Your article about Benjamin Britten's health seems to be based on the serialisation of my biography of the composer, not on the book itself, and so gives an uninformed impression of my argument and evidence ('Extremely unlikely' that syphilis led to Britten death, 23 January).
Interviewing Michael Petch, the cardiologist who looked after Britten at the time of his heart surgery and for the remaining three years of his life – and whose dissent I acknowledge in the book – your report says "he believes it is 'extremely unlikely' that Britten had the venereal disease, and 'complete rubbish' that his surgeon would or even could have covered up the condition".
Petch is further quoted as saying that syphilis "does not fit with everything else … there is no serological, bacteriological, pathological or histological support for the diagnosis". The point is, as the book shows, that it does fit with everything else.
What we actually know is this: some years after Britten's heart operation, his surgeon, Donald Ross, told a reliable expert witness (cardiologist Hywel Davies) that the aorta clearly displayed symptoms of advanced syphilis. This fits with everything else we know about Britten's health at the end of his life. It also explains why the tissue valve did not form a tight fit with Britten's aorta, which prevented his recovery.
"If Ross had thought there was syphilis," your article quotes Petch, "he would have called in a venereologist." Yet Ross only discovered the symptoms in theatre. In the 1970s the stigma attached to the disease lingered, as it does today, and it is not surprising that a surgeon might think it discreet not to write up the condition in a report that would be seen by many, especially concerning so eminent a patient.
Your article also quotes Beng Goh, a consultant physician and expert in syphilis, on Britten's serious illness in 1940 and my suggestion that it was symptomatic of secondary syphilis. "Sweating and hallucination are most unlikely to be symptoms of secondary syphilis," he says. But in the book I describe far more symptoms.
In early 1940 Britten suffered from severe urticaria, which left him eventually with new skin on his face, hands and feet; exceptionally sore throat; aching teeth (one later removed); fever with temperatures of up to 107 degrees; prolonged nose bleeds; and infected tonsils, which had to be removed. I also quote from a paper by two leading authorities on secondary syphilis of the tonsils. "The otolaryngologist especially must be on the alert because he may be the first to see the patient with manifestations in the oral cavity and pharynx and these are the most common extra-genital sites of syphilis … In many cases advice is not sought and, even when it is, the true significance of the findings may be missed."
Syphilis is referred to as a "great imitator" for good reason: it can make itself appear to be any number of diseases. But Ross's testimony taken with Britten's symptoms together point clearly to a specific diagnosis: the "strange kind of scarlet fever" Britten was told he had in 1940 was actually secondary syphilis.
The strength of the reaction to my conclusions is perhaps a surprising indication of the longevity of the disease's stigma. The tragedy here is not what Britten died of, but that he died just as he was beginning an extraordinary late period of composition, producing works of great originality and vitality.
