Читать книгу The Disease of Chopin. a comprehensive study of a lifelong suffering - Victoria Wapf - Страница 5

Both life and creative endeavors of Frédéric Chopin (1810—1849), a pianist and composer of French-Polish origin, were in many ways shaped by his disease. Chopin’s chronic condition still remains not clearly identified and evokes debates. Given the scarcity of medical-biographic data, Chopin’s symptoms provoked a number of thoughts and discussions both in the historical and medical community. However, despite the obvious interest in this topic, and a number of recent publications – especially around the recent bicentennial (2010) of the pianist/composer – there were no broad review of his possible and probable diagnosis in the recent time. The classic work, Chopin’s pathography by Edmond R. Long (1956)1 was focused on tuberculosis only. Later scholars explored further possible diagnoses, with cystic fibrosis (O’Shea, 1987)2 being the most known. Nevertheless, virtually all reports on the composer’s life and disease were centered on one or two possible pathologies only. In this comprehensive review, the medical and historical literature on Chopin’s disease and on the medicine of that era was examined to evaluate tuberculosis and cystic fibrosis, as well as other possible conditions for their significance in influencing the health of the innovative musician during his lifetime. It was found that though tuberculosis remains the usual suspect, several other hypotheses cannot be discounted either, especially if further exploratory methods may potentially become available. Chopin’s situation is unique, because in his case a tissue specimen could possibly shed further light on his disease, and, consequently, on our understanding of his life and works.

Moreover, the study of Frédéric Chopin’s medical history is an exciting opportunity to gain additional insights into the nineteenth century medicine, in the physician-patient relationships, and to see how the progress of medical science in the newer times has contributed to diagnostic and treatment of formerly fatal diseases. While working on this review, clear preference was given to the studies and interpretations of Chopin’s life and disease done by medical professionals – physicians, medical historians and pathologists. Other sources, such as personal communication of Chopin himself and his family and friends were used as well.

This study is divided into several chapters. It starts with a nearly forensic review of Chopin’s medical history, following a standard pattern of a patient examination. The primary purpose of this chapter is to provide as many clinically relevant data as possible in order to lay a foundation for diagnosis and differential diagnosis. The following two chapters contain information about Chopin’s physicians, their professional profiles, and modes of treatment. A profound understanding of Chopin’s disease history would only be possible with knowing on who treated him and which principles each treatment was based on. As it is often the case throughout the whole human and medical history, a treatment itself may become an aggravating factor or even the cause of the patient’s suffering. Chopin, as a patient with chronic disease (s), had an extensive list of medications, many of them with a potential for toxicity or interactions. That is why his treatment deserved a separate chapter here.

Following the examination of Chopin’s medical history is a discussion on the terminal period and post-mortem exploration of the composer’s disease. Chopin’s case is standing out because at least in theory, a further exploration with today’s instrumental methods is technically possible thanks to the existence of the tissue specimen.

The next chapter is the most crucial one. It is focused on the diagnosis and differential diagnosis of Chopin. Beginning with an outline of two leading hypotheses for Chopin’s most suspected diagnoses, namely tuberculosis and cystic fibrosis, other, less known or less probable diagnoses and discuss possible comorbidities will be reviewed and described in detail. Finally, an attempt to lay out an examination plan with the twenty-first century methods of analysis will be undertaken in order to advance our understanding of Chopin’s disease.

1.1 Methods: detailed description

The literature search for this study involved three steps: the search criteria, the timeframe and what information to extract – all this was set prior to the start of the study. The first step of the literature search took place between October 16^th and November 16^th 2013 and had the following objectives:

– databases search and retrieval of relevant documents

– quality assessment of those documents

– weighing up the total volume of evidence for CF and TBS

– identification of knowledge gaps, i.e. subjects of search at the step III.

At this step, a search for available publications was conducted to identify all medical documents describing Chopin’s status and disease (s). The following search criteria were employed with strong preference for academic journal articles as sources:

– records by attending physicians – if any such exist;

– records by other medical and/or paramedical professionals (coroners, pathologists etc.) – if any;

– publications at the PubMed and other medical/scientific databases (Questia, Science Direct, MedlinePlus, Cochrane Library, CHBD (Circumpolar Health Bibliographic Database), the Directory of Open Access Journals, Web of Knowledge, Worldwide Science, and Index Copernicus);

– other relevant publications by medical professionals (such as biographic, demographic or historical documents);

The search languages were English, German, French, Polish, and Russian. Though valuable and interesting publications exist in such languages as Norwegian and Hebrew, they remain outside of the scope of this review. Since it would be obviously technically challenging to do a comprehensive search in a greater number of languages, this search was limited to those languages spoken/written by Chopin himself. Following words were used for the search in all databases: <Frederic Chopin disease>, <Fryderyk Chopin disease>, <Frederic Chopin Krankheit>, <Frédéric Chopin maladie>, <Fryderyk Chopin choroba>, <Фредерик Шопен болезнь>. Additionally, the PubMed database was searched for <Frederic Chopin> and for <Frédéric Chopin>. Following information was set to extract: symptom descriptions, treatments descriptions, dietary preferences, lifestyle details, quality assessment of studies. Inclusion criteria at the first step were: date of publication later than 1948 (the year when Chopin’s heart tissues were made available for research); a provision of justified (i.e. based on official archive documents or similar sources) hypotheses. The first step’s exclusion criteria were lack of references, languages other than those ones listed above, wrong author (not a medical professional or a medical historian or a related official, for example a coroner). Hence, the standard set of reasons of rejection included wrong topic, wrong specialist, and wrong language.

The next (second) step involved sifting of the reference lists in the articles retrieved from the first step. The inclusion criterion at this step was a provision of justified (i.e. based on official archive documents or similar sources) hypotheses. At this step also publications by authors other than medical professionals were included (for example, biographic, demographic or historical documents authored by specialists or family members). The step II exclusion criteria were a lack of references and wrong languages (i.e. other than those listed above).

Finally, the last step of search was aimed at a retrieval of additional documents of interest that may not fit into the step I and II criteria, but may help to understand Chopin’s disease in its historical, cultural and social context. A hand search was attempted for the genealogical data and for original publications by Chopin’s attending physicians.

The first step of the literature search (between October 16^th and November 16^th 2013) was aimed at identifying of all medical documents describing Chopin’s status and disease (s). Six publications were found at PubMed3. Sixteen publications were found with additional key words at PubMed: “Frederic Chopin^”4. With a “related citations” option: 152 publications were found in a PubMed search5. Both PubMed and Go PubMed searches yielded the same results as the PubMed search. A Cochrane library search brought no results, as well as the CHBD (Circumpolar Health Bibliographic Database, the Directory of Open Access Journals, Worldwide Science, Index Copernicus (this database includes over 700 journals from Poland), and the Medline Plus. A search in the Questia database yielded twenty-two books and two academic journal articles6. A search at the Web of Knowledge: twelve results7. Sixty-two more results were found at the Science Direct database.

After this three-step search was completed, the gathered information was systematized in a form of medical history.

1

Long, E. (1956), “A History of the Therapy of Tuberculosis and the Case of Frederic Chopin”. Lawrence: University of Kansas Press, 1956.

2

O’Shea, J. (1987), “Was Frédéric Chopin’s illness actually cystic fibrosis?”. Med J Aust. Dec 7—21; 147 (11—12), 586—9.

3

Search results, retreived on 16. October 2013 at: [битая ссылка] http://www.ncbi.nlm.nih.gov/pubmed/?term=Frederic+Chopin+disease.

4

Search results, retreived on 16. October 2013 at: [битая ссылка] http://www.ncbi.nlm.nih.gov/pubmed/?term=Frederic+Chopin.

5

Search results, retreived on 16. October 2013 at: [битая ссылка] http://www.ncbi.nlm.nih.gov/pubmed.

6

Search results, retreived on 16. October 2013 at: http://www.questia.com/searchglobal?q=keyword!frederic%20chopin%20disease!allwords#00000Book.

7

.Search results, retreived on 16. October 2013 at: [битая ссылка] http://apps.webofknowledge.com/summary.do?SID=Z1oHXp5Dd8JgXZBKJ5H&product=UA&qid=2&search_mode=GeneralSearch.