A BURNT OUT CASE
GRAHAM GREENE
1960
Vintage, Centenary edition, 2004
208
£7.99
978-0099478430
THE ISLAND
VICTORIA HISLOP
2006
Headline Review
496
£7.99
978-0755309511
Tropical diseases fascinated me as a medical student at a time when Professor Bruce-Chwatt was a world authority on malaria (distinguished malariaologist 1907-1989). Yet, since qualification I have only seen two case of malaria in general practice and had very little practical involvement with tropical medicine. My interest in leprosy was awakened many years ago when I read Graham Greene's A Burnt Out Case and this was despite the fact that I would probably never see a live case. Imagination is a strange thing and I can know see how the author Jules Verne could write books like Around The World In Eighty Days and Michel Strogoff, which was set in Russia without ever traveling very far in his early years. Recently I read The Island by Victoria Hislop and I was immediately transported back to the world of leprosy which is the main theme of the book.
Graham Greene started to write A Burnt Out Case at a low ebb in his life in 1959. He wanted to spend some time at a hospital of the Schweitzer kind (Albert Schweitzer. German-French theologian, musician, philosopher and physician, 1875-1965), run by a religious order in West Africa. Greene was trying to escape the void that he used to find after writing a successful book (In this case he had just finished Our man in Havana). He was put in touch with the well-known leprologist Dr Michel Lechat (Professor Michel Lechat. Greene dedicated A Burnt Out Case to him). After years of successful self expression the famous author was now suffering from a loss of imagination and spiritual bareness, he was becoming burnt-out. For many years he suffered from recurring depression and this would often lift once he was involved in a new project. Dr Lechat agreed for Greene to stay in Yonda in the Belgian Congo.1 This was a leprosarium described by Lechat as composed of two distinct groups: the lepers and those that nursed them. He suspected that the author would be more interested in the latter. Greene was a formidable observer who wanted to blend into his surroundings so that he could make his own undisturbed personal observations. He decided to go to Yonda with the hope of a spiritual leper. Greene much admired the writer Joseph Conrad who had been made captain of a steamship on the great river Congo in 1890. Conrad used much of his experience in Africa at this time to write his novel Heart of Darkness. So Greene was going to try to set his novel in Conrad country.
The novel does describe some of the terrible physical effects of leprosy. The descriptions are taken straight out of his notes in the Congo Journal,2 such as the assistant Deo Gratias who has lost all his toes. Greene also describes some of the side effects of new medication being tried at the time for leprosy and the doctor waiting for new equipment to measure the skin temperatures. It is however, Querry the retired architect, his motives, and those of the carers that really form the book. Querry is based loosely on Greene himself. He has lost his faith and interest in his job, is tired, impotent, in fact, burnt-out. His central trait is honesty, and, like Greene, he tels the truth about himself. Dr Colin in the book also has some similarities with Dr Lechat although he is older and not married. He is however, a caring doctor, a practical non-spiritual scientist. A Burnt Out Case is full of wonderful descriptions and feelings but it is a sad book. It offers no solutions and remains slightly pessimistic almost as if the author would have liked more spirituality in the leprosarium. The harsh reality perhaps was that the conditions were difficult and people were working hard simply to survive.
The Island by Victoria Hislop is a much more cheerful book. It has been described as a beach book with a heart. Although it is a Mediterranean love story it is wel researched and based on not only the disease of leprosy but the historical leper colony of Spinalonga. The island of Spinalonga is located off the eastern coast of Crete. From 1903-1957 it was used as a leper colony and it was one of the last active leper colonies in Europe. The lepers used to enter the island through a tunnel known as Dante's entrance as they did not know what was going to happen to them when they arrived. Certainly towards the end of the life of the colony the patients were in fact wel looked after and received medical attention and social security payments. Since the colony was closed tourists can now visit the island by boat although they cannot stay as there is no accommodation. Victoria Hislop first became interested in the plot for the novel when she visited Crete with her family in 2001.3
The story is told by a young woman Alexis Fielding who has travelled to Crete on holiday. Here an old family friend tells her about her mother's Greek past through several generations. The people of Crete had a fear of leprosy possibly exaggerated because of a leper colony on their doorstep in Spinalonga. A member of a family who developed numb patches of skin could spread panic in the community as they thought wrongly that the disease was highly contagious. The end result of a confirmed case often led to isolation from relatives on the nearby island leper colony. The only contact people had with the outside world on the island was the trips from the fishing boat that supplied the regular provisions and post. The book is not just about the disease of leprosy but it is also about the culture of Crete. The patients on Spinalonga are described as having a ful life with their own community spirit despite the fact that for many, the island has to be their final resting place. The book deals with love, illness, prejudice and death.
These two novels are very different but they both address problems posed by leprosy, the patient and those that look after the patient. One is set in Africa and the other in Europe. So if you want to be entertained with plenty of emotion read The Island. If, on the other hand, you want to think more about the human condition read A Burnt Out Case.
- © British Journal of General Practice, 2010.
