One day in November 1912, Mrs Emma Hardy was decidedly off-colour. Troubled by pain in her back, she nonetheless felt well enough in the afternoon to come downstairs from her bedroom to entertain two ladies who had called unannounced to see her, or her husband Thomas. One of her guests, Rebekah Owen, noted later that Mrs Hardy had seemed depressed, moved slowly, wept a little, and she (Rebekah) thought it "as likely to be nerves and melancholia as anything". The next day Emma was seen by her husband's doctor, Dr Gowring, who apparently did not know her well. He thought she was suffering principally from lack of nourishment, and she is said to have refused to let him examine her. The following morning, November 27, 1912, she initially felt a little better and planned to get up, but then took a sudden turn for the worse; her fourteen-year-old maid was alarmed by her appearance and rushed to inform Mr Hardy, who was working in his study. They came directly to her room, where she was lying in a collapsed state, moaning in pain and unable to speak. She expired a short while later. Dr Gowring gave as the cause of death "Heart failure and impacted gallstones" and commented in a note to Hardy that he thought she had suffered an internal perforation.

Emma Hardy had not been in good health for some years. She had been troubled by coughing and perhaps by angina. More worryingly, her mental state had been precarious, to say the least. She had been subject to delusions, even imagining that she was a greater writer than her illustrious husband, and that she had herself written one or more of his great novels, when in fact she had acted as his amanuensis, and had in that capacity merely taken one of them down from his dictation. Her behaviour at times was infantile, she dressed inappropriately in a white frock with blue ribbons, and she had gradually altered her religious beliefs towards the ecstatic end of the spectrum of Anglicanism, maybe even beyond that, into religious mania. She was the author of some impenetrable religious tracts which her friends begged her not to publish. Apparently one of the guests at Max Gate, the house near Dorchester that Hardy designed and had built in 1885, had been a Commissioner in Lunacy, and he had expressed the opinion that the first Mrs Hardy was "probably certifiable". There are suspicions that she had been using opiates -on the dresser in her room after her death was a pencilled note to a chemist, to the effect that Mrs Hardy found herself in need of "Liq. Op. Sed." which she "knows how to take".

A slow mental deterioration over the course of some years, delusions of grandeur, perhaps a disorganized knee joint, pain of a degree sufficient to require treatment with an opiate, and at the end, back pain followed by sudden death: there has to be a strong suspicion that Emma had been suffering for years from neurosyphilis, may well have had incipient General Paralysis of the Insane and the lightning pains of Tabes Dorsalis, possibly Charcot's Joint. Other pathologies could of course be invoked to explain one or other of her symptoms and illnesses over her latter years, but only quaternary syphilis would accommodate all of them under a single diagnostic umbrella. The cause of death was surely not gallstones, impacted or otherwise -it was much more likely to have been a ruptured aortic aneurysm, which in 1912 was again more likely than not to have been syphilitic in its aetiology.

At this time acquired syphilis (sometimes referred to as lues) was traditionally classified in three stages, primary, secondary and tertiary. Today a quaternary stage has been added. In some other respects medical understanding of the disease may have advanced but the essentials then as now were known to be as follows. In the primary stage the infection has just been encountered, and it is characterized by an incubation period of about three weeks followed by a small painless ulcer (the primary chancre) on the genitalia, often hidden from sight, unnoticed but very infectious. This heals within a few weeks, and all seems well for a further few weeks. However during this time the causative organism (treponema pallidum) is quietly multiplying in the body. The secondary or bacteraemic stage may then occur, much more dramatic than the primary, usually characterized by headaches, fever, general malaise and aches and pains throughout the body, sweating, sore throat, and enlargement of the lymph nodes; although it can be so mild as to pass almost unnoticed. There is a faint rash on the trunk, usually described as "coppery". Before penicillin there was really no effective treatment. Improvement occurs within a few weeks, and the disease then apparently disappears but infectious relapses occur in 20 per cent of cases in the first year and may persist or recur for up to four years.

In most cases -say 60 per cent -that is the end of it. But the unlucky minority will after some years begin to show degenerative signs, most seriously in the central nervous system (spinal cord and/or brain), and inflammation of the aorta may also occur, sometimes leading to dilatation known as aneurysm, which might rupture at any time, causing sudden death. This tertiary stage was often eventually fatal before antibiotics were discovered. The interval between the primary stage and death was usually fifteen to thirty years. When the tertiary stage affects the brain it is known as General Paralysis of the Insane and is characterized by ill-defined personality changes beginning five to twenty years after the initial infection, associated with headaches, forgetfulness, irritability and poor concentration. Grandiose delusions may feature. Dress, personal appearance and behaviour may become inappropriate. Dementia ensues, and motor signs gradually appear in the latter stages until the patient becomes paralyzed, mute and incontinent. No wonder Thomas Hardy considered death preferable to this.

He, though, as everyone knows, lived on until 1928, having married for a second time in 1914. He was luckier than Emma, as were approximately six out of ten of those who acquired syphilis in those pre-antibiotic days. The presumption must be that his own immune resistance to the spirochaete was of a different order from that of his wife, and in him the disease never progressed beyond the secondary stage (or so he seems to maintain in "The Man With a Past"); fear of its doing so, however, must surely have contributed to his gloom. But is there any further evidence that this indeed had been the state of affairs, and Emma's fate as I have suggested? We know for certain that at a particular point in their long, childless marriage Emma Hardy had withdrawn all affection from her husband, never to restore it. This seems to have occurred around 1891, some twenty-one years before her death. In his biography of Hardy, Michael Millgate mentions that Emma had a debilitating 'flu-like illness in the autumn of 1891 (not the season for true influenza) which could have been florid secondary syphilis, at which point the diagnosis may have been made. At about that time she began a diary, entitling it "What I think about my husband"; it was found and destroyed after her death. There are more pointers, from Hardy himself, in poems -though these are often undated and difficult to date -such as "The Change", "The Blow", "The Man with a Past", "He Fears his Good Fortune", "The Voice of Things", "Near Lanivet", "Had You Wept", and, perhaps above all, "The Interloper", which bears the dreadful epigraph "And I saw the figure and visage of Madness seeking for a home".

There are three folk driving in a quaint old chaise, And the cliff-side track looks green and fair;
I view them talking in quiet glee
As they drop down towards the puffins' lair
By the roughest of ways;
But another with the three rides on, I see,
Whom I like not to be there!
No: it's not anybody you think of. Next
A dwelling appears by a slow sweet stream
Where two sit happy and half in the dark:
They read, helped out by a frail-wick'd gleam,
Some rhythmic text;
But one sits with them whom they don't mark,
One I'm wishing could not be there.
No: not whom you knew and name. And now
I discern gay diners in a mansion-place,
And the guests dropping wit -pert, prim, or choice,
And the hostess's tender and laughing face,
And the host's bland brow;
I cannot help hearing a hollow voice,
And I'd fain not hear it there.
No: it's not from the stranger you met
once. Ah,
Yet a goodlier scene than that succeeds;
People on a lawn -quite a crowd of them. Yes,
And they chatter and ramble as fancy leads;
And they say, "Hurrah!"
To a blithe speech made; save one, mirthless,
Who ought not to be there.
Nay: it's not the pale Form your imagings
raise,
That waits on us all at a destined time,
It is not the Fourth Figure the Furnace showed;
O that it were such a shape sublime
In these latter days!
It is that under which best lives corrode;
Would, would it could not be there!

This poem takes us forward from 1870 or thereabouts in the first stanza to maybe 1910 in the last, each successive stanza clicking forward several years. This telescoping of time was a favourite poetic device of Hardy's -as in the great, much-anthologized "During Wind and Rain" where the scene leaps suddenly forward by several years within each stanza. The "three folk" would be (unless the one male present is Hardy himself) the Revd Caddell Holder, the elderly incumbent of St Juliot's Church near Boscastle in Cornwall, his young wife Helen Catherine, whom he had married in 1868 following the death of his first wife, and her sister Emma Lavinia Gifford, who met Hardy in 1870 and became his wife in September 1874. The second stanza probably refers to Sturminster Newton, Dorset, where the Hardys spent the happiest times of their marriage, from July 1876 to March 1878, when they moved to London. We next find ourselves at a soiree in the capital, then on the lawn at Max Gate, where a hundred London journalists came to pay their respects to the famous author.

The last stanza raises the spectre of Death, the "pale Form", whose presence might be preferred to Pestilence, "under which best lives corrode". Was there ever a better and more succinct description of tertiary/quaternary syphilis than these five words? We know that Hardy had a weakness for pretty young women, and in the nineteenth century it was not necessary to be especially promiscuous to contract syphilis, just unlucky. As the old aphorism had it (still current when I was a medical student in the 1960s), "One night with Venus, and a lifetime with Mercury". But however unlucky he was to contract the disease, he was well aware that Emma, whom he must have infected in his turn, had by far the worst of it -this is made explicit in "The Man With a Past" (from Moments of Vision, published in 1917):

There was merry-making
When the first dart fell
As a heralding, -
Till grinned the fully bared thing,
And froze like a spell -
Like a spell.
Innocent was she,
Innocent was I,
Too simple we!
Before us we did not see,
Nearing, aught wry -
Aught wry!
I can tell it not now,
It was long ago;
And such things cow;
But that is why and how
Two lives were so -
Were so.
Yes, the years matured,
And the blows were three
That time ensured
On her, which she dumbly endured;
And one on me -
One on me.

The "first dart" is the primary chancre of syphilis, to be followed a few weeks later by "the fully bared thing", a chilling phrase referring to the florid secondary stage, which puts the diagnosis beyond doubt. The "three blows" that fell on her are the primary, secondary and tertiary stages of luetic disease. The poet says that he himself got off lightly, not aware of any progress beyond the primary stage. Can we view this poem as autobiographical? When the impersonal description of the first stanza suddenly gives way to the personal pronouns of the rest of the poem, it is as if Hardy had abandoned the pretence of anonymity.

In "The Change", Hardy relates events from the two most important weeks of his life, when he first met Emma in March 1870, and the week of the diagnosis of her infection.

Out of the past there rises a week -
Who shall read the years O! -
Out of the past there rises a week
Enringed with a purple zone.
Out of the past there rises a week
When thoughts were strung too thick to
speak,
And the magic of its lineaments remains
with me alone.
In that week there was heard a singing -
Who shall spell the years, the years! -
In that week there was heard a singing,
And the white owl wondered why.
In that week, yea, a voice was ringing,
And forth from the casement were candles flinging
Radiance that fell on the deodar and lit up the path thereby.
Could that song have a mocking note? -
Who shall unroll the years O! -
Could that song have a mocking note
To the white owl's sense as it fell?
Could that song have a mocking note
As it trilled out warm from the singer's throat, And who was the mocker and who the mocked
when two felt all was well?
In a tedious trampling crowd yet later -
Who shall bare the years, the years! -
In a tedious trampling crowd yet later,
When silvery singings were dumb;
In a crowd uncaring what time might fate her,
Mid murks of night I stood to await her,
And the twanging of iron wheels gave out the signal that she was come.
She said with a travel-tired smile -
Who shall lift the years O! -
She said with a travel-tired smile,
Half scared by scene so strange;
She said, outworn by mile on mile,
The blurred lamps wanning her face the while,
"O Love, I am here; I am with you!" . . .
Ah, that there should have come a change!
O the doom by someone spoken -
Who shall unseal the years, the years! -
O the doom that gave no token,
When nothing of bale saw we:
O the doom by someone spoken,
O the heart by someone broken,
The heart whose sweet reverberances are all time leaves to me.

It is reasonable to infer that when Emma became ill with secondary disease she would have consulted her GP in Dorchester. He must have told her what he suspected, and suggested a second opinion, probably from a London physician who specialized in such matters. Emma, who never lacked courage, went alone to her appointment. Hardy was there to meet her on the station platform in Dorchester. Her words as given in "The Change" are surely what he wishes she had said, though what she actually said would perhaps have been more along the lines of "Well, now we know the worst". What ensued is suggested in "Had You Wept":

Had you wept; had you but neared me with
a frail uncertain ray,
Dewy as the face of the dawn, in your large
and luminous eye,
Then would have come back all the joys the
tidings had slain that day,
And a new beginning, a fresh fair heaven,
have smoothed the things awry.
But you were less feebly human, and no
passionate need for clinging
Possessed your soul to overthrow reserve
when I came near;
Ay, though you suffer as much as I from
storms the hours are bringing
Upon your heart and mine, I never see you
shed a tear.
(. . . .) When I bade me not absolve you on that
evening or the morrow,
Why did you not make war on me with
those who weep like rain?
You felt too much, so gained no balm for
all your torrid sorrow,
And hence our deep division, and our
dark undying pain.

There is only one way to read the line "When I bade me not absolve you on that evening or the morrow", which is that Hardy denied having introduced the infection into the marriage, and said it could have originated in her. She met this with a dignified silence, when, he says, she should have raged -a veiled admission of guilt on his part. Events in the ensuing years of their marriage would seem to confirm this interpretation -Emma behaved from about 1891 like the injured party, withdrawing from the marriage and withholding all favour from her husband, writing critical resumes of her thoughts towards him, treating him with a haughty froideur. Hardy was conciliatory, and perhaps more patient than might have been expected had his wife been at fault; then of course there is his immediate and extravagant remorse after her death, and the agonized elegies of "Poems of 1912-13". By the standards of the time he had loved her, betrayed her, ruined her and lost her. Poor Hardy! He was not the first to realize that God was dead, and to conclude that His capricious ordinances could thenceforth be ignored. No one told him that Mosaic Law, the Ten Commandments, and Christian attitudes to marriage were as much about sexual health and hygiene and the order of society as they were about religion. He was to learn a very hard lesson. Poor Emma! Condescended to by the likes of A. C. Benson, ridiculed behind her back for her gaucherie even when she was terminally ill.

Hardy's Annus Horribilis of 1891 contained at least one further blow for him. It was then that he found it necessary to break off relations with his literary protegee, Mrs Rosamund Tomson (1860-1911). Millgate tells us that she was about to be divorced by her (second) husband when Hardy thought it wise to sever the connection. She could most charitably be described as an emancipated woman. Professor Millgate remarks in his measured tones that "the experience, whatever it may actually have amounted to, seems to have marked a turning point in his relations with Emma".

Writing about the years after Emma's death, Millgate also makes passing mention of a long-standing friend of Hardy, Dr Henry Head, a consultant neurologist who lived nearby. It does not require any great leap of the imagination to suppose that when the tertiary stage of Emma's disease first showed itself she probably would have had neurological symptoms and her GP would have referred her to Dr Head, who presided over her decline and became a friend to her and her husband. Were this indeed the case it would explain how Emma knew of her impending demise (Dr Head would have been expecting the aneurysm and would not have been slow to diagnose it when the onset of angina pointed to it), and it would leave Thomas Hardy accused of dissimulation when he claimed that her death came as a complete surprise. I am sure it was shocking enough at the time, but I doubt if those in the know were surprised by it. Did Hardy and Dr Gowring collude to misrepresent the real cause of Emma's death, or were they in the dark about it? No harm would have resulted to anyone by misstating the cause, and at the time much pain might have been saved. I suggest that the evidence of the poems leads us to believe that Hardy intended that it should all come out, some day.