Читать книгу The Disease of Chopin. a comprehensive study of a lifelong suffering - Victoria Wapf - Страница 9

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 explain its frequent use. A number of Chopin’s symptoms can be found on the vast list of opium side effects: drowsiness, headache, malaise, CNS depression, insomnia, mental depression, nausea, vomiting, anorexia, stomach cramps, neuromuscular and skeletal weakness.

Ganche (1935) lists other medications and remedies prescribed to Chopin: foxglove (digitalis), monkshood (aconite), creosote, protioduret <of mercury>, jelly lichen (collema), gum water (diluted acacia sap that was a popular prescription for phthisis87). Most of those remedies are known for their toxicity, but little is known on how Chopin’s treatment may have influenced his symptoms. Caruncho and Fernandez (2011) discussed opium toxicity as a possible reason for Chopin’s mental problems, only to dismiss it on the grounds that the symptoms (particularly hallucinations) were present before Chopin began receiving the treatment on a regular basis and that the hallucination pattern differed from that of toxicity. The authors point out that the exact treatment chronology remains unknown. Chances are, the symptoms’ onset might, in fact, have preceded or coincided with Chopin’s treatment. Certainly, a simultaneous occurrence does not equal to causality, but it is possible that at least some of Chopin’s pathology might be explained with toxic effects of the remedies he was treated with88.

Foreign travel

At various periods of his life Chopin has visited geographic areas that today are known as Germany, Poland, France, Austria, United Kingdom, and Spain89. Following diseases were present in those parts of Europe in the 19th century and/or caused outbreaks of a significant importance:

– typhus

– scarlatina

– measles

– smallpox

– cholera

– smallpox

– tuberculosis

– influenza

However, the course of Chopin’s disease does not match the spread and the magnitude of those epidemics. For instance, neither his gastrointestinal symptoms nor his pulmonary problems were aggravated or first present at the times of cholera or influenza outbreaks, respectively.

Exposure to environmental pathogens

With an exception of a regular exposure to biomass (wood) home heating and passive smoking (as many of Chopin’s friends and family were heavy smokers), no particular environmental exposures are known.