The Arm That Wasn't Paralyzed

An intelligent, lucid 60 year old named Nora was interviewed by the neuroscientist V.S. Ramachandran.  Ramachandran tells the story in his book, the Tell-Tale Brain.

"Can you walk?"
"Yes." (Actually, she hadn't taken a single step in the last week.)
"Nora, can you use your hands, can you move them?"
"Yes."
"Both hands?"
"Yes."  (Nora hadn't used a fork for a week.)
[...]
"Touch my nose with your left hand."
Nora's hand reamins motionless.
"Are you touching my nose?"
"Yes."
"Can you see your hand touching my nose?"
"Yes, it's now almost touching your nose."

Nora's left side is paralyzed.  But she won't admit it.  This is a more common phenomena than you'd think.  After suffering a stroke in the right hemisphere of the brain, many people suffer paralysis of the left-hand side of their bodies.  About one in twenty of these people will insist that they are not in fact paralyzed.  This is called anosognosia, which is medical-speak for denial-of-illness.

Anosognosia does not necessarily go along with any other mental impairment.  A person can be psychologically completely normal in every respect--except when it comes to the inert mass of their paralyzed left half.

A notable sufferer of anosognosia was Woodrow Wilson who became paralyzed in 1919 after being smitten with a flu-related.  He was bedridden, blind in his left eye, and paralyzed on the left side of his body.  He remained in office, even as he was on the brink of death, mumbling limericks to himself, his wife serving as his 'steward' (read: regent).  He didn't attend any cabinet meetings for a full half year, and when he finally presented himself to his cabinet, his staff were shocked at the frail state of his heath, and at the secrecy which had covered it up.  But Wilson grew angry with any mention of his incapacities, and fired many functionaries who dared suggest that there was something wrong with him.  He even pondered running for a third term.

Anosognosia can come in many exotic flavors.  Some anosognosiacs will refuse to admit that other paralytics are paralyzed.  A syndrome called somatoparaphrenia often accompanies anosognosia, in which a person will deny all ownership of their paralyzed arm.  Nora, mentioned above, had somatoparaphrenia.  "Whose arm is this?" Dr. Ramachandran asked her.  "That's my mother's arm," she replied.  "Where's your mother?"  "She's under the table."

People can be anosognosiac about more than just paralysis.  Patients with Wernicke's aphasia--brain damage which limits their communication to a fluent stream of babble--are often anosognosiac about their condition, nodding and smiling and talking even though they have no content to their speech.



Sources today are V.S. Ramachandran's the Tell-Tale Brain, and Errol Morris' five-part blog post on anosognosia which is fun, philosophical, and exhaustive--not words you usually associate with five-part blog posts, I know.

A Pipe A Day Keeps The Plague Away

17th Century summers were seasons of plague.  Those rich enough to escape left the cities for the countryside.  Those who couldn't escape waited, fearful that soon they too would have to paint the tell-tale red cross of the plague on their doors, and watch their family be consumed by the pestilence.  Autumns sometimes fell with one in seven Londoners dead.

Bubonic plague, spread by fleas on the body of the black rat, is one of the most painful diseases observed on our sweltering earth.  Buboes--big pus-filled lumps--form around the lymph nodes in the neck, underarm and groin.  Sometimes they even explode.  Other symptoms range from fever to gangrene.

All the glories of 17th Century medicine were brought to cure the plague.  One of the most exciting panaceas touted at the time was a new miracle herb from the New World.  Think of it as the acai berry of the 17th Century.  It could cure migraines, toothache, worms, bad breath, cancer, lockjaw, and even poor fingernails.  Best of all--it tasted great!

Beloved diarest Samuel Pepys writes of prescribing himself the miracle cure after seeing a plague house:

This day, much against my Will, I did in Drury-lane see two or three houses marked with a red cross upon the doors, and "Lord have mercy upon us" writ there - which was a sad sight to me, being the first of that kind that to my remembrance I ever saw. It put me into an ill conception of myself and my smell, so that I was forced to buy some roll tobacco to smell to and chaw - which took away the apprehension.

Yes, you read right.  During the 17th Century tobacco was considered medicine of the highest potency.  Some students at Eton were punished for not smoking.

The idea wasn't as crazy as it sounded.  The best-educated doctors of the time believed that the plague was spread by bad air.  Accordingly a lot of preventative medicine had the same character as potpourri:  replace the bad smells with good ones.  Doctors carried poultices, herbs, vinegar and masks--all to reek away the bad air.  Tobacco smokers, cloaked in a billow of non-pestilent smoke, were thought to be especially protected from malodorous vapors.

The other cures for plague out to be as effective as smoking a bowlful of tobacco.  Plague was caused by fleas, not noxious odors, so even the most expensive pot pourri was completely ineffective.  The best thing you could do when plague season came?  Run.  Run far away.  And don't keep pet rats.

My inspiration for today's post is the fantastic Shakespeare's Restless World episode, Plagues and Playhouse.