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Feature Christmas 2011: Diagnosis

Was James Joyce myopic or hyperopic?

BMJ 2011; 343 doi: (Published 15 December 2011) Cite this as: BMJ 2011;343:d7464

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A Portrait of the Artist as a Patient : the eyes of James Joyce

He wrote books that were outlandishly original. It was this man of the stylus, from a land where they spoke Irish Gaelic, who undertook experiments on the language of England that were so ludicrous that the aftershocks of the boulders he threw into the literary arena are felt by a contemporary coliseum of readers.

It was he who painted “A Portrait of the Artist as a Young Man” (1916), he who was the artisan of “Ulysses” (1922), and he who was impenitent when they baulked at the oddness of “Finnegans Wake” (1939). Wilfully, he ignored the etiquette of syntax and punctuation. Who, but he, student and teacher of language, could excise the apostrophe and revise Finnegan’s to Finnegans. The title of his book referred not to the waking of one man. It signified the awakening of many persons, each of them sinking into sleep, a sort of death, before waking to their rebirth – an awakening of Finnegans. This was the fellow, a writer of the British Isles, who taught himself Norwegian to read the plays of Ibsen. Born in Dublin, Ireland in the 1880s, who could he be except the nonpareil James Joyce.

A maverick, in the 1910s he exchanged the bibulous alleys of Dublin for the life-affirming avenues of Europe. Promenading in Trieste or Zurich, he was a lissom figure, straw-hatted, glasses on nose, and a cane of ashplant in hand. The cane was carried not because he was a dandy, but because it was like a saber that could be unsheathed from its scabbard to shoo away street-dogs. He had a phobia of dogs. On a Parisian afternoon he liked to sit in cafés and hear the casuistries of the other artists and intellectuals who also had spurned their homelands.

Joyce has a medical history the merest inspection of which shows that he had a life of sustained discomfort. In his bag of tribulations was eye disease that began in his twenties and persisted intractably until his death at sixty. Victimised by alcoholism, anxiety, and asthenia, Joyce had a constancy of stomach pain that was unsolvable by his physicians. He died in 1941 of a perforated gut and its postoperative course.

Worsening inexorably over his lifespan of sixty years, the eyes of Joyce were the main source of his misery. It was a feat of preternatural breadth, his undertaking of literary labours via a shroud of painful blindness. Joyce's struggle with his eyes led him to naming his daughter Lucia, after St Lucia, patron saint of the blind. A scrutiny of him as a young man attests to his longsightedness – his glasses magnify the Irish-blue eyes. The wearing of such spectacles is notable because it reveals that Joyce had eyes of a crowded shape : anatomy which increases the risk of high pressure developing in the eyeball. Ordeals of the ophthalmic type began in youth, but inflammation in Joyce's eyes (rather than pressure) was the initiator of his sufferings in 1907.

From the Latin “inflammatio,” the word “inflammation” has kinship with “flame.” Fire attacked the inside of Joyce’s eyes and would barely glow into cinders before bellowing up again into a raging flare that rendered him supine. He was frequently ill. Joyce, notably, was not a beneficiary of steroid, a remedy for inflammation that appeared in the 1940s.

Oculists were consulted to assuage the agony. But those attending to him could not acceptably douse the flames. To curb the flammatory pain from his eyes the doctors injected Joyce with arsenic and phosphorus. Since these dosings were inefficacious they would apply a fistful of leeches to his scalp. Ill-advisedly, he had his teeth extracted, on the strength of some advice which ascribed his ocular ills to the bacteria in his mouth. Surgery of the eye was performed and the series between 1917 to 1930 comprised iridectomies, sphincterotomy, capsulectomy, and a removal of cataracts.

Irritation inside the eye – anterior uveitis – of the type that affected Joyce can be caused by many conditions. However, the range of possibilities is narrowed by considering his clinical pattern and historical context. Regarding the pattern, the available vignettes suggest a uveitis that started in youth and affected both eyes. It is not clear whether this inflammation was oscillating between the eyes over time, or simultaneously struck both eyes, a detail that is germane in diagnosis.

Joyce had relapse after relapse, a clinical course that was not surprising given the lack of modern drugs. Predictably, these spates of uveitis led to the sequelae of blinding cataract and glaucoma. The latter sequela was further favoured by the crowded, hyperopic anatomy of his eyes.

On the history, the conditions that could have caused Joyce’s eye trouble are sarcoidosis, syphilis, tuberculosis, and a possession of the HLA-B27 marker. Able to affect any tissue, sarcoid is common in persons with ocular inflammation. Syphilis and tuberculosis, as infections, were endemic in Europe in the Joycean lifespan from 1882 to 1941. Pointing to his frailty, biographers have uncharitably speculated that Joyce had bodywide syphilis.

From amongst the photos of a man – who some have apotheosed as the greatest writer of English of the last century – are the poses of Joyce with a piratical eyepatch over his left eye. Blind in his left eye, the right with ten percent vision, Joyce by the age of fifty was a countenance of sadness, head resting on hand. But the portrait to be saved in the mind should not be that of a very pure breed of artist subdued by illness. It should be the image of a writer-in-residence, as painted by Nora Barnacle, his comradely wife, who confided in a visitor :

“I go to bed and then that man sits in the next room and continues laughing about his own writing. And then I knock at the door, and I say, now Jim, stop writing or stop laughing.”

Competing interests: No competing interests

01 July 2016
Jagdeep Singh Gandhi
Consultant Ophthalmic Surgeon
Worcester Royal Eye Unit
Worcestershire Royal Hospital, Worcester, UNITED KINGDOM