BJGP Library: The Story of San Michele

The Story of San Michele by Axel Munthe was first published in 1929. It became a worldwide bestseller and is one of the most widely translated books, with sales numbering in the millions. Munthe himself said that being a bestseller is no guarantee that a book is any good and this is up to posterity to decide. The novel has universal appeal as Munthe was a very accomplished storyteller, and it’s of interest to doctors because of his insight into the human condition, covering both mental and physical illnesses. Not only a good read, it also contains many useful concepts and ideas for the present generation of practising doctors. The book also gives some historical insight into the practice of medicine in the late 19th century when Charcot and Pasteur, among others, were making great scientific progress. Munthe also wrote extensively about our journey’s end as he was fascinated by death. It was not until he reached the age of 70, however, that he finally put his mind to writing this most unusual piece of work. A review written soon after publication stated that the book contained grim, drastic, and humorous images taken from an unusually varied life that burn themselves into the memory.

The preface tells us that Henry James told Munthe that writing was a good cure for insomnia. So, with poor vision and a typewriter he set about writing a book that must have been forming in his mind for many years. He describes The Story of San Michele as neither an autobiography nor as a memoir but occupying somewhere in no man’s land between the real and unreal. In truth, much of the book is autobiographical as it is based on his life’s experiences but he admits to using, in his own words, ‘some technical tricks’, which means it is also part fiction. Many of the chapters can be read as short stories and they provide a fascinating insight into a variety of medical problems of the time, for example, diphtheria and scarlet fever, rabies, psychosomatic illnesses, and cholera epidemics.

Axel Munthe was born in Sweden in 1857 and he studied Medicine in Sweden, Montpellier, and Paris. He is said to have studied under the famous neurologist Charcot in Paris, although his time there may have been rather briefer than that described in his novel. It does seem, however, that because of this encounter he developed an interest in psychological medicine. After his hospital experience he started a private practice in Paris. Within a few years he grew tired of Paris and moved to Rome, taking up residence at 26 Piazza di Spagna next to the Spanish Steps, in the same house once occupied by John Keats.

Now he was in Italy he could make frequent visits to his beloved Capri, which he had first come to know in his youth. Munthe bought several properties in Capri and spent much of his leisure time there. He was a physician to royalty and in particular to Queen Victoria of Sweden with whom he had a long and close relationship over many years. He also treated the diplomatic circle, the rich and famous in society, and, last but not least, the poor to whom he usually waived his fee.

Munthe in his early years was influenced by the writings of Leo Tolstoy. The main attraction was Tolstoy’s philosophy of hard physical work combined with a simple life and reducing one’s needs. He was attracted by Tolstoy’s unorthodox ideas on Christianity. Saint Francis of Assisi also appealed to him because of the saint’s philosophy of love, in particular for the birds and the poor.

Munthe suffered from tuberculosis as a young man, and insomnia and hypochondriasis most of his life. His private life was sad because he had two failed marriages and his sons lived with his mother, and he had recurring problems with his vision. Yet, despite all these obstacles he maintained an enthusiasm for life combined with enormous generosity. Charity and giving money to the poor and institutions were also very important to Munthe — though he did once comment wryly that charity and vanity are twins! In his will the Villa San Michele was left to the Swedish state and it remains a museum and a guest house for students. Special provision was made for the protection of migratory birds in Capri and also in Sweden during his lifetime and after his death.

In 1943 Munthe returned to Sweden for the last time, having worked for most of his life abroad. He died peacefully after a stroke in the King of Sweden’s palace in 1949, aged 91.

• © British Journal of General Practice 2016