James Joyce’s knowledge of Obstetrics

BLOOMSDAY in MELBOURNE SEMINAR, SATURDAY JUNE 16th 2018.

James Forrester King

Dr James Forrester King

Reading Joyce in my twenties led me to believe (and I know that I’m not alone in this) that we had much in common, despite him being an Irishman (or should I say Dublinman) twenty years buried and me a student in Melbourne on the other side of the world. Despite this separation, I found that we shared many educational and religious experiences, emotional struggles, similar carnal temptations, and kindred spiritual demons.

An important difference between us was, needless to say, Joyce’s ability to articulate his emotional experiences and struggles through his characters, especially Stephen Dedalus, his alter-ego in ‘A Portrait of the Artist as a Young Man’ and ‘Ulysses’. But little did I know, and I didn’t discover this until many years later, that James Joyce and I had something else in common, and that is, we had both once been medical students.

In the spring of 1902, the twenty year old Joyce graduated from University College Dublin with a mediocre degree in Modern Languages and Classics. Despite this unexpectedly poor achievement by the stellar undergraduate student, his self-belief was such that he was confident that he could pursue a career as a literary artist.

Unlike his brother Stanislaus, and his other seven surviving siblings, James Joyce had an abiding fondness, even admiration for his mercurial father John Stanislaus Joyce, who himself had studied medicine at Queen’s College Cork for two years, failing to complete the course, the first of a long list of professional and financial failures.

Probably as a result of this filial fidelity, James submitted to his father’s request that he ‘make something useful of himself’, and in October 1902 enrolled in medicine at St Cecilia’s Medical College, which subsequently became the faculty of medicine of University College Dublin. Nor did I know that James’ UCD friend Oliver St John Gogarty also attended St Cecilia’s, although he subsequently transferred to Trinity College Dublin, and the two medical students stayed close friends for a couple of years until separated by the inevitable clash of their massive egos.

After only a few months at St Cecilia’s, Joyce was able to persuade his father that he must leave what he felt was the stultifying and paralysing atmosphere of Dublin, and declared his intention to study medicine at the Sorbonne in Paris, where he could support himself by writing book reviews and giving English lessons. He left Dublin for Paris in December of 1902, and enrolled at the Sorbonne, where he attended lectures sporadically, spending instead most of his time in the Bibliothèque Nationale and the Bibliothèque Sainte-Genevièvereading the Greek philosophers.

I can find nothing on his experiences with the medical curriculum, but his tenure as a medical student at the Sorbonne was abruptly terminated on Good Friday the 10th of April 1903, when returning to his lodgings from Mass, (yes, despite his rejection of Catholicism, he still occasionally attended Mass), he received a telegram with its famously stark message and its equally famous typographical error – “Nother Dying Come Home Father.” The story of his mother’s death and its impact on Joyce is for another day.

In June of the following year 1904, Joyce met Nora Barnacle in Dublin and they instantly clicked- she stuck to him like a barnacle, becoming his life-long companion and muse, until he died thirty six years later in 1941. In October of that year James and Nora eloped to Europe, in order pursue his literary ambitions in what he saw as a more favourable cultural climate, and so he abandoned his formal medical studies, which would have covered in total a period of about two years. Like father, like son. Seemingly he had few regrets about this decision, and much later, Joyce reflected-  “I would have been even more disastrous to society at large than I am in my present state, had I continued”.

In my reading and rereading of Ulysses, after I graduated in medicine, I became ever more aware of how Joyce’s curiosity about the functioning of the human body in general, and his medical knowledge in particular, keep irrepressibly cropping up through the thoughts and imaginings of his characters, especially Bloom. To what extent Joyce’s medical studies influenced his thinking and writing, it’s hard to say, but it is reasonable to suspect that his deep and abiding interest in the functioning of the human body and mind and the panoply of medical ailments and their treatments was at least in part the legacy of his medical training. In 1920, Joyce drew up a schema (what we might today call a roadmap, Joyce called it a skeleton key), to assist his translator friend Carlo Linati better understand the structure of Ulysses. The Linati schema, as it is known, gives a chronology of the events of the day, Thursday 16th June 1904 and amongst other rubrics, Joyce assigned an organ of the body to all but the first three episodes of the novel. Although the connection between the individual episodes and the nominated organ is often easy to recognise- for example the the circulation of the blood in Wandering Rocks, and the ear as the organ for Sirens, in some other instances it seems to be obscure or fanciful, for example the organ for Circe is the skeleton. Nevertheless the prominence Joyce gave to the body’s systems in the Schema suggests his pre-occupation with the parallels between physiology of the body and complexity of life events, which possibly drew Joyce to study Medicine in the first place, and which seemingly remained with him throughout his life.

There’s no ambiguity about which organ Joyce assigned to the ‘Oxen of the Sun’ episode – of course it has to be the uterus. Oxen is an analyst’s smorgasbord, pregnant with gestational allusions, providing fuel for waves of PhD theses, fulfilling the author’s not-so-humble prophesy that his work would keep the professors and the literati puzzled for centuries. ‘Oxen’ is written in over thirtydifferent parodied literary styles, presented in chronological order. Joycean scholars point out that this is consistent with the pregnancy theme, covering the gestation and development of English literature. The chapter opens with three complex invocations, each repeated three times. Three threes are nine, yes the nine months of pregnancy. Joyce himself said that in this episode, “Bloom is the spermatozoon, hospital the womb, the nurse is the ovum and Stephen the ovary”, and assigned as the technic, Embryo-Foetus-Birth, which many find baffling

The topic of Joyce and medicine is the subject of multiple treatises, and biographers have described Joyce’s own frequent and painful experiences as a patient. His medical history includes the personal ownership of diagnoses from the fields of ophthalmology, gastro-enterology, rheumatology, immunology and venereology for starters, not to mention psychiatry, especially with regard to his daughter Lucia’s shizophrenia. The vastness of the medical influences and allusions in Joyce is daunting. My brief is to report on some impressions of Ulyssesthrough the eyes of someone at least partly familiar with the medical milieu of Dublin, having trained in Dublin in Obstetrics in the late nineteen sixties and early seventies at the Rotunda Hospital, more of which later.

To start at the beginning- in the opening scene in the Martello tower, Buck Mullligan mimics the tea lady, who presumably is famous for the strength of her brew:

‘When I makes tea, I makes tea, as old mother Grogan said,  and when I makes water I makes water’. ‘Begob ma’am’ says Mrs Cahill, ‘god send you don’t make them in the one pot.’

Apart from the joke, it seems that Joyce, besides being deeply interested in physiology in general, (he passes this trait on to Bloom) this extended to a fascination with the rather unusual topic of the acoustics of female micturition.In a letter of 1917, he related to a woman friend that one of his first moments of sexual arousal was provoked by the sound of his sister’s nanny urinating under a bush- although his eyesight might have been poor, there was nothing defective about his hearing (or his imagination). In the Sirens episode, he invites Poldy to muse on the same topic- :

Chamber music. Could make a kind of pun on that. It isa kind of music. I often thought that when she.

Acoustics that is. Tinkling.. Like those rhapsodies of Liszt’s. Hungarian, gypsy-eyed. Pearls. Drops. Rain.

Diddle iddle addle addle oodle oodle hiss.

Joyce’s first book of poems was titled Chamber Music. Was his curiosity physiology or fetish?

Physiology rears its head again (if you can excuse the awful pun) in the Cyclopsepisode, when the banter in Barney Kiernan’s pub turns to execution by hanging:

-There’s one thing it hasn’t a deterrent effect on, says Alf.

-What’s that? says Joe

-The poor bugger’s tool that’s being hanged, says Alf.

-That so? says Joe.

-God’s truth, says Alf. I heard that from the head warder that was in Kilmainham when they hanged Joe Brady, the Invincible. He told me when they cut him down after the drop it was standing up in their faces like a poker.

-ruling passion strong in death, says Joe, as someone said.

-That can be explained by science, says Bloom. It’s only a natural phenomenon, don’t you see, because on account of the …

And then he starts with his jawbreakers about phenomenon and science and this phenomenon and the other phenomenon.

and now in the style of a scholarly article from the Lancet of the day:

The distinguished scientist Herr Professor Luitpold Blumenduft tendered medical evidence to the effect that the instantaneous fracture of the cervical vertebrae and consequent scission of spinal cord would, according to the best approved traditions of medical science, be calculated to inevitably produce in the human subject a violent ganglionic stimulus of the nerve centres, causing the pores of the corpora cavernosa to rapidly dilate in such a way as to spontaneously facilitate the flow of blood to that part of the human anatomy known as the penis  or male organ resulting in the phenomenon which has been denominated by the faculty a morbid upwards and outwards philoprogenitive erection in articlulo mortis per dim in utionem capitis.

The fourteenth chapter Oxen of the Sun, is set in the National Maternity Hospital, Holles street Dublin, where Joyce takes on the role of the sleeves-rolled-up obstetrician, telling us all he knows about conception, pregnancy, childbirth and related matters. Joyce refers to the he hospital as the House of Horne – a Dr Andrew Horne was Master of the hospital in 1904. What a fine literary co-incidence, to have the Oxen episode set in the house of Horne! Leopold Bloom the weary wayfarer, calls in to the hospital to see how Mina Purefoy is progressing, because earlier in the day Josie Breen has told him that ‘she’s bad three days now’, and compassionate man that he is, he’s genuinely concerned for the welfare of his erstwhile neighbour Mina. Purefoy is an interesting name, Joyce would probably have chosen that name to acknowledge the Rotunda Hospital, the older (and at that stage more prestigious) maternity establishment across the river, where the Master was a Dr Purefoy!

Early on in this chapter, Joyce pays homage to the leading role that Ireland had played in the art and science of medicine in general, and maternity care in particular- as related in this passage in the style of the mediaeval Latin chronicles:

It is not why therefore we shall wonder if, as the best historians relate, among the Celts…. the art of medicine shall have been highly honoured.

Certainly .. a plan was by them adopted.. whereby maternity care was so far from all accident possibility removed, that whatever care the patient in that all hardest of woman hour chiefly required and not solely for the copiously opulent but also for her who not being sufficiently monied could scarcely subsist..and for an inconsiderable emolument was provided’ ….

and so on.

Through his wide interests, and perhaps especially through his medical studies, Joyce would have been well aware that Dublin had earned an early reputation for being a centre of excellence for midwifery and obstetrics. The Rotunda hospital was founded in 1745, as The Dublin Lying-in Hospital, the first purpose-built maternity hospital in Britain and Ireland. It was founded expressly as a charity hospital, according to its Charter, for the “poor Distressed women of Dublin“. Despite the appalling living conditions of the poorer classes (most of whom lived on the North side of the river), high standards of maternity care were introduced and maintained, and reductions in maternal mortality following the introduction of hand antiseptic washing by the obstetric and midwifery staff were recorded in Dublin even before Semelweiss in Vienna. In the early 19th century, the Rotunda became celebrated for having the lowest recorded maternal death rate from puerperal sepsis (childbirth fever) in Europe.

On entering the hospital, Bloom recognises a medical student, Dixon, who invites him into the students’ refectory, where they are making merry.  Bloom reluctantly goes in, and for the first time in the day, (it’s now ten at night), and after 500 pages of the novel, two of its main characters, the lonely Leopold and the sozzled Stephen, finally meet. We now hear (using the style of Middle English) that

the man that was come into the house then spoke to the nursing-woman and he asked her how it fared with the woman that lay there in childbed.

The nursing-woman answered him and said that that woman was in throes now three full days and that it would be a hard birth unneth to bear but that now in a little it would be.

She said thereto that she had seen many births of women but never was none so hard as was that woman’s birth. 

This was Mina’s twelfth or thirteenth child (the text is unclear) – in obstetrical parlance she would have been described a grand multipara. The great risk to the grand multipara is prolonged labour and no grand multipara would have or could have survived a labour of three days at that time for she would have sustained a ruptured uterus which would have killed both mother and child.  The moral of this story is don’t trust a novelist masquerading as an an obstetrician.

We next eavesdrop on the argy-bargy of these right witty scholars. Madden the medical student, recalls a case of the year before, where a maternal death occurred in the hospital, and ‘all cried with one acclaim that the wife should live and the babe to die.’

Joyce was prescient in raising this topic in the context of maternity care. Fast forward a century or so- many will be aware of the widespread publicity in Ireland which followed the death in Galway in 2012 of Savita Halappanavar. The death was deemed avoidable, judged to be the result of the reluctance of the medical and midwifery staff to intervene to save the mother’s life, on the grounds that such intervention would have directly or indirectly resulted in the death of the unborn baby. The public outcry was likely very influential in steering the national conscience away from the dictates of the pulpit, (as had happened many years before with contraception) and would have had a major influence on the outcome of the recent referendum which overturned the constitutional embargo on abortion by a massive 66% majority.

Leopold Bloom is in sombre mood, as the childbirth scene makes him cast his mind back eleven years to the birth of his son Rudy, who died aged eleven days, (probably from congenital heart disease), which Joyce portrays as having a devastating effect on their conjugal relationship, and on which later, Molly poignantly grieves in her soliloquy. The general attitude to the death of an infant in those times and for many decades afterwards, was to advise the parents to ‘get on with having a replacement baby’ which sounds callous now, but Joyce was clearly more aware of the sensitivities of the experience of miscarriage and perinatal death than was the standard medical view of his day. He had knowledge of the impact of infant death on the family, through his own mother May’s first pregnancy which resulted in a term still birth and possibly caused or aggravated her subsequent depressive illness. Furthermore, Nora suffered a late miscarriage (or possibly a stillbirth) in Trieste in 1908, the year following Lucia’s birth, which they both found deeply harrowing.

Returning to the students’ refectory, where the flamboyant Malachi Buck Mulligan joins the party, handing out business cards announcing ‘Mr Malachi Mulligan Fertiliser and Incubator’, stating that he had been led to this by consideration of the causes of sterility, including ‘conjugal vexations’, and declaring his intention to set up a national fertilising farm for infertile females, offering himself as the comprehensive solution to the problem, diagnosis and treatment, money no object. This proposal wonhearty eulogies from all present.

Again we see Joyce ahead of his time, in raising the topic of infertility. Although the problem of involuntary fertility was suffered passively and helplessly by the vast majority of married women, (‘poor Mina, a child a year’), the tragic problem of involuntary infertility, experienced by a significant minority, seems to have been largely ignored by the medical profession at the time. The first infertility clinic in Dublin was set up at the Rotunda in 1972, about which I have an amusing brief personal anecdote to tell you.

At this infertility clinic, one of the first investigations was to rule out the male factor, which in those days for ‘moral reasons’ could  only be undertaken by performing a post-coital test.

This involved asking women to present themselves for examination a few hours after ‘marital relations’. Such sensitive topics were considered controversial to say the least, if not totally out-of-bounds in the outpatients Department at the time, which was under the firm direction of a particularly starchy sister-in-charge, a sister O’Donnell (not her real name of course). Sister O’Donnell eyed these developments with a fair degree of suspicion, and possibly a touch of suppressed moral outrage. In this test, a specimen of mucus was aspirated from the cervical canal, and examined under the microscope for the presence of motile spermatozoa. Soon after the clinic was set up, I was the registrar, and was demonstrating the test to a medical student, who declared ‘that’s simply amazing’ (or words to that effect), just as Sister O’Donnell swept by, nose pointing firmly skywards. And what is it that’s so amazing? said Sister O’Donnell, and I invited her to take a look down the microscope.

What in the name of God is that? she exclaimed, and I explained to her that she was witnessing human spermatozoa vigorously migrating through receptive cervical mucus.

She took another look and murmured ‘Sweet suffering mother o’ Christ, but isn’t that DISGUSTING!’.

The conversation in the refectory continues, covering semi-educated debates on (amongst other things) in-utero twin rivalry, caesarean section, infanticide, congenital abnormalities, embryology, anaesthesia and twilight sleep, pregnancy after rape, sudden infant death syndrome and the determination of the sex of the offspring by the timing of intercourse.

One might wonder what Joyce is getting at here. My interpretation is that he has chosen (informed by his medical knowledge) a litany of contemporary controversial topics, and by introducing them into the bawdy environment of the student’s refectory, brings them to almost a layman’s level, which divests them of intellectualism and presents them as suitable topics for public debate.

At last the students hear that a bouncing baby has been born, the placenta is safely delivered and so, with Bloom and Stephen in tow, they all rush off to Burke’s pub before it closes.

It seems right that Molly has the last word, as she does in the closing episode, Penelope, where she describes her experience with a fashionable Dublin gynaecologist:

who knows is there anything the matter with my insides

or have I something growing in me

getting that thing like that every week

when was it last I?

Whit Monday, yes

its only about three weeks I ought to go to the doctor

only it would be like before I married him when I had that white thing coming from me

and Floey made me go to that dry old stick Dr Collins for womens diseases up on Pembroke road

your vaginahe called it

I suppose thats how he got all the gilt mirrors and carpets getting round those rich ones off Stephens green running up to him for every little fiddlefaddle

her vagina and her cochinchina they’ve money of course so they’re all right

I wouldn’t marry him not if he was the last man in the world ……

asking me if what I did had an offensive odour what did he want me to do…  what a question

if I smothered it all over his wrinkly old face for him with all my compriment I suppose he’d know then

and could you pass it easily pass what

I thought he was talking about the Rock of Gibraltar the way he put it…

still all the same paying him for that

how much is that doctor one guinea please

and asking me had I frequent omissions

where do those old fellows get all the words?…

with his shortsighted eyes on me cocked sideways I wouldn’t trust him too far to give me chloroform or God knows what else

still I liked him when he sat down to write the thing out

frowning so severe/ his nose intelligent like that..

Molly was clearly not terribly impressed  by the society gynaecologist, particularly by his obscure linguistic jargon.

In conclusion, this presentation just scratches the surface of the medical content of Ulysses, and barely ruptures the membranes of Joyce’s distended gestational sac, which full of obstetrical and gynaecological allusions. I hope you agree that these selections highlight Joyce’s deep interest in human physiology and disease in general and reproductive medicine in particular, which add to the rich complexity of his work, especially in Oxen of the Sun, all of this would surely have been stimulated and nourished by his time as a medical student in Dublin and Paris.

Selected source material:

James Joyce: Ulysses. The 1922 text. Oxford University Press 1998.

David Pritchard: James Joyce. Geddes and Grosset 2001.

Vike Martina Plock: Joyce, Medicine and Modernity. University Press of Florida. 2010.

Dr. James Forrester King

James King is a research obstetrician who trained at the Rotunda and who has been reading Joyce intensively since he was a teenager.

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