Intended for healthcare professionals

Views & Reviews Between the Lines

An antiepidemiologist

BMJ 2012; 344 doi: (Published 18 May 2012) Cite this as: BMJ 2012;344:e3497
  1. Theodore Dalrymple, writer and retired doctor

Recently I suffered from a cold severe enough to land me in bed for three days on wife’s orders. I do not mention this to arouse the reader’s sympathy, only to draw attention to the truth of what Robert Louis Stevenson (1850-1894) said in his essay “Ordered South”: “it is not altogether ill with the invalid, after all.”

By the time he wrote this, Stevenson was “a mere complication of cough and bones,” thanks to the tuberculosis that was to kill him, so he was hardly speaking out of turn or from the callowness of youth. My illness was, of course, trivial by comparison with his: severe enough to let me rest, but not serious enough to prevent me from reading, if the volume was slight enough for me to hold it aloft while recumbent.

I chose Stevenson’s Virginibus Puerisque (“For Girls and Boys”). This was published in 1881, and the dedication is to his friend, William Ernest Henley, the poet of his own age who also knew a thing or two about being an invalid: Henley spent three years in the Edinburgh Royal Infirmary under the care of Joseph Lister, whose beneficent genius he celebrated in his collection of poems In Hospital. Henley was the inspiration for Stevenson’s Long John Silver.

Virginibus Puerisque, written in a discursive style not much in fashion nowadays, might be called, among other things, an antiepidemiological text. Its whole spirit is antithetical to that of our times, with our narrow, double entry bookkeeping attitude to life. For example, Stevenson recommends that no woman should marry a teetotaller or a non-smoker, because drinking and smoking imply an ability to enjoy effortless pleasure, a precondition of married contentment. (I do not say that Stevenson is right, I report only what he says.)

He writes an apology for idlers, claiming that “extreme busyness is a symptom of deficient vitality,” whereas “a faculty for idleness implies a catholic appetite and a strong sense of personal identity.” The most important things in life are not taught formally: something that I should suggest medical educators remember, were they not likely to turn the necessity for informal learning into a course with multiple choice questions at the end of it.

But it is in the essay “Aes Triplex” (“triple brass”; that is to say, a strong defence) that he poses his challenge most strongly to the epidemiological philosophy. “It is better,” he says, “to lose health like a spendthrift than to waste it like a miser. It is better to live and be done with it, than to die daily in the sick-room.” This is not a man speaking who is and has always been at the peak of health and cannot imagine what it is to be ill; it is a man speaking who for years has hardly known a day’s respite from his symptoms.

Stevenson’s view of life is romantic, not precautionary: “For surely the love of living is stronger in an Alpine climber roping over a peril, or a hunter riding merrily at a stiff fence, than in a creature who lives upon a diet and walks a measured distance in the interest of his constitution.”

One of his most famous poems (lines from which are inscribed on his tomb in Samoa) starts: “Under the wide and starry sky, / Dig the grave and let me lie. / Glad did I live and gladly die . . .”

Nevertheless, I am pleased to report that I am now quite recovered, and just as busy as ever.


Cite this as: BMJ 2012;344:e3497

View Abstract