Читать книгу The Disease of Chopin. a comprehensive study of a lifelong suffering - Victoria Wapf - Страница 10

According to ample verbal and visual evidence Chopin had asthenic habitus. In his travel passport, used for the journey to England in 1837, his height is stated as 170 cm90, weight – 50 kg91 at some points – in 1835, and, probably, in 1838, too – dropping below 45 kg92. Both parameters substantially deviate from population averages (see Appendix). Chopin’s body mass index (BMI) varied between 16 and 17, which is considered underweight (normal range BMI ranges between 18.5 and 24.9). A number of sources depict Chopin’s poor exercise tolerance and failure to gain weight93.

Musculoskeletal system

What reliable evidence might help to assess Chopin’s appearance from a clinical viewpoint? Obviously, various verbal and graphic depictions are always to some extent subjective and may sometimes be rather a telltale of their creator, not so their object. Various portraits, inclusive photographs are consistent in portraying of asthenic, thin-faced man. The written sources convey an image of a man who is ‘whiskerless, beardless, fair of hair, and pale and thin of face … <and has> a prominent aquiline nose94. But it is barely possible to draw a clinically relevant conclusion based on something as trivial as a caricature95. For example, based on a sketch by P. Vairdot, Kuzemko (1994) suggests that Chopin has probably had emphysema, since he become apparently barrel-chested in his early thirties. However, that very sketch – as fairly pointed out by other researchers – shows Chopin with a disproportionally giant head, too.

The other authors describe Chopin as having “thin, long and barely muscular limbs, very slender, delicate hands96. Those extraordinary thin limbs might probably be interpreted as an early sign of emaciation97. Almost all observers noted the extreme thinness of his limbs. Here is one fact that let us think that Chopin may, indeed, have had a distorted musculoskeletal development that goes beyond a mere asthenic habitus. While travelling in horse-drawn carriages, Chopin feared he may fracture his frail limbs98. Both Erlinger (2010) and O’Shea (1987) hypothesize that this could be due to his pulmonary hypertrophic osteoarthropathy, that manifested itself by painful swelling of distal joints and soft tissue99,100. Quite evidently (see Appendix 10.7,“Postmortem hand cast”), Chopin did not have digital clubbing (finger clubbing). Though finger clubbing is most commonly seen in patients with bronchiectasis (as well as in those with cystic fibrosis and bronchial carcinoma) and not commonly seen in patients with pulmonary tuberculosis101, this sign is neither specific nor particularly sensitive for lung pathology102 and cannot be reliably used for a differential diagnosis in Chopin’s case.

Throughout most of his adult life, Chopin frequently suffered of pain in the ankles, feet and hands103. During the terminal phase of his illness, he also developed severe pain in his wrists and ankles, which was relieved partially by massage and sometimes worsened at cold and wet weather. The hot weather was also poorly tolerated: according to O’Shea (1987), Chopin had frequently experienced prostration and hyperhidrosis in summer104. As mentioned above, at least once in his life – namely in winter of 1826 – Chopin had nodal swelling that Kubba and Young, referring to Chopin’s letter dated February 12, 1826 to his friend, physician Jan Bialoblocki105, regarded as a cervical lymphadenopathy. Cervical lymphadenitis is a common (about 15%) manifestation of extrapulmonary tuberculosis, especially in patients with compromised immune system106. A nodal regression is possible indeed, but only under chemotherapy107. Other infections or neoplasia, and rarely, drug reactions may also cause a nodal enlargement that in some cases can resolve untreated108.

Respiratory system

Chopin’s lung problems are dated back to his adolescence with prolonged episodes of cough and lymphadenopathy. There are reports of Chopin’s repeated exacerbations of nasal infection with substantial blockage of air passage (i.e. a possibility of polyps), pulmonary infections with productive cough, hemoptysis and recurrent fevers, later chronic dyspnea109. O’Shea (1987) and Kuzemko (1994) citing G. Sand argue that a cavitating lesion was not found during an auscultation of Chopin’s chest (by Dr. Papet)110.

The bouts of cough and dyspnea accompanied Chopin throughout most of his adult life. Long (1956) describes the episodes of hemoptysis consisted of blood streaking purulent sputum as “a picture of bronchiectasis or chronic bronchitis”111