Ivor Gurney and the Question of Syphilis
by Pamela Blevins
©2001
In a BBC Radio 4 program broadcast in October 2000
and in article published in the Ivor Gurney Society Journal also
in 2000, it was suggested that Ivor Gurney might have suffered from
syphilis.(1) It was further suggested that this illness might offer
an explanation for the nature of his hallucinations and perhaps his
mental illness as well. This is an issue that my colleague David Goodland
and I first began exploring in March of 1999 after we both read through
the Gurney medical records at the Gurney Archive. The records, which
we had seen earlier at the City Archives in London, were not exactly
the fountain of new information we had anticipated but there were several
things in them that raised questions for us.
The medical records and censorship
After reading the records, it becomes clear that
the doctors who treated Gurney did not know what was wrong with him.
His diagnosis upon admission to the City of London Mental Hospital in
December 1922 was "Delusional Insanity (Systematic)" with
one entry noting that "During the war Patient suffered from shell
shock". There is no documented evidence in these records supporting
the shell shock diagnosis.
Further, there is no diagnosis in the medical records
to indicate that Gurney had syphilis. The word simply does not appear
in these documents. However, the notion that he might have had syphilis
arises from the fact that he was treated with malarial injections in
1923. At the time, malaria was the standard treatment for syphilis.
The other hint is in the fact that someone — my guess is the late William
Trethowan — believed he had found a good reason to seal the medical
records for 100 years after Gurney’s death, which would effectively
keep them from the public until 2037. (Fortunately this restriction
was lifted in 1999.) While there is no direct proof that Trethowan is
responsible for this censorship, who else would have been in a position
to make such a judgement? Who would have had the medical knowledge to
understand the implication of malarial treatments? Who had access to
the medical records? Who based his own research on them? Who donated
the records to the Gurney Archive? William Trethowan, Professor of Psychiatry
at the University of Birmingham.(2)
That 100-year blackout of Gurney’s medical records
always troubled me and triggered suspicions that prompted questions.
Why would anyone deliberately seal the records unless there is something
in them that might be embarrassing? What is in them that should be hidden
from the public? The flip side of that coin is that the records could
have been sealed just because they dealt with mental illness and because
they sometimes graphically describe Gurney’s condition. Even in the
late ’70s and early ’80s, mental illness bore a stigma that is not completely
erased in the 21st Century and some people still regard it
as a shameful condition. Indeed, I had spoken to a distant relative
of Gurney’s in Gloucester about five years ago. She had an elderly aunt
or cousin more closely related to Gurney, who simply would not discuss
Gurney or his illness. This relative felt that his mental illness was
too much of an embarrassment for the family.
Malaria and syphilis
From the hospital records, we can read about Gurney’s
behavior and his hallucinations and his physical condition to a comparatively
limited degree. From 1926 to November 1935, he steadfastly refused to
allow doctors to examine him physically. Only when he became too weak
to resist would he allow doctors to touch him. Therefore, the observations
in the medical records offer incomplete or at best only superficial
evaluations of Gurney’s physical condition. Letters written to Marion
Scott by Gurney’s doctors are sometimes more illuminating. Some information
is simply not in the records such as laboratory reports on blood work,
details on the patient’s daily activities, details on his physical condition,
the kind of detail that would be found in medical notes recorded today.
To the hospital authorities, Gurney was just another patient about whom
his care givers knew little as one entry in his records indicates: "Said
to have been assistant organist in Gloucester Cathedral and to have
been a capable composer, and an approved poet". However, although
potentially important information is missing, the records do supply
results of urinalysis tests and reveal some of the medications he took
and some of the treatments he was given for his various physical ailments.
One of those treatments was a "mild form of
Malaria" administered to him in the summer of 1923. And it is this
treatment which points to Gurney having syphilis.
While it is possible that Gurney’s doctors might
have thought that syphilis was contributing to his mental problems,
they do not say so in his medical records. Thus, it is left to us to
look at what evidence there is to support the assumption that Gurney
had syphilis and to draw our own conclusions based on two questions.
What physical complaints or symptoms did Gurney
have from the time entered the City of London Mental Hospital? How do
those symptoms correspond to the known stages of syphilis?
Gurney and sex
We must first establish a time-frame within which
Gurney might have contracted syphilis. Was it in 1913 when he had his
first recorded breakdown, as has been suggested? Or even earlier in
his teens when he might have been the victim of sexual abuse? Or during
his time in France from May 1916 to September 1917? The latter period
seems most likely given most soldiers’ abundant sexual opportunities.
Gurney’s sexuality was dismissed in Michael Hurd’s biography, The
Ordeal of Ivor Gurney, and it has been assumed ever since that "sex
simply did not enter Gurney’s calculations in any shape or form".
But it did and it was a driving force in his life. And if Gurney is
thought to have had syphilis, sex was certainly involved.
Gurney was not about to write of his sexual experiences
in his letters to Marion Scott, the Hunt sisters, Ethel Voynich or other
friends, particularly if he were having relations with other men as
well as with women. If such letters did exist, it is likely that they
were destroyed upon receipt or later by well-meaning individuals seeking
to protect and purify Gurney’s image. We cannot pretend that Gurney
was not a sexual being or that he would shy away from enjoying sexual
pleasure. He patronized cafés, drank beer, enjoyed the company
of the French people. He admired the courage of the French women. He
reports that he and his friend Basil Cridland spoke enough French "to
get what we want". Are we to believe that Ivor Gurney, a passionate
young man, spent 16 months in France abstaining from sex and denying
himself pleasure knowing he could be killed any day? Most men would
make the best of such a situation and indulge themselves whenever possible.
Would Gurney be any different under the circumstances?
The symptoms of
syphilis
Once a time-frame is established, it is important
to look closely at the course syphilis runs. The initial symptoms of
the disease, which usually appear within two weeks to three months after
infection, are ulcers or chancre sores on the genitals, rectum, mouth,
fingers or other parts of the body and enlarged lymph nodes in the area
containing the sores. The sores may be painless and heal in about 4
to 8 weeks. Then the secondary symptoms come along anywhere from a week
to six months later. These include skin rash characterized by brown
sores the size of a penny, extensive lymph node enlargement, ulcerations
of mucous membranes, headache, aches and pains in the bones, loss of
appetite, fever, fatigue, patchy hair loss. The signs of this stage
may come and go for one to two years. Then there is a latent stage during
which there are no symptoms but if the disease is untreated changes
begin to occur in the internal organs or in the cardiovascular and central
nervous systems. Syphilis can remain latent for as long as 20 or 30
years before the tertiary stage appears. Then it gets nasty — ulcer-like
sores appear on the skin, hard nodules occur in the tissue under the
skin, in the mucous membranes and in various internal organs. Bones,
the liver, kidneys and other organs may be involved. The cardiovascular
system can become infected sometimes causing an aortic aneurism and
the disease can affect the central nervous system and lead to mental
illness.
If Gurney had picked up syphilis in 1913, or later
during his war service in France, the secondary stage would have been
long past by the time he entered the City of London Mental Hospital
in 1922. Yet he was given the malarial treatment in the summer of 1923,
a year and a half after his admission and at a time when he was highly
delusional and praying "continually for death". The records
pertaining to Gurney’s examinations prior to the malarial treatment
indicate that Gurney had been "ill (mentally) off and on since
1917" and that "patient had ulceration of stomach some years ago".
The only marks noted on his skin were scars on the back of his neck
and on his left knee. There is no record of the kind of sores associated
with syphilis and no reference is made to enlarged glands. Gurney was,
however, suffering from "auditory hallucinations" and insomnia
and was thought to be suicidal. In late 1931, he was said to be enjoying
"satisfactory health". As late as 1936 when Gurney was finally
examined by doctors, they found "no aneurisms" or abnormalities
in his heart, lungs, and abdomen, which would surely have shown signs
of degeneration by then if he had had syphilis.
Gurney’s health in the asylum
Not until March 1925, a year and a half after Gurney
endured the malarial treatments, did the hospital physicians diagnose
him with a condition that syphilis might imitate, something that they
defined as "evidently a scurvy". Scurvy is a disease caused
by a vitamin C deficiency. It’s presence is first observed in the mouth
where it causes inflammation and sponginess of the gums, which loosens
teeth, bodily weakness and swollen and tender joints. If Gurney had
picked up syphilis in 1913 or during the war, sores should have appeared
in his mouth well before he ever entered the hospital. It would not
be surprising to find a condition like scurvy in Gurney whose eating
habits were appalling and indicative of a serious eating disorder that
had plagued him from early adulthood onward. Today, we might regard
Gurney as suffering from a form of bulemia.
In the asylum, Gurney also complained of pains
in his head and we know that he must have suffered from other aches
and pains as well. These complaints could be symptomatic of syphilis
in its initial stages, just like the mouth sores, but they could just
as easily be symptoms of a number of other ailments. Gurney also suffered
from "bad muscular rheumatism" and was given "special
infra red treatment".(3) This condition, which was mentioned in
1935 and 1936 had been present "for some time". While one
of the treatments for syphilis did include "raising the temperature
of the body" with radiant heat, the medical records say that this
infra red treatment was for the rheumatism. They do not say it was for
syphilis.
Again, it would not be unusual to find Gurney suffering
from rheumatism, especially considering the physical hardship that he
endured during his months at the Front. For example, in his letters,
he describes experiences like sleeping on bare boards covered only by
a damp blanket and that was during basic training. By the time he got
to the Front, conditions were much worse. He was outdoors in all kinds
of weather and was often freezing and wet. These miserable physical
conditions would surely have an effect on him later in life and would
make him a very likely candidate for rheumatism and a host of other
muscle and joint ailments. Thus, the medical records seem to indicate
that the diagnoses of scurvy and rheumatism were completely separate
from any possible diagnosis of syphilis and that none of the symptoms
of these illnesses were stated by Gurney’s doctors to be symptoms of
syphilis.
Looking at the time frame again for the stages
of syphilis, if Gurney had contracted syphilis in France during the
war, he should have been in the latent stage by 1922. If he had contracted
it while a student at the Royal College of Music, he might have gone
through the latent stage and have progressed to the tertiary stage by
1922, but I don’t think this is the case. If Gurney had reached the
tertiary stage of syphilis by 1922, he would have begun a more pronounced
downward spiral with symptoms possibly affecting his heart, eyes, brain,
nervous system, bones, joints, or just about any part of the body. This
stage can last for years. The final stage of the disease can result
in mental illness, blindness, neurological problems, heart disease and
finally, death. Gurney was not demented, a characteristic of neurosyphilis.
He could still reason and understand what was happening around him until
the very end of his life. He was able to write poetry at least until
1929. He still read books and could communicate with Marion Scott about
what he was reading well into the 1930s. Indeed, could a demented individual
write
All night the fierce wind blew —
All night I knew
Time, like a dark wind, blowing
All days, all lives, all memories
Down empty endless skies....
When Helen Thomas, the widow of poet Edward Thomas
visited Gurney in the asylum in 1932, he knew who she was and understood
her relationship to Edward. He talked with her and she found him "generally
quite sane and lucid". This is not the behavior of a man suffering
from syphilis-induced dementia.
If Gurney had neurosyphilis, he might have experienced
the following symptoms as the illness took hold of him: headache, stiff
neck and fever, which result from an inflammation of the lining of the
brain; possible seizures, symptoms of stroke with numbness, weakness
and visual complaints. Neurosyphilis can take up to 20 years to develop.
Before the advent of malarial treatments, neurosyphilis usually killed
its victims in two to four years after it actually developed. Penicillin
began replacing malaria as a treatment for syphilis in 1945. Today,
malaria is still considered an effective treatment for certain illnesses
and is being studied and used to treat AIDS, cancer and Lyme Disease,
a serious and debilitating tick-borne illness in the United States.
Gurney’s behavior
In the Gurney Journal article it was noted
that a 1951 description of syphilis "bears an uncanny resemblance
to our image of Gurney in the asylum years: the outbursts of temper,
the uncharacteristic obscene speech, the steady decline of creative
power and the delusion that it was he who was the author of Shakespeare’s
plays...and the composer of much of the music of Beethoven, Brahms...".
It is also noted that "one result of syphilis in the nervous system,
Tabes Dorsalis (wasting of the dorsal columns of the spinal cord),
subjects the sufferer to sensations of lightning pains akin to electric
shocks" and that "Throughout the period of his mental illness
Gurney was convinced that he was a victim of ‘electrical torture’."
First, what proof do we have that "outbursts
of temper" and "uncharacteristic obscene speech" were
not in fact characteristic of Gurney throughout his life? Gurney had
a terrible temper from childhood onward but over the years his friends
attempted to soften this aspect of his behavior by making light of it.
Composer Herbert Howells does this in his descriptions of Gurney’s relationship
with their teacher Charles Stanford. Marion Scott, who knew all too
well how violent Gurney’s temper could be, makes only veiled references
to it in an effort to diminish its severity. She knew, for example,
that Gurney could be physically violent when in a temper and once cited
an account of Gurney attacking another boy, knocking him down and breaking
his spectacles because he "was annoyed by some things" the
other boy had said. Scott acknowledged that Gurney’s "own anger
was lightning when it came." Gurney enjoyed raunchy humour and
obscenities and admitted it even to Scott. During the war he wrote to
Scott telling her that he had created an "obstetric Journal"
that greatly amused his fellow soldiers. He acknowledged that he had
always been a crude person, and "these things come naturally to
me. Music and lewd nonsense and using words". Another note to Howells
reveals that Gurney could be quite vulgar when writing about the bowel
functions. Gurney also had an obsession with enemas.
Second, the issue of Gurney’s hallucinations and
delusional behavior is very complex and I do not believe that there
is a single answer to explain the form his hallucinations took. In the
asylum, Gurney told doctors that he could "see that all his life
he [was] subjected to Electricity". When dealing with mental illness
it is important to remember that quite often symptoms and behaviors
overlap, a factor that can create confusion when trying to understand
the root cause of an illness.
For many years, it was believed that delusional
behavior was connected with schizophrenia and the so-called split from
reality. Thus, Gurney was incorrectly labeled "schizophrenic".
However, modern psychiatry has found that such behavior is also symptomatic
of manic-depressive illness, an illness that had begun to show signs
in Gurney in his late teens, possible even earlier. The nature and effects
of this complex illness, which was severe in Gurney’s case and never
treated, provide a more realistic explanation of Gurney’s behavior prior
to entering the asylum and his condition as the illness progressed during
the 15 years of his incarceration there.
The mystery of hallucinations
According to the American psychologist, Dr. Kay
Redfield Jamison, "Depression affects not only mood but the nature
and content of thought as well". Manic states create degrees of
mental responses that include these words to describe them: "ebullient",
"self-confident", "fluctuating", "volatile",
"euphoric" "visionary expansiveness", a "mystical
merging of identities", "flighty thought", "leap
from topic to topic", "leapfrogging nature of thought",
"florid psychosis" and so on. People in these states are often
"tortured" and "tormented" by unseen forces of all
kinds. Some synapse in the brain misfires, perhaps mimicking an electrical
sensation, or the body undergoes a shift in its chemistry and the hallucinations
can take any form.
Another factor to consider is the period of time
it takes for the hallucinatory stages of syphilis to manifest after
it is contracted. The involvement of the central nervous system and
the brain occurs in the later stages of the disease, which can take
up to 20 to 30 years to appear. It doesn’t appear likely that the mental
symptoms of syphilis would have appeared with such force in Gurney after
only five or six years following possible infection. Gurney was already
suffering from hallucinations in 1918 and we know that such episodes
are symptomatic of manic-depressive illness as it progresses through
its complex manifestations.
Studies of the lives of other poets and composers
suffering from manic-depressive illness reveal hallucinations and delusional
behavior similar to what Gurney suffered. There are even occasional
references to terms with "electrical" connections used by
these suffers to describe their behavior or their perceptions of the
world around them. Virginia Woolf spoke of being "a sensitive plant
exposed to invisible rays..." while the Russian poet Vladmir Mayakovsky
described himself as being the recipient of "lightning telegrams".
The American poet Robert Lowell believed that he was the Holy Ghost
while another American poet, Theodore Roethke once felt himself to be
a lion. Roethke walked into a diner and demanded a raw steak and then,
to the horror of other diners, he began to eat it. There is no known
evidence that any of these individuals had syphilis.
Each of these poets and writers suffered from hallucinations
and delusional behavior associated with their manic-depressive illnesses.
You can read through history and find similar examples of hallucinations
and delusions in Van Gogh, Schumann, Byron, Shelley, Plath, Coleridge,
Poe, Melville, Berlioz, etc. and in them see little rhyme or reason
or sense. Thoughts of suicide or attempts to commit suicide also figure
in the behavioral patterns of some manic depressives.
There are as many examples of hallucinations and
delusions are as there are people suffering from them. All sorts of
threads run through them from violence to euphoria to pleas to die.
When the mind is "touched with fire" it is very difficult
to find the source of the flame and that might well be the case with
Gurney and the nature of his hallucinations.
Third, if Gurney had syphilis, the malarial treatment
should have provided some relief from his mental symptoms. It did not.
After the treatments ended the doctors reported that Gurney was improving
physically but "there is little or no change in his delusions".
The research and experimentation done by Dr. Julius Wagner-Jauregg in
the early years of the 20th century revealed that malarial
treatment of syphilis had "striking" results in curing patients.
In fact, these early medical pioneers claimed a cure rate of up to 85
percent of late-stage victims who were treated promptly.
Malarial treatment and shell shock
David Goodland and I went off in two different
directions on the syphilis question. I consulted with a biologist who
is an authority on malaria. He told me that as far as he knew, the only
use for malaria was to treat syphilis.
"My guess is that they (the doctors) thought,
rightly or wrongly, that Gurney was suffering from syphilis and that
this was contributing to his mental problems," he said. Other medical
people I later spoke with confirmed this and I thought "Here’s
a possible explanation for some of Gurney’s trouble" although I
wasn’t convinced at that point in March 1999.
In the meantime, David uncovered vitally important
information that doctors and authorities on malaria and sexually transmitted
diseases do not seem to be aware of. During the World War I era, malarial
therapy was an experimental treatment used on soldiers believed to be
suffering from shell shock or other mental/emotional effects of the
war. Doctors thought that the malaria, which produced hallucinations
and very high, dangerously high, fevers mentally "cleansed"
these men. Thus, malaria was NOT used exclusively to treat syphilis
and, after World War I, it was indeed used "speculatively"
in the hope of curing the mental anguish suffered by soldiers who had
served on the battlefield.
When Gurney was admitted to the City of London
Mental Hospital in 1922, his doctors were clearly puzzled by his behavior.
Partly because Gurney became so uncooperative and partly because they
simply did not have the knowledge or diagnostic skills, they were forced
to do a lot of guess work in their efforts to find reasons for Gurney’s
mental condition. Without any concrete medical evidence to support them,
they assumed that he had suffered from shell shock during the war. It
is important to remember that sometimes "shell shock" was
a catch-all name for ailments physicians could not otherwise define
or whose root cause was not known to them. Thus, it is likely that as
Gurney’s mental health deteriorated, the doctors, assumed that his condition
might be the result of shell shock that was noted on his admission papers.
Since malaria was being used experimentally to treat soldiers suffering
from shell shock, Gurney’s doctors could very likely have believed that
such a treatment would enable them to control or even cure his escalating
mental symptoms.
However, the fact that the malaria treatment failed
to improve or change Gurney’s hallucinations and delusional episodes
and behavior should be considered as evidence that he did not suffer
from syphilis. "The malaria has had no beneficial effect mentally,"
states an entry in the medical records dated 5 November 1923. If Gurney
was infected with neurosyphilis, the malaria fevers should have destroyed
the invading bacteria that cause the illness.
Footnotes
1. Anthony Boden, "Ivor Gurney: Schizophrenic?",
Ivor Gurney Society Journal, Volume 6, 2000, pp. 23-28. Anthony
Boden and Michael Hurd, "Tormented Genius", BBC Radio 4, 31
October 2000.
2. While such medical records are generally sealed
for 100 years, Gurney’s asylum were already open and available at the
Corporation of London Records Office before they were unsealed at the
Gurney Archive. David Goodland and I worked with them in 1996.
3. Adeline Vaughan Williams letter to Marion Scott,
1935.
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