Chapter 17: “The Cream of Things,” (page 271 in hardback)
“Louisa continued to believe Dr. Kane’s 1870 diagnosis, that mercury poisoning from calomel lay at the root of her ills. That diagnosis went unchallenged until 2001, when Drs. Norbert Hirschhorn and Ian Greaves, working with another colleague on a paper about the effects of Abraham Lincoln’s mercury-based “blue pills,” learned that Louisa Alcott was believed to have died of mercury poisoning. Could they confirm that diagnosis? Greaves and Hirschhorn set out to be Louisa’s doctors, compiling a medical history from her writings and reports by others. They noted her excellent health and exceptional vigor before contracting typhoid pneumonia, her treatment with mercury, her recovery, and the symptoms and debility that began about three and a half years later.
“Hirschhorn and Greaves classified Louisa’s symptoms as headaches (“neuralgia”), joint pain and swelling (“bunches on the leg”), and a welter of gastrointestinal ills: “loss of appetite, nausea, heartburn,” also “eructation” (belching) and stomach discomfort. Louisa’s intestinal problems overshadowed the others and pointed to gastro-esophageal reflux disease, or GERD. Louisa also complained of laryngitis and bronchitis; GERD is a known cause of those symptoms.
Hirschhorn and Greaves found that mercury poisoning was not a plausible explanation for Louisa’s symptoms. She did not have the trembling hands or “extreme sensitivity to slights, [and] irrational outbursts of rage” that were known effects of mercury poisoning. Louisa had a tem- per, but however quick and at times unkind, it always had a cause and a rational target.
“The pattern of Louisa’s poor health over many years also refuted the mercury poisoning thesis. Mercury causes symptoms only as long as it is taken, and Greaves and Hirschhorn found no evidence that Louisa took mercury after she left the Georgetown hospital. The medical profession knew that mercury was dangerous and ineffective. That knowledge had supported Lincoln’s decision to discontinue mercury when he became president. Dr. Kane had been correct about the danger of mercury, but his belief that it never left the body and that the painful “bunches” on Louisa’s leg were from dormant mercury was unfounded. Louisa’s body would have been free of mercury in a year after treatment, at most, Hirschhorn and Greaves maintain.
“What, then, was causing Louisa Alcott’s many distressing symptoms? Drs. Hirschhorn and Greaves looked at two theories. Either Louisa suffered from several seemingly unrelated chronic illnesses, or, more likely, all could be explained by one multisystemic disease. If so, which one? Without being able to conduct modern diagnostic tests, Greaves and Hirschhorn wrote, “we can only recall the old professor’s teaching: ‘Listen to the patient. She is telling you the diagnosis.’ ” Louisa was “telling” them that she had an autoimmune disease. Exposure to mercury had the potential to trigger an autoimmune response but would not cause the symptoms per se. An autoimmune disease such as syphilis or lupus, on the other hand, could attack Louisa in exactly the miserable ways she described. Discarding syphilis as less probable, the doctors posited lupus as the likely candidate.
“Without Louisa their theory could not be proved, and lupus can be difficult to diagnose in any case. But the doctors came very close to clinching the case when Dr. Hirschhorn found a visual clue that had been hiding in plain sight for over a century. As in the best detective fiction, the clue was in the portrait—the only painting of Louisa—by the acclaimed artist George Healy. Louisa had enjoyed sitting for Healy when she came to Rome in 1870 after a run of sunny days in northern Italy. She was less pleased with the portrait, which she described in Jo’s Boys as notable for the “curious effect of light upon the end of the nose and cheeks as red as the chair she sat in.” She hung it behind a door.
Harriet had also mentioned in a comment on the previous post that the article could possibly be obtained for free through your public library. It’s a surprisingly easy read considering that it’s for a medical journal. Check it out!