around in his tales and novels, and few figures of the time were spared his wit and

irony. He did not back away from the preposterous duels in which he got involved, and several times took great risks with his career, for instance making fun of the catholic church, his fellow provenaux, and even the prestigious Acadmie Franaise, the accession of which remained for him forever closed after his sarcastic novel LImmortel. More to the point, La Doulou definitely vindicates him as a genuine explorer of the deepest human torments and certainly would make any ex-schoolboy reconsider his former opinion of the charming Nmois.

Daudets Syphilis and Tabes dorsalis

As strange as it may seem, despite the omnipresence of syphilis in the social landscape of the time, the word itself rarely appears as such in the literature [Wald-Lasowsky, 1982]. It is altogether absent from Daudets work for instance, and it doesnt even appear in La Doulou. One commentator wrote: Barely suggested here and there, it is the great absentee of the text, as if the disease withdrew into the indivisible core of pain, black violence and only certainty [Solal, 2002]. If there was a taboo on the word, such was not the case with the idea, as it was omnipresent in late 19th century literature. It even came to be fashionable in intellectual circles to be afflicted by it. Barnes [2002, p. 85] recalls the famous anecdote of Maupassant howling triumphantly when he was definitely diagnosed with it in 1877: My hair is beginning to grow again and the hair on my arse is sprouting. Ive got the pox! At last! Not the contemptible clap no, no, the great pox, the one Franois Ier died of. The majestic pox and Im proud of it, by thunder. I dont have to worry about catching it any more, and I screw the street whores and trollops and afterwards say to them, Ive got the pox! [see also Hayden, p. 916]. In brief, syphilis was proof of virility, originality, an unmistakable sign of creativity, the true seal of the artist, in short, the real thing. Syphilis Then and Now As late as 1937, it was considered that about 10% of Americans were at risk to be infected with syphilis in their lifetime [Golden et al., 2003]. What happened then, of course, was the introduction of penicillin in the 1940s which almost eradicated this medical and social catastrophe. Infection rates declined dramatically during the rest of the century, only to slightly re-emerge with the new millennium. It is a complex disease. Not anymore an etiological mystery since the discovery of the bacteria Treponema pallidum by Schaudinn and Hoffmann in 1905, but still a clinical puzzle to practitioners of many medical disciplines.

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Indeed, syphilis as been dubbed the great simulator, it can disguise itself in innumerable differential diagnoses liable to mislead any clinician from the dermatologist to the neuropsychologist. Its other strategy is to hide and wait. It is such a Machiavellian disease that some even argue that the incriminated agent rapidly evolved, upon his appearance in 16th century Europe, precisely to produce milder forms in early stages, which would in turn favor its spreading in the population [Knell, 2004]. Syphilis is a progressive disease par excellence and its manifestations present themselves through three stages, although only a meagre 10% of patients with first stage syphilis end up developing a full-blown third stage [Janier, 2004]. Unfortunately for him, Daudet did with his progressive locomotor ataxia (Duchenne de Boulognes term for Rombergs tabes dorsalis). This is one of the many clinical appearances of third stage syphilis, which is almost always synonymous with neuropsyphilis. Meningitis and the ever terrifying dementia called general paresis are other little enviable presentations. That classification of syphilis in three stages, by the way, was first established by Philippe Ricord at the beginning of the 19th century [Janier, 2004]. He was the one who first diagnosed Daudets disease, possibly in 1861. Another simpler distinction is made between early and late syphilis, distinguishing the severe manifestations of advanced neurosyphilis from the mildest manifestations of the years immediately following the inoculation of the bacteria. Nowadays, diagnosis is based on the careful study of the cerebrospinal fluid and T. pallidum serology. Brain imaging is useful in advanced cases to look for vascular lesions and the presence of gummas in the parenchyma, but mostly to exclude other diagnoses [Conde-Sendn et al., 2002]. All this was of course unavailable in Daudets times, so Ricord and all others had to rely solely on clinical observations. The course of the disease is as unpredictable as is its clinical variety. In Daudets case, as much as 20 years separated is its infection from his first severe tabetic manifestations. But as we will show, even though his last 10 years were the most excruciating, the disease was in one form or the other always present in his writing career and life as a family man. The dreadful spirochete T. pallidum can attack the central nervous system very early on. Indeed, in 2540% of untreated cases the invasion occurs within 318 months of the infection [Silberstein et al., 2002]. Most often, this results in asymptomatic meningitis, but it may be relevant in Daudets case for he presented painful fits, sleep disturbances and mood lability well before reaching his full-blown tabes, which was diagnosed by Charcot only in 1885. Daudets Early Syphilis As we briefly hinted before, he caught it at 17 from a lectrice de la cour. The first manifestations of early syphilis were examined by Doctor Philippe

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Ricord, one of Mornys medical advisors and a founder of syphilography. The specialist was absolutely positive in his statement: it is syphilis. Alphonse confessed to his friend Edmond de Goncourt: I caught the pox with a lady from the top drawer, a terrible pox with buboes and all, and I gave it to my mistress [quoted in Caracalla, 2003, p. 92]. He was by then a new member of the prestigious French literary syphilitics club, right in the top five with Baudelaire, Maupassant, Flaubert and Jules de Goncourt [Daudet, 2002]. However, Daudet was not as proud as Maupassant, he considered his ailment as a form of penance. Anatole France reported that shortly before he died, Daudet declared: I am justly punished for having loved life too much [Daudet, 2002, p. 85]. He was immediately treated with mercury, a substance used since the XVI century for the treatment of syphilis [Hediguer, 1985]. The disease mostly lay dormant for a time, and Barnes [2002, p. viii] notes that [he] worked, published, became famous, married, had three children. He also continued an active, carefree, careless sex life. However, before the full emergence of tabes, we know that Daudet had various unpleasant disturbances, which he reports in hindsight in La Doulou: Warning signs going back a long way. Strange aches; great flames of pain furrowing my body, cutting it to pieces, lighting it up A burning feeling in the eyes. The hideous pain from light reflected in a window. Also, from that time onwards, pins and needles in the feet, burning feelings, hyper-sensitivity Hyper-sensitivity of the skin, loss of sleep, the coughing up blood The first moves of an illness thats sounding me out, choosing its ground. One moment its my eyes; floating specks; double vision; then objects appear cut in two, the page of a book, the letters of a word only half read, sliced as if by a billhook; cut by a scimitar [Daudet, 2002, pp. 67]. It is difficult to precisely date these disorders, but other sources, like the Goncourt brothers Journal, show the ineluctable progression of the disease and the intermittent acute crisis, like those of hemoptysis that almost killed him on a few occasions [Benoit-Guyod, 1947; Mantoux, 1941]. Nevertheless, it is about Daudets debilitating late syphilis that we have the most information, perhaps too much information we might say. Daudets Tabes dorsalis (Progressive Locomotor Ataxia) As every psychiatrist knows, the clinical picture of general paralysis is at the very heart of modern neuropsychiatric reasoning, or better stated of the organic model of mental illness [Colle and Qutel, 1994]. That a bacterial infection could produce disorders of the soul was indeed a revolutionary advance in medical thought. Tabes also has its own history, not devoid of controversy either. Moritz Romberg first described the condition, but didnt mention syphilis as a possible etiology. In his 1840 textbook, he did, however, insist on a past history of excessive drinking and sexual activity as being frequent

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