Commonplace 62 George & Syphilis PART ONE Sooner or later,
with George Gissing, all roads lead to Syphilis.
One of the most contested notions in the whole realm of Gissing studies
is that George suffered from venereal disease. To say the camp is divided is to
say a mouthful. As ever with George, there is a lack of hard evidence and a lot
of supposition, but no overview of his life and works can escape the issue,
because, if he suffered from it, much will be explained (and even forgiven); if
he didn't, then that's a whole new Gissing to consider. Of course, we have no
way of knowing for sure either way, but we do have tantalising clues and some
documented information to help us make up our minds - or leave us sitting
squarely on the fence.
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| Iris by John Atkinson Grimshaw 1886 |
Sometimes, the Victorian age seems to be little more than an endless
parade of autistic savant detectives, midnight throat slashings and Hannah with
her banner - and where would English literature be without them? But, there is
a special place in nineteenth century popular culture for syphilis.
This is because it was (and still is) such a monster, producing visible horror
and decay, with the added terror of being, for long stretches, a silent
invasion force capable of fatally overwhelming its host at any given moment,
either a swift end or a long, drawn-out and truly terrifying slow meandering
slog to madness and disability. Neurosyphilis, the most destructive form, can
eat a brain in a couple of years, and on the way, render you blind, insane and
immobile. And, then there is the pain it can cause. Some of George's real-life
heroes suffered from the 'French disease' (or, the English disease', if you
lived the other side of the Channel haha) - Alphonse Daudet, Fyodor Dostoevsky,
to name but two. Daudet suffered very badly - read Julian Barnes' account of
poor Alphonse's struggle with it: In The Land Of Pain.
As ever, the Wellcome Collection is an invaluable tool for anyone
seeking to know more on the subject click (strapline: The free destination for the incurably curious).
However, anyone thinking syphilis is a thing of the past, would do well to take
their misguided arse off here click.
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| Lady of The Lilacs by Thomas Hughes 1863 |
Let us explore the evidence that might lead us to confirm or disconfirm
that George was syphilitic. You will have to make up your own mind. Let's
gather information.
In order to appreciate the challenges of treating the disease in
George's time, we have to accept there was no way then for science to identify
the bacterium treponema pallidum responsible for it and still no worldwide
clear consensus on what constituted the disease or how it progressed throughout
what was termed the 'economy' - an old-fashioned term for the body and its
systems. Much of the work towards understanding disease was carried out by
individual doctors who dabbled in medical research as a sort of hobby - many
specialists were self-taught or picked up what tuition they could along the
way. Take Arthur Conan Doyle. He qualified as a general practitioner in 1882,
worked as a GP, then went to Vienna to study ophthalmology in 1890 - just in
case the writing career didn't last (notes to Gissing: proper day jobs are not a
threat to creativity and writing books people want to read is not a thing of
shame).
Because there are so many computations to an exact prognosis - ranging
from a long life free from overt disease, then a swift decline into immobility
and madness, to a raging secondary phase that ate the brain and killed you
quickly, to a full life lived with the disease in remission - you begin to
appreciate how tricky this disease can be to diagnose, especially in the days
before effect blood tests and powerful microscopes. The more a physician came
into contact with sufferers, the better able they were to make accurate
diagnoses. Needless to say, doctors in towns with a high population of serving
armed forces personnel were likely to have good knowledge of venereal disease,
as were those doctors who worked in inner city areas.
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| Girl With Golden Rod by Charles Courtney Curran 1915 |
In the 1860s, the fear of syphilis as an engine of social disorder
prompted a particularly savage approach in the form of the Contagious Diseases
Act click. The London Lock
Hospital had been instituted in the eighteenth century to treat sufferers - but
it was the Victorians who made the worst use of it by forcibly incarcerating
and treating women if they became infected. Only a woman could truly appreciate
the hypocrisy of locking up sick women while infected men roamed free. This is
a fascinating story, and anyone who wants to know more should look up WT
Stead click and Josephine
Butler click. For an overview of
how France reacted to a rise in incidence of syphilis click
Syphilis is a very clever little fellow. The old saw is that syphilis
was considered to be 'the great imitator' because, its signs and symptoms were
easily confused with other severe ailments. What was presented by a patient's
condition could be baffling to all but the very experienced physician, and so
cases often went undiagnosed, misdiagnosed or inadequately (even
iatrogenically) treated - which often resulted in a set of problems of its own.
The main challenges to accurate diagnosis were: the various signs of infection could
be visually mistaken for similar conditions; a new infection quickly went
'underground' (creating the mistaken belief it had cured itself), often before
the sufferer sought help; it presented without pain and so went unnoticed; the
seat of infection could lurk out of sight - in the mouth, rectum or vagina, for
example, and so only became apparent when severe damage was done; embarrassment
kept people from seeking help, and drove them to seek out useless
do-it-yourself remedies from chemist's shops or even by mail order. An obvious,
but not very accurate way of diagnosing syphilis was trial and error dosing
with the treatments (note: not cures) available, then waiting for a result.
What made this less reliable for diagnostic purposes was that the alleged cures,
such as mercury and iodide of potassium, were toxic even in small quantities;
much of the damage done to bones and teeth, the nervous system and in
particular, the brain, could be laid at the door of mercury, strychnine,
antimony and arsenic - all used in patent syphilis cures. Something for you to
think about: as so many cases of syphilis went misdiagnosed or undiagnosed in
the late nineteenth century, there could be a much higher incidence of the
disease in the population than we generally think. There is every chance your
antecedents suffered from it! Here is a letter published in the British Medical
Journal of December 1913, which relates to military personnel, not civilians,
but it gives some idea how difficult it still was then to identify a cure even
when the famous 'magic bullet' of Salvarsan click had been developed.
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THE
ROYAL COMMISSION ON VENEREAL DISEASES. SIR,
I have
noticed in the JOURNAL of November 29th certain extracts from the official
report on the above subject in which it is stated that Colonel Scott gives
the following statistics of venereal disease from 1888 to 1912 - namely:
1888 -
Admissions into hospital 224.5 per 1,000
1912-
Admissions into hospital in 56.6 per 1,000
and in
India the reduction had been still more marked. Colonel Scott attributed this
diminution to greater temperance and care of the soldier, etc., with which I
in part cordially agree, but surely there must be something more to explain
this extraordinary decrease as shown by statistics, which can so often be
fallacious. Let me suggest one explanation. I believe I am correct in stating
that before I left the service in 1891 the practice l had begun of not always
admitting men into hospital with primary diseases, but treating some of them
in barracks with subcutaneous injections of mercury, etc., whilst doing light
duty, or, if admitted in the first place, were, later on treated in barracks
and not readmitted. If this be true such action must considerably affect
statistical returns. Whilst I am on this subject, with a past experience of
thousands of cases treated by mercurial inunction and otherwise, it is a
source of great regret to me to find that salvarsan is becoming so much
adopted by the profession in preference to mercury, although I have no right
to express an opinion on the new treatment, having no personal experience of
it. But mercury has stood the test of generations whilst arsenic has yet to
stand the test of experience, and, already, I see antimony suggested in its
place, and my firm belief is that the day will come when mercury will regain
its well-merited position in the past as the best treatment for syphilis in
its primary stage.
|
So much for progress.
Back to George, in particular. To tease out the facts, we have to
appreciate George's health was always a preoccupation for him, but in an age
with few cures for many diseases, many people would have worried about their
twinges and lumps and bumps, and rushed to the doctor at the first sign of a
sniffle - if they could afford it. The poor had to struggle on with their folk
remedies but the fear of starvation kept them upright. In a time of advertising
freedom, any ridiculous claim could be made in order to sell a medicinal
product, and patent medicines were often shamelessly marketed as cures for all
sorts of incurable diseases. Like his younger brother, William, George always
followed health trends - for a man so unimpressed by science, George showed
remarkable interest in the latest developments in cures. Of course, a
preoccupation with health is not necessarily proof of chronic, incurable
disease, but it is an indicator that something was worrying him. As an
impulsive sort of chap (after periods of drawn-out contemplation, George often
then went off and did the first thing that came into his head) we can imagine
him window shopping in the local chemist's and then popping in to buy whatever
took his fancy, healthwise. Maybe this is why he hated street advertisements so
much - he knew they did their job and did it well! We know he enjoyed the fads
of the time for creosote and cod liver oil; the nastier it tasted, the more
efficacious the result! For a diverting overview of why we choose what we
buy click
We can confidently claim George had two recurring themes in his medical
record: what appeared to be neurosis, and the pulmonary form of tuberculosis.
The 'neurosis' took many forms, one of which was the manifestation of seemingly
trivial ailments - man flu, breathing difficulties, stomach problems,
diarrhoea, insomnia, skin rashes, excess sweating aka hyperhidrosis, malaise
and chills - all could have been psychosomatic in origin - certainly Gabrielle
thought so. We must not assume psychosomatic disorders are a form of
malingering. The mind (for want of a better term) seeks to defend itself from
perceived threat by any means necessary. Deflecting the stress of a threat you
cannot run from has to be sublimated into a survivable situation - minor
illness concentrates the conscious mind and relieves the pressure of built-up
anxiety. As the impetus to do this is deep in the unconscious, the sufferer is
unaware the symptoms might be auto-generated. Neurosis is a survival mechanism,
and a very good one, democratic and reliable. However, all of the above listed
manifestations of it are also typical symptoms of real physical disease: latent
stage syphilis.
We know George had phthisis - which we now call tuberculosis - and claimed
to have suffered from it for most of his life. TB as we know it, was not fully
understood in the nineteenth century in terms of aetiology or progression
through the body, and so no specific, reliable cure had been developed - that
wouldn;t come along until the rise of the antibiotics during WWII. We now know
it is a system-wide infection caused by mycobacterium, usually mycobacterium
tuberculosis. Pulmonary TB - which is located in the lungs and respiratory
tract - was what made George so short of breath, and William, his brother, and
Marianne spit blood (haemoptysis) - and George checked his sputum every day
(every cough?). TB may have caused him all sorts of associated problems,
including, if the infection became system-wide, heart disease, brain disorders,
skin lesions, reproductive problems, bone decay, cachexia and, eventually,
multiple organ failure. More things to confuse with syphilis.
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| The Flower Girl by Emile Vernon 1904 |
TB was more likely to be mistaken for syphilis (and vice versa) than any
other disease. To differentiate TB and syphilis was tricky and fraught with
potential error. A serious threat to accurate diagnosis was lack of continuity
of care in medical supervision - George and Marianne had frequent changes of
address and used different physicians and, in Marianne's case, hospitals.
Consistency of medical opinion might have provided a medical history -
consulting with random doctors would just produce medical notes, which were not
shared with other professionals. This often allowed different doctors to makes
different diagnoses yet based on the same medical evidence. And, as patients don't
always know how to accurately explain what ails them, and rarely know the
correct jargon or appropriate medical terms, they can fail to do justice to
what they are trying to describe. When the causes and prognosis of both TB and
syphilis were virtually unknown quantities, is it any wonder they were so often
confused with each other?
So, what do we have that points to an undifferentiated diagnosis of
syphilis in our man? Well, we have the letters of John George Black. The first
letter describes JG's physical reaction to being caught fraternising with the
girl George fancies - he is overcome with embarrassment. He talks about how ill
he feels. He mentions how weak and feverish he's been, how debilitated, and how
he had to confine himself to bed. In a second letter, he asks about poorly
penises. John George writes to his 'Adonis' (his pet name for George - bless
his cotton socks; George does so often bring out the bromantic in a fellow!):
The irritation continued growing worse, & on
examination, I found the prepuce swollen, & on turning it down, I found the
whole of the inside salmon-coloured, as you would call it, only little spots as
though the skin had been eaten away so as to show the flesh, & almost
looked as though were bleeding. I applied a little of the subtilissimus, but
the end continues to be irritated. The prepuce is a little hard as well; &
there was a drop or two of yellow matter near the red spots. I don’t know what
an ulcer should look like. Are these anything like the symptoms of soft
chancre? Or, is it like your inflammation? Or do you think it is only
balanitis?
He then adds: Should the subtilissimus go a
bright green?*
*I have a theory about this. Many patent cures were
thrown together to appear to work -
visually - as much as to effect a cure. Copper, often used for its cleansing
antibactericidal properties, can turn skin green. click In
a patent medicine, one of the advantages to a green colour on the skin, is that
it cancels out the redness of the irritation - thus making it look less
inflamed - in the same way green make-up works on flushed complexions to reduce
the pinkness.
Thanks to the power of google images, and with your own innate
curiosity, you can look at pictures of the above venereal conditions (warning!
google images search results are quite scary and will involve cocks and
suchlike). As I have done (I'm fearless). It would seem - from the above quoted
section - that John George is not describing
balanitis click (as claimed by
one of George's biographers - who does not mention this second letter at all in
his biography of George, which is an odd editorial decision - he includes some
utter claptrap he can't prove but leaves out some primary evidence It's
as if he doesn't want to be impartial haha. You have to go the the first volume
of the Letters of GG to find the John George Black letter, or to the John
Rylands click collection in
Manchester), which has no blebs (the correct term for weeping red spots). Soft
chancre (also known as chancroid), you will see if you look click, is a more or less
round or ragged hole, Soft chancre is the non-syphilitic version of a chancre,
caused by the bacterium haemophilus ducreyi - not syphilis. Syphilitic
chancre click produces round
ragged holes. Chancres seems too large to be mistaken for spots. From what is
described (red spots forming crusts) - is JG describing
condylomata lata, a common feature at the secondary stage - see
these images: click
Some things about the John George letters leap
out:
1) In the first (apologetic) letter, John George
seems to be describing the typical symptoms of secondary syphilis - fever and
malaise and a general feeling of unwellness are not features of primary
syphilis.
2) John George does not mention pain at the site of
the problem - lack of pain is typical of the symptoms of syphilis and atypical
of other venereal diseases
3) blebs are typical of secondary stage
infection, however, gonorrhoea can produce something called penile pyodermal
lesions - pus-filled spots on the penis. And herpes produces crusty blebs. My
own feeling is that the latter two are unlikely candidates - based on what John
George goes on later to share
4) 'I applied a little of the
subtilissimus' - this was a herbal ingredient often used to offset the
irritation of mercury on delicate skin, and to soothe irritation
5) After the anxious first two letters, the tone of
the last two is quite perky. It's almost as if nothing has bothered JG about
his health. The secondary stage of syphilis sometimes passes quickly and
leaves few visible signs it was ever present, which can lead to the false
belief it is cured, frequently with some sufferers abandoning treatment or
failing to follow medical advice
6) he mentions George's 'inflammation'. There is no
way to diagnose George from JG's symptoms!! Inflammation, when the term is used
correctly, is a localized physical condition in which part of the
body becomes reddened, swollen, hot, and often painful, especially as a
reaction to injury or infection.
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| Girls Putting Flowers In Their Hats by Auguste Renoir 1893 |
From this we can deduce that John George Black was probably suffering
from secondary stage syphilis. But - this was contracted long
before he visited the lodgings where he had some sort of encounter with a girl
George was interested in - who is presumed by biographers to be Marianne
(despite a lack of evidence), the girl whom they wrongly suggest passed on a
venereal infection to both boys. The symptoms John George describes are not
consistent with a picture of primary syphilis, but do fit a
picture of secondary - which means he will have contracted it at least a month
before his visit to the place Anthony West refers to as Mother B's. Anyone who
has read Commonplace 60 focusing on Anthony West's biography of his father, HG
Wells, will recall how he was told by HG that John George Black said, apropos
recommending George visit Mother B's house: he would find a
beginner there who was hot stuff. This is a predatory statement, if true;
it has the sense of a man promoting the defiling of innocence - and of pimping.
'A beginner' presumably means either a virgin or a girl with limited sexual
experience. It takes the business of paying for sex to a particularly low,
immoral state, especially in our modern social climate where we are sensitised
to child exploitation - but, the age of consent in 1876, was 12. (Imagine the
misery of this in real terms - and how easy it would be for a vulnerable child
to be seduced into sexual exploitation. In the UK, we know only too well how
this happens.) And,, let us not forget, then, as now, there is a myth that
sleeping with a virgin cures syphilis - but this was probably not what JG had
in his mind when he passed on this useful nugget of information to our man,
because he didn't realise he had the infection. He claims.
The girl John George visits in lodgings is not seen by him as George's
exclusive girlfriend, and so this suggests George's relationship with her is
new and still tentative at this stage. As John George clearly states, in
mitigation, George has mentioned an interest, but not strongly
enough to be taken seriously. George staked an exclusive claim
to the girl in the boarding house with his letter to John George - this letter
elicited the guilty, apologetic response from JG - so George must have only
recently met the girl. This means George could not have contracted a
disease from the girl in Mother B's - because the timeline is all wrong. His infection
had been or was still being treated and that indicates infection going back
some weeks, possibly months. An important point here: John George
having syphilis does not mean our George had it - JG is comparing and
contrasting, not claiming the two problems are the same. But, if George
had contracted syphilis during his time in Manchester it is clear he caught it
much earlier in the academic year - John George Black's first (apologetic)
letter was written 1st March 1876, and George is already familiar with the
treatment and so must have had his disease for a few months, at least. My own
view is that he contracted it in around November or December 1875 - join me in
Part Two for an explanation of why I think this.
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