The Disease of Chopin. a comprehensive study of a lifelong suffering. Victoria Wapf
Читать онлайн.| Название | The Disease of Chopin. a comprehensive study of a lifelong suffering |
|---|---|
| Автор произведения | Victoria Wapf |
| Жанр | Медицина |
| Серия | |
| Издательство | Медицина |
| Год выпуска | 0 |
| isbn | 9785448315312 |
The youngest sister, Emily Chopin (aka Emilia Chopin) lived only fourteen and half years long (1812 – 1827). She was described as a frail child; from the early age her health was a subject of concern. She was underweight and suffered from periodic bouts of cough, breathlessness and ‘asthma’ (episodes of wheeziness). With regards to Emilia’s symptoms, which became especially severe when she was about eleven years old, the biographers opinions vary. Some researchers suggest that she started to have hematemesis and consequently died from a massive gastrointestinal hemorrhage, most likely from portal hypertension due to cirrhosis or severe gastric erosion69. Yet other biographers consider her symptoms mostly pulmonary, noting Emilia’s frequent respiratory infections and syncopes. They refer to Emilia’s blood spitting as hemoptysis, not hematemesis, and suggest that she had pneumonia in her terminal phase:
“From her early childhood Emilia’s health was a matter of growing concern. Early symptoms of an illness (probably tuberculosis) caused a general weakness of the organism… Despite medical attempts (whose efficiency has been questioned and even accused of having speeded up her death) Emilia’s illness quickly developed and she spent her last months coughing with blood and often losing her senses”.70
In a letter to a friend as of March 14th 1827, Chopin describes his sister’s sufferings that lasted already four weeks. He also describes Emilia’s anorexia and the treatment she received:
«…the bloodletting, which was done once, twice, innumerable leeches, vesicle-producing plasters, mustard plasters, and herbs, adventures over adventures. During this whole period of time, she did not eat and was so run down that one could hardly recognize her, and only slowly did she somewhat recuperate.”71,72
Emilia died less than a month later, on the 10th of April, 1827. There is no sufficient data to say with confidence whether Emilia’s death occurred on the grounds of a pathological process in her lungs with or without portal hypertension or due to a gastrointestinal disease. Depending on the initial pathology, it is possible that her death was caused by cachexia and anemia, both probably exacerbated by the wrong treatment Though chronic iron deficiency may rarely lead to death directly, a severe (or even moderate) anemia can cause sufficient hypoxia to aggravate underlying comorbidities (in Emilia’s case pulmonary and, probably gastrointestinal disorders)73 and become lethal this way.
Speaking of an exacerbating treatment, bloodletting (or bleeding) was widely practiced at that time and, according to Frederic’s accounts, Emilia Chopin underwent this treatment, too. It is important to note that the regular amount of blood extracted on each occasion was substantial: 600 – 1 000 ml. The treatment regime varied and Emilia might lose close to 2 800 ml of blood in three days, or 3 000 ml in 4 days. As much as 6 200 ml of blood could be let over a six day period74. In total, Emilia was losing blood – both as a result of her disease and her treatment – at least eight week long. Taking into consideration that patients at that time were regularly bled to syncope75 and both her nutritional status and food/liquids intake were absolutely inadequate, the cause of death could well be a posthemorrhagic anemia, and not an underlying pulmonary or gastrointestinal disease. With Emilia’s prolonged history of treatment with bleedings, an iatrogenic infection, such as hepatitis B virus (HBV), remains a possibility, too. Such infection may have affected the hepatocellular function, interfering with production of thrombopoetin. The resulting thrombocytopenia could additionally contribute to the Emilia’s hemorrhages, and, finally, to her death.
1.5 Social history
Living arrangements
Chopin’s living arrangements varied greatly. Reportedly, he had never owned a house himself and lived in rented accommodations, at times sharing them with friends. It is likely that many of his dwellings have helped to an exacerbation of Chopin’s pulmonary symptoms and progression of disease:
– Fireplaces and cooking stoves – are all known sources of irritants of the upper airways
– Cold damp dwellings (for example, the one on Mallorca).
– Mold and fungae are regularly present in damp settings and may have contributed to Chopin’s cough bouts, too (Szpilczynski) discussed Chopin’s allergic predisposition in 196176).
Marital status / Children
While known for having had numerous sexual relationships – some of them lasted for years – Chopin was never married and no biological children are known.
Drug use
Though the composer did not like wine, he occasionally got drunk, likely on social grounds or as an effort of self-medication for his bouts of melancholy77. Chopin detested tobacco smoke which made him cough. However, chronic passive smoking was an important factor influencing his lung disease. Throughout the most of his life he was surrounded by many cigar and pipe smokers such as George Sand, Liszt and his father Nicolas, to name a few78.. Fair to note, the adverse effects of tobacco smoking on health were not widely known at that time. A century after Chopin’s time, in the 1920s, a German internist F. Lickint has published the results of his scientific investigations of health issues related to alcohol and tobacco, describing lung cancer and stomach ulcer associated with prolonged smoking79..
As brief Chopin’s recreational drugs list is, as ample was his usage of medications. He frequently took opiates80. One such remedy, laudanum, is known to contain [битая ссылка] morphine, codeine, [битая ссылка] morphinan, thebaine, papaverine, and noscapine (narcotine). Laudanum is a [битая ссылка] tincture of [битая ссылка] opium containing approximately 10% powdered opium [битая ссылка] by weight (the equivalent of 1% [битая ссылка] morphine). In the nineteenth century laudanum was widely used “against many ailments”81. Opium was used not only as laudanum tincture and not only as a single medication. It was a part of numerous prescriptions and well as home remedies. It was mixed with virtually anything available: sugar, alcohol, mercury, hashish, cayenne pepper, ether, chloroform, belladonna and so on82. Chopin’s attending physicians have most likely recommended laudanum – and not another tincture – not only due to analgesic and antitussive effects of this medication, or to control Chopin’s frequent diarrhea, or to alleviate his sleep problems, but also because laudanum was a strong emetic. Emetics were popular, (as one can see on the example of Emilia’s treatment) since medieval times they were deemed important as “body cleansers”83. The emetic treatment is further discussed in Chapter. As Chopin had a pre-existing pulmonary condition, the use of opium tincture was especially dangerous due to the risk of a respiratory depression, even at therapeutic doses84. Opium is also known for releasing histamine from skin and muscle. Histamine, in turn, plays a primary role in the respiratory system as a bronchoconstrictor85.
The composer’s dependence on opium86 may
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