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The Traviata in the movie of Zeffirelli. A history of tuberculosis and other ailments

Oscar Bottasso

Instituto de Inmunología. Facultad de Ciencias Médicas.

Universidad Nacional de Rosario (Argentina).

Correspondence: Oscar Bottasso. Facultad de Ciencias Médicas. Santa Fe 3100. Rosario -2000- (Argentina).

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Received 8 february 2005; accepted 19 april 2005


Adapted from the novel  The Lady of the Camellias of Alejandro Dumas (son), The Traviata is a landmark in the history of the opera in which the movie of Zeffirelli almost arrives at perfeccion. By uniting together, in a magical way, the deep contradictions of society and the implications of an illness that has crossed it completely, this great work of Romanticism arrives in our time with a power of flawless seduction.  There exists combined commentaries about   the artistic merits of the opera and the film production, the work poses a phisiopathogenic hypothesis about the mechanisms that would have contributed to a fatal course of the protagonist’s tuberculosis.  The special emphasis that is placed on the relation between the psychological processes of neuroendocrines and the immune system can offer us an answer as to why there is an increased risk or vulnerability to illness during emotionally difficult situations. 

Keywords: The Traviata, Verdi, Zeffirelli, Tuberculosis, Psiconeuroimmunology.

Technical details

Original Title: The Traviata

Country: Italy

Year: 1982

Director: Franco Zeffirelli

Music: Giuseppe Verdi

Screenwriter:Francesco María Piave (based on the work The Lady of the Camellias of Alejandro Dumas son)

Cast: Teresa Stratas, Placid Sunday, Cornell McNeil, Allan Monk, Pina Cis,.. 

Runtime: 110 minutes

Genre: melodrama

Production Companies: Accent Films B.V. and Radiotelevisione Italian (RAI)

Synopsis:Violetta Valéry (Teresa Stratas) is a courtesan of one of the high Parisian circles threatened by tuberculosis and the bewilderment, one day she falls in love with a rich provincial heir, Alfredo Germont (Placido Domingo), The daring housewife desires to be free from all of her past her wrongs.  They both take refuge in the French countryside to live a love that never before have they ever felt.  Germont´s father, Giorgio (Cornell MacNeil), fearful of the consequences of their relationship, is able, nevertheless, to convince Violetta to abandon her love, pretending not to love Alfredo anymore and returning to Paris under the protection of the baron Douphol (Allan Monk).  Upon returning to the city, Alfredo publically humiliates her and pays money to a prostitute in exchange for her favors.  Violetta is the victim of immense uneasiness.  Sick and alone, she waits for Alfredo to understand her sacrifice and return to her.  When he finally arrives with his repented father, Violetta is on the verge of death. 

Historical Circumstances

While it is true that the movie offers an endless number of resources to recreate and to praise masterpiece works in art history, it remains clear that it is only possible when one is located behind the camera to be, at the same time,  the artist and the artisan.  The film version of The Traviata (The Mislead) that Zeffirelli made in 1982 is a clear example that it possesses plenty of both qualities. 

Adapted from the novel La Dame aux camélias/ The Lady of the Camellias of Alejandro Dumas (son)¨ by Francesco María Piave, Giuseppe Verdi is set to music with total dependability as a  drama capable of awakening as much piety as indignation. 

Alejandro Dumas met Marie Duplessis in 1844, she was his lover until 1845 and then he was later inspired by the soul of Marguerite Gautier in The Lady of the Camellias.  The romance is published in 1848, one year after the death of Marie and it was subsequently adapted for the theater in 1852, becoming one of the most important events of the 19th century.  Margarita is a young and beautiful courtesan  who is maintained financially by rich and important men.  Nevertheless to Armando Duval she appears a sensitive woman and lover and he falls in love with her.  Armando, in turn, represents a youth chosen for a great destiny that, motivated by his feelings, puts his reputation and the welfare of his family at risk.  In a lucky rescue operation the father of Duval manages to persuade Margarita to abandon him, after which there is a significant and unexpected worsening of her illness.  Margarita´s nobility later makes him reveal the truth to his son.  They both they respond when the death is about ready to overcome her.

The underlying elements in this plot in prima facie is not as strong as so that they transcend to the point in which they were and continue being.  The drama of Alejandro Dumas is a very good representation of the French society of this period and certainly of other European countries also.  Nevertheless, the demonstration of strict moral codes on the part of that bourgeoisie of the eighteenth century, shows the underlying sexual hypocrisy in which prostitution was as prevalent as it was condemned.  A gentleman could have “lover” whenever he pleased, as long as he kept the affair reasonably secret, and he put his infatuation aside.  These women were not part of the community of street prostitutes.  On the contrary they earned a lot of money and received many lovely gifts.  Also, even in the most respected environments they detested such “predators”.  Furthermore, the prominent families not even related to those had some of their members with connections of this type.

At the same time as all of this, there is another part of history that, at the beginning of the 19th century and as legate of the previous century came about the belief that consumption (the common name for tuberculosis) could be caused for mental worries of various kinds especially those caused by a premature intellect or a person of with great creative and poetic ability.  This esthetics of the tuberculosis had been credited for histories of women that had had emotional losses and got very sicknddied, luck of sentimental heroines or celestial women.  During the decade of 1830, it became apparent that people subjected to extreme situations such as difficult or extensive work, bad diet, overcrowding, filth, and alcoholism were at a higher risk for tuberculosis.  Nevertheless, in high society, the state of consumption was causing great concern.  In 1865 Dr. Jean-Antoine Villemin discovered that tuberculosis could be transmitted to guinea pig with the injection of ill tissues, showing the contagious nature of the illness.  By its obvious content and underlying message it is evident that Dumas’s drama was one of obvious force and clear strength for the period.  Margarita’s sacrifice represents the romantic spirit but the history also offers us a criticism of the double standards.  Safeguarding the historical circumstances, it does not seem to be a very accepted argument.

It is clear that the general theme of this work was a ¨boccata di cardenale¨ for Verdi.  In a letter written to his friend Cesare of Sanctis he pointed out that, ¨this is a matter of a contemporary theme. Another perhaps it would not have done by the wardrobe, by the time period and for thousands ofstupid courtesies.  I do it with great pleasure”1.  And surely then it would have been as this, we think that had just converted a deformed fool to a influential person in the history of the Opera, and had brought to the scene ¨thorny¨ themes such as the conjugal infidelity of a  Christian pastor.  In Italy existed a society even more conservative thanParis in respect to the sexual issues? The history  should  have been a bit more sweetened.  Between the conjunction of Piave´s talent and Verdi´s understanding of the human condition, they were able to produce a literary work to a text achieved and viable in operatic terms. 

Despite the ringing success that began to come forth for those years, discordant voices arose nevertheless.  In 1859 a Florentine critic warned about a certain danger of the theme undertaken in The Traviata: “…an obscene and immoral argument, seen universally with good eyes today only because of the universal vice that it represents…..a  private, sensual voluptuous love of all that angelical purity that is found in Belliniana music” 1.  By luck the blazes will leave it to burn! 

Outline of the movie

The prelude of the first act shows us the Violetta that we will see in the third act; dying and abandoned while contemplating how they go leading what was one time hers.  The arches fortell what is to come with the melody of the "Amami Alfredo quant' io t'amo"..., reliable invocation al love.

Based on Dumas´s text where he relates the auction of Maruerite´s belongings (Verdi changed the name of the protagonists, Marguerite of Dumas in the opera takes the name of Violetta), one of the youths in charge of moving the furniture remains fascinated (figure 1) by a portrait of Violetta (figure 2), who at the same time observes the scene and tries to withdraw from this past humor.  The characters that initially appear like ghosts turn to reality at the beginning of the first act.  The party describes the general playful bewilderment and alcoholism that have taken refuge in the Parisian society.  The removal of the cigarette factory worker by one of the other guests illustrates the superficiality of the supposed ties of friendship.  Very they are achieved two effects that Zeffirelli introduces toward the end of the act when Violetta remains in silence before its own aria Ah, fors' è lui…and the momentary apparition of Alfredo in the part of Sempre libera.

The aria of Alfredo De miei bollenti spiriti is illustrated by their experiences with Violetta in the countryside, while Provenza’s portrayals saturate the interventions of Giorgio Germont.  Perhaps to smooth out his abrupt, accusative and stubborn way, that will scare Annina, who is aware of the collapse of Violetta after her separation with Alfredo (figure 3). 

The scene of the gypsies and bullfighters during the party in the house of Flora Bervoix (Axelle Gall) is a representation of insurmountable grandeur (figure 4). What is also excellent is the juxtaposition of images in the playroom between the figures of Violetta and Alfredo gives an idea of the distance that invades their lives. The second act concludes with a final shining concertato of obscurity that initiates the third act. 

From the all-invasive darkness, Violetta talks with the boy, about how she yearns for all that is lost.  The aria Addio, del passato bei sogni ridenti, with  her plea to God to receive her and forgive her (della traviata….perdona; tu accoglila, o Dio) reaches a dramatic reality of breakage to the most insurmountable nature.  The scene where the image of a very regretful Giorgio Germont appears as a mockery of himself in the mirror, is another testimony of mastery.  At the very last moment Zeffirelli’s camera only registers Violetta at the exact moment of her death.  Possibly in an attempt to reflect the deserted condition that had encircled her life. 


A hypothesis about the reasons for Violetta’s death

The Medical Sciences have offered, throughout history, a series of proposals “temporarily accepted” that try to explain the mechanisms by which an illness develops.  Obviously the tuberculosis is not an exception to it.  Adhering to this phisiopathogenic  exercise we will try to outline the facts could have contributed to the fatal course of Violetta’s illness. 

The pulmonary infection from Mycobacterium tuberculosis can cause an extensive range of organic compromise that move from a few permeable wounds to a picture of intense destruction of the lung parenchyma with caseose necrosis and the formation of caverns.  This spectrum of affectation is the result of a complex interaction between the pathogen and the cell-mediated immune response (CIR) developed by the guest.  The essential components of this answer include the macrophagic and the lymphocytes T, especially the CD4 + (called cells T cooperative), which are essential for the development of the granulomatose reaction and at the same time stimulate the effective functions of the macrophage by way of the gamma interferon production.  The studies performed by different laboratories indicate that the operation of the CIR returns negative to the extent that progresses the illness.  This loss can be the result of a series of linked processes that do not only involve the immune system but also influences originating from other systems, for example the neuroendocrine system.  Several of the mediators produced during the infection tuberculosis, among them the interferon gamma and the interleucine 6, perform immunoendrocrine actions and activate the hypothalamus-pituitary-adrenal axis that gives rise to the secretion of glycocorticoides (cortisol) by the adrenal cortex 2,3

The T lymphocytes are white blood cells very important of the action of the glycocorticoides  as much in physiological as in pathological conditions, for example the stress.  The glycocorticoides  inhibit the synthesis of factors that promote the immune answer cellular4, while the dehidroepiandrosterone, another steroid of the adrenal cortex, the facilitates it5.  The results of a study with monocytic blood cells of patients with pulmonary tuberculosis, stimulated with extract of M. tuberculosis in absence or presence of cortisol and/or dehidroepiandrosterone, points to the fact that both hormones can participate in the immunopathogenesis of the illness.  The processing with cortisol inhibits the lymphocyte proliferation as thus also the gamma interferon production to practically undetectable values in the advanced cases.  These patients present, at the same time, high concentrations of factor transformance of growth beta (a capable mediator to irritate the infection) that falls notably when added dehidroepiandrosterone is added to the cultures6.  At a plasmatic level the infected indicate inflated levels of cortisol, interleucine 6 and estradiole, with greater notoriety in the patients with advanced sickness, while the concentrations of dehidroepiandrosterone appear at a much lower level still in the progressed forms.  It conclusively establishesimmunoendocrine environment unfavorable for the articulation of answers defensive of the mycobacteria. 

It is possible that the hypothalamus could be one of the places involved in the development of this neuro-inmuno-endocrine imbalance, since it is a key area for the control of essential functions of the somatic, autonomous and neuroendocrine systems.  These processes combine, at the same time, a program of defense under the control of the limbic system; which is interconnected with the hypothalamus and promotes the secretion of corticotropin-releasing hormone, that will carry out the release of ACTH (Adrenocorticotropic Hormone) with the consequent production of adrenal steroids.  The limbic system  configures an emotional “representation” of the exogenous and endogenous stimuli.  The profiles that acquire these emotions have a lot to see with our pathobiography and the context in which we live7. Therefore, an emotional series linked to the neuroendocrine-immune processes is established that can offer us an approximation of reason for the increased vulnerability to get sick during emotionally adverse states. 

Without courage to perform a detailed exegesis of the drama, the text of the opera offers more than sufficient elements of how to infer that something such as this occurred in the life of Violetta.  The emotional bonds that surrounded their existence only were only there in appearance.  Two passages from the first act give an obvious test to this respect:

Povera donna, sola

Abbandonata in questo

Popoloso deserto

Che appellano Parigi

Poor woman, alone

Abandoned in this

Populated desert

That they call Paris,

Sarìa per me sventura un serio amor?

Che risolvi, o turbata anima mia?

Null'uomo ancora t'accendeva...O gioia

Ch' io odd conobbi, essere amata amando!

Will be for me this misfortune a love in truth

What do you resolve or disturbed my soul?

No man even lit you OR happiness

That I did not know, to be beloved loving!

Violetta risks the card and the love bursts into her life, as intense as it isfleeting, in its real possibilities.  To little of to start a love affair, is done to present Germont, a luck of executor of the imposed mandates by the existing consensus; since the relation between Violetta and Alfredo appeared “politically incorrect”, in post modern terms. Certain is that conscious or unconsciously Germont father does not think to abandon the room with empty pockets (figure 5). Violetta’s past is an essential element to be able to blame the ruin of his son on:

...Dell'incauto, che a ruina corre,

Ammaliato gives voi.

Ah, il passato perché, perché v'accusa?

...of the unsuspecting the ruin runs to,

Bewitched by you.

Oh, the past because, because the accused

Più odd esiste or amo Alfredo, e Dio

Lo cancellò col pentimento mio!

Does not exist more, now I love Alfedo and God

He revoked him with my repentance!

This repentance of Violetta will serve of argument so that Germont demands the removal of the life of Alfredo.  Violetta insists nevertheless “Lui solo amar vogl’io” (I want to love only him), before which Germont, strikes a luck of final stab. 

Sia pure... ma volubile

Sovente è l'uom...

That thus could be. .....but changing

The man often is

Un dì, quando le veneri

Il tempo avrà fugate,

Fia presto il tedio a sorgere...

Che sarà allor? Pensate...

Per voi non avran balsamo

I più soavi affetti

Poiché dal ciel non furono

Tai nodi benedetti.

One day, the beauty

Time will have erased

The tedium will arise...

What will be then? Think about it

For you will not be a balm

The most yielding affections

Put that they were not blessed

By the sky such bonds.

Chio mi separi da Alfredo?

Ah, il supplizio è si spietato,

Châ morir preferirò.

That I will be separated from Alfredo?

Oh, the torture is too merciless

Death, I will prefer.

We can suppose that Violetta’s days would have been consumed with depression, feelings of fault, devaluations, solitude and recurrent thoughts of death.  If this were to happen in today’s world, it would be labeled “state of persistent maladjustment,” in addition to the immunologic stress of tuberculosis, the  neuroimmunoendocrine imbalance would therefore be adding to the progression of the illness (figure 6).

In general lines the greater frequency of high respiratory infections favored by the stress is associated with a suppression of the mechanisms of resistance of the host organism, and the social isolation also contributes to the development of these8.  As for the depression, a agreement exists in that of the disturbances immunological more reproductions of that state is a reduction in the activity of the cells responsible for the immune caution, aggravated when a history of alcoholismo  is added9


Independently of how many times we have listened or attended its show, Traviata brings us to tears.  Verdi, in his melodramatic mastery brought audience through a various spectrum of human experiences: revenges of a terrifying impiety (I due Foscari, Il Trovatore), the wickedness in its purer state (The Lake of Otello), and the pestilences of the arbitrary and all-embracing might (Rigoletto and Don Carlo), among others.  Traviata is, point and aside, a singular fact. 

In spite of being considered a neoclassical and belcantist opera, the characters who reside in are so real that they could be confused with the public if they go out from the stage. What is represented bares all the painful consequences of the human stupidity. The immemorial mark where the prejudices and the promoting stereotypes of the exclusion are forged, provokes us to consider that the other is as much a person as ourselves.  The seduction of Traviata perhaps resides in that face that it has achieved an esthetically impeccable way to represent this human drama. 

Dumas, Piave, Verdi and Zeffirelli create an unmatched conjunction of the art in its diverse forms and at the same time evidence of a more comprehensive society, an authentic spirit ….a LOVE with capital letters. 


  1. Marchesi G. Verdi: Anni, opere. Parma: Azzali editore; 1991.
  2. Besedovsky H, del Rey A. Immune-neuro-endocrine interactions: facts and hypothesis. Endocr. Rev. 1996; 17: 64–95.
  3. Turnbull AV, Rivier CL. Regulation of the hypothalamic-pituitaryadrenal axis by cytokines: actions and mechanisms of action. Physiol. Rev. 1999; 79: 1-71.
  4. Wiegers GJ, Reul JM. Induction of cytokine receptors by glucocorticoids: functional and pathological significance. Trends Pharmacol. Sci. 1998; 19: 317-321.
  5. Yen SSC. Dehydroepiandrosterone sulfate and longevity: New clues for an old friend. PNAS. 2001; 98: 8167-8169.
  6. Mahuad C, Bay ML, Farroni MA, Bozza V, Del Rey A, Besedovsky H, Bottasso OA. Cortisol and dehydroepiandrosterone affect the response of peripheral blood mononuclear cells to mycobacterial antigens during tuberculosis. Scand. J. Immunol. 2004; 60: 639-646.
  7. LeDoux JE. Emotion circuits in the brain. Annu. Rev. Neurosci. 2000; 23: 155-184.
  8. Cohen S, Doyle WJ, Skoner DP. Psychological stress, cytokine production, and severity of upper respiratory illness. Psychosomatic Medicine. 1999; 61: 175-180.
  9. Irwin M. Depression and immunty. In: Ader R, Felton DL, Cohen N, editors. Psychoneuroimmunology. 3rd ed. New York: Academic Press; 2001. p. 383-398.


International Studies Abroad (I.S.A.)


Translated by: Laura Funke

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Figure 1: A fascinated boy.

Figure 2: The portrait of Violetta

Figure 3: After the toast, the love

Figure 4: Party at the house of Flora Bervoix

Figure 5: Violetta, with Mr. Germont

Figure 6: Violetta’s death