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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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