In the month of October, a 63-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 reasonably good
health for over a decade. However, early in life he had been sickly.
He was born prematurely (after seven months gestation) and as
a child, suffered from a succession of obstinate disorders, including
milk allergy and frequent febrile illness. 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 well 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 to 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 acrocyanosis and a 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 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 a historian.
Physical examination showed an obese man in moderate dress.
The temperature was normal. The eyes were injected. The hearing
from 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.
