In the Count of Monte Cristo When Didhe Count Reveal to Villefort About His Baby

J R Soc Med. 2003 Aug; 96(8): 412–414.

Cerebrovascular affliction in Dumas' The Count of Monte Cristo

Alexandre Dumas' famous novel The Count of Monte Cristo (1844-1845) tells of the unjust imprisonment of Edmond Dantès, his escape and revenge. An incidental feature of this novel is the clarification of two cases of cerebrovascular illness, with expression of contemporary opinion on pathology and treatment. Earlier readers of the work in English language may accept missed this since most versions are based on an 1846 translation that has substantial omissions. A retranslation of the unexpurgated text provides access to the original novel in English.ane This gripping tale includes drug-taking, a serial female poisoner, lesbianism and two cases of infanticide. (The quotations in this paper refer to this translation by Osculation, as do the page numbers.) It is far from the children'southward novel that virtually people perceive it to be.

CASE One: ABBÉ FARIA

Abbé Faria is an elderly Italian priest with Bonapartist and Pan-Italian sympathies who was incarcerated at the Château d'If four years before Dantès. The prison guards experience that Faria is mad because he has offered them part of a great treasure, which they do not believe exists, if he is released. Faria becomes Dantès' teacher, having inadvertently tunnelled into Dantès' cell (Figure 1).

An external file that holds a picture, illustration, etc.  Object name is 412f1g.jpg

Abbé Faria teaching Edmond Dantès. (From an early edition of The Count of Monte Cristo)

Xv months later their first associate, Faria suddenly becomes unwell. Dantès is warned by Faria what to expect and what he must practise with some medicine that Faria has kept for the purpose:

'This is what volition happen. I shall fall into a cataleptic fit. I may perhaps remain motionless and not brand a sound. But I might too froth at the oral fissure, stiffen and cry out.... When you see me motionless, cold and equally it were, dead—and only at that moment you lot sympathise—force my teeth apart with the knife and poor 8 to x drops of the liquid into my mouth. In that case, I may revive.' (p. 148)

Faria regains consciousness merely has a correct hemiplegia, describing himself equally being 'half a corpse'. This is Faria's second attack, the kickoff having been more than x years previously:

'Last time the fit lasted half an hour, and after it I felt hungry and got up myself. Today, I cannot movement my right leg or my right arm. My head is muddled, which proves there is some effusion on the brain. The tertiary time, I shall remain entirely paralysed or shall die at once.... Information technology is a hereditary illness. My father died on the tertiary set on then did my grandad. The doctor predicted the same fate for me.' (p. 150)

Faria dies as predicted later the 3rd cerebrovascular event even though Dantès gave the rest of the medicine equally instructed.

'The medicine produced an immediate effect, galvanizing the old man with a tearing shudder through all his limbs. His eyes reopened with a terrifying expression, he let out a sigh that was closer to a shout, then the whole trembling trunk relapsed gradually into immobility' (p. 166).

After Faria'southward death, Dantès escapes from the Château d'If past substituting himself inside Faria's shroud. He is unexpectedly thrown into the sea, with his anxiety tied to a xxx-six pound cannonball, despite which he escapes.

Manifestly we can but speculate equally to Abbé Faria's condition, which although familial presents with epilepsy, renders the patient hemiplegic after the second episode and kills on the third. From a 21st-century perspective it does not brand sense, and this is of class a work of fiction. We can speculate that 'some effusion on the brain' represents subarachnoid or intracerebral haemorrhage, possibly autosomal dominantly inherited. Dumas' description of Faria does non support (or anticipate) a diagnosis of Osler-Rendu-Weber syndrome or Sturge-Weber syndrome. Nosotros can too speculate that the medicine given to him by Dantès somehow acted on intracranial or blood pressure.

For answers we should look at medical concepts of apoplexy at the time Dumas was writing, bearing in listen that the postmortem differences betwixt bleeding and infarction were non defined until the middle of the nineteenth century. In 1822 Serres divided apoplexies into two groups—those with and those without paralysisii—only Dumas' agreement is more than likely to have been influenced by Abercrombie'due south Pathological and Practical Researches on Diseases of the Encephalon and the Spinal Cord 3 first published in 1828. In this work, seen every bit a milestone in the development of neuropathology,4 Abercrombie divides apoplexy into three classes: 'First those which are immediately... apoplectic: secondly that which begin with a sudden attack of headache and pass gradually into apoplexy: thirdly those which are distinguished by palsy and loss of speech without coma'. He further subdivides chief apoplexy into apoplexy with extravasation of blood, apoplexy with serous effusion and apoplexy without any morbid appearance in the encephalon. This last category Abercrombie counts equally simple apoplexy.

According to this classification Faria succumbed to primary apoplexy with serous effusion.

CASE TWO: MONSIEUR NOIRTIER DE VILLEFORTE

Monsieur Noirtier de Villeforte, an old human who is the father of one of Dantès' enemies, has get in modern terms 'locked-in' after an earlier stroke. Dumas describes the condition more than eloquently as 'when the soul is trapped in a body that no longer obeys its commands'. Although his intellectual faculties are intact he is physically powerless:

'Sight and hearing were the just two senses which, like two sparks, however lit up this man matter, already 3 quarters moulded for the tomb. Moreover only ane of these two senses could reveal to the outside world the inner life, which animated this statue.... He was a corpse with living eyes, and at times, nothing could be more terrifying than this marble face out of which acrimony burned or joy shone.' (p. 564)

He is able to communicate through blinking, endmost his eyes once for 'yes' and several times for 'no'. His granddaughter Valentine uses a dictionary to aid him spell out letter by letter what he wishes to say. Attempts accept been made to restore Monsieur Noirtier's health past use of Brucine (x,11 dimethoxystrychnine): '... in some illnesses, poisons get remedies, paralysis is ane of these.' (p. 694). For Noirtier it is ineffective, merely this agent is relevant to the plot. The cause of his locked-in syndrome, i of the most terrible fates that tin befall united states, is presumably vascular or traumatic damage in the ventral pons with preservation of the dorsal tegmental area, resulting in interruption of the corticospinal and corticobulbar tracts.5 The differential diagnosis includes akinetic mutism, a condition in which nether some circumstances a patient can speak and move.vi A clinical entity resembling locked-in syndrome from basilar artery occlusion was reported by Darolles in 1875,7 only information technology was not until 1966 that this term was put forwards by Plum and Posner,8 who also in a single sentence commented on Monsieur Noirtier. The condition has to be distinguished from coma and prolonged coma-like states. Classic locked-in syndrome is characterized by total immobility except for vertical eye movements and blinking, combined with preserved consciousness.9 If other movements are present the diagnosis may be incomplete locked-in syndrome. Few patients recover.

Dumas' clarification recognizes the importance to such individuals of visual and auditory stimulation and of some ways of expression and control. Although our understanding of this status has considerably increased since The Count of Monte Cristo the practical challenges have changed little. At that place is a contempo instance written report of the successful use of intrathecal baclofen to improve motor office,x merely a review refers to the condition as a syndrome looking for a therapy.xi , 12

DUMAS' Agreement AND FEAR OF CEREBROVASCULAR Disease

In the novel, these accounts of cerebrovascular disease seem more than a device to movement the plot frontward or add together dramatic tension. Dumas returns to it repeatedly in a way which suggests he knows and fears it himself:

'There are other things to fear... apart from death, old historic period and madness. For case, apoplexy, that lightning bolt which strikes you downward without destroying yous, yet later which all is finished. Y'all are notwithstanding yourself just you are no longer yourself: from a near affections similar Ariel, you lot have become a dull mass which, like Caliban, is close to the beasts.' (p. 478)

Dumas gives a wider description of adult cerebrovascular disease within this work. For example, in that location is the fate of Monsieur de Saint-Méran, who is poisoned but is diagnosed by his medico as dying of an apoplectic stroke. A second instance refers to the role of temperament in stroke: Madame de Saint-Méran, a woman of sixty-half-dozen previously of 'splendid health, sound mind and undiminished energy' dies unexpectedly (she has been poisoned). Apoplexy equally a cause of her unexpected death is rejected:

'I too saw Madame de Saint-Méran a couple of times: she was petite, slightly built and much more of a nervous than a sanguine temperament. It's very rare for grief to produce apoplexy in a person of Madame de Saint-Méran'south constitution.' (p. 705)

Dumas clearly had a broad understanding of cerebrovascular disease but where did he obtain this cognition? He was not a medical student turned author, or even formally educated. However, in 1827 he became first a patient and and then a friend of Dr Thibaut who instructed him in anatomy, physiology, physics and chemistry. Dumas sometimes accompanied Thibaut every bit he made morning visits to the Hôpital de Charité. In his memoirs Dumas acknowledged his debt to Thibaut: 'From these visits, I learnt a little about medicine and surgery which has often been useful in my novel writing.'13 Nosotros can speculate that, every bit with medical students, experience of walking the wards had a profound influence on him, though information technology is noteworthy that he had an 'insurmountable repugnance for operations and expressionless bodies'.14

Dumas' descriptions of cerebrovascular disease are not confined to The Count of Monte Cristo. Rønnov-Jessen has recognized vertebrobasilar insufficiency in the symptoms of the musketeer Porthos immediately before his death.fifteen Details can be found in his paper but over again there is a family history (on the begetter'due south side) and three previous episodes. Possibly Dumas encountered these conditions at the Charité; notwithstanding, the inspiration may take been more than personal. By the time he wrote The Count of Monte Cristo his mother had died of cerebrovascular illness, having suffered a stroke in 1829, leaving her left side paralysed, and a fatal recurrence in 1836.xvi We tin can speculate that Dumas subconsciously expressed fearfulness of a like fate and hoped by his writing to avoid information technology. The family history ran truthful, and he in plough developed cerebrovascular disease and died of a stroke in Dieppe on 5 December 1870.17

Acknowledgments

I thank my colleagues Dr Margaret Holloway, Dr Charles Essex and Mr R G Arnott from the Centre for the History of Medicine, Academy of Birmingham Medical Schoolhouse, for helpful comments.

References

ane. Dumas A. The Count of Monte Cristo transl R Buss. London: Penguin Books, 1996

2. Serres AERA. Sur les maladies organiques du cervelet: des apoplexies cérébellerises. J Physiol Exp Pathol 1822;2: 172, 249 [Google Scholar]

3. Abercrombie J. Pathological and Practical Researches on Diseases of the Encephalon and the Spinal Cord, 3rd edn. Edinburgh, 1834: 235

4. McHenry LC. Garrison's History of Neurology. Springfield: Charles C Thomas, 1969: 249

v. Bannister R, ed. Brain's Clinical Neurology, 6th edn. Oxford: Oxford University Press, 1989: 175

half dozen. Caplan LR. Vertebrobasilar occlusive illness. In: Barnett HJM, Stein BM, Mohr JP, Yatsu FM, eds. Stroke Pathophysiology, Diagnosis and Management. Vol. i. New York: Churchill Livingstone, 1986: 591

seven. Darolles M. Ramollissement des protubérances: thrombose du tronc basilaire. Progr Méd (Paris) 1875;3: 629 [Google Scholar]

viii. Plum F, Posner J. The Diagnosis of Daze and Blackout. Philadelphia: Davis, 1966

9. Bauer M, Gerstenbrand F, Rumpl Eastward. Varieties of the locked-in syndrome. J Neurol 1979;221: 77-91 [PubMed] [Google Scholar]

10. Cairns K, Stein J. Motor function improvement following intrathecal baclofen pump placement in a patient with locked-in syndrome. Am J Phys Med Rehab 2002;81: 307-9 [PubMed] [Google Scholar]

xi. Leon-Carrion J, Van Eeckhout P, Dominguez-Morales M, Perez-Santamaria FJ. The locked-in syndrome: a syndrome looking for a therapy. Brain Inj 2002;16: 555-69 [PubMed] [Google Scholar]

12. Leon-Carrion J, Van Eeckhout P, Dominguez-Morales Thou, Perez-Santamaria FJ. The locked-in syndrome: a syndrome looking for a therapy. Brain Inj 2002;sixteen: 571-82 [PubMed] [Google Scholar]

13. Dumas A. My Memoirs (transl and ed. A C Bell). London: Peter Owen, 1961: 102

14. Bell Air-conditioning. Alexandre Dumas—A Biography and Written report. London: Cassell, 1950: 49

15. Rønnov-Jessen R. The death of Porthos, or the showtime description of vertebrobasilar insufficiency in fiction. BMJ 1988;297: 1658. [PMC free article] [PubMed] [Google Scholar]

xvi. Ross M. Alexandre Dumas. London: David and Charles, 1981: 183

17. Hemmings FWJ. The King of Romance: a Portrait of Alexandre Dumas. London: Hamish Hamilton, 1979: 212

In the Count of Monte Cristo When Didhe Count Reveal to Villefort About His Baby

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC539579/

0 Response to "In the Count of Monte Cristo When Didhe Count Reveal to Villefort About His Baby"

Post a Comment

Iklan Atas Artikel

Iklan Tengah Artikel 1

Iklan Tengah Artikel 2

Iklan Bawah Artikel