Literature "magistra vitae": What literature teaches about society's reactions to pandemic outbreaks.

INTRODUCTION: COVID-19 put out many interesting aspects of society's responses to an epidemic. Epidemics have a long-standing history in literature. We want to analyze if society's responses to the epidemic have changed over time, and what literature can teach about the society's reaction to an epidemic. MATERIAL AND METHODS: We searched and discussed the references to the social effects of the epidemic that are provided in three famous works of European literature providing descriptions about society's reactions to an epidemic throughout the centuries have been selected: "The Decameron" by Giovanni Boccaccio, "The Betrothed" by Alessandro Manzoni, and "The Plague" by Albert Camus. RESULTS: Literature teaches us that: the epidemic's spread is often preceded and favoured by a phase of negation or under evaluation of the problem; restrictive measures are the most efficient for containing the virus' spread; some people have difficulties in being compliant with these measures; infodemia may accompany an epidemic, feeding chaos and fear among the people. CONCLUSION: Looking at examples of epidemics reported in the past, we can conclude that the current COVID-19 pandemic shows that society's responses to an unknown disease are not changed over time.

Which Saint to pray for fighting against a Covid infection? A short survey.

BACKGROUND: In the absence of a treatment still considered universally effective, and of a vaccine validated by the health authorities, we wanted to know which Catholic saint the European Christian community turned to in the event of infection with Covid-19 to request a miraculous healing. METHODOLOGY: An online survey was carried out on a sample of 1158 adults using social media tools. RESULTS: All results are presented in this research, with a few saints in the majority, and some dictated by the symptomatology of the Covid-19 infection or the personalities of certain « doctor guru ¼. CONCLUSION: This medico-anthropological study is revealing the psychology of Western patients vis-à-vis the magic-religious means used in the fight against diseases, particularly in the epidemic/pandemic context.

The Autopsy of the Prophet Muhammad in Dante's Inferno.

Dante places the sinners who promoted scandals, schism, and discord in the ninth Ditch of the Inferno. Among those is also the Prophet Muhammad. Describing the Prophet's punishment, Dante resorts to technical terms and vulgar expressions. This poetic representation highlights Dante's medical and anatomical knowledge and reflects 14th c. Christian religious beliefs. At that time, autopsies were performed only on prisoners, prostitutes and people without identity. By comparing the Prophet to an autopsied corpse, Dante associates Muhammad with those bearing the badge of shame. Moreover, this description is a further confirmation that Dante had good medical knowledge.

Lessons from the Past: Some Histories of Alpha-1 Antitrypsin Deficiency Before Its Discovery.

A1AT deficiency- a genetically inherited autosomal codominant disease with more than 120 identified alleles- was first identified by Laurell and Eriksson in 1963. The most common hereditary disorder in adults, A1AT causes an increased risk of developing pulmonary emphysema and liver disease. In A1AT patients, lung disease generally presents at a younger age than "usual" chronic obstructive pulmonary disease (COPD) and it may be misdiagnosed as asthma. Because A1AT deficiency patients can show the same clinical features as non-deficient COPD (including increased evidence of bronchiectasis, frequent exacerbations, impaired health status and a degree of reversibility of airflow obstruction), the World Health Organization recommend to test every patient with a diagnosis of COPD or adult-onset asthma for A1AT deficiency. Despite these recommendations, the epidemiology of A1AT deficiency remains uncertain. Although recently discovered A1AT deficiency has affected human populations since antiquity. By using scientific data and recently studied skeletons and historical cases, we show that it is now possible to reconstruct the natural history of pathological processes, whether due to genetic, infectious or environmental factors. We believe that the evolution of disease in patients and research to elucidate the relationship between social science and environmental are pertinent contemporaneous subjects.

Was Ugo Foscolo (1778-1827) affected by alpha-1 antitrypsin deficiency?

Niccolò Ugo Foscolo (1778-1827), known as Ugo, is one of the masters of the Italian poetry. A writer and a revolutionary, he embraced the ideals of the French Revolution and took part in the stormy political discussions, which the fall of the Republic of Venice had provoked. Despite his poor health, Foscolo lived an adventurous life serving as a volunteer in the Guardia Nazionale and in the Napoleonic army. Following Napoleon's fall (1814), he went into voluntary exile in early 1815. He reached London in Sept. 1816 and lived in poverty at Turnham Green (Chiswick) until his premature death. Foscolo's medical history has been poorly investigated and the cause of his death remains unclear. In an attempt to shed light on his clinical history, we analyzed his Correspondence (Epistolario), a series of more than 3000 letters written between 1794 and 1827. From the age of 26 (1808), Foscolo had frequent episodes of cough and dyspnea that progressively worsened. Four acute respiratory exacerbations occurred in 1812. Between September 1812 and April 1813, he had breathlessness as that of asthma. Frail and ailing, he developed a chronic liver disease in 1826. In August 1827, weakness, dyspepsia and drowsiness further increased and dropsy became manifest. He went into coma on September 7, 1827 and died aged 49 three days later. Based on a brief history of urethritis and urinary obstructions (1811-1812), previous scholars have suggested that Foscolo had urethral stenosis that caused a chronic bladder outlet obstruction and led to consequent renal failure. This hypothesis, however, does not mention the respiratory symptomatology present since 1804, which is a pivotal feature of Foscolo's illness. We surmise that Foscolo suffered from alpha-1 anti trypsin (AAT) deficiency, a rare genetic disease, which caused his premature death and support our interpretation with documental evidence.

The Death of Balzac (1799-1850) and the Treatment of Heart Failure During the Nineteenth Century.

Overweight, workaholic, and a caffeine abuser, Honoré de Balzac lived a life of excess. He prematurely died at the age of 51 owing to gangrene associated with congestive heart failure. Textual sources allow us to take a glimpse into his last 3 months of life. Because of ventricular hypertrophy, Balzac's respiratory conditions were appalling and he developed severe leg edemas and possibly stasis dermatitis. Here we report on Balzac's demise and provide first evidence of a pioneering medical treatment applied to save his life: the use of a trocar to drain leg edema. Based on the empirical observation of the benefits derived from an accidental leg drainage, Balzac's physicians anticipated the invention of the "Southey tube", whose use evolved in the following century to treat obstinate edema in heart failure patients. Unfortunately, following the daily maneuvers for trocar insertion and in the absence of adequate disinfection measures and antibiotics, bacteria infected the open wound and gave rise to the gangrene, which caused the writer to die within 24 hours of its onset.