Abstract
W Somerset Maugham. Liza of Lambeth. London: T Fisher Unwin, 1897 (Penguin Classics 1992)
William Somerset Maugham is best known, nowadays, for his semi-autobiographical novel Of Human Bondage and for his short stories such as Rain. For me, though, Liza of Lambeth – his debut novel published in 1897 – is his masterpiece and one that should be widely read, including by all medical students. 1
Maugham wrote Liza of Lambeth when he was a medical student at St Thomas’ Hospital, London. It was based on his experiences as an ‘obstetric clerk’, which involved him attending women in labour, in their own homes, in Lambeth. He later described how he delivered 61 babies over a three-week period!
Liza of Lambeth is the story of a vivacious and beautiful 18-year-old girl, Liza Kemp, who lives with her widowed mother in a fictitious working class street just off Westminster Bridge. Liza works at a local factory and has an admirer, Tom, whom she does not love and whose offer of marriage she rejects. Instead, Liza falls for a married man, Jim Blakeston, who has recently arrived in the same street. Not only is Jim more than 20 years older than Liza but also he has nine children as well as a pregnant wife. Liza becomes pregnant as a result of her liaison with Jim and dies from a miscarriage.
Liza of Lambeth is in many ways a simple tragedy but it has a special resonance for me and, I would hope, for others. First, it is beautifully written. It is not entirely easy to read because the dialogue is written in cockney. Nevertheless, it uses simple but evocative language to describe the tragedy that befalls Liza Kemp.
Secondly, Liza of Lambeth provides medical students with the opportunity to start to understand the real lives of their patients. Becoming a good doctor has two components. Students need to learn about the nature of the diseases they are likely to encounter. They have to learn how to take histories from patients, how to examine them and how to draw appropriate conclusions about diagnosis and treatment. These though are the easy parts. What is much more difficult is learning about patients as real people. How do they live their daily lives? What hopes and fears do they have for themselves and their families? And what effect is their illness having on them both as individuals and as members of their communities?
Maugham describes the highs and lows of working class life in vivid detail. He writes about the pleasure from a walk in the local park, the excitement of going on a coach trip and the drowning of sorrows in the local public house.
Liza of Lambeth also reminds us of the miseries experienced by working class people at the end of the 19th century. Wife beating was nearly universal. Childbirth was almost an annual event for most married women and families with eight to 10 children were commonplace. And both maternal and infant mortality rates were dreadful by modern standards. As Liza lies dying, Mrs Hodges the midwife attending her says to her mother: ‘I’ve been very unfortunate of lite; this mikes the second death I’ve ‘ad in the last ten days – women, I mean, of course I don’t count the bibies’. Mrs Hodges then goes on: ‘The other one – well, she was only a prostitute, so it didn’t matter so much. It ain’t like another woman, is it?’
Thirdly – and perhaps provocatively – Liza of Lambeth should remind medical students that there can be an alternative life beyond medicine. Maugham himself graduated as a doctor but never practised. Instead, he became an accomplished and successful playwright as well as the author of numerous books and short stories. A few of my own medical school contemporaries, from the 1960s, also had successful careers outside of medicine after graduating. They include Michael O’Donnell (writing and broadcasting) and Jeffrey Tate (conducting) as well as friends who managed to combine successful careers in medicine with equally successful careers as entertainers (Alan Maryon-Davies). So for some medical students, medical school is a starting point for successful careers beyond the call of medical practice. And they should not be ashamed or embarrassed by such a change in the direction of their careers.
In later life, Maugham wrote: ‘Most people cannot see anything, but I can see what is in front of my nose with extreme clearness; the greatest writers can see through a brick wall. My vision is not so penetrating’. 2 He was wrong. In Liza of Lambeth, he saw through, and beyond, the brick wall with utter clarity.