O. Appenzeller

Peripheral neuropathy in chronic disease of the respiratory tract

Abstract Eight patients with chronic obstructive bronchopulmonary disease were studied. In seven who had wasting associated with chronic respiratory tract disease, evidence of peripheral neuropathy was found on clinical and electromyographic examinations. Histologic changes were also present in muscle and sural nerve biopsy specimens from these patients. Biochemical analysis of these sural nerve specimens showed them to differ from those in normal control subjects and patients with alcoholic neuropathy. It is suggested that the neuropathy in chronic obstructive bronchopulmonary disease might be due to abnormalities in the metabolism of Schwann cells.

Boy with cortical visual impairment and unilateral hemiparesis in Jeff Huntington's “Slip” (2011)

Face recognition is strongly associated with the human face and face perception is an important part in identifying health qualities of a person and is an integral part of so called spot diagnosis in clinical neurology. Neurology depends in part on observation, description and interpretation of visual information. Similar skills are required in visual art. Here we report a case of eye cortical visual impairment (CVI) and unilateral facial weakness in a boy depicted by the painter Jeff Huntington (2011). The corollary of this is that art serves medical clinical exercise. Art interpretation helps neurology students to apply the same skills they will use in clinical experience and to develop their observational and interpretive skills in non-clinical settings. Furthermore, the development of an increased awareness of emotional and character expression in the human face may facilitate successful doctor-patient relationships.

The Heart of Frederic Chopin (1810-1849)

We read with interest the paper by Witt et al,1 which details the visual examination of Chopins heart. The organ is described as massively enlarged and completely covered with whitish, massive fibrillary coating.1 Tuberculous (TB) pericarditis coupled with massive enlargement of the right ventricle, possibly due to pulmonary hypertension, was proposed as the most plausible cause of death of the artist.1 The retrospective diagnosis of probable TB pericarditis was made by the authors based on the identification of three small nodules, between several mm up to 1 cm in diameter, of white-glass appearance, two on an upper part of the ventricle one just near the apex (Figure, A).1 However, these nodules were not examined histologically.

Was Ugo Foscolo (1778–1827) affected by alpha-1 antitrypsin deficiency?

Niccolò Ugo Foscolo (1778-1827), known as Ugo, is one of the masters of the Italian poetry. A writer and a revolutionary, he embraced the ideals of the French Revolution and took part in the stormy political discussions, which the fall of the Republic of Venice had provoked. Despite his poor health, Foscolo lived an adventurous life serving as a volunteer in the Guardia Nazionale and in the Napoleonic army. Following Napoleons fall (1814), he went into voluntary exile in early 1815. He reached London in Sept. 1816 and lived in poverty at Turnham Green (Chiswick) until his premature death. Foscolos medical history has been poorly investigated and the cause of his death remains unclear. In an attempt to shed light on his clinical history, we analyzed his Correspondence (Epistolario), a series of more than 3000 letters written between 1794 and 1827. From the age of 26 (1808), Foscolo had frequent episodes of cough and dyspnea that progressively worsened. Four acute respiratory exacerbations occurred in 1812. Between September 1812 and April 1813, he had breathlessness as that of asthma. Frail and ailing, he developed a chronic liver disease in 1826. In August 1827, weakness, dyspepsia and drowsiness further increased and dropsy became manifest. He went into coma on September 7, 1827 and died aged 49 three days later. Based on a brief history of urethritis and urinary obstructions (1811-1812), previous scholars have suggested that Foscolo had urethral stenosis that caused a chronic bladder outlet obstruction and led to consequent renal failure. This hypothesis, however, does not mention the respiratory symptomatology present since 1804, which is a pivotal feature of Foscolos illness. We surmise that Foscolo suffered from alpha-1 anti trypsin (AAT) deficiency, a rare genetic disease, which caused his premature death and support our interpretation with documental evidence.

Antonio Ligabue: “the Madman”

The medical history of some famous painters, such as Van Gogh, Goya, and Munch, is characterized by symptoms attributable to psychiatric diseases that seem to have contributed their artistic genius. This is evident in the life-history and the artistic work of the Italian painter Antonio Ligabue (1899–1965), also called “the Madman”. Considered one of the most important exponents of Naïve art in the 20th century, he was born on December 18, 1889 in Zurich, Switzerland, to Elisabetta Costa and an unknown native Italian father [1]. His real name was Antonio Laccabue, however in 1942 he changed his surname to Ligabue, perhaps to dissociate himself from his hated father. Since childhood, Ligabue’s life was marked by suffering and trouble: he was entrusted to a Swiss family and, due to poverty, he suffered from rickets that characterized his physical appearance [1,2]. At the age of fourteen Ligabue’s biological mother and his three brothers died due to food poisoning which the painter thought was caused by his father [1,2]. Ligabue was almost illiterate and working as a farmer, he lived the life of a wanderer, isolated from society [1,2]. He had a conflicted and morbid relationship with his stepmother and during his adolescence frequently had “nervous crises” that led him to be hospitalized in psychiatric clinics [1–3]. During one such hospitalization, his natural and superb talent for painting was recognized. However, he was forced to leave Switzerland in 1919, after being labeled dangerous and violent, and moved to Gualtieri, a small town in Italy, which was his father’s home town [1–3]. There, Ligabue continued to live an isolated life. Alienated by society his behavioral problems increased. During the 1930s and 1950s Ligabue’s artistic work continued to flourish [3]. Nevertheless, between 1937 and 1948, Ligabue was hospitalized three times in a psychiatric Clinic in San Lazzaro of Reggio Emilia. These hospitalizations were caused by his “maniac-depressive state” which were marked with episodes of self-harm (particularly to his nose and head) and aggression towards other people [1,2]. In 1948 he began painting more frequently, and journalists, critics and art dealers began to finally take an interest in him [3]. In 1962, he had a which left him with a right hemiparesis. He died on May 27, 1965 the age of 65 [1–3]. Antonio Ligabue’s life is an example of a psychiatric disease contributing to the artistic genius. His isolation and exclusion from society, his turbulent and conflicting behaviors, and his aggressiveness and self-harm could be consistent with a diagnosis of borderline personality disorder [4]

Michelangelo Buonarroti (1475–1564) had the deconditioning syndrome while painting the Sistine Chapel ceiling

The brilliant painter, sculptor, architect and poem writer of the Italian Renaissance, Michelangelo Buonarroti (Fig. 1) documented his own life, habits and diseases [1]. Between 1508 and 1512, he painted the vault of the Sistine Chapel and described his demanding work in a poem addressed to Giovanni da Pistoia. Lying supine all day on a high scaffold, his head was bent forwards using muscle contractions and support for hours with paint dripping on his face [1]. After two years (1510), he had trouble with his eyes.

Earliest evidence of malignant breast cancer in Renaissance paintings

In the ancient world, breast cancer estimates appear to be higher than those for any other types of cancer. Several potential cases of breast cancer during antiquity have been described in medical papers over the past millennia. However, a clear distinction between breast cancer and other non-malignant breast pathologies cannot be confidently made with the available evidence, and it is not possible to ascertain whether the estimates provided by ancient writers reflect the real incidence of the disease at the time.

Did Frédéric Chopin die from heart failure

On October 17, 1849, Polands greatest composer, Frédéric Chopin (1810-1849) died aged 39. His cause of death remains unknown. An investigation of the documental sources was performed to reconstruct the medical history of the artist. Since his earliest years, his life had been dominated by poor health. Recurrent episodes of cough, fever, headaches, lymphadenopathy- a series of symptoms that may be attributed to viral respiratory infections- manifested in his teens. Later in life, he had chest pain, hemoptysis, hematemesis, neuralgia, and arthralgia. Exhaustion and breathlessness characterized all his adult life. Coughing, choking, and edema of the legs and ankles manifested four months before his death. Several hypotheses ranging from cystic fibrosis to alpha-1 anti-trypsin deficiency and pulmonary tuberculosis have been proposed to explain Chopins lifelong illness. We suggest that Chopin had dilated cardiomyopathy with consequent heart failure and cirrhosis that caused his death.

Charité Hospital and infectious diseases

Films are useful for medical education and introduce Science fiction movies or historic documentaries and pioneering scientists who developed the field of infectious disease research. Between the late nineteenth and early twentieth centuries, expert talents such as von Behring, Koch, and Ehrlich were present at the Charité Hospital. These individuals contributed significantly to the scientific study of infections, their prevention, treatment, and social impact. Here, we compare the relative impact of infectious disease research centers during the study period (late nineteenth and early twentieth centuries) by assuming that the number of publications listed on Wikipedia about the individual scientists working in London, Paris, and Berlin is Poisson distributed. We show that using reference counts that appear after individuals’ names on Wikipedia is a useful tool to assess the impact of centers of excellence in the study of infectious diseases. However, the accumulation of talent in Berlin during a relatively short period, even though historically the protagonists did not interact or support each other, lead to greater advances in the treatment and prevention of infections in humans than the work of individuals such as Pasteur in Paris or Lister in London.

The Complex Aura of Nikola Tesla

A genius and a visionary, Nikola Tesla (1856-1943) was a man ahead of his time who invented many things including alternating current, the radio, and fluorescent lights. In his private life, Tesla was also a complex man whose brilliant mind was plagued by visual and auditory disturbances, obsessions, and repetitive behaviors. A weak and vacillating child until the age of eight, Nikola grew up plagued by thoughts of pain and death in life and by religious fears. His infancy and boyhood were also deeply influenced by his parents’ characters and abilities. The young Tesla, however, had longed to be an engineer. Oppressed by his inflexible and dominant father, he was unable to argue against him. Since childhood, his father taught him to visualize objects and to modify them as he wished. Those skills became the hallmark of his brilliant mind. Tesla had a rare ability to visualize his inventions and to complete working models before they were manufactured. Once the model was made for the first time, it worked exactly as he had visualized it. Tesla’s later boyhood and adolescence were dominated by visual disturbances, which he described in details in his autobiography, “The Inventions.” Aged eight “I had a peculiar affliction due to the appearance of images, often accompanied by strong flashes of light, which marred the sight of real objects and interfered with my thought and action. They were the pictures of things and scene, which I had really seen, never of those I imagined.” Similar manifestations had also affected his older brother, Dane, and Tesla did not have control over the flashes, which manifested when “I found myself in a dangerous or distressing situations, or when I was greatly exhilarated.” When Tesla became older, the visual disturbances “still manifested themselves from time to time. . .but they are no longer exciting, being of relatively small intensity.” Their presentation appears almost stereotyped. Tesla described them as “a background of very dark and uniform blue[. . .] animated with innumerable scintillating flakes of green, arranged in several layers and advancing towards me.[. . .] This picture moves slowly across the field of vision and in about ten seconds vanishes to the left.” Based on these excerpts and in agreement with a previously proposed hypothesis, we surmise that the visual phenomena experienced by Tesla since his boyhood can be attributed to migraines with aura. It appears that most of Tesla’s attacks were episodes of migraine with aura without headache. Moreover, Tesla also had a series of symptoms associated with migraine. In his autobiography, he recounts extraordinary visual and hearing abilities. His auditory acuity even increased apparently after a “nervous breakdown” in 1878. Based on the above excerpts, it emerges that Tesla suffered from hyperacusis, sleep inversion, hypnagogic hallucinations, and synesthesia, all co-morbid conditions associated with migraine. Following his own words, he could not sleep more than two hours per night and dozed from time to time “to recharge his batteries.” Hypnagogic hallucinations occurred before falling asleep and, in their absence, he could not sleep at all. Epidemiological and clinical studies have shown a close association between migraine and sleep disturbance. Both excess and lack of sleep can trigger migraine attacks. Also synesthesia, a condition from which Tesla suffered, can be associated with migraine (“when a word was spoken to me the image of the object it designated would present itself vividly to my vision”). Based on the description of his “many strange like– dislike habits,” eg, the violent aversion against the earrings of women, the hair of other people or the germs, or the need that “all repeated acts or operations I performed had to be divisible by three,” we also propose that Tesla suffered from an obsessive-compulsive disorder. A number of mood and anxiety disorders have been identified