Books: Words in Pain. Letters on Life and Death

The Conway Hall library is within the headquarters of the Ethical Society; Conway Hall being the oldest free thought organisation in the world. Trevor Moore, one of the editors of Words in Pain came across this book in the library, a collection of letters written between 1909 and 1913 by Olga Jacoby, a woman dying of an unspecified illness, who records in her letters her fear of a long drawn-out death, her decision to adopt four children — an unregulated activity at that time — and her rejection of any formal religious belief, feeling that religion gave insufficient credit to the achievements of science. She writes: ‘… Science is turning on the light, but at every step forward dogmatic religion attempts to turn it out, and as it cannot succeed it puts blinkers on its followers, and tries to make them believe that to remove them would be sin.’

Prescient, insightful, and startling for that era. The illness while not defined, is recognisable to most of us as mitral stenosis, no doubt in the setting of rheumatic heart disease: there are mentions in the letters of at least one heart operation, and the portrait of Olga (a pastel portrait painted in 1899 in Hamburg) on the cover of the book graphically records the pathognomonic malar flush. It is possible that the surgery was closed mitral commissurotomy, first carried out as early as 1902, though at that time the techniques were little more than experimental.

Following research, Trevor Moore traced the descendants of the writer and liaised with her great granddaughter, psychotherapist Jocelyn Catty, the two of them, as editors, completing any blanks and reordering some of the letters to provide a more readable narrative.

The letters are addressed to Olga’s doctor, though research has not revealed his identity. Olga herself is a rationalist and philosopher who documents her strong interest in science: she reads Thomas Huxley and books on social justice referring to this in her letters, and covers her feelings about enduring a gradual terminal illness along with her descriptions and aspirations for motherhood. She powerfully challenges her doctor’s deep Christian faith.

A stipulation to her doctor is that the letters are preserved and passed back to her husband after her death, and the letters were first published in 1919, achieving Olga’s ambition to be remembered as a writer, thinker, and rationalist with strong views on morality and religion, and most of all, that she would be immortalised.

And Olga Jacoby is immortalised in this book for the following startling reason: she dies at a time of her own choosing by her own hand following an overdose of barbiturates. The document is the first account of what we would now term assisted dying and a vital read for all who are challenged in this era by the polarisation of the current debate.

Olga stockpiled her ‘sleeping draughts’: her doctor, it is clear, was not aware of his role in enabling her to achieve her intentions, and so, as such, this was not an assisted death. But the book is a poignant and erudite reminder that human nature does not change, and that this is one arena where our governance over ourselves has got harder and not easier in contemporary times.

A book to read and read time and again.

• © British Journal of General Practice 2019