In Sickness and in Health

M0011138 A physician telling a patient that he is going to die (?): t“Think of the situation of that man – think of his poor disconsolate wife who weeps, but whose tears are unlike those which accompany complaints and recrimination, for love and affection complain not of an injury but forgive; Think of the wife’s connections and family, who will not forgive – who have a right to their anger and who will also give vent to it; Think of the unhappy infant, who, in place of being the ‘dear baby’, upon which the hopes and dreams of the young wife have centred, and whose advent the family have expected with so much delight, is to all nothing but an object of horror and disgust; Think also of the nurse now infected, who threatens, gossips, divulges – and throws shame upon the whole family…”

It sounds like the opener to a Wilkie Collins sensation novel, or to a neo-Victorian horror in the style of Michael Faber’s Crimson Petal.

It’s taken from neither. This melodramatic vignette actually appears in a late nineteenth-century medical textbook: Alfred Fournier’s Syphilis et Marriage, to be exact. Translated into English by Alfred Lingard, a Member of the Royal College of Surgeons, it made its way onto the UK market in 1881 with a primarily professional audience in mind.

This striking portrait of an unhappy family life was intended to persuade medical professionals just what lay at stake when they pronounced whether a syphilitic patient (inevitably male in the author’s imagination) was fit to marry an ‘innocent’ wife’.

Syphilis and Marriage was the most incredible gem I found during my recent research for a paper on syphilis and the family. Originally I intended for it to inform my readings of Sarah Grand’s The Heavenly Twins (1893) and Henrik Ibsen’s Ghosts (1881) but it became one my primary texts in its own right; a real eye-opener about the role of medical professionals in the nineteenth century and attitudes towards marriage and the family more generally.

It was a pioneering text of its day, forcefully challenging the long-held (and disturbingly persistent) assumption that syphilitic men were ‘safe’ to marry perhaps a year or so after their first dose of the disease had disappeared.

It contributed to a gathering moral panic about the threat posed by middle-class men to their innocent ‘families’ – a panic which reached its crescendo in the fin-de-siècle; by 1894, Dr Henry Allbut was proclaiming (in The Wife’s Handbook) “I should like to see it the custom for women or their parents to demand a recent certificate of freedom from syphilis from all men proposing marriage” [emphasis added].

To a modern reader there remain many problematic aspects to Fournier’s text – not least his suggestion that medical professionals collude with husbands to protect unsuspecting wives from knowing the real nature of the disease afflicting them (lest it dent their affection/esteem/respect for their spouse!)

Nevertheless, to many Fournier must have seemed to occupy an optimistic middleground between those that suggested a syphilitic man may never be fit to marry and those that peddled the more cavalier theories that syphilitic sufferers posed no real risk.

For whilst Fournier went to great pains to highlight the dangers that a man could pose to his wife and children (although the Victorians mistakenly believed the disease to be ‘inherited’ rather than congenital, they certainly understood the threat it posed to the offspring) he also went to painstaking lengths to suggest under what scenarios a syphilitic man might be fit to marry. He insisted (from his own experience as venereologist) that syphilis posed only a “temporary bar” to wedlock.

To an enlightened modern mind, none of his caveats seem quite enough; for this was an age in which the primary treatment for syphilis was mercury, which not only gave way to grisly symptoms but was not even that effective in the first place.

But Fournier’s advice was careful and considered. He insisted that any syphilitic sufferer thinking of embarking on marriage must have spent (at a minimum) three to four years “devoted unremittingly to treatment”. He also recommended considering whether the treatment had been sufficient and specific, whether the disease lacked “menacing” characteristics and whether there had been a set period of “absolute immunity” since the last specific manifestation. He was scathing about those men that sidestepped these vital questions.

For all that the text tells us about medical advances of the period, it yields just as much about marriage and the sexual double standards of the nineteenth century. It is undeniably seeped in sort of the Victorian hypocrisy which would have sanctioned a man indulging in “youthful folly” but recoiled from the idea of a (respectable) woman doing anything even approaching the same.

The implication throughout most of the text is that syphilis is transmitted from prostitute to husband during an early indiscretion, and that he may then pass it to his wife and child years later. Fournier is also troubled by the unpleasant idea that some men may transmit the disease to wives from extramarital affairs (and liaisons mere days before their wedding), but he does not cast his net much wider than that.

He never really confronts the possibility that a woman may pass the disease to a husband (and certainly not a man to a man). In reality, of course, this avenue of transmission was perfectly plausible. The records of the London Lock Hospital (housed in the Royal College of Surgeons) – which focused on treating venereal disease – certainly testify to the fact that many of the female patients hospitalized for syphilis eventually went on to marry.

Yet despite its somewhat limited outlook, readers should be in no doubt about the ‘radical’ nature of Syphilis and Marriage’s subject matter. For its unremitting focus on a male model of disease was a significant departure from the previous obsession with female (prostitute)-to-male transmission which had been infamously enshrined in the Contagious Disease Acts less than twenty years earlier.

While Fournier did not attack the sexual double standard which saw innocent (and ignorant), virginal women united with much worldlier men (dangerous before the advent of safe sex) he did recognise the threat husbands could pose to women and, in doing so, acknowledged that marriage and parenthood could be far from an idyll.

Picture courtesy of Wellcome Library, London

Select Bibliography

Allbutt, Henry, The Wife’s Handbook, 23rd edition, (1894), qtd. in: Claudia Nelson, Family Ties in Victorian England (Westport: Praeger, 2007).

Fournier, Alfred, Syphilis and Marriage, trans. by Alfred Lingard, with prefatory remarks by Jonathan Hutchinson (London: David Bogue, 1881).


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