Commonplace 68 George & Syphilis PART SEVEN Edith's Heroic Life part 3
'Nothing but terror and despair at first; then, gradually, the mind, like the body, adjusts to this appalling condition.' Alphonse Daudet.
We are looking at the probability that Edith, George's second wife, suffered from paresis, one of the neurological forms of syphilis - contracted from George. There is a very strong case (presented in Commonplace 66) for the assertion George was syphilitic when he married both Edith and Marianne aka Nell.
We take up the story using the article from the Gissing Journal of July 2010 (Volume XLVI Number 3) written by Anthony Petyt.
The Fisherton House Asylum records (AP discovered) show clinical reviews every three months - these would have been the doctor's notes. Nursing notes on patients' care and treatment would have been made weekly, at least, usually on a Sunday, but all kinds of basic things would be recorded by nurses, including weight measurement, bowel movements (vitally important when nursing epileptic patients!), baths taken, treatments administered (such as wound care and dressings); injuries, doctors' deliberations and examinations, medication given, monthly menses; food and drink taken/refused, visitors received, and pocket money expenditure - all standard depending on hospital policy and the thoroughness of staff to record such happenings. 'Incidents' would be recorded - these would include entries for how compliant vs troublesome the patient was with regard to staff and other patients. Woe betide any patient who pissed off a nurse with too much backchat - it would all be recorded; if a patient attacked a fellow patient, that would be described and logged. If a patient attacked a nurse...that would be dealt with summarily and harshly. It should be remembered, psychiatric nursing was not the noble profession it is today - staff working in institutions then were little more than gaolers and had no real sense of vocation. In Edith's time, of course, some nursing staff were compassionate and caring, but the system was not set up for too much identification with the patient - the bedrock of today's more empathic and Humanistic service - but as a form of containment and supervision. For a good understanding of asylums in Edith's time, read Sarah Wise's book: click. Another thing to dwell on - even today, in psychiatry, once a patient is given a diagnosis it is very hard for anyone to change it - or challenge it.
What we have to go on, from the Fisherton House notes on Edith, needs looking at in terms of definitions and frequency of occurrence of observable signs of illness. However (and this is the voice of experience speaking!), what we have has been recorded by different doctors with differing levels of knowledge and skill in their specialism, some of whom possibly never sat and spoke to Edith but used nursing notes, and a chat with the ward superintendent over a cup of tea, as references. Or, read the previous doctor's entry, and thought, 'Well, this patient has an intractable condition; she won't have changed much since last quarter, will she?' and just cut and paste what was previously in the file.
Superficially, it looks impossible to pick apart the Fisherton notes and make any sort of a diagnosis - so we just assume Edith was 'mad' - that dreadful, powerfully negative term now rightly out of use. But, we can find clues here, even in these brief entries - some of them amount, in the Gissing Journal's rendering - to five words (for three months' reflections on observations!).
From her admission (to Fisherton House) September 1904, and through to June 1905, Edith was described as excited, deluded, threatening and dangerous and violent. We might take 'excited' in this as meaning hypermanic or over-active, or even anxious. But, some people are highly strung by nature and 'live on their nerves', as they say in common parlance. However, this can also be a symptom of paresis (see below). Delusions are false beliefs - or, erroneous translations of internal thoughts or memories which become confused in the mind. They are not lies - the patient believes them to be true. In Edith's case, she thought George Gissing was her husband - which he had been. She also thought he was still alive - as covered in the previous post, she may not have known he was dead. So, her delusions are not entirely false beliefs, are they? 'Threatening and dangerous' sound much worse than they probably were - based on the fact Edith did not do much damage to anyone - or it would have been recorded in the notes. I seriously doubt if she was 'dangerous and violent' to any degree (any more than any of us might be when detained against our wishes and surrounded by demented people) - again, there would have been serious repercussions to this sort of behaviour and she would have been medicated or 'dealt with' to suppress them, on orders of the medical staff. If it is not recorded, it was trivial. 'Dangerous', used here, is meaningless - unless we are told in which way she is dangerous, it could mean anything and nothing. Generally, any threats to staff are treated with a zero tolerance approach - and patients tend to be penalised either legitimately, or in underhand ways. If Edith was free to move around the ward, and if she wasn't restrained by any manual restraint (straitjacket, etc) she can't have been that much of a handful. As Edith tended to be a bit verbal, she probably specialised in spoken threats and abuse. Before the days of the 'liquid cosh' click, physical punishment was meted out in psychiatric care, and solitary confinement and restrictions were used to penalise troublesome people. Unless Edith was punished - which would have been recorded - the chances are she was never much of a challenge.
Something happens in or about June 1905. Edith is described as quieter and better behaved since the last note but continues full of delusions, will not believe her husband is dead, says she got carbolic acid in her tea previous to coming here, etc. In the September, she is described as obstinate and troublesome at times... in the December: Has quite a depressed air, states that she tasted carbolic acid in her tea, that her husband is in this asylum & that he writes on the ward door. As the tea claims involve the sense of taste - which is an external-stimulus response - the chances are this might have been an hallucination, not a delusion. Hallucinations are based on sensory input being wrongly processed either physically (by an altered or abnormal brain) or cognitively - depending on your school of psychology beliefs. However, carbolic acid as a disinfectant was becoming standard in the early 1900s and was of particular interest to psychiatric settings as it masked the smell of urine. Patients who were 'difficult', in terms of behaviour, were often housed with others who were difficult - and many of these would have been incontinent of urine and faeces. Carbolic acid 'gets in the mouth', as we call it, and produces an aftertaste - as strong odours tend to do. Maybe that smell is what tainted the tea - to Edith's taste buds? Smell is the last sense to die - and it is, therefore, the strongest to persist in memory.
The important feature from this time is that Edith has changed - we see 'depression' entering the story. Depression is a feature of all mental health difficulties - mania, a feature of manic-depression (an outmoded term but easy for the lay person to understand) is a form of depression, not bliss. Paresis brings its own form of depression - partly the effects of the spirochete eating away at brain tissue, partly because of the disease affecting all other bodily systems, and, in Edith's case, as she was incarcerated in an asylum, the comprehension that the situation is hopeless. Bluntly, Edith had a lot to be depressed about.
In June and September 1906: Patient has been exceedingly noisy & troublesome on account of her delusions of persecution & visual & auditory hallucinations and her hallucinations cause her to be troublesome. No explanation or description is given of these hallucinations, and so it is difficult to try and fathom what they meant to Edith. But, she is back to responding to them - they are interfering in her life. That really is the definition of mental illness - when your ideas and actions begin to negatively affect your life, it becomes an illness - until then, it is just you being eccentric, my friend!
We discover on March 15th 1907 the 'her tactile hallucinations seem to have disappeared... In June, 1907, she apparently conceals her hallucinations of touch. Then, in September of that year: complains of electricity in her feet.
This is one of the most compelling bits of evidence for a diagnosis of paresis. Why did Edith feel compelled to cover up her hallucinations? Was it a feature of her persecution delusion - she had insight into how the staff would judge them as being more evidence for madness (which is what happened)? Was it because she knew these sensations were real and were associated with the shameful syphilis; that they were never 'hallucinations' at all? Some of the more prominent syphilitics of George's age were afflicted with this sort of pain, but let's consider Alphonse Daudet, one of George's heroes (though I suspect Daudet's disease was one of the things that put George off reading him, and Edmond and Jules de Goncourt!), who endured agonies in his legs and feet. This was, in Daudet's case, tabes dorsalis click (much more likely to be the syphilis variant in males than females) but the pain he describes is the same. In La Doulou (the basis for Julian Barnes' In the Land of Pain click), an account of his experience of tabes, not published in France until the1930s, there is a description of the pain and sensations it caused. Daudet writes:
Warning signs going back a long way. Strange aches; great flames of pain furrowing my body, cutting it to pieces, lighting it up... Also, from that time onwards, pins and needles in the feet, burning feelings, hyper-sensitivity. Lighting up?
In March 1908, Edith is prescribed potassium bromide. This was a treatment for a variety of ailments, and was known for its sedative effects. However, it was also used in cases of insomnia, headaches, epilepsy. And syphilitic pain. Daudet: Haven't had recourse to morphine for a long time, not since I've been taking bromide... How much I suffered last night in my heel... Varieties of pain. Sometimes, on the sole of the foot, an incision, a thin one, hair-thin...Intolerable pain in the heel...I spend half the night with my heel clasped in my hand...Flashes of pain in the foot...Then, Bad night, woken with a jolt at three; no actual pain, but highly strung and in fear of pain. Might 'highly strung' be taken as 'excited'?
We know paresis has spontaneous remissions and exacerbations - in a way that, for example, untreated schizophrenia, generally does not. In her book on syphilis click, Deborah Hayden highlights the tendency for paresis to appear to spontaneously improve without treatment. Was Edith's more 'settled' (as nurses might record in their notes) behaviour a sign of such a quiescent phase? When the worst of the 'psychotic' symptoms eased, insight would return - Edith would begin to realise what was happening, and have a clearer idea of her situation. Hallucinations can be caused by transient trauma to the brain, such as inflammation caused by infection. Inflammation is the process of tissue swelling, and in such a delicate area as the brain, any form of swelling puts pressure on vital functions. Anyone doubting how this could cause all of Edith's symptoms - have a look here click
We also have changes in behaviour. When George first met Edith he described her as biddable - he claimed she was just in need of guidance and she would pass muster - as long as her London accent took a hike. She behaved in a ladylike manner and she and George spent a good deal of time together alone - innocently, of course. Their companionship grew, though George (and Edith!) had reservations. However, Edith was not a coarse and brutal woman, judging by the early Diary entries, so something happened to her to make her aggressive and violent. Was it her reaction to his illness - to phthisis and syphilis? - or was it the beginning of her paresis? There are changes, too at Fisherton House from noisy to quiet, scary to calm - typical of paresis.
Edith died of what was described as 'organic brain disease' in 1917.
JOIN ME IN THE FINAL PART OF OUR INVESTIGATION INTO THIS FASCINATING SUBJECT TO EXPLORE EDITH'S FINAL YEARS AND SAD END.
'Nothing but terror and despair at first; then, gradually, the mind, like the body, adjusts to this appalling condition.' Alphonse Daudet.
 |
| The Bride, Bridegroom and Sad Love by Simeon Solomon 1865 |
We take up the story using the article from the Gissing Journal of July 2010 (Volume XLVI Number 3) written by Anthony Petyt.
The Fisherton House Asylum records (AP discovered) show clinical reviews every three months - these would have been the doctor's notes. Nursing notes on patients' care and treatment would have been made weekly, at least, usually on a Sunday, but all kinds of basic things would be recorded by nurses, including weight measurement, bowel movements (vitally important when nursing epileptic patients!), baths taken, treatments administered (such as wound care and dressings); injuries, doctors' deliberations and examinations, medication given, monthly menses; food and drink taken/refused, visitors received, and pocket money expenditure - all standard depending on hospital policy and the thoroughness of staff to record such happenings. 'Incidents' would be recorded - these would include entries for how compliant vs troublesome the patient was with regard to staff and other patients. Woe betide any patient who pissed off a nurse with too much backchat - it would all be recorded; if a patient attacked a fellow patient, that would be described and logged. If a patient attacked a nurse...that would be dealt with summarily and harshly. It should be remembered, psychiatric nursing was not the noble profession it is today - staff working in institutions then were little more than gaolers and had no real sense of vocation. In Edith's time, of course, some nursing staff were compassionate and caring, but the system was not set up for too much identification with the patient - the bedrock of today's more empathic and Humanistic service - but as a form of containment and supervision. For a good understanding of asylums in Edith's time, read Sarah Wise's book: click. Another thing to dwell on - even today, in psychiatry, once a patient is given a diagnosis it is very hard for anyone to change it - or challenge it.
 |
| Study of A Girl by Simeon Solomon 1873 |
What we have to go on, from the Fisherton House notes on Edith, needs looking at in terms of definitions and frequency of occurrence of observable signs of illness. However (and this is the voice of experience speaking!), what we have has been recorded by different doctors with differing levels of knowledge and skill in their specialism, some of whom possibly never sat and spoke to Edith but used nursing notes, and a chat with the ward superintendent over a cup of tea, as references. Or, read the previous doctor's entry, and thought, 'Well, this patient has an intractable condition; she won't have changed much since last quarter, will she?' and just cut and paste what was previously in the file.
Superficially, it looks impossible to pick apart the Fisherton notes and make any sort of a diagnosis - so we just assume Edith was 'mad' - that dreadful, powerfully negative term now rightly out of use. But, we can find clues here, even in these brief entries - some of them amount, in the Gissing Journal's rendering - to five words (for three months' reflections on observations!).
 |
| Untitled Simeon Solomon 1905 |
 |
| The Angel Of Death by Simeon Solomon 1896 |
 |
| Dawn by Simeon Solomon 1871 |
The important feature from this time is that Edith has changed - we see 'depression' entering the story. Depression is a feature of all mental health difficulties - mania, a feature of manic-depression (an outmoded term but easy for the lay person to understand) is a form of depression, not bliss. Paresis brings its own form of depression - partly the effects of the spirochete eating away at brain tissue, partly because of the disease affecting all other bodily systems, and, in Edith's case, as she was incarcerated in an asylum, the comprehension that the situation is hopeless. Bluntly, Edith had a lot to be depressed about.
In June and September 1906: Patient has been exceedingly noisy & troublesome on account of her delusions of persecution & visual & auditory hallucinations and her hallucinations cause her to be troublesome. No explanation or description is given of these hallucinations, and so it is difficult to try and fathom what they meant to Edith. But, she is back to responding to them - they are interfering in her life. That really is the definition of mental illness - when your ideas and actions begin to negatively affect your life, it becomes an illness - until then, it is just you being eccentric, my friend!
 |
| Cupid by Simeon Solomon 1886 (looking very much like a young Oscar Wilde?) |
This is one of the most compelling bits of evidence for a diagnosis of paresis. Why did Edith feel compelled to cover up her hallucinations? Was it a feature of her persecution delusion - she had insight into how the staff would judge them as being more evidence for madness (which is what happened)? Was it because she knew these sensations were real and were associated with the shameful syphilis; that they were never 'hallucinations' at all? Some of the more prominent syphilitics of George's age were afflicted with this sort of pain, but let's consider Alphonse Daudet, one of George's heroes (though I suspect Daudet's disease was one of the things that put George off reading him, and Edmond and Jules de Goncourt!), who endured agonies in his legs and feet. This was, in Daudet's case, tabes dorsalis click (much more likely to be the syphilis variant in males than females) but the pain he describes is the same. In La Doulou (the basis for Julian Barnes' In the Land of Pain click), an account of his experience of tabes, not published in France until the1930s, there is a description of the pain and sensations it caused. Daudet writes:
Warning signs going back a long way. Strange aches; great flames of pain furrowing my body, cutting it to pieces, lighting it up... Also, from that time onwards, pins and needles in the feet, burning feelings, hyper-sensitivity. Lighting up?
In March 1908, Edith is prescribed potassium bromide. This was a treatment for a variety of ailments, and was known for its sedative effects. However, it was also used in cases of insomnia, headaches, epilepsy. And syphilitic pain. Daudet: Haven't had recourse to morphine for a long time, not since I've been taking bromide... How much I suffered last night in my heel... Varieties of pain. Sometimes, on the sole of the foot, an incision, a thin one, hair-thin...Intolerable pain in the heel...I spend half the night with my heel clasped in my hand...Flashes of pain in the foot...Then, Bad night, woken with a jolt at three; no actual pain, but highly strung and in fear of pain. Might 'highly strung' be taken as 'excited'?
 |
| Study of A Woman With Red Hair by Simeon Solomon 1873 |
We also have changes in behaviour. When George first met Edith he described her as biddable - he claimed she was just in need of guidance and she would pass muster - as long as her London accent took a hike. She behaved in a ladylike manner and she and George spent a good deal of time together alone - innocently, of course. Their companionship grew, though George (and Edith!) had reservations. However, Edith was not a coarse and brutal woman, judging by the early Diary entries, so something happened to her to make her aggressive and violent. Was it her reaction to his illness - to phthisis and syphilis? - or was it the beginning of her paresis? There are changes, too at Fisherton House from noisy to quiet, scary to calm - typical of paresis.
Edith died of what was described as 'organic brain disease' in 1917.
JOIN ME IN THE FINAL PART OF OUR INVESTIGATION INTO THIS FASCINATING SUBJECT TO EXPLORE EDITH'S FINAL YEARS AND SAD END.
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