In the month of October, a 60-year old man developed postprandial
abdominal pain and vomiting. He had been feeling well until passing
out during a banquet in which he had consumed a large quantity
of wine and a variety of dishes, of which one composed of mushrooms,
was a long-time favorite. On regaining consciousness a short time
later, he complained of severe abdominal pain. He vomited and
felt somewhat better.
Prior to this illness, the patient had enjoyed reasonable good
health for over a decade. However, early in life he had been sickly.
He was born prematurely (after 7 mos. gestation) and as a child,
suffered from a succession of disorders, including mild allergy
and frequent febrile illnesses. He is also believed to have had
malaria, measles (complicated by unilateral deafness), erysipelas
and colitis. Since early childhood, he had weakness of both legs
so pronounced that he limped noticeably and could ambulate no
further than short distances without assistance. He had long-standing,
intention tics and jerks of his head and hands as will as stammering
and drooling, which were most pronounced when he was excited.
He was also prone to fits of inappropriate laughter. He regularly
ate and drank to excess, rarely leaving his dining room until
he was both "stuffed and soaked." Thus, it was not unusual for
him to fall asleep immediately after dining and have to be carried
unconscious to his bed. He had gained considerable weight in recent
years and had been complaining bitterly of episodes of heartburn
so frequent and severe that he contemplated suicide as a means
of relief.
The patient's father died of trauma at age 28; his mother committed
suicide at age 73. He had one brother who had died at age 34 of
a mysterious illness manifested by progressive wasting with terminal
acocyanosis trunkal rash. His sister was executed for adultery
at age 34. There was no family history of neurological abnormalities
similar to the patient's.
The patient was a native of northern Greece and was active in
military service. He had traveled extensively through Asia Minor
and the Middle East and to the Indian frontier. He had been married
twice and was bisexual. A homosexual partner had recently died
from a febrile illness. The patient did not use tobacco; he intermittently
drank large amounts of alcohol. The patient's mother and half-brother
were alive and well. His father had been murdered.
The patient was born in France, but had spent most of his life
in Italy. He had been married four times and had also had numerous
heterosexual relationships, including several with prostitutes.
He had three children, all of whom were alive and well at the
time of his illness. He was a politician, and an historian.
Physical examination showed an obese man in moderate distress.
The temperature was normal. The eyes were injected. The hearing
was impaired unilaterally. The abdomen was mildly tender throughout.
The voice was hoarse and indistinct. The patient stammered uncontrollably
in response to questioning with considerable slobbering and rhinorrhea.
The neck muscles were enlarged. The muscles of his upper extremities
were well developed and strong, whereas those of both lower extremities,
especially the calves were weak and atrophied. When the patient
walked, he dragged his right foot.
A physician induced additional vomiting by placing a feather
in the back of the patient's throat. Shortly thereafter the patient's
condition deteriorated. He became confused and exhibited signs
of unremitting abdominal pain and fecal incontinence. He expired
12 hours after the onset of his illness.
