Kafka Making of an Icon © Jessica Chaundy, Bodleian Libraries.

One way to read Gregor’s transformation in The Metamorphosis is as an analogy for the changes in bodily experience and self-perception that are wrought by serious illness. Literary scholar Robert Douglas-Fairhurst draws that out in his book Metamorphosis: A Life in Pieces’[i], which talks about his own experience as a sufferer of multiple sclerosis – the cover highlights MS as the first and last letters of ‘Metamorphosis’. Douglas-Fairhurst empathises with how Kafka deals with the need to recalibrate when your body becomes foreign to you, turning to strange flesh you have to carry around. And he identifies stylistic features in The Metamorphosis that fit his own experience closely. First, the slapstick in the tragedy – we root for Gregor, but his battles are like those of a silent comedian in world set against him. Second, Kafka catches how the person presented to world becomes unmoored from the unchanged interior perception of the self – reinforcing the deadpan comedy that runs alongside the tragedy. Third, there’s a mixture of first and third person in Kafka’s text – and that fits with having an awkward relationship with one’s own body – ‘Is this really me?’. You start, says Douglas-Fairhurst, to think of having separate versions of yourself in past, present and future – who I was; who I am; and who I will be, as deterioration goes further.

Kafka himself started coughing blood in 1917, indicative of lung tuberculosis, and died seven years later, aged forty, spending much of that time in sanatoria. Towards the end, he developed secondary tuberculosis in the larynx, leading to constant coughing and increasing voicelessness. Not only did he suffer from a lack of appetite, his condition made it agonising to eat: by the end he could only consume calorie-rich liquids, like beer. The six-foot-tall Kafka was always slender, but according to medical records he weighed just 45 kilograms at his death on 3 June 1924. He had been just too early to benefit from the development of a vaccine: the first trials were carried out in 1921. That said, Kafka might have been an anti-vaxxer, so perhaps he wouldn’t have taken it anyway. There are no vaccinations recorded on his military conscription card; he subscribed to the naturopathic Reform Magazine for Healthcare from 1911 to his death; and he was friendly with its publisher, Moriz Schnitzer, a Bohemian businessman who founded the organisation Union for Natural Healing in 1894, and opposed vaccination.

Photograph of Kafka with his sister Ottla at her farm in Zürau, where he spent several weeks after being diagnosed with tuberculosis. MS. Kafka 55, fol. 7r © The Bodleian Library, University of Oxford.

Kafka’s views on eating and health more generally were unorthodox for his time. He was a vegetarian from 1910 onwards, and credited that diet with settling his previously chronic digestive ailments. He also favoured vegetarianism on ethical grounds: his friend Max Brod reported him being overheard whispering to a fish in the Berlin aquarium: ‘Now I can look you in the eye with a clear conscience – I don't eat you any more.’

Kafka also followed the exercise regime presented by Danish athlete, Jørgen Peter Müller[ii]. Much of that which Schnitzer and Müller espoused is in line with modern views of what is healthy. Accordingly, Kafka was a non-smoker, drank very little alcohol, ate lots of fruits and vegetables, and went swimming regularly. He continued his active lifestyle – which also ran to gymnastics, hiking, tennis, horse riding, and kayaking – even after contracting tuberculosis. Müller also recommended maximising fresh air[iii], leading Kafka to sleep at an open window, work in the garden (not so normal at the time for the successful lawyer he was by day), and take exercise as naked as possible. That said, even in his visits to Jungborn, a German nudist colony, Kafka was sufficiently conscious of keeping his circumcised penis – the marker of his Jewishness – hidden, that he was known as ‘the man in the shorts’[iv]. Such a lifestyle may well have delayed Kafka’s demise – he lived seven years with active TB at a time when 40% of sufferers died within a year and hardly any lasted longer than five years. Moreover, in October 1918, he survived the additional complication of catching the notorious Spanish influenza.

Kafka Making of an Icon © Jessica Chaundy, Bodleian Libraries.

If Kafka had an enthusiasm still likely to be looked at askance, it was his intermittent application of the extreme chewing regime of Horace Fletcher (1849–1919). Known as America’s ‘great masticator’, Fletcher campaigned for chewing food until it tastes of nothing, however long that takes – 100 chews would be unsurprising. You were to swallow only liquid whilst chewing – nothing solid, and to spit out whatever solid residue remained in your mouth when there was no taste left. As Sam Keane explains[v], Fletcher’s reasoning was flawed: ‘He had the mistaken idea that digestion happens in your mouth, not your gut. So if you didn’t chew your food thoroughly, it would lodge in your intestines and block you up. He also claimed that chewing food liberated more nutrients. So by chewing more, people could get by with eating far less food, and get more energy out of what they did eat.’ However, there may be other benefits to thorough chewing. In 2015, a review of the relevant research[vi] concluded that prolonged chewing reduced feelings of hunger in a third of the studies and reduced total food intake in half of the studies. It seems that increasing the number of chews per bite increases the gut hormones that are involved in registering fullness, as well as the time taken – so making it less likely that large amounts will be eaten.

As for tuberculosis itself, the history is well understood[vii]. Genetics indicate that the Mycobacterium tuberculosis bacteria (MTB) first infected humans some 70,000 years ago, and accompanied the migrations of people out of Africa. Since then, consumption, as it was often called historically, has caused more deaths than any other infectious disease, killing a billion people over the last 200 years, and accounting for 1 in 5 of all deaths in Europe in the 17th-19th centuries. That included many famous artistic figures: Emily Brontë, Anton Chekhov, John Keats, Frédéric Chopin, Aubrey Beardsley, and Walt Whitman, to name just half a dozen 19th century examples. The most obvious initial symptom of active tuberculosis is a persistent cough, followed by insidious fatigue, unexplained weight loss, lack of appetite, and night after night of waking up covered in sweat.

Postcard Kafka sent to his sister Ottla from a sanatorium Schelesen in 1918 captioning his drawings ‘Scenes from my life’. MS. Kafka 49, fol. 79r. Jointly owned by The Bodleian Library and The Deutsches Literaturarchiv Marbach © The Bodleian Library, University of Oxford.

Given the success of neo-natal vaccination and availability of drug treatments – such as the antibiotic streptomycin – for those who are nonetheless infected, TB tends to be seen as problem of the past. Yet that isn’t true[viii]. Tuberculosis has re-established itself, following the Covid peak, as the world’s leading cause of infectious death. In 2022, 10.6m people developed TB and 1.2m died from it, even though it is different from HIV and malaria in that we already have a vaccine. Drug resistance is an increasing problem – about half a million people are resistant and get TB every year. It's estimated that about a quarter of the world's population is latently infected with TB and at risk of reactivation – 10% of cases can be expected to so progress, but with worse prospects for anyone who becomes immuno-compromised for any reason. The bacillus Calmette-Guérin (BCG) vaccine has been given to over 3 billion people around the world, and it gives very good and reliable protection against disseminated TB – tuberculosis that has spread outside of the lungs, particularly that spreading to the brain as TB meningitis. However, it doesn't consistently protect against lung disease, particularly in young adults and adolescents. Moreover, the protection seems much less in India and Africa. So there remain challenges to understand what is underlying that variability, and how can we develop vaccines that provide more universal protection.

Kafka doesn’t mention tuberculosis in his works. The Metamorphosis was written before his diary reports waking at four in the morning on August 9, l917, and being ‘surprised by the strange amount of saliva in my mouth, I spat it out then decided to turn on the light. That is how it began.’ His characters tend to be healthy in body but tortured in mind – and Kafka did have those problems, too. He even wrote in a letter to Milena Jesenska: ‘I am mentally handicapped, the lung disease is none other than an overflow of the mental disease’. Kafka’s characters are, however, often doomed. Perhaps they do carry something of the burden of an incurable disease.

Photo-postcard showing Kafka in June 1921 with guests and staff of a sanatorium in Tatranské-Matliare, one of many he visited on the grounds of his pulmonary condition. MS. Kafka 51, fol. 26r © The Bodleian Library, University of Oxford

References

[i] Robert Douglas-Fairhurst: ‘Metamorphosis: A Life in Pieces’, Jonathan Cape, London 2023

[ii] Jørgen Peter Müller: My System, Copenhagen, 1904 – sets out a programme of ‘15 Minutes of Exercise a Day for Health's Sake’

[iii] Jørgen Peter Müller: The Fresh Air Book, Copenhagen, 1908

[iv] According to the Bodleian Library exhibition ‘Kafka: Making of an Icon ‘, Oxford, 2024 – a source for much of the information given here

v Sam Keane: ‘Chewing it Over – and Over and Over and Over’, Science History Institute podcast, 2021

[vi] Miquel-Kergoat, S. et al ‘Effects of chewing on appetite, food intake and gut hormones: A systematic review and meta-analysis’. Physiology & Behaviour, Issue 151, 2015

[vii] As summarised by Philip Fowler, Associate Professor in the Modernising Medical Microbiology consortium in the Nuffield Department of Medicine in the Oxford University podcast ‘Tuberculosis: vaccines, diagnostics and experience’, 2024 

[viii] As summarised by Professor Helen McShane, Professor of Vaccinology at Oxford University in the Oxford University podcast ‘Tuberculosis: vaccines, diagnostics and experience’, 2024

KAFKA, EATING, AND HEALTH

References