Too late to die early

In the spring of 1877 T.M. Greenhow, a retired surgeon, published an article in the British Medical Journal on the case of Harriet Martineau, who had died in her house in Ambleside the previous summer. Greenhow hoped to settle a heated debate about Martineau’s medical history that had been ignited – or rather, reignited – by some disparaging remarks about doctors which Martineau had managed to circulate posthumously. Greenhow’s principal evidence was a detailed autopsy report, written by another physician, that described the removal of ‘a vast tumour’, measuring 12 inches by ten, from her left ovary two days after her death. Greenhow also happened to be Martineau’s brother-in-law, though she had permanently broken with him 32 years earlier, after he published an article on her condition whose clinical specificity as to her symptoms, from ‘irregular uterine discharges’ to constipation, had offended her almost as much as its attempt to discredit her conviction that after five years as a hopeless invalid she had been cured of a fatal tumour by mesmerism.

Though the ‘organic or functional derangement of the uterus’ Greenhow had diagnosed in that article turned out to be a benign tumour of the ovary, the results of the postmortem vindicated his belief that the cause of Martineau’s previous symptoms had never disappeared, only shifted position, and that the tumour’s increasing pressure on her heart and other organs had finally killed her. Described in the autopsy report with homely concreteness as a ‘pear-shaped’ vessel that released ‘about half a pint of brown fluid’ when cut, and whose remaining contents could only be compared to ‘bread soaked in tea, dotted here and there with white hardish pieces, exactly like half of apple-pips’, Martineau’s tumour served for Greenhow – and most of the other doctors who joined the debate – as conclusive proof that her faith in mesmeric treatment was an illusion. Later that same month, Thomas Spencer Wells, a prominent specialist in ovarian diseases, delivered a lecture on the case to the Clinical Society of London, in which he described the growth itself – displayed for the audience together with a specimen bottle of its contents – as common enough and ‘not of much interest to the morbid anatomist’.

Having suffered from a variety of physical ailments since her early childhood, Martineau had long been familiar with the ‘impassable gulf between the experience of the sick and the well’ – and in this case the phenomenological gap was even greater than the doctors supposed. Though Greenhow was intent on showing that his sister-in-law had been wrong to believe herself fatally ill when she first felt the effects of her tumour in 1839, the conviction that she was about to die seems to have struck the patient herself as distinctly liberating. Life in the Sick-Room, the book that she wrote while believing herself to be dying of her uterine complaint, contends that ‘the abolition of the future’ is a ‘great and strange blessing’ to invalids: not so much because it promises an end to their suffering, but because it allows them to concentrate on the present – ‘our interests are all occupied with immediate and pressing objects, in which we have ascertained our true life to consist.’

Among those ‘pressing objects’, though she did not say so, was Life in the Sick-Room itself. Written in 1843 and published anonymously the following year, it was almost immediately recognised as her work. ‘I never wrote any thing so fast as that book,’ she was to say in her Autobiography: ‘I was hardly conscious of the act . . . so strong was the need to speak.’ And although she repudiated both the ‘morbid’ state of mind in which Life in the Sick-Room was written and the ‘youthful vanity’ with which the ailing and ‘pious’ child had anticipated her swift translation to heaven (‘I hoped for, and expected early death till it was too late to die early’), the Autobiography, too, owed its existence to Martineau’s belief that she was about to die. Convinced that she was ‘again ill, as hopelessly, and more certainly fatally’, this time from heart disease, Martineau set about writing both her life history and her own obituary at the age of 53 – only to survive for another 21 years. The Autobiography, now generally regarded as her greatest achievement, was finally published in 1877, after her death. (It was her attack in the obituary on the medical profession that had reignited the old controversy about mesmerism.)

Not that Martineau was incapable of writing when she felt comparatively well. She herself partly attributed her collapse in 1839 to overwork; and since she had published more than 20 books by that date, her wish to rest for a while seems understandable. The work that established her reputation, the hugely successful Illustrations of Political Economy (1832-34), filled nine volumes when reprinted; and even while its original monthly publication was still in progress, the following books appeared: The Faith as Unfolded by Many Prophets: An Essay Addressed to the Disciples of Mohammed (1832), Providence as Manifested through Israel (1832), Poor Laws and Paupers (four volumes, 1833-34), Christmas-Day; or the Friends (1834) and the five-volume Illustrations of Taxation (1834) – all this before she took off for the US to write Society in America (1837) and published her first novel, Deerbrook, in 1839. The Autobiography identifies the decade of relative health between her mesmeric ‘cure’ and her renewed conviction that she was fatally ill as the ‘best years’ of her life: the first product of that period, Eastern Life, Present and Past (1848), was the record of an arduous journey in Egypt and Palestine, much of it by camel and on horseback. But if Martineau was disappointed that ‘it was too late to die early,’ she continued to value the thought that death might come at any time. Like Florence Nightingale, who would later confide to her that ‘I too have "no future” & must do what I can without delay,’ she made of the invalid’s foreshortened prospect a further incentive to work.

Life in the Sick-Room returns repeatedly to the altered perspective, both physical and metaphysical, that it identifies with invalidism. After a brief period under Greenhow’s care in Newcastle, Martineau moved in 1839 to Tynemouth, where she rented quarters whose wide prospects over land and sea are affectionately memorialised in the work she composed there. But she intended her book to be more than the record of one woman’s experiences; and her curious way of mixing description with prescription often makes it seem as if every invalid in Victorian Britain should decamp to the seashore, taking care to bring a telescope with them: ‘Think of the difference to us between seeing from our sofas the width of a street, even if it be Sackville Street, Dublin, or Portland Place, in London, and thirty miles of sea view, with its long boundary of rocks, and the power of sweeping our glance over half a county, by means of a telescope!’ Though in that instance the instrument, like the vista, is literal, at another time ‘that inimitable telescope we carry about in us’ enables the invalid to share in the festivities of Christmas while remaining alone in her bed. Presumably she also employs the figurative telescope to gaze on the remote vistas described in her ample supply of travel books, since these provide the invalid, according to Martineau, with ‘scenery, exercise’ and ‘fresh air’.

Elsewhere Martineau seems to argue that the sick actually see further than other people – whether because all ‘human life, from the cradle to the grave, lie[s] open’ to them, as she puts it with characteristic vagueness, or because, more mundanely, they have time to read several newspapers and thus to assimilate all points of view. Touchingly, the inveterate reformer suggests that the confinement of the sick helps to restore their faith in human progress – the gradual ‘amelioration’ of things being much more visible to those who are ‘out of the strife’.

Life in the Sick-Room argues that it is ‘incomparably the happiest plan for the sick one to live alone’; and the Autobiography would later make brutally clear that one of the great advantages of her own collapse in 1839 was the excuse it afforded to get away from her relatives. Though the earlier book emphasises the comfort the invalid derives from knowing that others do not suffer on her behalf, the Autobiography suggests that Martineau herself was also intent on not worrying about others. Indeed, the overwork on which she dwells most painfully in retrospect is not the writing of books but the care of ‘three anxious members’ of her family, her nearly blind mother especially, whose daily habit of ‘getting out into the crowded streets by herself when she could not see a yard before her’ prompted recurrent nightmares in her daughter.

Of course by prescribing solitude for the sick, Martineau does not mean that they should nurse themselves, only that there is ‘no attendance’, as she briskly puts it, ‘to be compared with that of a servant’. Rather than depend on the generosity of others, Martineau’s invalid wants to retain as much control as possible. The relative detachment of waged labour also keeps the ‘pain of sympathy’ at a minimum. Friends and relatives do well enough for a crisis, Martineau suggests, but in chronic cases they are too apt to console themselves by offering false consolation to the invalid. Invalids, she insisted, always prefer hard facts to what Nightingale would later call the ‘chattering hopes’ of their comforters: ‘Everything but truth becomes loathed in a sick-room.’

Maria Frawley calls Life in the Sick-Room a ‘hybrid’ text, ‘part memoir, part treatise’, but anyone who has wandered through a modern bookstore would recognise the genre: advice for the sick by a fellow sufferer. From Living Well with Hypothyroidism: What Your Doctor Won’t Tell You to No More Bad Hair Days: A Woman’s Journey through Cancer, Chemotherapy and Coping, the shelves are crammed with books purporting to tell the sick how another sufferer has managed to live and even to profit from the experience of illness. What distinguishes Martineau’s text from its contemporary successors is the generic character of the suffering she addresses, her implicit assumption that no cure is possible, and the almost total absence of the invalid’s body. Rather than advise her readers on how to get well, or at least on how to cope with their symptoms, Martineau determines to think of that body as little as possible. Whether or not it is true that invalids as a class ‘are in ever-growing danger of becoming too abstract’, as Life in the Sick-Room contends, there is no question that Martineau’s own book suffers from this ‘peril’ of invalidism.

Modern medicine has made a difference: while Martineau’s invalid is characterised only by ‘a condition of permanent pain’, advances in diagnosis and treatment have produced a specialised literature in which each disease has its own first-person narratives. Yet the anatomical specificity with which Martineau’s doctors could write of her condition suggests that her own vagueness did not simply follow from the state of 19th-century medicine. Nor was it altogether a matter of Victorian pudeur, though a woman of her time and class could hardly have been expected to describe her menstrual symptoms for everyone to read. Much of her outrage at her brother-in-law’s first report was directed at his choice of audience: rather than describe her case in ‘a Medical Journal, where nobody but the profession would ever have seen it’, he had produced ‘a shilling pamphlet – not even written in Latin – but open to all the world!’ Though the author of Life in the Sick-Room chose to say almost nothing about what ailed her, the very abstractness of her rhetoric invited widespread identification: distinguished neither by sex nor by age, suffering from nothing more concrete than chronic pain, ‘we’ invalids, as Martineau’s first-person plural has it, apparently encompass a large portion of Victorian Britain. The strategy seems to have worked: the initial print run of Life in the Sick-Room was exhausted within two months.

Still more than the hope of appealing to a large audience, Martineau’s rhetoric signals her determination to conquer illness by transcending it. An opening chapter on ‘the transient and the permanent in the sick-room’ relegates all physical sensation, however intense, to the realm of the ephemeral. Since even a familiar pain cannot be recalled once it has passed, it is thus ‘annihilated’, while ideas – ‘the unseen realities’ – ‘are indestructible’. Life in the Sick-Room was already in print when its author submitted herself to a mesmerist, but the woman who had written ‘we can vindicate the supremacy of mind over body’ was clearly prepared for the experiment.

The bravura sentence that opens Virginia Woolf’s haunting essay, On Being Ill, contends that sickness is too rarely a subject of literature:

Considering how common illness is, how tremendous the spiritual change that it brings, how astonishing, when the lights of health go down, the undiscovered countries that are then disclosed, what wastes and deserts of the soul a slight attack of influenza brings to view, what precipices and lawns sprinkled with bright flowers a little rise of temperature reveals, what ancient and obdurate oaks are uprooted in us by the act of sickness, how we go down into the pit of death and feel the waters of annihilation close above our heads and wake thinking to find ourselves in the presence of the angels and the harpers when we have a tooth out and come to the surface in the dentist’s armchair and confuse his ‘Rinse the mouth – rinse the mouth’ with the greeting of the Deity stooping from the floor of Heaven to welcome us – when we think of this, as we are so frequently forced to think of it, it becomes strange indeed that illness has not taken its place with love and battle and jealousy among the prime themes of literature.

Though Woolf acknowledges a few exceptions – De Quincey’s Opium Eater and ‘a volume or two about disease scattered through the pages of Proust’ – it is hard to imagine that she would have added Life in the Sick-Room. For what she misses in literature is precisely what Martineau is so determined to avoid: a vivid representation in language of what it feels like to be ill.

On Being Ill purports to contemplate this problem, not redress it, but the brilliance of Woolf’s own writing implicitly counters the linguistic ‘poverty’ she associates with illness. Not that she is any more specific about what ails her than Martineau: rather than list symptoms she makes metaphors. ‘All day, all night the body intervenes; blunts or sharpens, colours or discolours, turns to wax in the warmth of June, hardens to tallow in the murk of February.’ The sufferer ‘is forced to coin words himself’, she writes, and offers a striking figure for the process: ‘taking his pain in one hand, and a lump of pure sound in the other . . . so to crush them together that a brand new word in the end drops out.’ The essay, Hermione Lee explains, had its origins in a fainting spell Woolf suffered at a party given by her sister Vanessa at Charleston in the summer of 1925, which was followed by months of illness marked by terrible headaches, lassitude and an attack of German measles. Lee also reports the startling fact that tooth-pulling was recommended as a cure for persistent fever and ‘neurasthenia’: hence the figurative death and resurrection at the dentist’s. But as Lee’s elegant introduction suggests, these are little more than the incidental occasions of an essay whose playful figures and associative leaps are even more improvisatory than usual. ‘In health,’ Woolf says, ‘our intelligence domineers over our senses.’ On Being Ill is less an argument about illness than a demonstration of what the writer can do when the ‘police’, in her formulation, go ‘off duty’.

There are no telescopes in On Being Ill, but there is sky-gazing: a pleasure reserved, Woolf implies, for those who have ceased to march with ‘the army of the upright’.

This then has been going on all the time without our knowing it! – this incessant making up of shapes and casting them down, this buffeting of clouds together . . . this interminable experiment with gold shafts and blue shadows, with veiling the sun and unveiling it . . . One should not let this gigantic cinema play perpetually to an empty house.

Here, too, sickness affords a privileged relation to the truth, but rather than the transcendent prospect of Life in the Sick-Room, the perspective of On Being Ill is defiantly ‘recumbent’. Whereas Martineau ascends a figurative ‘upland’ in order to perceive ‘the progress of amelioration’ hidden from those in the valley below, Woolf has only to lie down and opt out in order to see through the ‘genial pretence’ by which civilisation is conducted. And while the invalid of Life in the Sick-Room has ‘a sense of property’ in nature, it is the very ‘indifference’ of natural things that the speaker of On Being Ill finds comforting: ‘only the recumbent . . . know, what, after all, nature is at no pains to conceal – that she in the end will conquer.’ In an odd moment, Martineau suggests that the reason the sick don’t commit suicide more readily is that ‘a sense of necessary immortality’ makes them despair of dying, but Woolf suggests that no amount of wishing can produce an imaginable afterlife for believers: ‘Would one of them dare leap straight into Heaven off Beachy Head? None but a simpleton would ask such questions.’

Having been raised as a Unitarian, Martineau abandoned her faith soon after the appearance of Life in the Sick-Room. Though the Broadview text is usefully supplemented by a range of contemporary material, including exchanges with Nightingale, Greenhow’s medical reports and the first of Martineau’s ‘Letters on Mesmerism’, only the excerpt from the Autobiography has more than historical interest. Frawley admits that she hesitated to reprint Greenhow’s first pamphlet because Martineau found it so offensive, but I wonder whether she would have been much better pleased by the reappearance of a book she had firmly consigned to ‘the débris of the theological’. The Paris Press edition of On Being Ill suffers from no such liability. The pamphlet it seeks to replicate, typeset by Woolf herself for the Hogarth Press in 1930, was the third version of ‘On Being Ill’ to appear in print – the first was published by T.S. Eliot in the New Criterion of 1926; the essay also surfaced again in two collections edited by Leonard Woolf after Virginia’s death. As Lee’s introduction makes clear, these various incarnations are far from identical, but the history she outlines sorts rather strangely with the publisher’s prefatory allusion to ‘this long-neglected essay’. There are many good reasons to read Woolf’s essay, but neglect is not among them.