By W. Somerset Maugham (1874-1965)
A Study Guide
Cummings Guides Home..|..Contact This Site
Type of Work
Point of View
Plot Summary
Maugham's Writing
Study Questions
Writing Topics
Biography of Maugham
Complete Text
Index of Study Guides
Study Guide Prepared by Michael J. Cummings...© 2011

Type of Work

......."Sanatorium" is a short story centering on tuberculosis patients. It first appeared in  Cosmopolitan magazine in the issue of December 1938. 

.......The setting is a tuberculosis sanatorium (also spelled sanitarium) on a hilltop in northern Scotland. The action begins in the winter and ends in the spring. 


Ashenden: Newcomer to the sanatorium. The third-person narrator tells the story from his perspective.
Mr. McLeod: Patient who has stayed at the sanatorium longer than anyone else—seventeen years. He despises Mr. Campbell, although he dines and plays bridge with him. 
Mr. Campbell: Patient who has stayed at the sanatorium longer than anyone else except McLeod. He despises McLeod as much as McLeod despises him. 
Dr. Lennox: Physician in charge at the sanatorium. The narrator says he is "small, brisk, and genial" and that he is a good doctor and businessman, as well as an avid fisherman.
Major George Templeton: Patient in his early forties who falls in love with another patient, Ivy Bishop. He was a wealthy playboy before he became ill.
Ivy Bishop: Pretty woman, age twenty-nine, who agrees to marry Templeton.
Henry Chester: Accountant in his thirties who obsesses about his health and mistreats his wife when she comes to visit him at the sanatorium.
Mrs. Chester: Wife of Chester. She is a pleasant woman and a good mother to her two children.
Old General: Dining companion of McLeod, Campbell, and Miss Atkin.
Miss Atkin: Middle-aged spinster, honorary librarian, and gossip.
Old Indian Civilian: Onetime ruler of a province in India. He has been at the sanatorium longer than anyone else except McLeod and Campbell.
Navy Sub-Lieutenant: Pleasant twenty-year-old who dies a few months after arriving at the sanatorium.

Point of View

.......Maugham tells the story in omniscient third-person point of view, enabling the narrator to reveal the thoughts of the characters. The narrator tells the story from Ashenden's perspective as a new patient getting to know the other residents at the sanatorium.


.......In writing "Sanatorium," Maugham, a physician, drew upon his own knowledge of tuberculosis. He also drew upon his own experiences as a patient at a Scottish sanatorium after serving in the British intelligence service in Russia in 1916 and 1917. He spent a year in the sanatorium.

Plot Summary
By Michael J. Cummings

.......After contracting tuberculosis, Ashenden travels to a sanatorium on a hilltop in Scotland for treatment and rest. He has been told that he can recuperate if he takes good care of himself. He lies in bed for six weeks before the doctor allows him, with the help of a nurse, to go down to the veranda for some sun. He is heavily wrapped, for it is mid-winter. He and other patients lie on deck chairs as they look out upon the snow-covered countryside.
.......The nurse introduces him to a gaunt man in the next chair, Mr. McLeod, who has been a patient in the sanatorium longer than anyone else. Lounging on the other side of Ashenden is a pretty girl with red hair and a thin face. 
.......McLeod strikes up a conversation with Ashenden, saying he has the best room in the place. Another man, Mr. Campbell, covets the room, he notes. But McLeod says he has a right to it, for he has been a patient for seventeen years compared to Campbell's sixteen-and-a-half. Although McLeod used to leave the sanatorium in the summer to visit friends and relatives, he now remains there.
"I’ve got a brother and two sisters," he says, "but . . . they’ve got families; they don’t want me. . . . Your pals have gone their own ways and you’ve got nothing in common with them any more . . .  No, one’s better off here."
.......McLeod says he spends a good deal of the day coping with his disease—taking his temperature, weighing himself, resting. He also plays bridge, goes for walks, and mingles with other patients, who "come and go"—either as cured patients or as corpses.
.......The redhead breaks into the conversation, saying McLeod gets a good laugh out of seeing a hearse. McLeod says, "Well, I’m just as glad it’s him and not me they’re taking for a ride."
.......McLeod then introduces Ashenden to the girl: Miss Ivy Bishop, a twenty-nine-year-old Englishwoman who has resided at the sanatorium for two years. Previously, she had spent six years in other sanatoriums in Switzerland and England. The sanatorium's physician, Dr. Lennox, has told her she may be able to go home in a few months.
.......When a Major George Templeton comes by leaning on a cane, Miss Bishop says she is happy to see him up and around again. Templeton—tall, somewhat handsome, and in his early forties—then suffers a coughing spell. When he recovers, he blames his smoking habit, which he says he cannot shake. He asks Miss Bishop to go for a walk with him, and she obliges. McLeod says, "I wonder if there's anything between those two." Templeton was reputed to be a ladies' man before becoming ill. 
.......Ashenden says Templeton does not now appear to be up to the task of wooing ladies. McLeod says, however, that a lot of romancing does go on at the sanatorium. For example, he says, "there was a woman here who was pretty hot stuff." Her husband visited her often, but Dr. Lennox suspected she was having an affair with another patient. One night, after everyone had retired, Lennox had a thin coat of paint applied to the floor outside her room. The following day, he found paint on the bottom of the slippers of a male patient. Lennox got rid of him. 
......."He doesn't want the place to get a bad name," McLeod says. 
.......McLeod says Ivy Bishop would be foolish to fall for Templeton, for she will probably get well soon. Templeton, on the other hand, appears to be very ill and, according to McLeod, may not last more than a few years.
.......A nurse takes Ashendon back to bed. Dr. Lennox comes in and, after looking at his temperature chart, says, "That's not so bad."
.......Lennox is a good doctor. When he asks Ashendon whether he has met any patients, Ashendon mentions McLeod. The doctor, laughing, says McLeod knows everything about everybody, including all the scandal. He says McLeod and Campbell despise each other and complain often about each other. Campbell, who lives in a room beneath McLeod's, irritates McLeod by playing his fiddle for hours at a time. Campbell hopes to drive McLeod out of his room so he can move into it.
.......Oddly, the two men play bridge together and eat together—but not without eventually arguing. Sometimes, the doctor threatens to expel them, and their behavior changes for a few days. They regard the sanatorium as their home and don't want to leave it. They have no one to turn to elsewhere.
.......Now well enough to eat in the dining room, Ashenden surveys his fellow diners when he eats there the first time. They are young, old, and middle-aged. Some had been there for a year. Others are newcomers like Ashenden. One middle-aged woman, Miss Atkin, resides at the sanatorium in the winter but stays with relatives and friends in the summer. She returns to the sanatorium each winter because she likes it there and has standing as an honorary librarian. She is a gossip. But Dr. Lennox benefits from her stories because they contain information about the condition of the patients. She sits at the table with McLeod, Campbell, and an old general. 
.......When Ashenden meets the ill-tempered Campbell, the newcomer notices how thin he is and wonders how he manages to hold himself together.
.......“Are you fond of music?” Campbell asks him. 
.......When Ashenden says he is, Campbell invites him to his room to hear him play. McLeod warns that Campbell plays badly, but Miss Atkin says he plays “very nicely.” Campbell does not forget McLeod's criticism. All afternoon, he plays the same song again and again. McLeod complains, but it does no good.
.......When dining, Ashenden sits with Miss Bishop, Templeton, and a London accountant named Henry Chester, who is in his thirties. Chester is a small but stocky man with broad shoulders. He has a wife, two children, a nice home, and a good income. It was a shock to Chester when he learned that he had TB. The doctor told him he might be able to return to work in two years. But at the beginning of his third year at the sanatorium, Lennox told him that the disease was still active and that he would have stay for at least another year. 
.......Because Chester is not interested in reading and has no hobbies, he concentrates on his disease. He used to check his temperature so many times that the staff had to take the thermometer away from him. He is cheerful and friendly when talking with other patients. But the moment he is alone with his thoughts, his mind returns to his disease and the possibility of dying. His wife visits him two days a month. She is a pleasant woman, and one can tell she is a good mother. When Ashenden is alone with her, they take a walk. She asks his opinion of her husband's condition, and Ashenden says he seems to be getting along well enough. Then she begins crying, saying her husband is beginning to hate her. Trying to comfort her, Ashenden says her husband talks about her all the time and thinks highly of her.
.......“Yes, that's when I'm not here," she says. "It's when I'm here, when he sees me well and strong, that it comes over him. You see, he resents it so terribly that he's ill and I'm well. He's afraid he's going to die and he hates me because I'm going to live . . . He complains that I treat him as if he didn't count any more.”
.......As the days pass, Ashenden makes friends with a new patient, a handsome twenty-year-old who was a sub-lieutenant on a submarine. He is a cheerful fellow who enjoys discussing movie stars and musical shows and likes to read the sports section of the newspaper. One day, he is confined to bed and, two months later, dies. A cloud hangs over the sanatorium for a few days before everything returns to normal. 
.......Over time, Ashenden becomes a good friend of Templeton, who had served in the Grenadier Guards during the war and resigned after the armistice. He likes good food and drink, sporting activities, and the London social life. He has plenty of money and lost and won large amounts at Monte Carlo. Generally, he treats others courteously and kindly. Templeton is dying. But he accepts his fate, saying he had a good time while it lasted. In a way, he is grateful for living as long as he has, for he could have died in the war.
.......Women like him, according to his stories, and he has had numerous affairs—his latest with Ivy Bishop. She herself has had many affairs and wants to limit her relationship with Templeton to just that, an affair. Ashenden detects, however, that Templeton wants more than an affair. His feelings for her are deepening. Ivy's mother and sisters do not pay much attention to her. They write to her and visit her on occasion, but it is clear that they are caught up in their own lives. 
.......Ivy shows an interest in the welfare of other patients, and one day tries to cheer up Mr. Chester by noting that it is the end of the month—the time his wife visits. But Chester says she will not be coming. He says it was Lennox's idea for her to stay away. However, in a conversation with Ashenden the next day, Chester admits that he asked her to stay away in a letter Dr. Lennox wrote for him.
.......""I spend the whole month looking forward to her coming and then when she's here I hate her," he says. "You see, I resent so awfully having this filthy disease.”
 Ashenden says, “Aren't you afraid you'll make her very unhappy, not letting her come?”
.......“I've got enough with my own unhappiness without bothering with hers,” Chester says. “It's all very well for you to be disinterested and unselfish, you're going to live. I'm going to die. . . . Why should I? It's not fair.”
.......Meanwhile, everyone eventually becomes aware that Templeton loves Ivy. But no one is sure whether Ivy loves Templeton. When people try to get her to reveal her feelings, she cleverly evades their questions. McLeod disapproves of their relationship. Since they both have TB, he says, “nothing can come of it.” Campbell, on the other hand, says they ought to make the most of their relationship. Templeton confides to Ashenden that he would marry Ivy immediately if he could, saying she is so unlike other women he's known. What is it about her that's gotten to him? 
.......“Virtue," he says. "Last thing I've ever wanted in a woman. But there it is . . . she's good, and it makes me feel like a worm.”
.......He has not made his feelings known to her, however, because he could be dead in six months.
.......One March day Ashenden plays bridge as McLeod's partner against Campbell and Templeton. It is a hotly contested game, and a small crowd gathers around to watch. McLeod plays brilliantly and wins.
.......“Play that off on your blasted fiddle,” he shouts. “Grand slam doubled and redoubled. I've wanted to get it all my life and now I've got it. By God. By God.”
.......Then he falls across the table, blood coming from his mouth. He is dead. Two days later, he is buried. A relative from Glasgow attends. Because he was not well liked, he is apparently forgotten by most of the residents. Not Ivy, though. “She cried her eyes out,” Ashenden tells Dr. Lennox. A patient from India gets McLeod's place at the table, and Campbell moves into McLeod's room. 
.......But Campbell is not himself. He won't play bridge or talk to anyone. He decides to move back into his old room, but Lennox won't let him. After all, the doctor says, Campbell had been trying to get that room for years. Either he stays there or leaves the sanatorium. Campbell stays—and merely exists from day to day. He doesn't even play his violin. Ashenden knows the time is not far off when he too will die.
.......Ashenden is recovering nicely and will soon be leaving the sanatorium. Templeton is not so lucky.
.......“The death-look was on his face,” Ashenden says. Nevertheless, Templeton tells Ashenden that he has asked Ivy to marry him. Ivy told him it was a ridiculous idea—but assented to the marriage.
.......Ivy and Templeton see Dr. Lennox to ask his opinion. His tests indicate that Ivy can withstand the strain of marriage if she does not unduly stress herself and does not have children. The doctor says Templeton can last two or three years if he does not marry—but only about six months if he does.
.......At lunch, Templeton and Ivy announce their plans. Ivy tells Chester she would like his wife to attend the ceremony. After a pause, he says he will write and ask her. Dr. Lennox will be giving the bride away. The the residents are impressed when they hear that Templeton is willing to shorten his life for the love of Ivy. Everyone adopts a spirit of good will. Even people who hadn't spoken to one another in a long time are speaking again.
.......Mrs. Chester arrives two days before the wedding. Mr. Chester does his best to be the good-natured fellow he probably was before coming to the sanatorium. On the day of the ceremony, Ashenden stands as best man. Everyone who is not bedridden attends the ceremony. After lunch, the newlyweds leave in a car while the patients and staff see them off. Afterward, Chester takes his wife's hand and apologizes for treating her poorly on her previous visits.
.......“All this about Templeton and Ivy Bishop—I don't know how to put it, it's made me see everything differently," Chester says. "I don't mind dying any more. I don't think death's very important, not so important as love. And I want you to live and be happy.”


.......The climax occurs when McLeod falls across the bridge table and dies. His death upsets Ivy, who “cried her eyes out,” and Campbell, who lost his savor for life. McLeod's passing also caused Templeton to review his life and tell Ashenden, “D'you know what I've done? I've asked Ivy to marry me.” Ivy later asks Mr. Chester to invite his wife to her and Templeton's wedding. He assents and later reconciles with his wife. Other patients do not mourn McLeod's death, for they did not like him. Perhaps they missed an opportunity to demonstrate love and concern.


The Importance of Love

.......The main theme of “Sanatorium” is that love is more important than long life. Mr. Chester learns this lesson through the example set by others. He tells his wife, 

I wanted you to suffer because I was suffering. But not any more. All this about Templeton and Ivy Bishop—I don't know how to put it, it's made me see everything differently. I don't mind dying any more. I don't think death's very important, not so important as love. And I want you to live and be happy. I don't grudge you anything any more and I don't resent anything. I'm glad now it's me that must die and not you. I wish for you everything that's good in the world. I love you.
.......George Templeton learns the same lesson. Before his affliction sent him to the sanatorium, he was a playboy. He wanted no commitments. Marriage was out. But after meeting Ivy Bishop at the sanatorium, he falls genuinely in love with her and marries her even though he knows the marriage will shorten his life.

The Importance of Friendship

.......Campbell and McLeod, sworn enemies, are forever trying to nettle each other. Yet they regularly eat at the same table and play bridge together. To be sure, they argue with each other and shout at each other at the dining and gaming table. Nevertheless, they continue to spend a good deal of time in each other's company. The fact is, they need each other; deep down, they are friends. Not until McLeod dies does Campbell fully realize how important McLeod was to him. 

Preoccupation With Death

.......Death stalks the patients at the sanatorium. Although many of them try to ignore it or push it to the far reaches of their minds, it manages to become a constant presence in their lives. The narrator says,

[T]he idea of death haunts the subconscious [of the patients]. It is a sardonic theme song that runs through a sprightly operetta. Now and again the gay, melodious arias, the dance measures, deviate strangely into tragic strains that throb menacingly down the nerves; the petty interests of every day, the small jealousies and trivial concerns are as nothing; pity and terror make the heart on a sudden stand still and the awfulness of death broods as the silence that precedes a tropical storm broods over the tropical jungle.
.......Henry Chester is among those preoccupied with the possibility of dying, even to the point that he resents his wife because she is healthy and he is not. Mrs. Chester tells Ashenden,
[H]e resents it so terribly that he's ill and I'm well. He's afraid he's going to die and he hates me because I'm going to live. I have to be on my guard all the time; almost everything I say, if I speak of the children, if I speak of the future, exasperates him, and he says bitter, wounding things. When I speak of something I've had to do to the house or a servant I've had to change it irritates him beyond endurance. He complains that I treat him as if he didn't count any more.
.......Templeton thinks often about death, but not because he fears it. What concerns him is whether his expected death in the very near future will stand in the way of his marriage to Ivy Bishop. 


.......McLeod's assessment of the condition of Templeton foreshadows the grim prognosis Dr. Lennox gives the major. McLeod tells Ashenden, "When I look at a fellow I make up my mind at once whether he’ll get well or whether he won’t, and if he won’t I can make a pretty shrewd guess how long he’ll last. I’m very seldom mistaken. I give Templeton about two years myself."


.......Here are the main conflicts in the story.

Patients vs disease: The narrator says, "There were people lying all along the veranda in deck-chairs, some chatting with their neighbours and some reading. Every now and then one would have a fit of coughing and you noticed that at the end of it he looked anxiously at his handkerchief."
Campbell vs McLeod: Dr. Lennox says, "He [McLeod] hates Campbell, and Campbell hates him. Funny, when you come to think of it, those two men, they've been here for seventeen years and they've got about one sound lung between them. They loathe the sight of one another. I've had to refuse to listen to the complaints about one another that they come to me with. Campbell's room is just below McLeod's and Campbell plays the fiddle. It drives McLeod wild. He says he's been listening to the same tunes for fifteen years, but Campbell says McLeod doesn't know one tune from another." 
Chester vs his fears: The narrator says, "Having no resources in himself, no interest in books, he had nothing to do but think of his health. It became an obsession. He watched his symptoms anxiously. They had to deprive him of a thermometer because he took his temperature a dozen times a day."
Chester vs his wife: Mrs. Chester says, "He resents . . . terribly that he's ill and I'm well. He's afraid he's going to die and he hates me because I'm going to live. I have to be on my guard all the time; almost everything I say, if I speak of the children, if I speak of the future, exasperates him, and he says bitter, wounding things. When I speak of something I've had to do to the house or a servant I've had to change it irritates him beyond endurance. He complains that I treat him as if he didn't count any more." 

.......Maugham's writing is straightforward and easy to understand, and it exhibits a keen understanding of people and their conflicts. Moreover, although his writing is generally concise and his use of adjectives spare, he knows how to write a convincing description when necessary, as the following passage demonstrates:

McLeod, lying there, gave you the impression that he was immensely tall; his skin was stretched over his bones, his cheeks and temples hollow, so that you could see the formation of his skull under it; and in that emaciated face, with its great bony nose, the eyes were preternaturally large.
A possible flaw in Maugham's plotting is that it is predictable. The death of one of McLeod and the reaction of the Campbell are not surprises. Nor are the Templeton-Bishop marriage and the reconciliation of Mr. and Mrs. Chester.


Study Questions and Essay Topics
  • In your opinion, who is the most admirable character in the story? Explain your answer.
  • Tuberculosis, or TB, was a leading cause of death in the world until the early twentieth century. Write an informative essay explaining the cause, symptoms, and treatments of TB. Include a section about whether TB still poses a threat in the twenty-first century. Use library and Internet research. 
  • Winter traditionally symbolizes death; spring symbolizes life. Why does the story begin in mid-winter and end in the spring? 
  • What caused Mr. Chester to overcome his fear of death?
  • In your opinion, why did Maugham include the young sub-lieutenant in his story?