You have failed me God … Come death. “Heavier the interval than the consummation”. I feel pain in every vein when I think of this line.1–,3

Embedded in this excerpt from Seán Ó Ríordáin's (1916–1977) 1951 dairy is the cathartic line from T.S. Eliot's verse drama Murder in the Cathedral, where main protagonist, Thomas Beckett, realises that the weight of his impending doom was far worse than the event itself. For Ó Ríordáin, an Irish language poet, it encapsulated his experience of his 13-year struggle with respiratory disease and tuberculosis (TB). A tormented soul, he found a plane of existence in his writing that kept him sane during the ennui of bedridden spells and in life's disappointments.

This article uses translations (from the original Irish) of his ego-documents to trace how illness came to dominate his life and paved the way for the recurrent themes of illness, isolation, mental anguish and death in his poems. In particular, it focuses on diaries 9a (1950) and 13 (1953–4), which represent periods of particular turmoil in Ó Ríordáin's life, and correspondence over a longer period (1936–1965) with his employers to emphasise the financial instability TB sufferers had to contend with. Readings of his employment records combined with his diaries show that fear of poverty and instability limited his marriage prospects and caused him much distress. Famed for a Hopkins-like style in his poetry, he broke with the traditional canons, and for this, he attracted praise and criticism in equal measure. In contrast with his poems, his diaries convey what his insightful biographer and close personal friend, Professor Séan Ó Coileáin, terms ‘Comhrá géar an leathbháis is na leathbheatha le chéile’—the sharp conversation of half-life and half-death together (p. 2),² or perhaps, Eliot's ‘Interval’.¹

Ó Ríordáin was a complex individual, a complexity exacerbated by his physical illness and his tendency towards depression, and he proves a difficult subject for analysis. Therefore, this article is confined to two major themes: being a TB sufferer in predrug therapy Ireland and his interaction with others. The first section outlines the social taints of being a ‘professional patient’ and the difficulties associated with maintaining full-time employment while battling with TB. The second section focuses on his relationships, how illness caused him to occupy a liminal space ‘idir chorp is anam’ [between body and soul] (p. 89)² and to retreat from life and love. It is against this backdrop that his poem Saoirse/Freedom can be understood as a culminating point in the self-imposed physical and emotional limitations he placed on his life because of TB. Translations of diary extracts are used literally to ‘give voice to the intentio of the original’ and may of course be interpreted in several different ways.4 In many ways his diary entries became therapeutic mediums where he honestly expressed intimate thoughts. This article contends that while difficulties associated with writing the history of the patient experience have bedevilled the history of medicine—being invariably drawn from medical records and therefore in the voice of the physician—the interdisciplinary nature of medical humanities, as Marshall and Bleakley have recently shown, offers some scope for redress.5 Furthermore, it aims to highlight how the richness of Irish language and literary sources might be mined for the purposes of research in medical humanities and in the social history of medicine.

Managing TB in Kyrie Eleison Ireland, 1908–1944

That Ireland was a source of particular global concern in epidemiological terms has been well documented by Greta Jones’ comprehensive history of TB in the nineteenth and twentieth century. Her work elucidates why the Irish epidemic lasted relatively longer than others (slowness to adopt vaccination coupled with poor socioeconomic conditions) and provides insights into the patient’s experience at the sanatorium (160–216).6 ,7 As a country of high outward migration, the Irish as a source of contagion have received a certain degree of consideration from scholars of transnationalism and history of medicine, but the day-to-day existence of those who bore the stigmata of the disease in Ireland has received little attention.8 ,9 This is partly due to the fact that the social ostracism experienced by sufferers facilitated the growth of a culture of silence in modern Ireland. Miasma myths associating TB with social class and poverty were slow to dissipate. Popular understandings of its aetiology were not helped by successive public health legislation that criminalised sufferers and their families in cases of underreporting. Furthermore, were it known that a member had fallen prey to TB, the marriage and employment prospects of the entire family could be jeopardised. Ó Ríordáin wrote of such social taints in a 1971 Irish Times article entitled Aicme Íseal [lower class]: “You and your people would hide it, lest they be put out of the area, or for fear none of your sisters would marry”.10 Even still, oral histories, as Susan Kelly has shown, have been difficult to collate.11 Two of Ireland's best-known TB sufferers include Dr Noel Browne (1915–1997) and Pulitzer Prize–winning author Frank McCourt (1930–2009). Browne was a controversial Minister for Health (1948–51) whose parents and brother died of TB while McCourt's biographical ‘miserable Irish childhood’ portrayed in Angela's Ashes described his personal experience of the disease.12 Despite accusations of inaccuracy in both cases, their autobiographical accounts reflect the pervasive and destructive power of TB in twentieth-century Ireland.

Using ego-documents to inform historical research is not without its torments; that the subject of this article is in living memory reinforces such ethical matters—it creates a certain unease as we trespass upon innermost thoughts that were not necessarily meant for public consumption. It could be argued that Ó Ríordáin, ever conscious of his mortality, penned his diaries mindful of their legacy: 30/6/54 Wednesday 11 pm, he wrote: “In case I die today I am writing a few words”.13 Ethical considerations notwithstanding, this article contends that—unlike Browne and McCourt's retrospective accounts—Ó Ríordáin's diaries that span 37 years offer us the rare opportunity of a concurrent account of a patient narrative in prepenicillin and postpenicillin contexts. In his poetry, he was open about being ill, with titles like Siollabadh/Syllable (pulse),14 An Leigheas/The medicine/cure,15 Fiabhras/Fever16 and Claustrophobia,17 conveying the symptoms, treatment and the ‘weight’ of pulmonary disease. By contrast, his diaries provide what was regarded by his friends and peers as shocking levels of emotion, honesty and poignancy that were never rendered to verse.

His openness about illness was necessarily selective; his application to the position of Junior Clerk in Cork City Hall dated 7 November 1936 (an English form) was completed in Irish and the section dealing with health was left blank.18 The chronology of illness is vaguely documented in his diaries. In January 1951, he claimed that it was 13 years since he first contracted TB.19 There is of course every possibility that he had TB prior to commencing work in January 1937 and was unaware, or perhaps, unwilling to admit it, for to do so would almost certainly condemn him to a lifetime of unemployment and impoverishment. The utter hopelessness of the condition cast a long shadow on Ó Ríordáin's family. In 1926, his father had succumbed to the disease, followed by two maternal uncles—a pattern that was common to many Irish families. Needless to add that his father's death altered the family's material circumstances in several ways. Perhaps more importantly for Ó Ríordáin as a poet of modern Ireland, it began a series of events that was to limit legitimacy to a ‘true-Irish’ identity through being born and reared until the age of 15 in the geo-spatially defined Irish-speaking or Gaeltacht area of Ballyvourney. Such legitimacy was not extended to those born in Galltacht, or English-speaking areas, whose knowledge of the language was acquired through rote learning in a state schooling system. The language revival and the conservation of the Gaeltacht areas had become integral to Irish identity in government policies (post-1922), but in Ballyvourney, which was located ‘on the edge of the two cultures’, it was in decline (p. 42).² Faced with a bleak future, his shrewd, English-speaking mother moved her fatherless and therefore ‘weak family’ closer to Cork city. At Inniscarra, she opened a shop; with the help of her two sisters (who later became duty of care to Ó Ríordáin) she purchased a house and thereby gave her three children access to better educational opportunities (p. 45).²

Filtering through Ó Ríordáin's poetry are strong discourses of displacement, belonging, masculinity and cultural nationalism—primary components of which were the position of the Irish language in the fledgling Freestate (established in 1922) and Catholicism. His most ardent critic, contemporary poet Máire Mhac an tSaoi (1922–), pointed repeatedly to what she regarded as his Achilles heel, an alleged lack of competency in the Irish language and his use of what she termed an Irish ‘Esperanto’ (p. 241).² 20 Professional differences aside, Ó Coileáin noted how her ethnocentric criticism crushed his already low confidence. Aware of this weakness, he made several trips to the true-Gaeltacht area of Dunquin in West Kerry, where ‘pure’ Irish was spoken, to perfect his command. Nonetheless, three volumes of poetry, Eireball Spideóige [the Robin's Tail] (1952), Brosna [Kindling] (1964) and Línte Limbó [Lines from Limbo] (1971), together with the regular publication of individual poems and prizes, earned him during his lifetime a well-deserved place in the canon of modern Irish poetry.

When he was first confined at Heatherside sanitorium on 1 April 1938, treatment was limited to observation, quarantine and Kyrie Eleison—there was ‘no mention of streptomycin’ (p. 89).² Ó Ríordáin was approved by the County Cork TB Committee (CCTBC) as a ‘non-insured’ patient in March 1938.21 The records of the committee show that unlike other patients, he was not approved for X-ray, surgery or any kind of medical intervention save observation. Being physically weak he refused to do the daily exercises central to the ‘fresh air regimen’ and this caused some friction between him and the resident physician. It is more than likely that he was the same J O'R, Inniscarra, who availed of a transportation allowance of £3 10s that was approved by the CCTBC on 19 December 1938, at which point, 31 patients were recorded at Heatherside.22 In Aicme Íseal, he likened Sanatoria to prison camps, but later admitted that it was because of his illness that his creativity blossomed. Late in life he commented that with respect to the writing of poetry: “Is dóigh liom go mba mhó an chabhair dom an chéim TB ná an chéim BA” [I think that my bout of TB was a far better help to me than a BA degree]—nota bene céim is both the Irish for bout and degree (p. 91).² He was recommended for readmission in February 1939 to Heatherside as a non-insured or pauper patient.23 It appears he had problems with ‘bio-power’ or the official management of TB. It is perhaps due to high levels of bio-surveillance that he had an acrimonious relationship with his line and City Manager, Philip Monaghan, who always wrote to him in English and called him John O'Riordan. Monaghan also chaired the various Cork city and county TB committees.24 The letters exchanged between them indicate just how difficult it was for him to hold down a full-time job while labouring under disease. For financial reasons, he regularly compromised his health and that of others with early returns to work. He wrote to Conchubhair, his maternal uncle and godfather (p. 24, 27):² “Before I left the office yesterday I felt unwell, feverish. When I reached home the usual bleeding started. It is not too bad and I ought to be over tomorrow. I will probably be able to go back by Friday … I am being looked after today by a neighbour who will post this. No need for any of you to call on me. In fact it would be better not to, because the least excitement sets it off again”.25 This cavalier attitude extended to recovery periods when he wilfully neglected his health through excessive drinking. Ó Coileáin maintained that he conducted his ‘benders’ in Ballingeary in West Cork, some distance from his other lives as a son in Inniscarra, a patient in Heatherside and as a ‘Halla man’ (Halla na Cathrach/City Hall, pun on T.S. Eliot's The Hollow Men) in Cork City (p. 91).² Central to his recovery and remission periods was his mother's support and the ‘lean to’ constructed for him in the back garden of their modest home. Such risks taken by families on the part of loved ones spared indefinite periods in remotely located sanatoria, where mild and advanced cases could be confined.26

Employment matters weighed heavily on the impoverished Ó Ríordáin, who wrote on 7 September 1944, “I am going to work in an office Monday. There is no welcome for me. Who cares. My mind is getting old and sleepy. I hope the change in life will waken it. All the same I am anxious. My body is wounded. If I could only buy a new body” (p. 65).² In monetary terms he was absent on full pay from March 1938 to August 1938, from then until March 1939 he was on half pay and from March 1939 until May 1940 he received no payment. His absences from October 1940 to June 1941 amounted to weeks at a time, but October 1941 to October 1944 was marred by consistent ill-health and absenteeism on a sliding sick pay; from October 1942 to August 1944 no pay was received.27 This influenced his entitlement to incremental pay in July 1946, which, Monaghan was careful to point out, was contingent on satisfactory performance in the previous 12 months.28

Persistent demands for documentation at work violated what little medical confidentiality he had. He stopped using Heatherside in 1950 and after that he appears to have had a better relationship with a number of doctors to whom he refers by name in his correspondence with his employer and with respect to medical appointments in his diaries. In a letter written to Monaghan in April 1950, he indicated that he was heeding the advice of Dr Hickey, who advised him not to return to work before June.29 About then a second opinion was sought in May 1950; this time, Assistant County Council Medical Officer Dr Ó Briain, wrote how he was unfit for duty. Another physician, Dr Andrew Whelton, wrote how his ‘fibrosis’ rendered him unfit for work in May 1951. Several letters were exchanged with Monaghan in 1952 and 1953 about increments and entitlements.30

His fractious relationship with his employer reached a crisis in February 1954 when his bi-monthly salary was unpaid. Monaghan noted that he was unpaid because he had not presented himself for work on a particular date, which later transpired to be a Sunday, and because “the amount of sick leave you have taken is very very great”.31 Like Franz Kafka and Brian O'Nolan (who wrote under the pseudonym Flann O'Brien) he felt his job limited his creativity. Juxtaposed with his disdain for his job was a sense of low professional esteem that rendered him unable to commit fulltime to poetry: “Leave that office, if you are a poet, if you have a profession let it go … there is no use in having free time at home in the midst of returning to the office, because the mind is not clear. But now under my work prison I have no desire to be on a definite road … they are threatening you now. Enemies all of them. They have a hold over you for as long as you have ties to them”.32 A subsequent letter noted how his accumulated sick leave exceeded 365 days in a 4-year period and that this was in contravention of the 1943 Local Government (Officers) regulations.33 Ó Ríordáin appealed the decision and wrote to the Minister for Local Government outlining the amount of leave taken and how the employment dispute caused him to return to work in mid-February against his doctor's advice.34 The Department of Local Government encouraged Monaghan to revisit the matter.35 Instead Monaghan tried to create ‘an unfavourable record’ against Ó Ríordáin arguing that his claim was ‘expressed in offensive terms’ and that he had informed the Minister.36 Incensed, Ó Ríordáin made an appeal under Section 10 of the Local Government Act 1941 to acquit him of charges and ‘cancel the unfavourable record’.37 The distress was recorded as follows in his diary on 30/6/54 Wednesday 11pm: “A poisonous enemy is fighting me at present … I am not better now … bloody spit in the evening when I come home from work. I am sick of myself and I have a bad taste in my mouth. Maybe it is death”.38 The Department encouraged Monaghan to make an exception citing how a 1952 circular permitted a one-off 6-month grace period to TB sufferers in the civil service and with his 10 years pensionable service that the rules should be retrospectively applied. Monaghan wasted no time in responding to say no.39 The matter was finally resolved in February 1955 when the Department overruled Monaghan; it should be noted that by this point Ó Ríordáin was an established and well-respected poet.40 Further certified absences for bouts of bronchitis followed in October 1956, 1960 and 1961. In March 1963, it was noted that he had taken 146 days sick leave in the preceding 4 years. By then Monaghan was replaced by the more compassionate Walter MacEvilly. In May 1965, Dr O’Connor wrote a letter detailing why he believed he should be recommended for early retirement on the following medical grounds “suffering from advanced bilateral fibroses of the lungs as a result of previous bilateral Pulmonary Tuberculosis”.41 On receipt of further medical clarification, his resignation was accepted and his full pension was granted.

Relationships

Notable devices used in his diaries are the categories of public and private in which he placed the male and female characters in his life, for instance, his love is not named directly nor is the woman he suspects loves him unrequitedly.42 Academic and literary friends like Seán Ó Tuama and several priests and brothers are named in full, while references to writers like W.B. Yeats, Nietzsche, Freud, Hardy, Day-Lewis, Eliot and St Augustine, among others, are peppered throughout, giving us a sense of how well-read he was but also conveying the fact that those who placed themselves in the public eye were to his mind ‘fair game’.

Narratives of loneliness and depression are strong in his diaries, but paradoxically he negotiated what company he kept. For several practical, emotional and intellectual reasons, Ó Ríordáin limited his interaction with others to such an extent that being ‘I measc na daoine’ or among the people was a planned, measured and concerted affair involving physical exertion and psychological priming. Saoirse/Freedom portrays the extent of his retreat and was written in 1950 at one of the happiest times in his life; he had started his first course of streptomycin in July, he was in love and his diaries were filled with day trips with ‘C’. Ó Coileáin has shown it was composed in one evening 4 days after Dr Ó Briain had given him medical dispensation to marry.43

Saoirse/Freedom,44⇓

In this poem of 18 verses, there are several wonderful examples of the ‘Irish Esperanto’ that Máire Mhac an tSaoi had such difficulties with, for instance, verse 6 line 1 scillingsmaointe is a coined word from the Irish for shilling and smaointe/thoughts, which Paul Muldoon translates as two cents.45 Despite the fact that ‘C’ had indicated her willingness to go to Switzerland with him for treatment and to marry him, he could not bring himself to subject her to his unstable health and income.46 There is no sense that ‘C’ was fearful of any eugenic implications but he clearly was: “She said again last night that she was happy to marry me. What will I do in the name of God? I have the disease in me still. Would it be fair?”47 His hesitancy cost him dearly a week or so later he wrote: “It is a pity I placed trust in a woman. Disaster on Saturday. Drink. I was blind drunk. I nearly killed myself”.48 A candle is a lonely thing. Lonely is the light it emits. But friendly is the light of radio light in the darkness. But the Lee outside is snoring. It is a pity that a woman took the rhythm out of the river and out of the radio and out of the candle come to me St Augustine.49

Unfortunately his relationship with ‘C’ did not endure; he spiralled into depression and he retreated from the world that he had little in common with. Again Ó Ríordáin took solace in his diary, if only to make reason of his decision.50 Although he vowed not to be like William Butler Yeats (and his unrequited love for Maud Gonne), he continued to agonise over who she kept company with. His stream of consciousness was often interrupted by thoughts of her with someone else: “It is a terrible thing to think of her and the fruit of another man inside her. That is an insufferable thought”.51 In trying to explain his failure to commit to her he would later blame his useless body: “It is not within my capability to be a MAN. Is that it. LACK [of] MASCULINITY”.52 His decaying body caused him to view his male friends in a jealous light. Without the shackles of disease they were free to love, live and prosper. Envy of healthy and happy people bore heavily on his conscience: “Sean Ó Tuama came in this morning. He was looking healthy and good looking. Marriage is suiting him it seems. I will not write anymore. … I am a bad person without any doubt … I am a real bad person”.53 A few months after he had lost in love, his neighbour Neilo, a regular caller, announced how he had purchased a farm, thus giving him the status and ability to pursue marriage if he wished. Again Ó Ríordáin agonised over his envy: “I am a bad type. I am person of no good, no will, no honesty, no holiness, no health, no money ten pounds left. That is all. And Neilo just bought a farm for £400”.3

Ó Ríordáin's attitudes towards life and death were heavily conditioned by his Catholic upbringing, and while he questioned God, he remained devout to the rituals of confession—which gave the grace to die well—and to the rosary so the Blessed Virgin Mary could intercede for him in life and in death.54 In many respects he was ‘killing the days’ and while he was not suicidal he certainly yearned for death to come (p. 79).² He lived for a very long time with a disease that invariably took people in their youth and he struggled with the ‘half-life’ as a result (p. 2).² His retreat from humanity and his reclusive phases can be traced to his illness that entrenched an Oedipal relationship with his mother. This has been the subject of analysis by scholars of Irish literature especially in the context of ‘Adhlacadh mo mháthar’ (My mother’s burial, published in 1952 and regarded as one of the most important poems in modern Irish). They lived together in Inniscarra until her death in January 1945, she waited on him faithfully and was ‘An lámh a bhí mar bhalsam is tú tinn’ [the hand that was a balm when you were sick].55 So distraught was he on her death and on the hopelessness of his health that he abandoned his diary from August 1944 until 1946.56

After his mother passed away and his relationship with ‘C’ ended, his country home seemed all the more remote: “3 pm I am going to get out of bed now. Maybe someone will come to me from Cork. When God will not help why doesn't the devil come to help me? 5.35 pm No devil came to help me.”57 The following day he wrote: “There is no wonder that I am going out of my mind here. Nobody speaks to me from morning to night. And my poor aunt I verge on hating her sometimes. I never cry and I am never sad. This story is gone well beyond sadness and weeping. … I will not write anymore. My mind is too-horrible tonight, and my poor mother died in this room. The grace of God that was in the room that night that is something there is not now. I remember the cold mouth I kissed the day of the funeral. Control—a grasp. I am a bad person without any doubt … I am a real bad person”.49 When his aunts retired, they came to live with him in Iniscarra, as was their right. He later confessed that all three occupied separate rooms, lived separate lives and all of them were lonely (p. 278).² Although his aunts helped to provide the stability of a home to his mother, he rejected emotional responsibilities towards them; instead he filled his solitary confinement with radio plays. Despite having several fond friends in Cork City he chose to dine alone on medical appointment or confession days58 and often felt that he was no company to the world: “I was a miserable loner around the city”.53

Drug therapy was introduced to patients at Heatherside in 1944, and it became part of the national treatment programme in 1951 (p. 231).⁵ His Heatherside physician believed it was not effective for ‘old wounds’ and thus he was slow to administer it to Ó Ríordáin despite the fact that others who had the disease for as long as him were placed on courses (p. 110).² Had it been administered, it may have eased some of his long-term suffering and perhaps changed the course of his life. Ó Ríordáin never forgave the doctor in question for his reticence. Years later the same doctor attempted to congratulate him in a crowded shop on receipt of an honorary D. Litt. from the National University of Ireland. Twenty-five years of pent-up ire was unleashed on the misfortunate doctor, who scurried away after Ó Ríordáin shouted “F… off, you F…ker” (p. 111).² He spent several periods in Heatherside, which amounted to nothing more than quarantine and bed rest; from July 1950 he paid privately for his care. Although it was a place of mixed emotions for him, it was where his creativity first emerged; there he had the company of fellow-sufferers and he did not have to worry about being ‘i measc na ndaoine’ [among people]. Ó Ríordáin agonised over relationships and interactions with others but the paradox was that it was in solitude—occasioned initially by his disease and self-imposed thereafter—that gave rise to his best work.