assessment of a certain flaw in Spinoza’s self-perception she provides us with a rather telling description of the house Spinoza moved into in Voorburg. She points out that although Spinoza, in her opinion, plays the role of the isolated sage, being crankily troubled by intrusions, he moved into one of the most bustling, connected locations in all of Voorburg:

Voorburg was a rural village, but Benedictus had not chosen to live in a peaceful part of it, for the Kerkstraat houses, huddled on a terrace and generally having only a gable loft above their ground floors, were flanked by the market place and a boat-servicing harbour beside the Vliet. Yet, whole this lodging was feverishly cacophonous compared with sleepy Katwijkerlaan, he never complained…nothing was easier that getting to any Dutch city from Voorburg. The philosopher could leave home almost at the ringing of the horse-boy’s bell to catch the trekschuit. Voorburg being on the way to everywhere (the canal system joined the River Schie at Delft, and continued south to Rotterdam and Dordrecht), he should have foreseen a continuous flow of callers (154-155)

She goes onto conclude that Spinoza himself does not own up to his own emotional needs for company, caught up in the production of his own image. I might suggest that Gullan-Whur has severely misread Spinoza’s contradictory needs for isolation and for contact. This essentially is the mindset of the chronically, if sporatically, ill. Rather than this being a profound conflict of conscience, or the inability for Spinoza to understand his own needs, Spinoza’s tuberculosis and his philosophical/scientific endeavours required both isolation and contact. Indeed I would suggest that it was likely the disease that forced Spinoza to reconsider his life, and it was this ever-present relationship to his own body and mortality that made his rationalist philosophy most concerned with the freedoms of the body. Gullan-Whur’s example of reading the man is actually instructive for all interpretations which ignore his physical histories. In fact I would think that all of Spinoza’s metaphysical positions on the body should benefit from being seen in the light of  a possible continual threat and experience of tuberculosis.

Summation

It is persuasive to infer, and least as persuasive as any other reasoning I have encountered, that Spinoza’s father and step-mother indeed died of tuberculosis, and that Spinoza had contracted the illness from them. On average, people have a 50 % chance of becoming infected with tuberculosis if they are in close contact eight hours a day for six months. If Colerus’s estimate is right that Spinoza had struggled with the disease for more than twenty years, this would put his first attack right at the decisive years of the late 50s, as Spinoza was forming his new political and theological relationships with Van den Enden and Prado, leaving behind the family business. (By stating this length as more than 20 years, Colerus at the very least seems to want to place the illness before Spinoza’s milestone move from Amsterdam.) This encounter with a disease that may have killed his father and step-mother surely would have shaped the decisions Spinoza was making. And the resultant dedication to philosophy, science and selective isolation should not be considered outside of this persistent awareness of both his disease and the effects it may have had on others. All the complexities of influence that we can convincingly conjure up may very well pale to the experience of the fatal fever and cough a year after you watched your father and step-mother, and perhaps even sister, pass under similar conditions. It is agreed that this is a time of plagues, and the death of family members and close friends, certainly by 1664 was not uncommon. This does not mitigate the personal effect the disease would have had upon Spinoza in the determinative years of 1655-1658, not to mention the consequences of managing the disease over a lifetime.

Why the timing and substance of the disease has not been well considered by biographers and interpreters of Spinoza’s life, I do not quite understand, except for the recognizable need to comprehend the man in terms of much vaster, more abstract historical and intellectual factors.