Neuro Syphilis: Portrayals by Sir Arthur Conan Doyle

Article excerpt

Byline: O. Somasundaram

The developments in neuro syphilis in the 19[sup] th century are integral parts of the history of psychiatry. The delineation of various aspects of neuro syphilis by Sir Arthur Conan Doyle in three of his stories is discussed in brief.

The medical profession is partial to the literature of medical writers. Sir Arthur Conan Doyle,[sup] [1] the author of The Adventures of Sherlock Holmes, etc., W. Somerset Maugham (1874-1961), the author of Of Human Bondage , Cakes and Ale, etc., A. J. Cronin (1896-1981), the author of Citadel , The Keys of the Kingdom, etc., and Anton Chekhov (1860-1904), the author of many short stories and Cherry Orchard (Chekhov once said: "Medicine is my lawful wife and literature is my mistress") are some of the famous medical writers. The medical men see their personal and professional life depicted in many of their stories, and it is not surprising that many medical illnesses are portrayed in minute details.

Conan Doyle is no mean exception to the aspect not only of the medical knowledge but also the psychological aspects of the mind that are replete in his stories. The following article narrates three stories related to neurosyphilis. His interest in and intimate knowledge of the disease can be gauged from his doctoral thesis on tabes dorsalis in 1885 in the University of Edinburgh. It is also interesting to note that his father Charles, an artist, had alcohol problems which necessitated his admission into the Montrose Royal Lunatic Asylum, the Edinburgh Royal Infirmary, and finally at Crighton Royal Institute where he died in 1893. Conan Doyle's familiarity with general paralysis of the insane (GPI) and tabes dorsalis should have increased enormously during his visits to the various asylums.

Before entering into the fiction of neurosyphilis, it is worthwhile recalling the history of neurosyphilis. Once called "the disease of the century," neurosyphilis has been virtually forgotten today and is routinely ignored by historians of psychiatry, according to Edward Shorter.[sup] [2] He also gives a concise history of this disease.[sup] [3]

Among its celebrated victims of the 19[sup] th century are Schumann (German composer, aesthete, and music critic), Maupassant (French writer), Donizetti(Italian composer), and Nietzsche (German philosopher and philologist). Clinical aspects of Maupassant are discussed by the author in an earlier article.

Hare[sup] [4] elaborately discusses the origin and spread of dementia paralytica. In spite of the widespread prevalence of syphilis in the Middle Ages, the central nervous system was not known to be involved till the early decades of the 19[sup] th century. This is attributed to a mutant neurotropic "syphilitic virus" strain, which spread from northern parts of France to Europe and other parts of the world. The descriptions of GPI are attributed to English physicians like Thomas Willis. John Haslam of the Bethlehem Hospital before this period is not given credence. Instead, Bayle (1882) Calmeil (1826) were given. Between January 1815 and July 1823 Bayle collected 189 cases of chronic meningitis (i.e., dementia paralytica) among 847 male admissions and 25 among 606 female admissions to Charenton.

Let us now go into Conan Doyle's fictional world.

Tale No.1: A Medical Document - The Classical Grandiose Type of G.P.I.

Charley Manson, Chief of Wormley Asylum gives the study of his patient:

"Well, take a common complaint which kills many thousands every year like G.P. for instance."

"What is G.P.?"

"General Practitioner", suggests the surgeon with a grin.

"The British Public will have to know what G.P. is" says the alienist gravely.

"It's increasing by leaps and bounds, and it has the distinction of being absolutely incurable. General Paralysis is its full title and I tell you it promises to be a perfect scourge. Here's a fairly typical case now which I saw last Monday week. …