The Painted Veil
Authors: Peter Cross
Journal: BMJ (2007)

The British writer Somerset Maugham (1874-1965) began training to be a doctor at St Thomas's Hospital, London, but never completed his studies. Instead he was lured away from the profession by early literary success. His innate empathy and ability to get strangers to reveal intimate stories suggest that he had many qualities that would have made him a first class general practitioner or psychiatrist. As it was his training was not wasted as there are medical themes running through many of his stories. The Painted Veil is a fine example.

The couple at the centre of this bleak tale are hopelessly incompatible. Walter Vane, an intense bacteriologist, falls helplessly in love with Kitty, an impulsive beauty who agrees to marry him only to avoid the humiliation of attending her younger sister's wedding. The couple move to Hong Kong, where the bored Kitty embarks on a passionate affair with the assistant colonial secretary. Walter finds out and offers his bride an ultimatum: either she follows him to a rural outpost where he will be fighting a cholera epidemic or gets her lover to promise to divorce his wife and marry her. Her lover, Charlie Townsend, turns out to be a serial adulterer and has no intention of leaving his wife so Kitty, with nowhere else to go, follows her husband.

For a medical readership the story really takes off once the couple have relocated to a small Chinese community. The story is recounted through Kitty's eyes, who has little interest or understanding in her husband's role, which makes the restricted insights all the more tantalising. We get to feel what it is like to be married to a devoted doctor and scientist.

A visit to the local convent, which effectively acts as a hospice and an orphanage, changes everything. And it is through conversations with the nuns that Kitty starts to realise the importance of Walter's work and how much he is valued and respected by the patients, nuns, and children.

There are also harrowing scenes of how cholera affects its victims and the depressing effect on the rest of the community. This deadly disease might have been better understood in the 1920s than in John Snow's time, but once someone had been infected there was little that a physician could do.

To continue this account will only spoil the story for readers who have not read the book or seen the recent film staring Naomi Watts and Edward Norton. Few writers are better than Maugham at taking you back to the early 20th century and the exotic East of that period, and painting an Asian community, its convent, and the few British inhabitants so convincingly with a few deft brushstrokes. In this instance Maugham is able to call on his extensive travels through the Far East, his own experience of a loveless marriage, and his knowledge of medicine. 

What is remarkable about this tale—both the book and the film—is that you come away uplifted in both instances. The film makers have changed the ending, perhaps realising that modern cinema audiences haven't the stomach of Maugham's readers 80 years ago. The film is fantastic but the book is better. While this is a story of a doomed relationship I would contest that the setting of a cholera outbreak, and one man's heroic fight to contain it, makes this a medical classic.