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In The Land Of Pain

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Authors: Dr. Asnia Latif, Dr. M. Faisal Amir Malik and Dr. Ali Madeeh Hashmi

(Authors’ Note: Alphonse Daudet (1840-1897) was a nineteenth century French novelist. A contemporary of Gustave Flaubert, Edmond de Goncourt and Emile Zola, among others, he achieved much fame and renown in his life-time. He contracted syphilis sometime in his twenties. In the last ten years of his life, he suffered from the effects of neurosyphilis. “In the Land of Pain” is a personal account of his struggle with the illness which eventually took his life.)

In the early nineteenth century, the tertiary form of syphilis began to be recognized. After lurking in the victim’s blood for several years, syphilis attacks the central nervous system. The resulting condition, called neuro-syphilis, is invariably fatal. It usually manifests in two major forms: Locomotor ataxia (also called “tabes dorsalis”) or general paresis (also called general paresis of the insane).

Indeed, neuro-syphilis spread so widely through Europe in the nineteenth century that it came to be known as the ‘disease of the century’. The disease also made its appearance among the literary luminaries of the period. Gustave Flaubert, Charles Baudelaire, and Guy de Maupassant formed the ‘big three’ of the literary syphilitics. The others included Alphonse Daudet and his “doppelgänger” in pain, the Italian poet Leopardi. To illustrate the attitudes of the time towards the illness, when Maupassant contracted syphilis, this prophet of pessimism cried out in exultation: “I’ve got the pox! At last! Not the contemptible clap… no, no, the great pox… The majestic pox… and I’m proud of it.’ He died in 1893 after spending eighteen months in a lunatic asylum.

When Alphonse Daudet became afflicted with neuro-syphilis, this ‘happy little novelist’ started to chronicle his experiences through the course of the disease. These notes were initially compiled and published as “La Dolou” (“The Pain”) in 1930.

In 2002, Julian Barnes translated these notes and published them with the title, “In the Land of Pain,” with a comprehensive introduction.  Copious foot-notes provide invaluable – and at times, witty – background to the notes.  In the notes, Daudet gropes to come up with some appropriate metaphor, ‘some … term to describe the crisis’ in which he found himself. The description begins with a literary flourish: The urinary symptoms, the ‘nothing which was the start of everything. The invasion’.

Soon, light reflected from windows begins to trigger excruciating pain, and after sleepless nights he hears spiders spinning their webs. His chest feels compressed, as if by a metal breast-plate. As ataxia progresses, he loses control of his legs and has difficulty writing.

“Armor is exactly what it feels like, a hoop of steel cruelly crushing my back. Hot coals, stabs of pain as sharp as needles”. In a profusion of inspired metaphors we read of pain being compared to a singer’s voice, stabbing like ‘wasps’, feeling like the crucifixion and becoming the cruel guest and the ‘impish little bird. ‘The generous use of metaphors serves, occasionally, to mitigate the grimness and dread associated with pain, disease and death. The sordid reality of experience comes through more vividly in raw, unvarnished descriptions, as when he breaks down and confesses the ‘sheer dread’ – of pain, death, and loneliness – that he felt. Expressions of sadness turn into frank declarations of despair. ‘My friends,’ he writes, ‘the ship is sinking. I’m going down, holed below the water-line.  … Beginning of the end’. But amazingly, throughout it all, Daudet maintains his, at times, grim sense of humor, likening, for instance, the pangs and variety of pain, ironically, to the playing of musical instruments which make him a ‘one man band of pain.’

It was only in 1905 that the causative agent of syphilis, Treponema Pallidum, was discovered. And it was not until the 1940’s that syphilis could be completely cured by using penicillin. Before that, physicians gave free rein to their ingenuity and imagination in their ultimately futile attempts to fight this tenacious illness. In the “heroic age of medicine” this meant cures which ranged from the comical to the truly tortuous.

Alphonse Daudet was friends with, and sought the advice of, some of the most celebrated physicians of the day – J. M. Charcot, Potain, Felix Guyon, Charles Edward Brown-Sequard. He was willing to be subjected to all sorts of treatments. These ranged from anodyne; being sent away to various spas or soaked in baths, to ‘esoteric diets … to [which] death was preferable,’ to downright bizarre therapies like being injected with elixirs extracted from guinea pigs, and the extremely painful “Seyre’s suspension”, ostensibly employed to relieve ataxia. The various drugs of the time used included chloral, bromide, laudanum, morphine, and mercury. Mercury was widely used for syphilis in the nineteenth century, giving rise to the joke – “spending one night with Venus and the rest of your life with Mercury”. At most these drugs brought temporary relief. Most of the time they caused more pain than they cured.

Interspersed in the footnotes of the book are brief, extremely insightful descriptions of famous medical or literary figures of the day e.g. this one about the ‘father of Neurology’, Jean-Martin (JM) Charcot (1825-1893): “For Leon Daudet, Charcot was a diagnostician and observer of genius, a man of vast erudition and ‘implacable wisdom’, whose case summaries were as concentrated as an Ingres drawing (the name comes from Jean-Auguste-Dominique Ingres, the eighteenth century French Neoclassical painter famous for his portraits, both painted and drawn); he was without leniency towards humanity (though full of pity for animals), found the illness more interesting than the patient, and ‘observed the malfunctionings of the human machine as an astronomer observes the movement of the stars’.

Daudet finally turned to morphine for his excruciating pain. While it brought some much needed respite from pain, it was at the cost of a slew of other problems which included confusion, disorientation, a clouding of the mind and “spiteful fits”. Eventually he became an addict. None of these treatments cured him. Daudet died in 1897.

A large number of people live with chronic pain and they are usually our least favorite patients. In Pakistan, chronic pain has not yet become an ‘epidemic’, unlike the USA where chronic pain and its associated scourge, the overuse and abuse of opioid pain medicines (medicines derived originally from the opium plant such as morphine and more synthetic derivatives) has become a national emergency. Living in pain is often not even considered living but only a phase to be endured, even terminated.  This is not to dismiss the extremely unpleasant reality of this experience, but to counter our narrowly monolithic and instinctively adversarial attitude to pain.  If pain sometimes dissolves the emotion of being it may also induce a greater awareness of self.

‘Pain is not only an inevitable component of human existence but thoroughly entangled with our experiences of love, joy, humor, and intimacy.’

Most physicians have a reflexive tendency to dismiss the insights of these experiences and view them as an aberration. But what does a writer have to day about it?

‘[I]t is the very blankness of pain – the lack of anything it’s truly like or about, that cries out for metaphor the way a blank chalkboard invites scribbling.’ Daudet struggled to convey his experience with pain, ‘Are words actually any use to describe what pain (or passion for that matter) really feels like? Words only come when everything is over, when things have calmed down. They refer only to memory and are either powerless or untruthful.’ Pain is ‘language destroying.’

Which suggests the mystery: Why would Daudet, then, continue to labor over these notes for several years?

Perhaps he found the act of writing to be cathartic, even therapeutic. Perhaps he believed, as many have done through the ages, that ‘suffering is instructive’, and that there is a value in truths “revealed” by pain?  Or maybe he held on to the hope of an eventual cure and respite from pain when he would be finally able to transform these fragmentary notes into a book.

Daudet died in 1897, his ‘pain diary’ incomplete. He had, apparently, stopped taking notes about three years before his death but, according to accounts of his family and friends, he maintained his zest for living till the end. His advice to his fellow pain sufferers was always the same: that illness should be treated as an unwanted guest to whom no special attention is accorded; daily life should continue as normally as possible. ‘I don’t believe I will get better’ he said, ‘nor does Charcot. Yet, I always behave as if my damned pains were going to disappear by tomorrow morning’.

Doctors may have a hard time understanding this but writers, those ‘vessels of the unseen’ know better. Everyone is afraid of dying and yet most people who face life threatening illnesses or near-death experience have, what might euphemistically be referred to as ‘a wakeup call’. They realize, thankfully, that life is short and can end any minute. For those few who choose to reflect over this, their life, whatever remains of it, becomes far more meaningful and happy where they can focus on the things that truly matter to them rather than running on the treadmill of day to day trivia. This is the real blessing of illness and even impending death: a stark reminder that life is beautiful and appreciating that beauty is the only way to live.

A version of this article appeared earlier in ‘Annals of King Edward Medical University’. 

The writers are all graduates of King Edward Medical University.

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