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MUNCHAUSEN SYNDROMES: HOAXES, PARODIES, AND TALL TALES IN SCIENCE AND MEDICINE IRVING M. KLOTZ* Two centuries ago Rudolph Erich Raspe, a scholarly man with a fertile imagination but questionable probity, published an anonymous collection of tall stories under the title Baron Munchausen's Narrative of His Marvelous Travels and Campaigns in Russia. The collection was promptly reprinted and frequently expanded after its initial appearance [1, 2]. Interestingly, although Raspe was a native German, the Munchausen stories were first printed in English and only later translated into German. Baron Karl Friedrich Hieronymus von Miinchhausen, curassier of Bodenwerder, did indeed exist, had been a soldier in Russia, and reputedly did relate tall stories about his adventures. Raspe evidently was acquainted with the Baron, but it is unclear how much of what he published was taken from recountings of the historical Miinchhausen and how much was borrowed and adapted from other sources. In any event, it is from Raspe's publication that the name Munchausen has entered our language as a generic term for an individual who tells tall stories in any of a range of types, from simple humorous ones to pathological lies. A taste of the original Munchausen style may be obtained from the following story, one of the first in the earliest editions [1, 2]. I went on [in my journey to Russia]: night and darkness overtook me. No village was to be seen. The country was covered with snow, and I was unacquainted with the road. Tired, I alighted, and fastened my horse to something like a pointed stump of a tree which appeared above the snow; for the sake of safety I placed my pistols under my arm and lay down on the snow, where I slept so soundly that I did not open my eyes till full daylight. It is not easy to conceive my astonishment to find myself in the midst of a village, lying in a churchyard; nor was my horse to be seen, but I heard him soon after neigh somewhere above me. On *Professor Emeritus, Department of Chemistry, Northwestern University, 2145 Sheridan Road, Evanston, Illinois 60208-3113.© 1992 by The University of Chicago. All rights reserved. 0031-5982/93/3601-00794$01.00 Perspectives in Biology and Medicine, 36, 1 ¦ Autumn 1992 139 looking upwards, I beheld him hanging by his bridle to the weathercock of the steeple. Matters were now very plain to me: the village had been covered with snow overnight; a sudden change of weather had taken place. I had sunk down to the churchyard whilst asleep, gently, and in the same proportion as the snow had melted away, and what in the dark I had taken to be a stump of a little tree appearing above the snow, to which I had tied my horse, proved to have been the cross or weathercock of the steeple! Without long consideration I took one of my pistols, shot the bridle in two, brought down the horse, and proceeded on my journey. To attest to his veracity, the Baron provided a notarized affidavit signed by the three internationally famous personalities (see Figure 1). TO THE PUBLIC Having heard, for the first time, that my adventures have been doubted, and looked upon as jokes, I feel bound to come forward and vindicate my character Jar veracity, by paying three shillings at the Mansion House ofthis great city for the affidavits hereto appended. This I have been forced into in regard of my own honour, although I have retired for many years from public and private life; and I hope that this, my last edition, will place me in a proper light with my readers. AT THE CITY OF LONDON, ENGLAND We, the undersigned, as true believers in the profit, do most solemnly affirm, that all the adventures of our friend Baron Munchausen, in whatever country they may lie, are positive and simple facts. And, as we have been believed, whose adventures are tenfold more wonderful, so do we hope all true believers will give him their full faith and credence. GULLIVERx SlNBADX ALADDINX Sworn at the Mansion House <)th Nov. last in the absence ofthe Lord Mayor. JOHN (the Porter). Fig. 1.—Notarized affidavit attesting to Baron Munchausen's veracity. Taken from [I]. In the 1930s, "Baron Munchausen" was adopted as a pseudonym by a popular radio comic, Jack Pearl, who performed in humorous skits with a style close to that of the original character. (The Baron walks on-stage to the accompaniment of a round of vigorous applause from the audience which recognizes him. The host on the program is 140 Irving M. Klotz ¦ Munchausen Syndrome "Charlie." The Baron has a strong gutteral German accent, difficult to convert into print.) Charlie: Baron: Charlie: Baron: Charlie: Baron: Charlie: Baron: Charlie: Baron: Charlie: Baron: Charlie: Baron: Charlie: Baron: Charlie: Baron: Charlie: Baron: Charlie: Baron: Charlie: Baron: Charlie: Baron: Charlie: Baron: Charlie: Baron: Charlie: Baron: Baron, I'm delighted to see you. What's the matter with you? You look so tired. Charlie, I verk like a horse. True? Really? I verk like a horse. I verk now in the war factory. Is that so? I verk 16 hours a day. Sixteen hours? The union allows only 8 hours. I belong to 2 unions. Oh, 2 unions. I verk like a hoont. You're working in an old ammunition factory? Yea, I clean out the insides of cannons. You see, I smooth them out. The other day I vas verkin so hard, it vas my twelfth hour, when I fell asleep. And while I vas sleeping, they came along and tested the cannon. You mean to say you fell asleep inside the cannon? Yea. And while you were in there they tested the cannon? Well, what happened to you? I vas discharged. I haven't seen you in over a year. They tell me you've been traveling too. Is that right? I vent all over the world. All over the world? All over the whole world. That so? Where abouts? Well, I vas in London. I vas in Paris. I vas in Rome. I vas in Wenice. Where? In Wenice. No, no. You mean Venice. Wenice. No, no, no. Venice, Ven, Ven. Last month. When you were in Venice, did you see the gondolas? I vas coming for ... I didn't get you. When you were in Venice, did you see the gondolas? No, no, no, I called them up. They vasn't home. The Baron has also been immortalized in medicine by the creation of the term [3] "Munchausen's Syndrome" for a class of factitious illnesses. Patients in this class present themselves to a hospital apparently acutely ill, claiming severe pain or distress and requiring emergency attention. When a history is taken, it seems very plausible in the context of the complaints, and various clinical tests and treatments are promptly initiated . These patients willingly submit to painful tests and invasive procedures (e.g., cardiac catherization), even surgery. As results from clinical investigations accumulate and disclose no current abnormalities, factual inconsistencies in the patients' histories become increasingly apparent. Perspectives in Biology and Medicine, 36, 1 ¦ Autumn 1992 141 When the attending physicians become suspicious and confront the patients with inconsistencies in their stories, the patients may promptly discharge themselves from the hospital, sometimes leaving with intravenous or lumbar infusion attachments intact. Almost invariably such individuals will subsequently appear at another hospital, either in the same city or a good distance away. A case reported from a London [4] hospital is representative. The case history reads as follows. A 49-year-old man employed as a new van deliverer presented with typical myocardial ischaemic pain. [According to the patient] he had previously had a myocardial infarction and aortic valve replacement. Despite rheumatic fever as a child he had been fit for a military career. Whilst serving in Cyprus he developed septicaemia after a shrapnel injury. Recovery was complicated by anaphylaxis when given prochlorperazine: a "biro" tracheostomy, ventilation and drainage of a pneumothorax were described in great detail. He had recovered to serve in the Falklands War under the command of Colonel H. Jones at Goose Green with the Parachute Regiments . . . He was admitted as a possible myocardial infarction. After the examination, the attending physician had time to check out the patient's history, and uncovered the following information: The unit he said had performed his valve surgery had no record of him. No next of kin were available. He had been removed from his general practitioner's list 2 years previously. The army had no record of him and the parachute battalion in which he claimed to have served does not exist. He declined photography and was discharged. A more extreme example with tragic consequences has been reported in the American medical literature [5] (italics added for emphasis): A 40-year-old man came to the emergency department of the Brooklyn Hospital , Brooklyn, NY, complaining of severe, crushing, retrosternal pain that radiated down his left arm. He related the following story: six months before he had gone to Paris, where, while jogging, severe chest pain developed and he was admitted to the "American hospital." He was told that he had an acute myocardial infarction, a diagnosis that was based only on elevations of creatine kinase levels. One week later, he had multiple embolic episodes. Despite repeated operations, gangrene of the left arm developed, necessitating amputation. Because of a generalized rash, biopsy of the left deltoid muscle and skin of the left leg was performed; he was told that he had a severe form of vasculitis. He was hospitalized for five months and was given treatment with cyclophosphamide, prednisone , and heparin sodium. After discharge, he returned to New York. His father, although alive, had had several myocardial infarctions and a brother had died of a myocardial infarction at age 36 years. On physical examination , the patient appeared to be in no acute distress and recounted the story with a belle indifference affect. The left arm was amputated below the elbow. He had many surgical scars. Peripheral pulses of the right upper extremities were absent , and arterial pulses of the right foot were diminished. There was severe bilateral calf tenderness. He also had a generalized follicular eruption and eczematous dermatitis of both cheeks. Results of cardiac examination were unre142 Irving M. Klotz ¦ Munchausen Syndrome markable. An ECG showed a sinus tachycardia and abnormal left axis deviation. Because of several "atypical features," the manner in which the patient presented his story, and absence of friends or family, we decided to investigate further. We thought that review of his insurance number might provide a clue to previous hospitalizations. When asked to review the patient's insurance number, a member of the admitting office identified the patient as one who had recently had billing problems at another hospital. When the patient was confronted with this story he admitted to another four or five previous hospitalizations; he said that he had not mentioned these hospitalizations because of a malpractice suit pending against one of them. He readily signed a consent form for release of previous medical records. Since we suspected that he had disclosed only a small part of the story, extensive interviews and telephone surveys were done, and his records, which were obtained from other hospitals, were reviewed. As shown in Table I, the patient had been admitted to at least 15 different hospitals in the New York and New Jersey area during the two years before his admission to our hospital. The following is a reconstruction of his history since age 13 years: he was a "mainline" abuser of cocaine, meperidine hydrochloride, and morphine, and had been arrested for grand larceny for forging documents. His father is a respected attorney and holds a position as a trustee of a leading medical center. Approximately three years earlier, his younger brother had died suddenly. At about the same time, the patient was rejected by his girlfriend. He soon learned that a history of chest pain, a strong family history of myocardial infarction, and absence of pulses in his right and left arms (probably related to inadvertent intra-arterial cocaine injections) prompted physicians to admit him to intensive care units and investigate the cause of his chest pain. In a previous hospitalization , the patient had had an allergic reaction to quinine sulfate. A biopsy of the skin lesion showed a nonspecific form of perivasculitis. As shown in the Table, he spent 58 percent (522 of 907 days) of the time between May 23, 1979 and Nov. 15, 1981, in a hospital. His failure to disclose previous hospitalizations resulted in his undergoing at least six cardiac catheterizations, with attendant complications. Thus, a vicious cycle was established that ultimately led to amputation of his left arm. Even more alarming sham illnesses, sometimes life-threatening, have been induced by parents, particularly mothers, in their children. Sometimes the parent displays ideal, concerned, caring behavior, so that the possibility of fabricated illness is not even suspected and invasive anesthetic and surgical procedures may be carried out on the child [6]. In some of these cases the child has died [7]. The appropriation of the name "Munchausen" for these medical syndromes is perhaps unfair to the Baron. Although the stories told by these patients are dramatic and untruthful, as were the Baron's, his intent was to be entertaining and humorous, not malevolent. Closer to the original Munchausen spirit are some of the hoaxes and tall stories found in the professional, serious scientific literature and in related publications. Some of these are subtle, so that many readers are deceived and accept them as serious scientific communications. Others are pieces that can be readily recognized as spoofs or hoaxes but that Perspectives in Biology and Medicine, 36, 1 ¦ Autumn 1992 143 Hospitals G D H TABLE I Summary of Hospitalizations, Angiograms, and Complications Admission Daces Discharge Dates Total Days of Hospitalization Invasive Procedures Complications 11/1/73 2/22/74 3/3/75 2/3/76 1/12/79 5/23/79 6/1/79 6/6/79 6/16/79 8/16/79 1/18/80 2/8/80 6/12/80 7/17/80 8/26/80 1 1/7/73 3/8/74 3/18/75 3/3/76 1/20/79 5/31/79 6/2/79 6/16/79 7/25/79 10/13/79 1/22/80 2/9/80 6/20/80 7/17/80 9/13/80 7 15 15 30 9 9 2 11 40 2 9 1 19 Cardiac catheterization Stenosis of left anterior descending artery Cardiac catheterizationNormal Cardiac catheterizationNormal Cardiac catheterization Cardiac catheterization Cardiac catheterization; Normal aortic arch &: bilateral upper extremity angiogram Left brachial thrombosis Ventricular tachycardia; urinary retention; cellulitis of left thigh Thrombosis of right Sc left brachial arteries Ventricular fibrillation Comment Thrombectomy Urinary retention required cystoscopy Sc suprapubic cystostomy Thrombectomy Í anastomoses J D N O The Brooklyn Hospital 10/13/80 10/23/80 1 1/20/80 12/12/80 8/30/81 9/29/81 10/23/80 11/18/80 12/11/80 1/14/81 6/27/818/30/81 9/24/8 1 11/8/81 11/15/81 11 27 22 34 131 25 41 Aortogram Aortogram Aortogran Aortogram Aortogram; skin biopsy; revision of left arm amputation Stenosis of left anterior descending artery branch near its origin Left and right brachial artery occlusion with distal vascularization Left brachial occlusion Occlusion of left subclavian & right common femoral artery Occlusion of right common femoral artery Nonspecific vasculitis; neuroma found and dissected Defibrillation Cyanosis of left hand progressing to gangrene requiring amputation of left arm below elbow To salvage left arm repeated unsuccessful operations were done* Resection of left first rib & thoracic outlet decompression Endarterectomy & angioplasty *To salvage left arm, the following operations were performed: (1) thrombectomy of left brachial artery; (2) left brachial artery to distal ulnar artery bypass with saphenous vein graft; (3) removal of thrombus and revision of bypass; (4) exploration of left axillary, brachial and ulnar artery, thrombectomy of left axillary artery and bypass between its axillary and left ulnar artery with use of graft; (5) reexploration, thrombectomy and reconstruction of the venous graft; (6) amputation of left arm; and (7) revision of amputation of left arm. contain a clever witty theme or are valiant attempts at humor, some of it barroom. In yet others, it may be difficult to discern whether the authors intended to be taken seriously or were writing parodies. Let us look at some representative examples of each genre. A humorous example of the first category appeared recently in the Journal of the Royal Society of Medicine. In line with current trends to persuade physicians to use a holistic approach in scrutinizing patients, this journal published a detailed study [8] of the relationship between age at death and the lifeline of an individual's hand. Suitably normalized to take account of differing hand sizes, the corrected lifeline length shows a strong statistical correlation with the age of an individual at death (Figure 2). The authors suggest that the diagnostic potential of palmistry, as well as of other "psychodiagnostics" such as phrenology, iridology, and physiognomy, has been underappreciated. Furthermore, [Lifeline] findings would have important financial and ethical considerations for the use of resources in a cash-limited health service (not to mention plastic surgeons who may wish to extend their private practice and their patients' lifelines ). It would, moreover, be a handsome gesture and augur well for future relationships with general [health care] managers if the diagnostic dexterity of a glance at the hands (to see whether an illness is the patient's last) were to dispense with these costly blood tests and X-rays. Lifeline measurements are far cheaper than current medical screening—and lucky individuals with lengthy lifelines could be spared the tedium of altering life style or taking treatment. . . . r- ? UJ UJ UJ Q LU N CC O I I I I I 1 I 1 I I I I I I I I I I I I I I I I I I I I I I I I I I I I I 0 90 AGE AT DEATH Fig. 2.—Relationship between age at death and the lifeline of an individual's hand [8]. 146 Irving M. Klotz ¦ Munchausen Syndrome Orthodox medicine has previously ignored palmistry—some would say to its credit. . . . Our results suggest that a new clinically useful prognostic indicator may be at hand. Another example of a paper written in a style that gives every indication of being a scholarly analysis but is likely to be a parody is "The Chemical Death of Lot's Wife," also published in theJournal of the Royal Society ofMedicine [9]. The application of modern scientific and medical knowledge to recountings of biblical episodes is a popular scholarly cottage industry. The paper on Mrs. Lot describes biochemical and biomedical principles that provide an elucidation of the circumstances that may very well have occurred during the seizure that led to her precipitous death and transformation into a pillar of "salt." At the outset, the article derives the thermodynamic equations that relate the onset of formation of the "salt," postulated to be calcite, to the concentration of calcium ion in tissues and the ambient pressure of carbon dioxide. With this foundation, the author then proposes the following scenario: When Mrs. Lot was hit by a blast of hot air from the fire [at Sodom], two powerful factors forced the free Ca2+ concentration upward. The increased CO2 pressure [Pc02] lowered the pH of the blood and then of the tissues and released bound Ca2+. In addition, heat denatures proteins so that bound ligands are released. Thus the free Ca2+ must have climbed steeply upward, toward the total concentration of 0.001-0.005 M. At the same time the PC02 in the air from the conflagration would have risen steeply and exceeded the normal value by orders of magnitude. At a partial pressure of 10~ 1 atm of CO2, a free Ca2+ concentration of 10~4 M, i.e., only 3 percent of the total available in blood, would have been adequate to initiate calcite formation. Actually even in normal blood, free Ca2+ is about 50 percent of the total, and hence at elevated values of PCo2' a catastrophic surge of calcite should spread throughout the vascular network. This effect would have been further amplified by the Ca2+ released on protein denaturation. At the same time increased free Ca2+ must have triggered muscle contraction, with resultant spread of rigor. Simultaneously pervasive diffusion of CO2 into all organs and tissues initiated massive formation of calcite within and between all cells. Thus by turning around in her direction of flight, Mrs. Lot exposed herself instantly to stresses that generated immediate enormous escalations in concentrations of (Ca2+) and (CO2), so that the critical limits specified by equation (6) were exceeded overwhelmingly and instantaneously. Internal, massive, pervasive crystallization of calcite followed immediately. Mrs. Lot died instantly of rigor calcium carbonatus and turned into a rigid block of calcite. Since the prevailing winds from the Dead Sea always carry along a spray of salt, which is accumulated on this pillar, succeeding generations, to modern times, have testified that the column is a block of salt. The paper concludes with the statement: "Thus, once again, we see how modern science serves to corroborate and elucidate medical events described in the Bible." Perspectives in Biology and Medicine, 36, 1 ¦ Autumn 1992 147 Subsequent letters showed that almost all readers of the article accepted it at face value and cited other instances where modern science elucidates a biblical description of a disease. A few readers implied that they considered the article a parody. The author remained enigmatic, writing in response to Letters to the Editor ofJRSM: I should like to call attention to a remark of T. H. Huxley, made over a century ago: "Mathematics may be compared to a mill of exquisite workmanship, which grinds you stuff of any degree of fineness; but, nevertheless, what you get out depends on what you put in." Outright, self-evident hoaxes in scientific writing have a long history, going back at least to the great chemist F. Wöhler [10]. One of the most prolific of early hoax creators in the scientific community was the famous American physicist R. W. Wood. Even in his pre-professional days he was very successful in placing his creative, startling news items in contemporary newspapers. For example, the following item [1 1] was published in the Chicago Tribune on July 23, 1887: A STELLAR VISITANT AN INCANDESCENT VISITOR FROM SPACE—MARKED WITH GRAVEN CHARACTERS Clayton, Ga., July 21.—(Special)—A phenomenon unparalleled in the annals of astronomical science occurred here one day last week, which, from the light it throws upon the hitherto open question of the habitability of the other planets, will prove of great value to science. At 7:45 o'clock P.M. there fell near this town a spherical metal ball or aerolite on the surface of which appear graven characters which give conclusive evidence of its having been molded by intelligent hands. Dr. Seyers, in whose possession the wonder now is, said this evening: "I was returning from a patient's house, situated some seven miles from the town, where I had spent the latter part of the afternoon. It was about 7:45 o'clock, though still light enough to read by. I was ascending a long hill, over which it is necessary to drive before reaching home, when my horse suddenly pricked up his ears, and, on glancing ahead, my eyes were dazzled by a brilliant white flash, resembling a lightning stroke, and immediately following came a sharp hiss as of escaping steam. I knew that an aerolite had fallen, for had the flash been electrical there would have been a clap of thunder. Driving on up the hill I noticed that steam was issuing from the ground some few rods back from the road, and on hastening to the spot found a hole about four inches in diameter, from which arose considerable heated vapor. I drove home as rapidly as possible, and taking a pick and shovel returned to the spot. After half an hour's hard digging I came upon the object of my search at a depth of about five feet. It was still too hot to handle, but I succeeded in getting it to my carriage by lifting it on the shovel. I noticed that it was remarkably heavy, but not until 1 reached my barn, and removed the adhering soil, did I realize what a prize I had. Instead of a rough mass of meteoric iron, there appeared a smooth, perfect sphere of steel-blue metal, with polished surface and engraved with pictures and writings. I could scarcely believe my eyes, but there was no mistaking facts. There upon the surface of the strange ball was a deeply-graven circle within 2 48 Irving M. Klotz ¦ Munchausen Syndrome which was a four-pointed star, a representation of a bird-reptile resembling in a measure our extinct archaeopteryx, and a great number of smaller figures, resembling those used in modern shorthand. The metal of which the ball was composed was unlike anything I had ever seen, being about as hard as copper and entirely infusible in my Bunsen blow-pipe. I filed off some small bits and sent them to a chemist, who made the following report: "Sir, I have made a spectroscopic analysis of the filings you sent. The metal is fusible only in the electric arc. It is a new element. Examined by the spectroscope , its vapor gives three fine yellow lines to the left of the D line of Sodium, a broad green one to the right of the line of Barium, and an innumerable number of fine purple ones. H. Randolph Stevens, Analytical Chemist Whence came this strange messenger? By what infernal power was it hurled into space? Possibly by some monster gun on Mars or Venus. Possibly launched toward us by some lunarian gunner. Many there are who will say that the whole thing is a hoax and a fable, and that the ball was manufactured on this earth, but the fact that it is made of a metal not found upon this sphere proves beyond a doubt that it is an alien. Hurled with frightful velocity, it traversed the vast distance of space separating us from our nearest neighbor, and, plunging through our atmosphere, became heated to incandescence, and thus losing some of its fearful speed buried itself in the soil of our planet without suffering any injury. How shall we determine whence it came? Is it possible to reply, and can a sort of communication be established between planets? A gun 130 feet long and strong enough to hold a charge of thirty pounds of dynamite would hurl a platinum bullet of two inches in diameter with a velocity sufficient to cause it to pass beyond terrestrial attraction. The dream ofJules Verne has in a measure become realized, and we are, without doubt, standing a bombardment from space. The ball is now in the possession of Dr. Seyers, but will be sent to the Smithsonian Institution in a short time, when an official report will be made. Although the rhetorical style used by Wood a century ago seems out of place today, the description of the circumstances is comparable to that of modern journalistic reports of UFO sightings by convinced believers in extraterrestrial visitors. A clear-cut example of scientific humor clothed in technical language is the description of a remarkable new natural product, thiotimoline, discovered by Isaac Asimov [12], the grand master of science fiction: "It was discovered that the compound thiotimoline will dissolve in water— in the proportions of 1 gm/ml—in minus 1.12 seconds. That is, it will dissolve before the water is added." In other words it possesses endochronic properties: The Endochronometer—First attempts to measure the time of solution of thiotimoline quantitatively met with considerable difficulty because of the very negative nature of the value. The fact that the chemical dissolved prior to the addition of the water made the attempt natural to withdraw the water after solution and before addition. This, fortunately for the law of Conservation of MassPerspectives in Biology and Medicine, 36, 1 ¦ Autumn 1992 149 Energy, never succeeded since solution never took place unless the water was eventually added. The question is, of course, instantly raised as to how the thiotimoline can "know" in advance whether the water will ultimately be added or not. Though this is not properly within our province as physical chemists, much recent material has been published within the last year upon the psychological and philosophical problems thereby posed. Nevertheless, the chemical difficulties involved rest in the fact that the time of solution varies enormously with the exact mental state of the experimenter. A period of even slight hesitation in adding the water reduces the negative time of solution, not infrequently wiping it out below the limits of detection. To avoid this, a mechanical device has been constructed, the essential design of which has already been reported in a previous communication. This device, termed the endochronometer, consists of a cell 2 cubic centimeters in size into which a desired weight of thiotimoline is placed, making certain that a small hollow extension at the bottom of the solution cell— 1 millimeter in internal diameter —is filled. To the cell, is attached an automatic pressure micro-pipette containing a specific volume of the solvent concerned. Five seconds after the circuit is closed, this solvent is automatically delivered into the cell containing the thiotimoline . During the time of action, a ray of light is focused upon the small cell-extension described above, and at the instant of solution, the transmission of this light will no longer be impeded by the presence of solid thiotimoline. Both the instant of solution—at which time the transmission of light is recorded by a photoelectric device—and the instant of solvent addition can be determined with an accuracy of better than 0.01%. If the first value is subtracted from the second, the time of solution (T) can be determined. The entire process is conducted in a thermostat maintained at 25.00°C—to an accuracy of 0.010C. The extreme sensitivity of the endochronic time of solution to trace impurities in thiotimoline is shown by the data in Table II. A variant of this theme in a current setting is a paper by Knox, Knox, Hoose, Zare [13], summarizing the "remarkable pace of development in ultrafast laser technology" in the femtosecond (fs) range (see Figure 3). It took two years of experimental research to go from a 30 fs pulse width to a 15 fs one, and only half-year intervals to reach approximately TABLE II Dependence of Time of Solution of Thiotimoline on Purity of Sample Time Stage of Purification(sec, avg. of 12 determinations) As isolated-0.72 First recrystallization- 0.95 Second recrystallization— 1 .05 Third recrystallization—1.11 Fourth recrystallization—1.12 First resublimation- 1.12 Second resublimation—1.122 150 Irving M. Klotz ¦ Munchausen Syndrome Ä 30 TIME (YEARS) Fig. 3.—Chronology of development of ultrafast laser pulses, and projected expectations of time of attainment of 0 and negative femtosecond pulses [13]. 10 fs and 8 fs pulse widths. As Figure 3 shows, one has every reason to expect therefore to achieve a 0 femtosecond pulse with another year's effort. After this milestone has been reached, one can hope to penetrate into the totally unexplored new region of negative pulse widths, with all its startling implications in wave mechanics and thermodynamics. Furthermore, such negative-width optical pulses should lead to remarkable practical devices. Sometimes what seems like medical humor may be a style to draw attention to a real, even if minor, health risk. A Letter to the Editor of the prestigious New EnglandJournal ofMedicine [14] entitled "Penile Frostbite, An Unforeseen Hazard of Jogging" is an illustration of this genre: To the Editor: A 53-year-old circumcised physician, nonsmoker, light drinker (one highball before dinner), 1.78 meters tall, weighing 70 kg, with no illnesses, performing strenuous physical exercise for many years, began a customary 30minutejog in a local park at 7 p.m. on December 3, 1976. He wore flare-bottom double-knit polyester trousers, Dacron-cotton boxer-style undershorts, a cotton T-shirt and cotton dress shirt, a light-wool sweater, an outer nylon shell jacket over the sweater, gloves, and low-cut Pro Ked sneakers. The nylon shell jacket extended slightly below the belt line. Local radio weather reports gave the outside air temperature as — 8°C, with a severe wind-chill factor. From 7:00 to 7:25 p.m. the jog was routine. At 7:25 p.m. the jogger noted an unpleasant painful burning sensation at the penile tip. From 7:25 to 7:30 p.m. this discomfort became more intense, the pain increasing with each stride as the exercise neared its end. At 7:30 p.m. the jog ended, and the patient returned home. Physical examination at 7:40 p.m. in his apartment at comfortable room temperature revealed early frostbite of the penis. The glans was frigid, red, tender Perspectives in Biology and Medicine, 36, 1 ¦ Autumn 1992 151 upon manipulation and anesthetic to light touch. Immediate therapy was begun. The polyester double-knit trousers and the Dacron-cotton undershorts were removed. In a straddled standing position, the patient created a cradle for rapid re-warming by covering the penile tip with one cupped palm. Response was rapid and complete. Symptoms subsided 15 minutes after onset of treatment, and physical findings returned to normal. Side effects: at 7:50 p.m. the patient's wife returned from a local shopping trip and observed him during the treatment procedure. She saw him standing, legs apart, in the bedroom, nude below the waist, holding the tip of his penis in his right hand, turning the pages of the New EnglandJournal ofMedicine with his left. Spouse's observation of therapy produced rapid onset of numerous, varied and severe side effects (personal communication). Pathogenesis of the syndrome was assessed as tissue response to high air velocity at -80C, penetrating the interstices of polyester double-knit trouser fabric and continuing through anterior opening of Dacron-cotton undershorts, impacting upon receptor site of target organ to produce the changes described. Let us turn now to illustrations of scientific reporting that present us with vexing enigmas. A particularly puzzling example is a paper published by Pierre Turpin in the journal of the French Academy of Sciences, Comptes Rendus [15], over a century ago. Turpin was a distinguished life scientist, a member of the French Academy of Sciences who, among other things, had shown that yeast is a living organism, a discovery often credited to his contemporary Theodore Schwann. In the 1830s, Englishman Andrew Crosse disclosed that in the course of experiments with electrical leads dipping into aqueous solutions of potassium silicate he had observed that small insects were generated on the electrical surfaces and that they emerged therefrom. The insects were identified as mites of the Acarus species. This astonishing creation of life produced an international sensation. Since Turpin was a highly respected systematist, it is not surprising that a specimen of Crosse's Acarus was presented to him, through intermediaries Mr. Buckland (an English geologist) and M. Roberon, a French colleague. Turpin made a thorough microscopic anatomical examination and a detailed drawing of the mite (a female with an egg in it). Since the specimen differed from any known mite, Turpin named it Acarus horridus. The identification of the specimen as a totally novel form of Acarus ruled out contamination as an explanation of Crosse's findings. Yet in subsequent years all attempts to repeat Crosse's work with precautions to maintain sterile conditions invariably failed to generate mites. Most of Crosse's critical contemporaries, and certainly all modern biologists, would attribute Crosse's findings to contamination (probably insect eggs) in the experimental vessels or contents. How then could Turpin, a highly respected systematist, find a "new" species? Was he writing a tongue-in-cheek parody? There are some hints in that direction at the end of Turpin's paper, where he expresses surprise that a container 152 Irving M. Klotz ¦ Munchausen Syndrome with aqueous silicates could supply the many constituents necessary for the complicated steps in the development of a mature living organism. But he never explicitly states his final opinion. Ultimately Munchausen-like scientific papers that seem fully serious begin to blend in with those that comprise the undefinable vast region of illusion, delusion, poor scientific judgment, and fraud. For example, when a paper appears [16] purporting to show that "cosmo-helio-geophysical factors" influence the course of hydrolysis of bismuth chloride, a critical scientist might be inclined to be skeptical. The hydrolysis of bismuth chloride produces bismuth oxychloride, an insoluble, poorly defined product. Colloidal aggregates form, and the course of coalescence into larger particles and settling thereof is usually very sensitive to all kinds of trace substances and minor perturbations of the solution. The author [16] in fact noted explicitly that "the results of the experiments fluctuate during the day, from day to day, from month to month and from year to year." However, her inclination was to look for correlations with radio-emission fluxes from the sun, intensity of neutrons from cosmic rays, diurnal variations in geomagnetic activity, solar flares, geomagnetic storms, revolutions of the sun about its axis, etc. And she concluded that: The dependence of the reaction on cosmo-helio-geophysical factors was established by the method of superposed epochs and study of the linear and nonlinear correlations [italics added]. Efforts to "disprove" such interpretations from convinced individuals almost always become exercises in futility. One is reminded of the maxim ofJohann Wolfgang von Goethe [17]: "Conviction depends not so much on insight as on inclination. ... In knowledge as in action prejudice casts the deciding vote." REFERENCES 1.The Surprùing Adventures of Baron Munchausen (with the original illustrations ), edited by F. J. Harvey Darton. London: privately printed by the Navarre Society Limited, 1930. 2.Raspe, R. E. and others. Singular Travels, Campaigns and Adventures ofBaron Munchausen, edited by J. Carswell. London: Cresset Press, 1948. 3.Asher, R. Munchausen's syndrome. Lancet 260:339-341, 1951. 4.Dickinson, E. J. Cardiac Munchausen's syndrome. /. Royal Soc. Med. 80:630-633, 1987. 5.Shah, K. A.; Forman, M. D.; and Friedman, H. S. Munchausen's syndrome and cardiac catheterization./. Amer. Med. Assoc. 248:3008-3009, 1982. 6.Rosen, C. L.; Frost, J. J.; Bricker, T.; et al. Two siblings with recurrent cardiorespiratory arrest: Munchausen syndrome by proxy or child abuse? Pediatrics 71:715-720, 1983. 7.O'Shea, B.; McGennis, A.; Cahill, M.; and Falvey, J. Munchausen's syndrome . BritishJ. ofHospital Med. 31:268-274, 1984. Perspectives in Biology and Medicine, 36, 1 ¦ Autumn 1992 153 8.Newrick, P. G.; Affie, E.; and Corral, R. J. M. Relationship between longevity and lifeline: A manual study of 100 patients. /. Royal Soc. Med. 83:499-501, 1990. 9.Klotz, I. M. The chemical death of Lot's wife./. Royal Soc. Med. 81:397398 , 1988. 10.Klotz, I. M. Diamond Dealers and Feather Merchants: Tales from the Sciences. Boston: Birkhäuser, 1986. 7-10. 11.Seabrook, W. Dr. Wood. New York: Harcourt, 1941. 22-24. 12.Asimov, I. The endochronic properties of resublimated thiotimoline. Astounding Science Fiction 41(1): 120— 125, 1948. 13.Knox, W. H.; Knox, R. S.; Hoose, J. F.; and Zare, R. N. Observation of the 0-fs pulse. Optics and Photonics News (April):44-45, 1990. 14.Hershkowitz, M. Penile frostbite, an unforeseen hazard of jogging. New Engl. J. Med. 296:178, 1977. 15.Turpin, P. Note sur une espèce d'Acarus. Comptes Rendus de L'Académie des Sciences 5:668-678, 1837. 16.Opalinskaya, A. M. Influence of external factors on reactions modelling biological processes (Piccardie's tesf). Biofizika 31:330-335, 1986; English translation in Biophysics 31:362-368, 1986. 17.Magnus, R. Goethe as a Saentut, translated by G. Schmid. New York: Henry Schuman, 1949. 1 54 Irving M. Klotz ¦ Munchausen Syndrome ...

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