Raffaella Bianucci

Invasive versus Non Invasive Methods Applied to Mummy Research: Will This Controversy Ever Be Solved?

Advances in the application of non invasive techniques to mummified remains have shed new light on past diseases. The virtual inspection of a corpse, which has almost completely replaced classical autopsy, has proven to be important especially when dealing with valuable museum specimens. In spite of some very rewarding results, there are still many open questions. Non invasive techniques provide information on hard and soft tissue pathologies and allow information to be gleaned concerning mummification practices (e.g., ancient Egyptian artificial mummification). Nevertheless, there are other fields of mummy studies in which the results provided by non invasive techniques are not always self-explanatory. Reliance exclusively upon virtual diagnoses can sometimes lead to inconclusive and misleading interpretations. On the other hand, several types of investigation (e.g., histology, paleomicrobiology, and biochemistry), although minimally invasive, require direct contact with the bodies and, for this reason, are often avoided, particularly by museum curators. Here we present an overview of the non invasive and invasive techniques currently used in mummy studies and propose an approach that might solve these conflicts.

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.

Cancer in two Renaissance families

We read with great interest the letter published by Raffaele Gaeta and colleagues1 describing a supposed concentration of cancer cases in the Renaissance court of Naples. However, this short report lacks important physiopathological and bibliographical data. First, more than five cases of malignant tumours have been published in the paleopathological literature.2 The authors focused exclusively on soft-tissue tumours in mummified human remains1, 3 without mentioning bone cancer cases,2 therefore giving a biased view of cancer frequencies in past populations.

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.

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

Lessons from the Past: Some Histories of Alpha-1 Antitrypsin Deficiency Before Its Discovery

ABSTRACT A1AT deficiency- a genetically inherited autosomal codominant disease with more than 120 identified alleles- was first identified by Laurell and Eriksson in 1963. The most common hereditary disorder in adults, A1AT causes an increased risk of developing pulmonary emphysema and liver disease. In A1AT patients, lung disease generally presents at a younger age than “usual” chronic obstructive pulmonary disease (COPD) and it may be misdiagnosed as asthma. Because A1AT deficiency patients can show the same clinical features as non-deficient COPD (including increased evidence of bronchiectasis, frequent exacerbations, impaired health status and a degree of reversibility of airflow obstruction), the World Health Organization recommend to test every patient with a diagnosis of COPD or adult-onset asthma for A1AT deficiency. Despite these recommendations, the epidemiology of A1AT deficiency remains uncertain. Although recently discovered A1AT deficiency has affected human populations since antiquity. By using scientific data and recently studied skeletons and historical cases, we show that it is now possible to reconstruct the natural history of pathological processes, whether due to genetic, infectious or environmental factors. We believe that the evolution of disease in patients and research to elucidate the relationship between social science and environmental are pertinent contemporaneous subjects.

Did Liszt have chronic pulmonary thromboembolism

Ferenc, also known as Franz, Liszt (1811–86) was an influential Hungarian composer and piano virtuoso. He studied in Vienna and Paris and toured Europe as a child prodigy (Germany, France, Austria, Belgium, Italy, and Great Britain). From 1871, he travelled regularly between Rome, Weimar, and Budapest teaching piano; it was estimated that Liszt travelled about 4000 miles a year by train and carriage.