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Saturday, 14 November 2015

The Keats-Shelley house by the Spanish Steps in Rome

Keats spent his last months in Rome, before succumbing in February 1821 at the age of 25 to consumption - tuberculosis. He had earlier nursed his brother Tom until the latter's demise from consumption at the age of 19. Keats had trained as an apothecary and had studied medicine at St Thomas' Hospital: surviving records mention treatment given by a "Mr Keats".

As a remarkable example of individual differences in susceptibility to the disease, the artist
Photo © Donald Singer: Keats-Shelley House and Spanish Steps, Rome
Joseph Severn survived until the age of 85, despite living with Keats for 3 months in Rome and nursing Keats' during this final illness. Severn painted Keats on his deathbed.

Shelley travelled to Rome after Keats' death and wrote the poem Adonaïs: An Elegy on the Death of John Keats. Whether for effect or real belief, Shelley is reported to have attributed the major cause of this final illness to bleeding from ruptured lungs in response to poor critical reception of Keats' poetry. Keats was more sanguine. He was confident in future recognition, writing to his brother George in 1819: "
‘I have no doubt of success in a course of years if I persevere ..."

The Vatican authorities were pragmatic,  aware in 1821 of consumption as a potentially transmissable disease. They gave instructions that all contents of Keats' rooms at Piazza di Spagna were to be removed and destroyed by burning - including his boat bed and the wallpaper.  

This was in the tradition of the germ theory of disease, which dated at least from Varro in 36BC, to microscope inventor Van Leeuwenhoek’s reports in the 17th Century, with firm evidence reported later in the 19th Century by Semmelweiss in Vienna, Koch in Berlin and Pasteur in Paris. 

Robert Koch was the first to describe the causative tubercle bacillus, supported by his formulation of postulates about evidence to confirm disease causation. Koch's investigations and discoveries in relation to tuberculosis lead to his receipt of the 1905 Nobel Prize in Physiology and Medicine. 

Read further historical notes about tuberculosis

The Tempest and Prospero's curse : magic, pleurisy, and other thoughts

Tuberculosis, Bel Ami and the Belle Epoque

More on the Keats-Shelley House: 26 Piazza de Spagna in Rome



Wednesday, 4 November 2015

The Father - remarkable play portraying decline into dementia

In recent decades, Alzheimer’s disease has become an epidemic cause of dementia, typically now affecting increasingly older patients than in the initial encounter in 1901 between German psychiatrist and neuropathologist Alois Alzheimer and a 51 year old woman suffering from progressive short-term memory loss. In 1906, he was the first  to relate the finding of amyloid plaques and neurofibrillary tangles in the brain to clinical symptoms of pre-senile dementia, abnormalities which are still the focus of research into causes, biomarkers and clues to treatment of this currently inexorable dementia syndrome.
Although families and health and community care services around the world are increasingly pressed by the condition, it is only recently that Alzheimer’s disease and other common causes of decline into dementia, such as vascular disorders of the brain, have been portrayed to public audiences in print and on the screen, for example in Iris, Amour, Still Alice, and The Iron Lady. 
A new remarkable addition on this theme is 2014 Molière award winning The Father (Le Père), by 35 year old French playwright Florian Zeller, now on stage in the West End in a translation by Christopher Hampton: moving, faithful to the condition and its wider consequences, and well acted by an outstanding cast led by Kenneth
Cranham and Claire Skinner. The play was first produced in France in 2012 at the Théâtre Hébertot in Paris and is due for transfer to Broadway in March 2016.
Important not to say too much so as not to spoil the impact on a future audience of the many themes of the play and the dramatic effects used by the writers, scene designers and musical director. Zeller is very effective, with a surprising amount of humour, in involving the audience directly in the confusing experiences of the failing protagonist Andre, his family and carers, and in the natural history of the condition. He is also excellent at describing interactions between the relative with dementia and relatives who take on the caring role, as well as possible attitudes and the behaviour of a carer’s partner.
The programme notes – and interviews in the French and English press – give little away on Zeller’s inspiration for the themes of the play. In interview, the translator Hampton – around twice Zeller’s age – alludes to universal concerns about the significance of senior moments, such as forgetting a name, as hints of the possibility of much worse to come. The programme notes also provide beautiful colour scans of the brain in health and in patients with dementia. The images are left to the reader to interpret. However little effort is needed to decipher the dramatic general and local effects of dementia shown in the images.

Public domain image from the Center For Functional Imaging, Lawrence Berkeley National Laboratory Alzheimer’s Disease Neuroimaging Initiative (ADNI)

The Father merits adapting for film as soon as possible, so that the play can be seen as widely as possible by all health professionals dealing with patients with dementia, their family and carers. Despite the many poignant facets of The Father, it will also be appreciated by the increasing many with direct experience of a family member or friend with the syndrome.