In the land of pain

It is sixty years since penicillin was first used to treat syphilis and, as a consequence, the ravages of its tertiary stage have faded from medical memory. All the more enlightening then to read this excellent first English translation of La Doulou (1930), a personal account of neurosyphilis written by the French novelist, playwright and journalist, Alphonse Daudet (1840-1897). Although largely forgotten today, Daudet made his name (and his fortune) with gentle stories and novels portraying life in the French provinces. Hailed as "the happiest novelist of his day", he was admired by Dickens and Henry James, and moved in the same literary circle as Turgenev, Flaubert, Proust, Zola and Edmond de Goncourt. Daudet caught syphilis shortly after his arrival in Paris at the age of seventeen, from a lectrice de la cour, a woman employed to read aloud at the Imperial court. Following treatment with mercury, the infection lay dormant for twenty years, during which time Daudet married (in 1867), fathered three children, maintained a "villainous" extramarital sex life, and became famous. By the early 1880s, however, the symptoms of progressive nervous system degeneration known as tabes dorsalis or locomotor ataxia were undeniable. For the last twelve years of his life Daudet experienced most of the "atrocious surprises" sprung by the disease-difficulty walking, especially in the dark, a girdle sensation around the abdomen and chest, double vision, urination problems, progressive paralysis and excruciating paroxysmal attacks, which he described as "great flames of pain furrowing my body, cutting it to pieces, lighting it up". All this should make for depressing reading, but Daudet, sociable, courageous and entirely devoid of self-pity, wrote with humour and perception of his visits to hydrotherapy baths and spa towns where patients "danced" the "ataxic polka" and gave each other useless advice; of being suspended in mid-air by the jaw for minutes on end in vain attempts to stretch his spine; of the hopeless efforts to balance benefits against side effects of morphine, bromide and chloral hydrate, and his body's increasing resistance to their sedative and pain-relieving properties. Whilst maintaining a cynically realistic view of doctors, Daudet could afford the best. Guyon probed his bladder, Fourier linked his tabes to syphilis, Charcot told him he was incurable, and Gilles de la Tourette tried to resuscitate him with electricity after his death. In the event, Daudet avoided the descent into madness that he feared and was the fate of other French literary syphilitics including Maupassant, who spent his final eighteen months in a lunatic asylum. Daudet's intimate and insightful account of what has been regarded as "textbook" tabes is enhanced by Julian Bames' informative and entertaining footnotes, which set the narrative in context. This is a valuable book not least because neurosyphilis, like AIDS today, was such a devastating chronic, incurable disease, destroying the useful lives of men in their prime (the disease was relatively rare in women) and consistently accounting for a quarter of all male asylum deaths in England and Wales. Read it and you will appreciate Ehrlich's use of the term "magic bullet".