Note: When Dalrymple’s long-running BMJ column ended in 2012, he had a backlog of about 60 unpublished pieces, and he kindly gave them to us to post here at Skeptical Doctor. We are posting them on Wednesdays to coincide with the schedule of his old BMJ column. We hope you enjoy them.

The life of Llewelyn Powys (1884 – 1939) was considerably shaped by tuberculosis. He had his first pulmonary haemorrhage in 1909 and went to a sanatorium in Davos and then to Kenya as a plantation manager in an unavailing attempt at a cure. Life in the sanatorium and in Kenya were the background of some of the stories in his first book, Ebony and Ivory, published in 1923.

Powys detested the Kenyan colonists, whom he saw as greedy philistine brutes. In one of the stories, a farm labourer is so badly treated by his employer, but has so little chance of escape, that he decides not to kill himself but simply to lie down and die – and he does, his corpse being burned as “Rubbish,” the title of the story. In another story, a young man just out to the colony starts out better and more refined than the other colonists but is gradually coarsened by them. He takes a local girl as a lover but contracts syphilis from her, so virulent that the doctor tells him that even salvarsan cannot help him. He takes a pistol and shoots himself in the head.

The story Not Guilty starts “No, I have never deceived a living man but, by Jove! I came near to doing so once.” As might be surmised, this turns out to be ironic.

The narrator is in a Swiss sanatorium for a cure of his relatively mild tuberculosis. There he meets a prosperous, slightly vulgar but very rich British boot manufacturer, whom he befriends, and whose beautiful young wife comes out to visit him. The manufacturer is very ill and close to death. The narrator and the wife are attracted to one another, and on one occasion find themselves alone, as they think, in the manufacturer’s bedroom, where they take the opportunity to make love. Suddenly, however, they realise they are not alone:

The doors leading on to the balcony were ajar and through the narrow open space I could see the end of my friend’s couch. Judge then of my horror on catching sight of one of the well-known brown boots! He had been there all the time and had doubtless been a witness of our illicit love! What were we to do?

The man’s wife decides to brazen it out; but on reaching the balcony realises that her husband is dead.

All the stories in the book are short and powerful, written with the greatest economy. Powys’ philosophy of life (his father was a clergyman, but he had no faith himself) is summarised in one of the stories and is clearly that of a man who had looked mortality in the face:

If, if our days in the garden of the earth are in reality so uncertain, if indeed as was made clear to me then, death cannot be gainsaid, then surely the secret of so sorry and insecure an existence must lie in detachment, for he who would lose his heart to a life so beset with tragedy had best have a care for his wits.

I suppose, when you come to think of it, that this is a little analogous to the doctor’s attitude to the human suffering with which he inevitably comes into contact. The introduction to this volume, which was written by Edward Shanks, says:

From these stories sensitive reader is not to expect anything but pain. But there is a pain in the realisation of truth which is a sort of ecstasy.