The Man Who Mistook His Wife for a Hat and Other Clinical Tales
By Oliver Sacks, M.D. Published by HarperPerennial, 1985 (pp. 102-107)

Part Two: Excesses — Cupid's Disease

The Man Who Mistook His Wife for a Hat and Other Clinical Tales, by Oliver Sacks, M.D.

A bright woman of 90, Natasha K., recently came to our clinic. Soon after her 88th birthday, she said, she noticed "a change." What sort of change? we queried.

"Delightful!" she exclaimed. "I thoroughly enjoyed it. I felt more energetic, more alive — I felt young once again. I took an interest in the young men. I started to feel, you might say, 'frisky' — yes frisky."

"This was a problem?"

"No, not at first. I felt well, extremely well — why should I think anything was the matter?"

"And then?"

"My friends started to worry. First they said, 'You look radiant — a new lease on life!,' but then they started to think it was not quite — appropriate. 'You were always so shy,' they said, 'and now you're a flirt. You giggle, you tell jokes — at your age, is that right?'"

"And how did you feel?"

"I was taken aback. I'd been carried along, and it didn't occur to me to question what was happening. But then I did. I said to myself, 'You're 89, Natasha, this has been going on for a year. You were always so temperate in feeling — and now this extravagance! You're an old woman, nearing the end. What could justify such a sudden euphoria?' And as soon as I thought of euphoria, things took on a new complexion… 'You're sick, my dear,' I said to myself. 'You're feeling too well, you have to be ill!'"

"Ill? Emotionally? Mentally ill?"

"No, not emotionally — physically ill. It was something in my body, my brain, that was making me high. And then I thought — goddam it, it's Cupid's Disease!"

"Cupid's Disease?" I echoed, blankly. I have never heard of the term before.

"Yes, Cupid's Disease — syphilis, you know. I was in a brothel in Salonika, nearly 70 years ago. I caught syphilis — lots of the girls had it — we called it 'Cupid's Disease.' My husband saved me, took me out, had it treated. That was years before penicillin, of course. Could it have caught up with me after all these years?"

There may be an immense latent period between the primary infection and the advent of neurosyphilis, especially if the primary infection has been suppressed, not eradicated. I had one patient, treated with Salvarsan by Ehrlich himself, who developed tabes dorsalis — one form of neurosyphilis — more than 50 years later.

But I had never heard of an interval of seventy years — nor of a self-diagnosis of syphilis mooted so calmly and clearly.

"That's an amazing suggestion," I replied after some thought. "It would have never occurred to me — but perhaps you are right."

She was right; the spinal fluid was positive, she did have neurosyphilis, it was indeed the spirochetes stimulating her ancient cerebral cortex. Now the question of treatment arose. But here another dilemma presented itself, propounded, with typical acuity, by Mrs. K herself.

"I don't know that I want it treated," she said. "I know it's an illness, but it's made me feel well. I've enjoyed it, I still enjoy it, I won't deny it. It's made me feel livelier, friskier, than I have in 20 years. It's been fun. But I know when a good thing goes to far, and stops being good. I've had thoughts, I've had impulses, I won't tell you, which are — well, embarrassing and silly. It was like being a little tiddly, a little tipsy, at first, but if it goes any further…"

She mimed a drooling, spastic dement. "I guessed I had Cupid's, that's why I came to you. I don't want it to get worse, that would be awful; but I don't want it cured — that would be just as bad. I wasn't fully alive until the wrigglies got me. Do you think you could keep it just as it is?"

We thought for a while, and our course, mercifully, was clear. We have given her penicillin, which has killed the spirochetes, but can do nothing to reverse the cerebral changes, the disinhibitions, they have caused.

And now Mrs. K. has it both ways, enjoying a mild disinhibition, a release of thought and impulse, without any threat to her self-control or further damage to her cortex. She hopes to live, thus reanimated, rejuvenated, to a hundred. "Funny thing," she says. "You've got to give it to Cupid."

created: Oct. 22, 2007
last modified: Sep. 18, 2010
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