Of sad and wished-for years: Elizabeth Barrett Browning's lifelong illness

The Victorian poet Elizabeth Barrett Browning suffered for most of her life from an illness that her physicians were never able to diagnose, and that Barrett Browning scholars and others have tried to diagnose since her death in 1861. Many suggestions have been offered, but none has been convincing. By happenstance, my daughter was reading the correspondence of Elizabeth and Robert Browning not long ago, and she recognized the symptoms described as those of the rare muscle-weakening disorder she herself has, hypokalemic periodic paralysis (HKPP). The evidence from Barrett Browning's letters and the diary she kept when she was 25 strongly suggest she too had HKPP.     

A case of dengue hemorrhagic fever in a Japanese child

A 6-year-old Japanese girl contracted a febrile illness with hemorrhagic manifestations when she traveled in Indonesia. A remarkable decrease in the numbers of platelets and white blood cells was observed in her acute-phase blood specimens. Her father, who accompanied her, showed dengue fever-like symptoms at almost the same time as her illness. It was determined by serological tests that they were infected with dengue virus type 1. Moreover, she showed a secondary antibody response to the flavivirus due to the pre-existing antibody to Japanese encephalitis virus. This is the first confirmed case of dengue hemorrhagic fever (DHF) in Japanese people.     

Stress-induced cardiomyopathy

A 58-year-old female presented with typical chest pain, which had started a week ago. She presented late because she first suspected that her symptoms were due to severe stress related to the terminal illness of her father.     

Memoirs of an amnesiac--two years with brain cancer,or the outer space of living with brain tumors.

Alexandra Dane Dor-Ner ("Ali" to friends) was a photographer, writer, and a producer of programs on child development. In February 1989, at the age of 41, she was diagnosed with malignant brain cancer. During the following months she underwent brain surgery, radiation, and implant radiation. Throughout her treatment, she continued to work on a novel and write stores and literary criticism. A volunteer in hospitals before her illness, she now became very active in a support group of brain tumor patients and often served as a first resource and contact for others diagnosed with brain cancer. All was very accomplished; her award-winning photographs have been exhibited in the Smithsonian Institution in Washington, and her articles and pictures were published in books, periodicals, and newspapers around the world. A native of Boston, Ali lived for 17 years in Israel, where she joined a group of photographers documenting disappearing neighborhoods in Jerusalem. She was awarded first prize in the "Israel Through the Camera''s Eye" competition in 1977. She also taught English and photography in Israeli high schools. Ali traveled extensively on photographic assignments. Early in their 22-year marriage, she and her husband circumnavigated the globe on a freighter, producing a documentary film of the voyage. "Memoirs of an Amnesiac" was written while Ali was a student at the Warren Wilson College Writers'' Program in North Carolina; she intended to explore the compensatory aspects of her disease. In February 1991, within days of completing the piece, Ali had a third brain operation to remove a regrowth of cancerous tumor cells, as well as necrotic tissue. Two days later, she was again operated on to remove blood clots resulting from the previous surgery. For the next 12 weeks she fought to regain her ability to walk, talk, and write. In May, she underwent a fifth operation to relieve pressure in the brain. She was still in the hospital when she learned, to her great pleasure, that she would be awarded a master of fine arts degree from Warren Wilson College. She died on June 19, 1991.     

The doctor as patient: an encounter with Guillain-Bárré syndrome.

The author describes the course and treatment of a severe acute illness that began with cranial nerve palsies and ataxia and progressed rapidly to generalized weakness with respiratory embarrassment. There was no sensory loss or elevation of the protein level in the cerebrospinal fluid. The Miller Fisher variant of Guillain-Barré syndrome was diagnosed. At the height of the illness, a period lasting about 2 weeks, the author was almost completely paralysed, retaining only a little motion in some fingers and one foot; she was able to breathe on her own but required suctioning through a tracheostomy, and her eyes had to be taped shut because of her facial paralysis. She remained mentally alert throughout. Proper care of such a helpless patient demands not only excellent technical performance of many nursing procedures but a sensitivity to the patient as a person. The author describes the many shortcomings of the care she received and the value of physiotherapy in her rehabilitation and makes a number of specific recommendations for the care of critically ill conscious patients.     

Healing the body, healing the self: the interrelationship of sickness, health, and faith in the lives of St. Lawrence Island Yupik residents

For about 15 years, Carol Jolles has been traveling to St. Lawrence Island, Alaska to study the role faith plays in the lives of Sivuqaq (Gambell) residents. From the outset, she was aware of the strong presence of two Christian faith traditions in the community. She was present when people “spoke in tongues” (entered a spiritual state, sometimes identified as an altered state of consciousness), and she was aware that people relied on prayer, often uttered in a spiritually inspired context, to ease the pain of daily life and to find the strength to do difficult tasks. Many months passed, however, before she realized that many people relied on faith to heal. From the perspective of her long-term working relationships and friendships with community members, Jolles takes a fresh look at some of the situations from her early work where faith and healing were intertwined. She also looks at more recent examples to place faith-based healing in a more general context. In the process, she focuses on a few special individuals to highlight the components of faith and healing associated with illness and mental distress.     

A case of Lassa fever: experience at St Thomas's Hospital.

An 18-year-old Nigerian girl, normally resident in Jos, was admitted to hospital for five days before she was diagnosed as having Lassa fever. There were several atypical features in the early stages of here illness, notably the absence of prostration, pharyngitis, or bradycardia and the development of appreciable leucocytosis. Consequent control and surveillance measures required checks for 21 days on 173 people who had had contact with as first line if they had handled her or specimens without taking precautions to avoid direct skin contact with her excretions, secretions, and blood; other contacts were categorised as second line. During her time in hospital she was managed in a single room on a general ward. She visited a number of investigative departments within the hospital, and her specimens were examined in five clinical laboratories. Despite this no secondary cases occurred among either first- or second-line contacts, and there was no serological evidence of subclinical infection among any of the contacts tested (159 people).     

Early Intervention in Psychosis: A Case Study on Normal and Pathological

Accumulating evidence suggests that delays in receiving treatment are associated with poorer prognosis and longer periods of unneeded suffering. The duration of untreated psychosis (DUP) is considered to be one of the most important determinants of outcome in the first episode of psychosis. However, the focus on decreasing the length of untreated illness tends to overlook the difficult task of making sense of psychotic experiences during a first episode. Using a qualitative analysis of narratives obtained from interviews with an individual and her husband, we examine what delayed her seeking help, how she became convinced that she needed treatment and what this meant for her and her husband. Additionally, we look at the five-year development of both a literal and a figurative space within which both the subject and her husband came to utilize, whether consciously or unconsciously, the ‘stories’ of her psychotic experiences to construct a shared and even ‘safe’ and familiar means of spousal connection. The exploration of this shared space reveals the normative and moral values embedded in the concept of DUP and suggests alternative ways of understanding the help-seeking behaviors in early psychosis.     

Odd Complaints and Doubtful Conditions: Norms of Hypochondria in Jane Austen and Catherine Belling

In her final fragmentary novel Sanditon, Jane Austen develops a theme that pervades her work from her juvenilia onward: illness, and in particular, illness imagined, invented, or self-inflicted. While the “invention of odd complaints” is characteristically a token of folly or weakness throughout her writing, in this last work imagined illness is also both a symbol and a cause of how selves and societies degenerate. In the shifting world of Sanditon, hypochondria is the lubricant for a society bent on turning health into a commodity. As a result, people’s rationality and their moral character come under attack. Catherine Belling’s recent subtle study, A Condition of Doubt: The Meanings of Hypochondria, unveils hypochondria’s discursive and cultural character. Running sharply against the tenor of Austen’s treatment, however, she argues in defense of the rationality of hypochondriacs; the notion that the condition may involve morally significant defects is not entertained; any connection to the commercialization of health care is muted. Here, I contrast Austen’s morally and epistemically negative rendering of her hypochondriacal characters in Sanditon with Belling’s efforts to create a sympathetic understanding of people with hypochondria. I will argue that, despite time gaps and genre differences, joint consideration of these texts can help bioethicists better appreciate how medicine can intensify, pathologize, and exploit anxieties about illness and death, thus adding to the challenges of living well in the face of mortality and morbidity.     

A 7q11.23 microduplication patient with cerebral palsy and facial dysmorphism

We report an 11year-old female with 7q11.23 microduplication detected by an array-CGH test performed because of her atypical facial appearance while being followed-up with diagnoses of epilepsy and cerebral palsy at the pediatric neurology department since she was 3 months old. We emphasize that the facial phenotype by itself should arise suspicion of the 7q11.23 duplication.     

Anna Fraentzel Celli (1878-1958)

This paper provides a short history of Anna Fraentzel Celli life, from her arrival in Italy in 1898 to her death in 1958, reviewing available documents and written testimonies. Anna Fraentzel was born in Berlin in 1878, third of four daughters from a bourgeois family; her maternal grandfather, Luigi Traube, was a very well known physician, as well as her father Oscar, and she developed an early interest in medicine that she couldn't fulfill: actually after her father's death she was forced to shorten her education, she couldn't enter the medical school, as she would have liked to, and she attended the nursing school, instead, displaying a lot of good practical sense. As a nurse in Hamburg in 1896 she met Prof. Angelo Celli, who was there on a professional visit, and who assisted the young nurse in finding a job at the city hospital. She was much younger than him, who was already a middle aged respected scientist; anyhow, even after his departure, they kept in touch and eventually fell in love. They married in 1899 and she moved to Rome to work at the S. Spirito Hospital joining a brilliant group of physicians and researchers as Tommasi-Crudeli, Marchiafava, Bignami, Bastianelli, Dionisi, Grassi, and her husband Angelo. They had long been studying the mode of transmission of the malaria infection and in 1898 they had identified the mosquito Anopheles as the vector of the malaria parasite. She got enthusiastically involved both in the scientific work and in the antimalarial campaign which Celli promoted in the Agro Romano. The strong personality of Anna Celli, her active involvement in social problems, her passionate dedication to her work, her peculiar way of being feminist, expressed fully her commitment to the struggle against malaria and illiteracy in the Agro Romano and in the Paludi Pontine at the beginning of the twentieth century. She must be credited as a major force in the creation and functioning of the Peasant Schools, as well as in the organisation of the experimental antimalarial health clinics. After her husband's death in 1914 she continued as a promoter of the antimalarial campaign, co-operating with the Red Cross and other institutions. Moreover, she edited the scientific and historical papers which Angelo Celli had collected and written during his life. She was also a prolific writer and lecturer on these issues and gained widespread appreciation both in Italy and in Germany. Toward the end of her life she retired to a nursing home in Rome where she died almost alone in 1958.     

MP offers a testimonial: “I've had superb care,and I'm alive today because of it”

When Beryl Gaffney, a Liberal member of Parliament, was told she had a brain tumour, she decided to take control of her own life. Instead of allowing the first doctor she saw to rush her to hospital, she travelled to Montreal and London, Ont., to get a second and third opinion. Then she showed neurologists in Atlanta her test results and asked which of the three options for treatment she had received coincided with their treatment recommendation. Today, she is back in the House of Commons, where she spends much of her time debating health care issues.     

Inbreeding,eugenics, and Helen Dean King (1869–1955)

Helen Dean King’s scientific work focused on inbreeding using experimental data collected from standardized laboratory rats to elucidate problems in human heredity. The meticulous care with which she carried on her inbreeding experiments assured that her results were dependable and her theoretical explanations credible. By using her nearly homozygous rats as desired commodities, she also was granted access to venues and people otherwise unavailable to her as a woman. King’s scientific career was made possible through her life experiences. She earned a doctorate from Bryn Mawr College under Thomas Hunt Morgan and spent a productive career at the Wistar Institute of Anatomy and Biology in Philadelphia where she had access to the experimental subjects which made her career possible. In this paper I examine King’s work on inbreeding, her participation in the debates over eugenics, her position at the Wistar Institute, her status as a woman working with mostly male scientists, and her involvement with popular science.     

Reappearance of catatonia. A case report

We describe a patient who was ill for more than 15 years. She was treated predominantly as a neurological case because of multiple motor signs. The diagnosis of catatonia was considered at the time when she was hospitalized in a psychiatric hospital after a suicidal attempt. The "therapeutic blindness", which was obviously present during 15 years of her illness, is discussed: the ICD--10 is perhaps misleading regarding this diagnosis while it associates it too tightly only to schizophrenia.     

Resting tachycardia, a warning sign in anorexia nervosa: case report

Background

Among psychiatric disorders, anorexia nervosa has the highest mortality rate. During an exacerbation of this illness, patients frequently present with nonspecific symptoms. Upon hospitalization, anorexia nervosa patients are often markedly bradycardic, which may be an adaptive response to progressive weight loss and negative energy balance. When anorexia nervosa patients manifest tachycardia, even heart rates in the 80–90 bpm range, a supervening acute illness should be suspected.

Case presentation

A 52-year old woman with longstanding anorexia nervosa was hospitalized due to progressive leg pain, weakness, and fatigue accompanied by marked weight loss. On physical examination she was cachectic but in no apparent distress. She had fine lanugo-type hair over her face and arms with an erythematous rash noted on her palms and left lower extremity. Her blood pressure was 96/50 mm Hg and resting heart rate was 106 bpm though she appeared euvolemic. Laboratory tests revealed anemia, mild leukocytosis, and hypoalbuminemia. She was initially treated with enteral feedings for an exacerbation of anorexia nervosa, but increasing leukocytosis without fever and worsening left leg pain prompted the diagnosis of an indolent left lower extremity cellulitis. With antibiotic therapy her heart rate decreased to 45 bpm despite minimal restoration of body weight.

Conclusions

Bradycardia is a characteristic feature of anorexia nervosa particularly with significant weight loss. When anorexia nervosa patients present with nonspecific symptoms, resting tachycardia should prompt a search for potentially life-threatening conditions.     

A case of 'contagious delusional parasitosis' in an adult pair of twin sisters

In July 1992, a 50-year-old married woman, who was a hospital administrative clerk with an adult daughter, stated that, for over 5 years, she had been parasitised by 'small animals coming out from her skin'. While physical and microscopical examinations did not show either lesions or parasites on the skin, both the patient's medical history and the conviction with which she reported the phenomenon, led to a diagnosis of Delusory Parasitosis, a condition which has been well-defined for over 50 years and considered of prevailingly psychiatric competence. The patient was examined several times during the course of 6 years. She exhibited varying levels of anxiety, and brought with her different species of insects which she had captured 'when she saw them coming out of her skin'. In July 1998 the patient returned with her twin sister, who 'had been infected by her'. Indeed, she too 'had discharged various insects from her skin' for more than a year. The authors provide information on the response of this hallucinatory syndrome to therapy which, as in this case, appears to be resistant to treatment, unless appropriate psychoactive drugs are used.     

Behavioral responses of an infant gorilla to maternal separation in a captive social group of lowland gorillas (Gorilla gorilla gorilla)

The present report describes behavioral reactions of a 33-month-old female infant gorilla to maternal separation in a captive social group whose composition is similar to that of wild groups. The infant gorilla responded differently to two types of maternal separation. When she remained alone for a few hours, she cried repeatedly and moved restlessly, indicating protest. Upon reunion and also for a few days thereafter, an intensification of the mother-infant relationship occurred. On the other hand, when she was separated from her mother but remained with the other group members for nine days, she did not display any behaviors that could be characterized as protest, but rather showed clear behavioral depression. During the 9-day separation period, she hardly played with other group members but she developed affiliative relationships with the leading male. After the reunion from the 9-day separation, she spent as much time near her mother as before separation and played with other infants at a level similar to that before separation, while she sometimes displayed behavioral patterns demanding the maintenance of physical contact with her mother. The present findings are compared with other reports in great apes and human children.     

Two cases of anorexia nervosa associated with Graves' disease

In this report on two cases of anorexia nervosa associated with Graves' disease, metabolism and the relationship between the two illness are considered. Case 1 was a 25-year-old female. Anorexia was associated with a stressful life situation following marriage. One year after the onset of anorexia, her condition was diagnosed as Graves' disease. In spite of high levels of serum thyroid hormone, she did not show the clinical signs and symptoms of hyperthyroidism. The hypermetabolic state of Graves' disease seems to be suppressed by the hypometabolism of anorexia. Case 2 was a 17-year-old female whose body weight, due to anorexia, at one time had decreased from 55 kg to 35.2 kg. A rebound from anorexia to bulimia increased her body weight to 80 kg in spite of an association with the hypermetabolic state of Graves' disease. In light of the abovementioned cases, it seems that the clinical picture of Graves' disease is usually hidden by the clinical symptoms of anorexia nervosa.     

Louisa May Alcott: her mysterious illness

Louisa May Alcott (1832-1888), famous in her own time and immortalized in ours as a major figure of the "American Renaissance," died at the age of 55 after intermittent suffering over 20 years. Her illnesses evoked intense interest in her time and in ours. Alcott tracked her signs and symptoms (in letters and journal entries), which included headaches and vertigo, rheumatism, musculo-skeletal pain, and skin rashes; in her final years she recorded severe dyspepsia with symptoms of obstruction, and headaches compatible with severe hypertension. Her death came suddenly with a stroke. Standard biographies propose that her illnesses were due to acute mercury poisoning from inorganic mercury medication she received for a bout of typhoid in 1863, a cause she herself believed. We have reviewed Alcott's observations, as well as those of others, and have determined that acute mercury poisoning could not have caused her long-term complaints. We propose instead that Alcott suffered a multi-system disease, possibly originating from effects of mercury on the immune system. A portrait of Alcott raises the possibility that she had systemic lupus erythematosus (SLE).