The medical plausibility of Osvald’s disease

The topic of how Osvald in Ghosts (1881) became infected with syphilis has been a recurring topic in Ibsen scholarship. The debate has focused on whether or not the disease is congenital, and if so, how Helene has remained uninfected. With a few notable exceptions, such as Sprinchorn (2004), Ibsen scholars have not consulted the writings of contemporary medical experts on syphilis such as Alfred Fournier, Jonathan Hutchinson and Carl Wilhelm Boeck. The medical discourse produced by syphilologists, to use the terminology of the time, provides contextual information that may help shed light on the issue of Osvald’s syphilis. I will argue in the following that Osvald suffers from congenital syphilis, which was transmitted to him at conception by his father, with both Osvald’s mother Helene and half-sister Regine remaining uninfected. From the perspective of the contemporary medical discourse on syphilis (henceforth simply “syphilis discourse”), this mode of transmission would have been regarded as medically sound and eminently plausible. Significantly for my understanding of Ghosts, congenital syphilis transmitted from father to child (paternal transmission) was associated with vastly different ill effects than maternal transmission, mixed transmission (both parents being infected), and acquired syphilis. Paternal transmission was thought of as giving rise to a condition of reduced vitality or decrepitude on the part of the child, manifesting in a susceptibility to other diseases and a general lack of vigor. The fate of children born with syphilis, and especially cases of late onset congenital syphilis (syphilis héréditaire tardive), is an example of how syphilis discourse aligns with contemporary discourses on degeneration. The trope of the hérédosyphilitique; the child born with syphilis, tapped into cultural anxieties regarding threats to the family line and by extension to society itself. Part of the literary appeal of syphilis, as it were, lay in the fact that the medical establishment differed on how the disease was transmitted.¹ The unpredictability and long latency of the condition provided authors with a compelling literary motif which encapsulated fin-de-siècle anxieties of social and even civilizational decline (Voss 2004, 28). My central argument is that Ibsen’s depiction of the cause and effects of Osvald’s disease not only accords with the medical understanding of syphilis at the time, but also serves the purpose of leveling criticism at a bourgeois patriarchy that, due to its failure to ensure the viability of its children, has doomed itself to extinction.²

I understand Ghosts as an instance of Ibsen’s long-standing engagement with degeneration discourse.³ What I refer to as Ibsen’s degeneration plot focuses on the decay and downfall of prominent families due to the introduction into the family line of various degenerative factors. In the case of Ghosts, chamberlain Alving’s descent into a state of degeneracy results in him contracting syphilis and passing on the disease to his child, thereby bringing about the end of the Alving line. In my reading, syphilis is thus at once a consequence of moral degeneracy (Alving) and an originator of biological degeneracy (Osvald). The most detrimental aspect of Osvald’s syphilitic inheritance is not the disease itself, but the lack of vitality resulting from the disease. It is on the issue of physicality that I differ sharply from earlier research. There is a tendency in Ibsen scholarship to emphasize the use of syphilis as a metaphor for bourgeois lechery, a tendency that can be exemplified by Erik Bjerck Hagen’s comment that the mode of transmission is quite simply irrelevant.⁴ Similarly, Elaine Showalter foregrounds the ideological connotations of the disease: “Ibsen’s ghosts are not the invisible spirochetes of syphilis but the virulent prohibitions of religion and bourgeois morality. Mistaken ideas about sexuality constitute the true hereditary taint […].” (Showalter 1991, 199) My concern with this tendency of shifting from the disease itself to the social and cultural connotations of the disease is that a reader who is disinterested in etiology (the cause of disease) risks not recognizing the symptoms of Osvald’s disease, most significantly his quality of reduced vitality. The frequent comments made regarding Osvald’s tiredness (Ibsen 2016, 199), his need for recuperation (Ibsen 2016, 209), his tendency to over-exertion (Ibsen 2016, 237), and his inability to sleep (Ibsen 2016, 252) all point to a constitutional impairment that accords with the contemporary understanding of paternal transmission.⁵ The characteristics of paternal transmission call for a shift in focus when reading Ghosts. The transmission of vital energy or life-force from parent to child appears above all as a male obligation. It was the duty of Alving, in his capacity as bourgeois patriarch, to ensure the biological viability of his offspring. At the expense of possibly removing some of the mystery attaching to Osvald’s condition, I hope to be able to bring into focus the specificity of the charge of immorality being leveled at the Alvings of the world.

I have found little evidence that Osvald’s condition was interpreted by contemporary audiences, medically trained or otherwise, as a case of paternal transmission. A hint can perhaps be found in the Italian criminologist Cesare Lombroso’s comment on what he sees as the central idea of the play, which is that “die Mängel und Krankheiten der Väter sich in immer verstärktem Maße von Generation auf Generation vererben, bis zum schließlichen Erlöschen des Geschlechts.” [the weaknesses and illnesses of the fathers are passed down in an ever-increasing scale from generation to generation until the final dissolution of the family line] (Lombroso 1893, 555) Lombroso’s phrasing of the “illnesses of the father” might indicate that he understands Osvald to have inherited Alving’s disease; more importantly for my argument, however, is that Lombroso regards the play as an illustration of the mechanisms of degeneration. By contrast, Max Nordau argues in Degeneration (1895) that Osvald cannot be afflicted with late onset congenital syphilis as he is “depicted as a model of manly strength and health.” (Nordau 1895, 354) The problem lies with the scarcity of information provided by the text itself, as the nature and cause of Osvald’s disease are never made explicit. The question of etiology is nonetheless of paramount importance when interpreting the text as it conditions the general perception of the play’s engagement with heredity. If Osvald has acquired the disease due to his own erotic escapades in Paris it would appear that he has inherited his father’s bourgeois immorality. In this case, the blame for Osvald’s condition would be shared by Osvald and his father. If Osvald has contracted the disease from having been sexually abused by his father, as Helland and Åslund (1996) suggest, the blame is apportioned squarely to Alving. If Osvald’s condition is congenital one might instead argue, as I do, that he has not inherited his father’s debauched tendencies but is rather an innocent victim suffering from the consequences of his father’s actions. I am attached to this line of interpretation, especially given how Osvald reacts with loathing to the sexual hypocrisy of bourgeois males in Paris (Ibsen 2016, 213). A reading built on the assumption of Osvald having acquired syphilis is at odds with the play’s characterization of him as being rather modest in terms of sexual mores.

What I am proposing in the following is that an examination of contemporary syphilis discourse will enable me to identify paternal transmission as the most plausible mode of transmission, according to the medical understanding of the day. All other modes of transmission are, in medical terms, unlikely. Working on the assumption that Ibsen was a realist writer, and that he therefore would have sought to remain within the realm of the medically plausible, I will argue my case by proceeding in four steps. I will begin by reviewing previous attempts at identifying Osvald’s condition. In the following section, I will outline the contemporary medical understanding of the different modes of transmission in an effort to delineate the problems attaching to other modes than paternal. Having made my case for paternal transmission, the next section will support my argument by examining how the characteristics attaching to syphilic children in the medical literature of the time aligns with the portrayal of Osvald. In the final section, I will examine the relationship between syphilis and degeneration by situating the centrally important but often misunderstood word vermoulu in its medical context. I will conclude with a few brief remarks on the wider literary context of Ibsen’s engagement with syphilis and degeneration discourse.

AN OVERVIEW OF SCHOLARSHIP ON OSVALD’S CONDITION

Osvald’s condition is a curious case of a literary character continuing to invite commentary from specialists in other fields than literary studies, as well as from literary scholars with a penchant for integrating medical discourse into their analysis. The literariness of Osvald may become obscured in studies attempting to in effect diagnose a character in a play. I will nonetheless contribute to this tradition by reading Osvald against the backdrop of the medical discourse on syphilis of Ibsen’s time. I regard the present intervention as an attempt at correcting a number of issues in earlier scholarship which have given rise to arguments and conclusions that cannot be sustained. In the following, I will delineate a few such issues in earlier scholarship on Ghosts, some of which I deem more problematic than others. The first such issue concerns how scholars approach the play’s historical context. One will occasionally find generalizing statements on the contemporary understanding of syphilis which are entirely misleading and moreover lack references to primary source materials. A comment by Joan Templeton may exemplify this habit: “In Ibsen’s day it was believed that syphilis was inherited from the male parent.” (Templeton 2008, 160, n 5) As noted above, this was not exclusively the case. Templeton’s approach can be compared to that of Svein A. Skålevåg, whose research background in the history of science does not prevent him from reaching what I regard as the faulty conclusion that Osvald is suffering from general paresis. Skålevåg notes that this condition may be caused by syphilis, but should not be designated syphilis as such (Skålevåg 2001, 266). Skålevåg is right to note the similarities between degeneration discourse and the progressive decline associated with general paresis (Skålevåg 2001, 267), but Skålevåg’s designation of general paresis is problematic from a historical perspective. The connection between general paresis and syphilis, first suggested in 1857, only became widely accepted by the medical establishment during the 1890s (Oriel 1994, 54–56). I find it difficult to argue that Ibsen integrated the as yet unproven link between syphilis and general paresis into his text; the explanation of congenital syphilis seems less complicated.⁶

The second issue I wish to highlight is the tendency of medical practitioners to diagnose Osvald according to our contemporary understanding of syphilis. Per Vesterhus adopts a decidedly presentist approach when examining Osvald’s condition entirely from the viewpoint of modern medicine. Vesterhus finds it difficult to accept that Osvald’s symptoms manifest late in life and that his mother somehow managed to infect her son while exhibiting no symptoms herself (Vesterhus 2007, 1814). Vesterhus discounts the pipe as the source of infection, and arrives at the conclusion that Osvald must have contracted the disease through sexual intercourse as an adult. I would characterize Vesterhus’ reading as a charge of medical implausibility being leveled at Ibsen. In this regard, Vesterhus has antecedents; similar charges were directed at Ibsen by his contemporaries.⁷ A related problem particular to medical practitioners is a lack of training in literary studies, which may lead to unfortunate misreadings of the text. Derek Russell Davis, a psychiatrist and professor of mental health, argues that Osvald does not suffer from congenital neurosyphilis, basing his argument on the late onset and “lack of physical signs of the disease.” (Davis 1963, [3]) In support of his reading, Davis enumerates a list of symptoms associated with congenital neurosyphilis and which Osvald supposedly does not display, failing to note that all these symptoms are discernible in the play.⁸

The third issue is not so much a problem as it is a question of interpretative credibility, and belongs squarely in the domain of literary debate. Literary scholars have a history of seeking to shed light on the mystery of Osvald’s condition by superimposing either the then-current or modern understanding of syphilis onto the text of the play. As I am doing precisely the same, I will need to argue the case that my proposed etiology of paternal transmission is more credible than other forms of transmission. What I wish to illustrate are the potential pitfalls of seeking to combine medical discourse with literary analysis. Evert Sprinchorn argues that Osvald contracted syphilis by smoking his father’s pipe (Sprinchorn 2004, 198), basing his argument on parallels between Osvald’s symptoms and those associated with cerebral syphilis enumerated in Fournier’s La Syphilis du cerveau [Syphilis of the brain] (1879). Sprinchorn understands Osvald’s comment “I’ll always think of cherry-coloured, velvety drapes – something that’s delicate to stroke” (Ibsen 2016, 258) as a veiled reference to Fournier’s description of two types of softening of the brain, ramollissement chronique [chronic softening] and ramollissement aiguë or rouge [sharp or red softening]. Fournier’s emphasis on the rarity of the second form is taken by Sprinchorn as evidence that “Ibsen did in fact consult Fournier’s works.” (Sprinchorn 2004, 196) While Ibsen may have read Fournier, it should be noted that Fournier includes softening of the brain in the class of symptoms only revealed during autopsy (Fournier 1879, 68). Sprinchorn also fails to explain why Ibsen chose this specific symptom among the multitude listed in Fournier’s work. By focusing on the pipe as the source of infection, Sprinchorn overlooks the importance of Osvald’s lack of energy.⁹

Frode Helland and Arnfinn Åslund focus on the pipe, but from a different perspective, reading the pipe as a metaphor for sexual abuse. Helland and Åslund engage in a presentist reading, arguing on the basis of our contemporary understanding of syphilis that if Osvald’s disease were congenital, we would be faced with two characters (Osvald and Helene) who have lived with syphilis for decades without ever reaching the final stage of the disease (Helland and Åslund 1996, 8). Helland and Åslund argue that contamination through the sharing of utensils is possible but unlikely, and from there arrive at an interpretation of the pipe as a phallic symbol signifying Alving’s abuse of his son (Helland and Åslund 1996, 11). The reading is supported with reference to Helene’s comment (Ibsen 2016, 219) on how she felt obligated to send Osvald away to safeguard him from Alving’s corruption (Helland and Åslund 1996, 11). This line of interpretation does not take into account the fact that a father was believed to be capable of infecting the fetus without infecting the mother. Equally problematic is Jørgen D. Johansen’s argument that Osvald became infected during his time in Paris (Johansen 2005, 100). Johansen supports his argument by consulting two professors of medicine, who respond by ruling out congenital syphilis by reason of the late appearance of Osvald’s symptoms (Johansen 2005, 105). This curious episode of a literary scholar consulting medical authorities fails due to the latter approaching the text on the basis of our contemporary understanding of the disease.

My final example from the world of literary scholarship is the argument made by Alexis Soloski that congenital syphilis can be discounted, as Osvald appears not to have exhibited any symptoms as a child (Soloski 2013, 299). Although Soloski acknowledges that syphilologists accepted the possibility of paternal transmission, the historicizing approach adopted leads Soloski astray when the degree of fatality associated with congenital syphilis is used to strengthen the argument: “Congenital syphilis is rarely fatal after infancy, though doctors of Ibsen’s day did not stress this point.” (Soloski 2013, 293) As will be demonstrated in the following, paternal transmission was singled out by syphilologists as debilitating but seldom fatal.¹⁰ Having concluded that Osvald’s condition cannot be congenital syphilis, Soloski traces the infection to his conduct in Paris: “This theory of origins fits the medical evidence, more accurately matching what Osvald actually suffers from.” (Soloski 2013, 300) What I will now seek to prove is that paternal transmission not only fits the evidence, as it was understood by syphilologists of Ibsen’s time, but that it does so to a higher degree than other modes of transmission.

THE LETHALITY OF DIFFERENT MODES OF TRANSMISSION

I believe that my argument of paternal transmission provides a solution for some of the textual problems noted above, and which derive from scholars reading the play through the lens of our contemporary knowledge of syphilis. To recapitulate, syphilis can be acquired through sexual contact or from being born to women who are infected with the disease. In the latter case, some children will be asymptomatic at birth. This was recognized at the time, and helps explain how Osvald’s condition could have remained undiagnosed. The only symptoms that point toward a diagnosis of syphilis are the headaches he suffered as a child and which have increased in severity during the past few years (Ibsen 2016, 237–8). The almost complete lack of symptoms points to paternal transmission, as does the fact that Osvald has survived into adulthood. In order to explicate this point, I will need to consider how syphilis discourse distinguished between the degree of lethality associated with different modes of transmission.¹¹ Syphilologists maintained that congenital syphilis could be transmitted from either or both parents, at conception or in utero (Parrot 1886, 10). Paternal transmission meant that the disease was transmitted via the father’s semen (Hutchinson 1887, 15). Paternal transmission was, however, a topic of debate. Diday was an early advocate for paternal transmission (Diday 1859, 17), whereas Charrier argued exclusively for maternal transmission (Charrier 1862, 330). Part of the problem was that experiments with inoculation had demonstrated that the semen of syphilitic men was not contagious. Fournier offered a solution by locating the contagion among the characteristics transferred from sperm to ovula (Fournier 1891, 51). Paternal transmission gradually became a commonly accepted notion that can still be found in medical textbooks ca. 1900 (Fauconney 1902–1903, 28).¹² Syphilologists routinely stressed that paternal transmission was a rare phenomenon (Langlebert 1864, 682; Boeck 1862, 508; Boeck 1875, 147; Boeck 1894, 22). The possibility of a man infecting the fetus without infecting the mother was also discussed. Cornil notes that syphilitic fathers only rarely transmit the infection to the child if the mother has remained uninfected (Cornil 1879, 13). Hutchinson argued that not all children of syphilitic fathers would necessarily be infected: “We shall probably be nearer the truth if we assert that the inheritance of a syphilitic taint is often irregular; that frequently, of several children born under apparently similar conditions, one may receive it and another escape; but that, if it be received, it is always one and the same specific malady.” (Hutchinson 1887, 70) Returning to the text of the play, the possibility that the disease skips a child, as it were, would explain why Regine has not inherited the disease.¹³

Similarly, the apparent lack of infection on the part of Helene, as well as Regine’s mother Johanne, can be explained with reference to the notion that the father could indeed pass on the disease without infecting the mother. Ricord included a case of “Syphilis héréditaire, transmise par le père à l’enfant, sans infection de la mère” [Hereditary syphilis, transmitted from father to child, without infection of the mother] (Ricord 1862, 186–8) in his influential treatise on venereal disease. Diday accounted for such cases by suggesting that the mother’s womb provided some form of immunity against the disease (Diday 1859, 21). The question of immunity appears unresolved to Després (Després 1873, 365), while Hutchinson was committed to the notion. Hutchinson’s reasoning is based on the argument that a mother who had been infected would inevitably exhibit symptoms:

It is improbable, in the highest degree, that a large number of married women should acquire syphilis in its primary form, pass through its secondary stages, and yet never know it. Yet this is the supposition which we must adopt, not once nor twice, but as being an every-day occurrence, if we reject the belief that a syphilitic father may beget a syphilitic child, quite independently of any previous infection of its mother. […] In nine cases out of ten, acquired syphilis is an affair which its victim cannot either ignore or forget. (Hutchinson 1887, 68)¹⁴

Colles’ law, which held that a mother might possess a congenital or acquired immunity (Langlebert 1864, 686), could be made to explain cases of congenital syphilis with non-infection of the mother. The notion of immunity, which also numbered Fournier among its adherents (Fournier 1880, 225), was based on a misunderstanding; the mother who appeared immune was in fact infected, but displayed no obvious symptoms. Hutchinson’s comment on acquired syphilis almost always manifesting in readily apparent symptoms can be read in conjunction with Helene’s lack of symptoms; if Alving had transmitted the disease to her, she would have known it. There is no textual evidence, however, that Ibsen was even aware of the possibility of intermittent congenital transmission or Colles’ law. The explanation that Helene remained uninfected while giving birth to a syphilitic child would have been considered within the realm of medical possibility, but it also remains within the realm of inference.

More information is needed and can be gained by posing the question what would have happened to Osvald if his mother had been infected. The syphilologist answer would be that Osvald would not have survived into adulthood. Maternal transmission and mixed transmission were associated with a high degree of mortality. Syphilis was singled out as the single deadliest disease in terms of infant mortality (Fournier 1886, 160). Children who survived gestation were expected to perish within the first few days or weeks (Donner 1896, 6). Maternal transmission was understood as a form of poisoning of the source of life itself (Fournier 1890, 113). Fournier explained the differing levels of lethality as a difference of fertilization versus nutrition and gestation; the mother’s disease influences the fetus for nine months, while the father’s only does so at conception (Fournier 1890, 113–4).¹⁵ The high risk of infection led syphilologists to regard maternal transmission as the most pervasive category of congenital syphilis (Fournier 1891, 43). While a syphilitic father might on occasion infect the child, a syphilitic mother would always transmit the disease (Boeck 1894, 24). The inevitability of infection provides another contextual piece of the puzzle. According to the then-current medical understanding of syphilis, the fact that Osvald survived past infancy would in and of itself be taken as evidence that Helene was not infected, thereby ruling out maternal or mixed transmission.

The characteristics associated with paternal transmission strengthen the case for this being the source of Osvald’s disease. Syphilis discourse depicted syphilitic men as having had their vitality compromised, a condition which would be passed on to their children. Syphilis was thought of as interrupting the successful transfer of vitality from father to child. Children infected by syphilitic fathers were thought to inherit, to quote Fournier, an “influence de déchéance vitale, de caducité, de dégénérescence.” [influence of vital decline, caducity, degeneracy] (Fournier 1890, 65) Such children would lack the vital energy required to grow into productive members of society, and were often depicted as unfit for life (Boeck 1894, 29) and generally frail and prone to disease (Fournier 1903, 385). At the same time, the infrequency of paternal transmission meant that the children of syphilitic fathers would more frequently survive than cases of maternal or mixed transmission. The notion of lesser lethality recurs in syphilologist writing (Boeck 1875, 148; Mauriac 1883, 87).¹⁶ This idea had practical consequences. Syphilologists tended toward the opinion that syphilitic men could marry provided they had undergone treatment. C.W. Boeck warned against prohibiting syphilitic men from marrying altogether (Boeck 1875, 148). Hutchinson called on his colleagues “to be reasonable and moderate in our recommendations” (Hutchinson 1887, 493) and suggested that men should hold off marriage for two years after infection (Hutchinson 1887, 494).¹⁷ Generally speaking, syphilologists prioritized the preservation of the institution of marriage over the health concerns of individual families. What we might today view as a callous disregard for the welfare of the wives and children of syphilitic men can be superimposed onto the Alving marriage as an instructive thought experiment. Once Alving had been infected, he would either have been aware or unaware of his condition. The latter seems unlikely, given the visibility of symptoms in cases of acquired sypilis, as per Hutchinson. If Alving was aware of his infection, and he continued to have relations with Helene, then he knowingly jeopardized the health of both his wife and any child that might result from the encounter. This hypothetical scenario may shed some light on the extent of Alving’s immorality; one might conclude that he knowingly valued his own pleasure above his family’s well-being.

THE SYPHILITIC CHILD AS AN EMBLEM OF DEGENERATION ANXIETY

The role of Osvald in the scheme of bourgeois patriarchy hardly needs pointing out; under normal circumstances, he would stand to inherit the Alving name and estate. The break in the transmission of vitality from father to child caused by Alving’s syphilis derails the continuation of the family line. Ibsen made use of the trope of the syphilitic child at a time when the actual birth of such children caused a particular type of anxiety among a bourgeoisie preoccupied with issues of heredity. While acquired syphilis was thought to be treatable, there were no easy cures for cases of congenital syphilis. Operating in tandem with notions of the inheritability of acquired characteristics and fears of depopulation and civilizational decline, syphilis became a flashpoint for concerns regarding the health and survival of nations.¹⁸ The syphilitic child “evoked the physical and mental deterioration of the race” (Pietrzak-Franger 2017, 237), especially when linked to debates on depopulation.¹⁹ The character of Osvald, whose decline signals the extinction of the haute bourgeois Alving line, can thus be read as commentary on a much wider and ongoing societal debate.

It is Osvald’s lack of vigor that most closely aligns the portrayal of him with contemporary syphilis discourse. Syphilologists invariably associated congenital syphilis with constitutional frailty. Such children were believed to be predisposed to other diseases, syphilis having imposed on the child’s constitution “a debility which predisposes it to all kinds of organic or functional affections.” (Diday 1859, 119) The notion of children being born with what is variously referred to as congenital weakness (Després 1873, 376) or insufficient vital resistance (Fournier 1891, 78) gradually coalesces into the image of the child whose appearance at birth resembles that of “little old men […].” (Diday 1859, 86)²⁰ These children take on the physical aspects of the elderly (Després 1873, 376) and come across as pale, scrawny and anemic (Boeck 1881, 292). Their predisposition to disease invites other afflictions such as hydrocephalus, tuberculosis, and nervous ailments, depending on the authority consulted (Boeck 1875, 167; Fournier 1880, 52; Mauriac 1890, 1128; Boeck 1894, 28). The impact of syphilis on the child’s health is such that the child will go through life as a sickly individual (Boeck 1894, 26). Congenital syphilis stunts the child’s growth and diminishes its capacity for life (Mauriac 1890, 1128).²¹ The child may nonetheless be capable of having children of its own as an adult, thereby transmitting its frailty to the next generation.²²

Simply stating that Osvald is a case of congenital syphilis is not, however, sufficient to explain how he could survive undiagnosed into adulthood. The concept of late onset congenital syphilis needs to be added to the equation. The concept can be summarized as a child being born with congenital syphilis and whose symptoms manifest late in life, often in connection with the transition into adulthood. Victor Augagneur’s Étude sur la syphilis héréditaire tardive [Study of late onset hereditary syphilis] (1879) was the first major work dedicated to the topic (Corbin 1981, 138), but the issue was debated by syphilologists from mid-century onward. Diday in 1859 is undecided (Diday 1859, 114–116). Langlebert and Lancereaux entertain the notion that the disease might manifest in adolescence or adulthood (Langlebert 1864, 696; Lancereaux 1866, 564). Jullien is skeptical but does not discount the possibility (Jullien 1879, 1002). Paget claims to have observed cases of symptoms first manifesting in youth and adulthood (Paget 1883, 7). The gradual acceptance of the notion can be illustrated by comparing the 1866 and 1873 versions of Lancereaux’s treatise on syphilis. Whereas the 1866 edition simply distinguishes between early and late manifestations (Lancereaux 1866, 539), the 1873 edition distinguishes between fetal syphilis, infantile syphilis, and late or adult syphilis (Lancereaux 1873, 408). As Hutchinson notes, cases of late onset congenital syphilis proved difficult to diagnose: “The term ‘congenital’ must not be held to imply that the inheritance is obvious at the time of birth, for it may easily be the fact that no signs of it become apparent until long afterwards.” (Hutchinson 1887, 65)²³ Mauriac notes that the first symptoms may appear as late as twenty, thirty or forty years of age (Mauriac 1883, 91). Syphilologists disagreed on the age when symptoms could be expected to manifest, but puberty was usually regarded as a cut-off date. Congenital syphilis was associated with infancy, and puberty was thought of as a second infancy (Augagneur 1879, 72).

The concept of late onset congenital syphilis was popularized by Fournier, who dedicated several works to the topic, most notably La Syphilis héréditaire tardive (1886). Fournier defines the condition as congenital syphilis that manifests in puberty or thereafter (Fournier 1886, 1).²⁴ According to Fournier, afflicted individuals appear frail and delicate (Fournier 1886, 23) and suffer from an arrested development that causes them to remain childlike well into adolescence (Fournier 1886, 27). In Fournier’s worst case scenario, an undiagnosed child will grow into a pseudo-adult, suffering from diminished intellectual capacity and impulse control (Fournier 1886, 158), while retaining the ability to transmit its weakness to its own children. Such generational transmission would imperil the health of the nation.²⁵ At some point, the adult sufferer would, however, reach a final stage marked by motor disorders such as paralysis and mental disorders such as depression or reduced mental acuity (Fournier 1886, 458). Fournier identifies three categories of symptoms that mark the outbreak of late onset congenital syphilis: convulsive symptoms, cerebral disorders (maux de tête), and intellectual disorders (Fournier 1886, 459). The difficulty in diagnosing the condition compels Fournier to call for proper precautions to be taken to prevent the spread of the disease. He counsels against the use of wet nurses, recommending instead that children should be breastfed by their mothers (Fournier 1880, 215). Fournier had previously explored the issue in a separate treatise (Fournier 1878). The possibility of infection through wet-nursing was a concern shared by other syphilologists (cf. Sherwood 2010). C.W. Boeck warned against sending potentially infected children to be raised in foster homes, arguing that such children might only present symptoms after having been assigned a wet nurse (Boeck 1875, 112). Boeck singles out this practice as the main driver of syphilitic contagion in rural Norway (Boeck 1875, 160). The spectre of syphilitic children spreading disease adds a sinister undercurrent to Helene’s decision to place Osvald in foster care, or in Manders’ phrasing to send “your child away to strangers.” (Ibsen 2016, 215) If Osvald was indeed infected since birth, these unnamed strangers would have been at risk of contamination, all because of Helene’s effort at preventing Osvald from becoming “poisoned just by breathing in the air of this infected home.” (Ibsen 2016, 219) The irony inherent in Helene’s decision – potentially spreading actual disease in an effort to prevent metaphorical contamination – becomes apparent once we take contemporary syphilis discourse into consideration.

SYPHILITIC DEGENERATION AND THE MEANING OF VERMOULU

My insistence on investigating medical discourse may appear at odds with my proposal that degeneration, and not syphilis per se, is the central theme in Ghosts. Degeneration is not strictly speaking a medical condition, but rather a quality of intellectual and physical decrepitude that ultimately derives from a manner of living that deviates from the norm. I maintain that the close conceptual proximity of degeneration, in the sense of a general term used to designate the ill effects of reprobate living, and syphilitic degeneration, as in the progressive decline caused by the disease itself, has led earlier research on Ghosts to conflate the literal with the figurative. On the literal level, Osvald’s body and mind collapse due to the disease; on the figurative level, his condition signifies that he is void of energy and incapable of continuing the family line. This tendency toward conflation can best be illustrated by examining the meaning of vermoulu, used in the play by a French doctor to describe Osvald’s condition (Ibsen 2016, 238).

Vermoulu is commonly read as a euphemism for syphilis.²⁶ Henrik Ibsens skrifter (Ibsen 2005–2010, 7K:563) explains the word by reference to Roche Lexikon Medizin, which provides a definition of état vermoulu as “wurmstichiges Aussehen der Großhirnrinde im Alter infolge Gewebszerfalls um sklerosierte Arteriolen”. [worm-eaten appearance of the cerebral cortex in old age due to tissue breakdown around sclerosed arterioles] (“vermoulu”) The problem here is that syphilologists used vermoulu to distinguish between syphilitic and non-syphilitic chancres. The word was primarily used to describe chancres that were not syphilitic in origin. Vermoulu was in particular used in reference to chancroid or soft sores, “a sexually transmitted disease caused by the bacterium Haemophilus ducreyi, resulting in enlargement and ulceration of lymph nodes in the groin.” (“soft sore”) The relationship between syphilis and chancres was not well understood in Ibsen’s time (cf. Tilles 2011). Vermoulu was specifically used to describe the characteristics of what was referred to as chancre simple or chancre mou.²⁷ Vermoulu was only infrequently used to describe symptoms of syphilis. These instances tend to gravitate toward skeletal tissue, as in “Les os sont perforés, vermoulus comme dans la carie, mais ils ne sont pas mous, ils ne se laissent pas pénétrer par le stylet.” [The bones are perforated, worm-eaten as in caries, but they are not soft, they cannot be penetrated by the stylet.] (“Syphilis”, 328)²⁸ Even less frequently, vermoulu was used to describe teeth affected by tooth decay caused by syphilis.²⁹ Equally infrequent are references to nails or the cranium.³⁰ The only instance of vermoulu being used in reference to brain matter that I have found is Fournier’s description of an autopsy of a child born with congenital syphilis. Fournier reports having found “excavations multiples creusées aux dépens de la table interne, qui était comme vermoulue, comme fouillée au burin, et rappelait exactement l’aspect du vieux bois rongé par les vers […].” [multiple excavations dug at the expense of the internal table, which was as if worm-eaten, as if excavated with a chisel, and exactly recalled the aspect of old wood eaten away by worms] (Fournier 1886, 456) It goes without saying that Osvald has not been subjected to an autopsy.

I believe that Ibsen’s use of the word is a misdirection. Uttered by a French physician during a medical examination, the word invites an association of vermoulu with syphilis. This association aligns with one meaning of vermoulu provided by Trésor de la langue française, “Attaqué par des insectes qui y creusent des galeries.” [Attacked by insects which dig tunnels in it.]³¹ This sense has a substantiveness to it which I believe has led Ibsen scholarship to connect vermoulu to the non-observable condition of Osvald’s brain. The word also has a figurative sense, however, and one which suggests an alternative interpretation of the doctor’s statement: “Rongé par le temps, vieux, caduc” [weathered, old, obsolete], exemplified by “Civilisation, œuvre vermoulue; passé vermoulu.” [Civilization, worm-eaten work; worm-eaten past.]³² The figurative sense is attested in Fournier, as in “finir avec les systèmes usés, vermoulus, impuissants” [end with worn, worm-eaten, powerless systems] (Fournier 1903, 52) or “mettre la sape dans un édifice vermoulu et le remplacer par un autre […].” [put the sap in a worm-eaten building and replace it with another] (Fournier 1903, 528) In its figurative sense, vermoulu signifies something that is old and decrepit and in the process of disintegration. Vermoulu can be used in this sense to describe societies or civilizations teetering on the brink of destruction. Ibsen uses the word in its figurative sense in Ghosts to signify that Osvald, and by extension the bourgeois tradition which he was supposed to perpetuate, is a failed order on the verge of collapse. The figurative use of vermoulu casts Ibsen’s use of congenital syphilis in a somewhat different light than commonly assumed, signaling that the implications of Alving’s degeneracy spread outward from one family to bourgeois patriarchy as a whole. Alving’s transmission to his son and inheritor of a disease that hollows out Osvald, leaving him a vigorless husk, stands as a pars pro toto of the wasting away of the bourgeois social order.

CONCLUSION

I have sought to demonstrate that the particulars of Osvald’s condition can best be understood, and the textual problem of Helene and Regine’s non-infection resolved, by examining the medical discourse on syphilis of Ibsen’s time. I believe that Ibsen’s familiarity with syphilis discourse was greater than commonly acknowledged, although I can only speculate on the possible sources of his knowledge.³³ While I have been wary of the efforts of earlier scholars to identify the exact nature of Osvald’s disease, I agree with Sprinchorn (2004) that Osvald is specifically suffering from cerebral syphilis. His symptoms accord with those outlined in Fournier’s La Syphilis du cerveau (1879). While I have previously drawn attention to Osvald’s lack of energy, his stated incapacity for work (Ibsen 2016, 237–8) is equally intriguing. According to Fournier, syphilis manifests in those parts of the body which have been overtaxed. Fournier regards cerebral syphilis as a result of the brain having been weakened by intellectual exhaustion, emotional excitation, or debauchery (Fournier 1879, 10). Primarily a disease of the intellectual class, Fournier singles out authors, lawyers, professors and doctors as especially prone to the disease. Symptoms include convulsive fits (Fournier 1879, 143) and cognitive difficulties, the latter of which Fournier divides into symptoms that are slow to develop and have a depressive aspect, and symptoms characterized by exaltation or cerebral excitation (Fournier 1879, 269). Fournier associates the first category with diminished intellectual capability, and the second with delirium and mania (Fournier 1879, 270). In my view, the first category aligns with Osvald’s condition.³⁴ Sufferers of cerebral syphilis will be painfully aware that their capacity for work has become diminished (Fournier 1879, 272), a realization echoed in Osvald’s complaints of being unable to work. In terms of dramaturgy, cerebral syphilis seems likes an obvious choice to afflict an artist.

I do not regard it as a coincidence that Ibsen made use of a disease characterized by an inherent spectrality, derived from its ability to mimic the symptoms of other diseases, in a play entitled Ghosts. Jonathan Hutchinson’s influential address on syphilis as an imitator is infused with Gothic imagery, as in his reference to the symptoms that syphilis can imitate as “syphilitic doubles” (Hutchinson 1879, 541) of other diseases. Transposed onto the realm of literature, such imagery lends itself to a text as indebted to the Gothic literary mode as Ghosts.³⁵ Much like how syphilis can imitate other diseases, however, Osvald’s syphilis conceals an underlying degeneration plot. The presence of this plot is, in a sense, obscured by the audacity of Ibsen’s use of the syphilis motif. Ibsen’s deployment of syphilis as a causative agent of the extinction of a venal and exploitative bourgeoisie is in line with how degeneration discourse was used in Scandinavian literature at the time, with notable examples such as August Strindberg’s similarly degeneration-themed Fröken Julie (1888) or “Mot betalning” [For payment] (1886), the model for Ibsen’s finest drama of degeneration, Hedda Gabler (1890).³⁶ It is against the backdrop of a literary-historical context in which degeneration and syphilis are employed as battering rams against a corrupt bourgeoisie that Ibsen employs the trope of the heredosyphilitic child in Ghosts.

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Henrik Johnsson

Henrik Johnsson is Professor of Nordic literature at Østfold University College, Norway. He holds a PhD in the history of literature from Stockholm University. He is the author of two monographs on the oeuvre of August Strindberg – Strindberg och skräcken: Skräckmotiv och identitetstematik i August Strindbergs författarskap (h:ström, 2009) and Det oändliga sammanhanget: August Strindbergs ockulta vetenskap (Malört, 2015). He is co-editor of the anthology The Occult in Modernist Art, Literature, and Cinema (Palgrave, 2018). His current research explores the intersection of horror and desire in Nordic Gothic fiction. E-mail: [email protected]

Notes

1 We now know that the disease is caused by the spirochaete Treponema pallidum. The progression of the disease is traditionally divided into three stages with varying clinical manifestations (Hook and Pelling 2006, 226). Congenital syphilis is transferred from mother to child, transplacentally or due to genital lesions (Cooper, Sánchez, and Williams 2018, 161), and presents a high degree of risk to the infant in terms of mortality (Hook and Peeling 2006, 225).

2 For a historical overview of the medical knowledge on syphilis, see (Brandt 1993). For an example of how syphilis can be examined as both a medical and cultural phenomenon, see (Quétel 1990). On the link between syphilis and morality, see (Temkin 1977). On how syphilis became a topic for artists and authors, see (Cabanès 1996). On how the disease coalesced into a cultural fear, see (Marx 2003). On how syphilis became associated with the lower classes, see (Sherman 2007). On the link between syphilis and debates on prostitution, see (Corbin 1990). For a Scandinavian case study in how syphilis was treated by medical authorities, see (Lundberg 1999).

3 For reasons of space, I will not conduct a reading of Ghosts in the present article. A reading of the degeneration plot in Ghosts can be found in my monograph Ibsen and Degeneration: Familial Decay and the Fall of Civilization (Johnsson 2024), to which I refer the interested reader.

4 “Når det gjelder selve de fakta Ibsen har lagt inn i sin intrige, har det vært en del diskusjon om hvordan Osvald har fått syfilis, men den diskusjonen virker beside the point. Hans sykdom er primært et hovedbilde på selve gjengangeriet og ferdig med det.” (Hagen 2015, 64).

5 To this can be added Helene’s concern over the toll that the fire (Ibsen 2016, 251) and the revelation of his father’s misdeeds (Ibsen 2016, 255) has taken on Osvald, which similarly accentuates the limits of his endurance.

6 The Danish neurologist Knud H. Krabbe makes a similar case for general paresis (Krabbe 1956).

7 Examples include literary critics (Ploug 1881) and physicians (Bang 1882; Ribbing 1885). Bang appears to have remained unidentified in Ibsen scholarship. He signs his article as “J. Bang, konst. reservelæge ved Gaustad asyl”. I will suggest that this is Jens Schanche Bang (1854–1927), cf. (Larsen [ed.] 1996, 1:210–211).

8 “The salient symptoms were mental: intense and persistent anxiety, out of proportion to external events, falling off in mental powers and in performance, feelings of dissolution and hopelessness, and contemplation of suicide.” (Davis 1963, [3]).

9 It is understandable why the pipe would attract interpretative attention, as the sharing of pipes was condemned by syphilologists. For examples, see (Boeck 1875, 111), (Leloir 1886, 62), (Hutchinson 1887, 2), (Boeck 1894, 13), (Fournier 1903, 225). As an aside, I do not read the pipe as related to either degeneracy or syphilis, but rather view Osvald’s smoking of his father’s pipe (Ibsen 2016, 210) as a misguided attempt by Alving to toughen up his son.

10 Soloski’s comment that “it seems unlikely that Mrs. Alving would have consented to continue to have relations” with her husband had he “contracted syphilis before Osvald’s birth” (Soloski 2013, 299) is speculation. One might just as well speculate that Alving did not disclose his condition to Helene.

11 On the history of research into congenital syphilis, see (Oriel 1994), (Obladen 2013).

12 Hutchinson maintains his belief in paternal transmission in the revised edition of his 1887 work on syphilis, stating that any conclusion as to the “impossibility” of paternal inheritance is “in direct antagonism with clinical facts.” (Hutchinson 1909, ix)

13 I am unconvinced by Sprinchorn’s explanation of how Regine’s mother remained uninfected: “Johanna did not contract syphilis from Alving because her affair with him began more than three years after he had been infected. According to Fournier, the chances of infecting one’s sexual partner are greatly reduced after the secondary phase, that is, after three years normally” (Sprinchorn 2004, 200). The timeline Sprinchorn suggests cannot be conclusively identified in the text. Furthermore, Fournier would only have considered the risk of infection to be reduced if Alving had undergone treatment, which cannot be inferred from the text.

14 Hutchinson is still adamant on this point in 1909 (Hutchinson 1909, 412). He references the case described in Ricord’s 1862 treatise in defense of his position (Hutchinson 1909, 556).

15 Fournier phrases the inevitability of infection as a rhetorical question: how can one imagine that syphilis would not affect the fetus that for nine months “vit de sa mère, se nourrit de la substance même de sa mère?” [lives off its mother, feeds on the very substance of its mother?] (Fournier 1891, 41)

16 The argument made by syphilologists can be summarized with Fournier’s opinion that maternal transmission affected the child in a manner that was both “beaucoup plus fréquente, beaucoup plus active, et, somme toute, bien plus dangereuse” [much more frequent, much more active, and above all, much more dangerous] (Fournier 1880, 71) than other modes of transmission. Fournier reiterates this stance in 1891 (Fournier 1891, 80).

17 Others had differing views on the duration required. Cornil considers the disease to be highly contagious for a period of up to five years (Cornil 1879, 13).

18 The association between syphilis and racial decline was established during the eighteenth century (Quétel 1990, 103–5).

19 A few examples may suffice. An 1841 report on prostitution in Marseille describes how syphilis “brings about the degradation and degeneration of the human race.” (quoted in Quétel 1990, 166–7) An 1837 report on prostitution in Paris depicts syphilis as a threat to the state due to the debilitating impact of the disease on men who could otherwise be expected to join the military or serve in government (Parent-Duchâtelet 1837, 38–9). On the debate concerning syphilis as a cause of depopulation, see (Nye 1984).

20 Langlebert provides a detailed description of such children as resembling little old men; they are described as thin, with deep-sunken eyes and wrinkly skin, and display a yellowish-brown hue (Langlebert 1864, 698).

21 Fournier describes the child’s life as a gradual wasting away; these children “ne meurent pas, à proprement parler; ils s’éteignent plutôt qu’ils ne meurent […].” [do not die, strictly speaking; they die out rather than die] (Fournier 1880, 63).

22 There was disagreement on this issue. Hutchinson argues agains the notion of generational transmission (Hutchinson 1887, 78).

23 Hutchinson clarifies that a lack of visible symptoms should not be taken as proof that the child is uninfected: “Lastly, it is certain that an infant may pass through the secondary stage of inherited syphilis without ever presenting any symptoms which attract the attention of its nurse. […] Those who have shown no symptoms in infancy may yet suffer in later life.” (Hutchinson 1887, 74)

24 In a later work Fournier asserts that syphilis héréditaire tardive could manifest anywhere between five and thirty years, or even later (Fournier 1891, 397).

25 Fournier’s linking of the individual’s condition to the fate of the nation can be seen in phrasing such as “un abâtardissement de l’individu, une dégénérescence de la race.” [a bastardization of the individual, a degeneration of the race.] (Fournier 1886, 31)

26 Hoenig provides an example: “It is noteworthy that Ibsen does not mention syphilis by name in the play; rather, he uses the French term vermoulu, which means ‘worm-eaten.’” (Hoenig 2018, 1524)

27 A few examples which I will provide in the original may suffice: “Chancre simple, à base parfaitement molle, à fond déchiqueté, vermoulu” (Fournier 1860, 26), “le fond vermoulu du chancre simple” (Jumon 1880, 56), “à fond inégal, vermoulu et recouvert d’un dépôt lardacé, grisâtre […].” (Finger 1900, 275) Other examples can be found: (Langlebert 1864, 128), (Jullien 1879, 348), (Fournier 1881, 209), (Mauriac 1883, 37), (Leloir 1886, 132), (Mauriac 1890, 198).

28 See also (Virchow 1860, 37), (Lancereaux 1873, 195), (Cornil 1879, 300), (Mauriac 1890, 349, 400).

29 (Rozès Joly 1873, 23), (Fournier 1886, 77).

30 Nails: (Lancereaux 1873, 128). Cranium: (Lancereaux 1873, 391), (Cornil 1879, 285).

31 http://atilf.atilf.fr/ [accessed 26 March, 2024].

32 http://atilf.atilf.fr/ [accessed 26 March, 2024].

33 I can only speculate as to how Ibsen familiarized himself with syphilologist writing. Daniel Cornelius Danielssen, with whom Ibsen was acquainted since the 1850s, wrote a book on innoculations against syphilis and leprosy (Danielssen 1858). Ibsen was also acquainted with Cæsar Hakon Boeck, nephew of C.W. Boeck, during the 1890s (Dingstad et al. [eds.] 2013, 59, 105).

34 Fournier’s list of symptoms belonging to this category include numbness of the mind; an inability to follow through on one’s ideas, projects, and actions; a general incapacity for work and cerebral fatigue when working for too long; in short “une véritable asthénie intellectuelle” [a veritable intellectual asthenia] (Fournier 1879, 271).

35 The Gothic aspects of Ibsenian drama go beyond the purview of this study, but see (Thakur 2018).

36 On Strindberg and degeneration, see (Johnsson 2015).