What Made Hanno Buddenbrook Sick?
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《新英格兰医药杂志》
To the Editor: Sickness and health figure prominently in the fiction of Thomas Mann (1875–1955). Whereas his preoccupation with disease may at first seem distasteful to the lay reader,1 it enhances his appeal for the reader who is a physician.2 Mann's first major novel, Buddenbrooks (1901),3 follows a prosperous German family for 40 years. Each new generation is less respectable, less morally sound, and less healthy — physically and emotionally — than the preceding one. The last-born male in the Buddenbrook line is Johann ("Hanno") Buddenbrook (1861–1875).
Hanno Buddenbrook is born after a difficult delivery. He is a "silent and less than robust baby." Soon after his christening (at one month of age), he has a three-day bout of diarrhea that comes "close to stopping his . . . heart." He has his first seizure with the eruption of his first tooth. The seizures became recurrent and increasingly severe. Hanno is "slow learning to walk and talk." He also suffers from night terrors.
One of Hanno's two most serious health problems is dental in nature. His gums repeatedly become inflamed and form abscesses. Tooth eruption is painful. His permanent teeth come in "all wrong, crowding each other." He requires multiple dental extractions (presumably of deciduous teeth) to accommodate the eruption of permanent teeth. The other critical problem, as already suggested by the presence of the gum abscesses, is recurrent infection. The adolescent Hanno says that "a wound that heals for other people in a week . . . takes four weeks with me. It just won't heal, it gets infected, gets really ghastly, and gives me all kinds of trouble." He dies of typhoid before the novel ends.
The hyper-IgE syndrome, formerly called Job's syndrome, is "characterized by recurrent staphylococcal skin abscesses, pneumonia with pneumatocele formation, and extreme elevations of serum IgE."4 Skeletal features include joint hyperextensibility and multiple fractures. Grimbacher et al. reported that nearly three fourths of their patients with the hyper-IgE syndrome had failure of shedding of the primary teeth. The syndrome affects both sexes equally. Most cases are sporadic.
If it is due to the delayed shedding of his primary teeth, the crowding of Hanno's secondary teeth, necessitating multiple extractions, is now a known feature of the hyper-IgE syndrome. Gum abscesses and repeated skin infections are some of the manifestations of the immunodeficiency that is part of the syndrome. Thus, it is reasonable to think that Hanno Buddenbrook had the hyper-IgE syndrome. The description of Hanno's medical problems may be another example of Mann's "describing symptoms which only later were attributed to a specific illness."5
Howard Fischer, M.D.
Children's Hospital of Michigan
Detroit, MI 48201
References
Disease, art, and life. In: Brennan JG. Thomas Mann's world. New York: Russell & Russell, 1962:37.
Dirckx JH. Disease and death in Thomas Mann's fiction. Pharos Alpha Omega Alpha Honor Med Soc 1988;51:23-27.
Mann T. Buddenbrooks: the decline of a family. Woods JE, trans. New York: Knopf, 1994.
Grimbacher B, Holland SM, Gallin JI, et al. Hyper-IgE syndrome with recurrent infections -- an autosomal dominant multisystem disorder. N Engl J Med 1999;340:692-702.
Sprecher T. Comments on Thomas Mann and medicine. Schweiz Rundsch Med Prax 2001;90:1235-1239.
Hanno Buddenbrook is born after a difficult delivery. He is a "silent and less than robust baby." Soon after his christening (at one month of age), he has a three-day bout of diarrhea that comes "close to stopping his . . . heart." He has his first seizure with the eruption of his first tooth. The seizures became recurrent and increasingly severe. Hanno is "slow learning to walk and talk." He also suffers from night terrors.
One of Hanno's two most serious health problems is dental in nature. His gums repeatedly become inflamed and form abscesses. Tooth eruption is painful. His permanent teeth come in "all wrong, crowding each other." He requires multiple dental extractions (presumably of deciduous teeth) to accommodate the eruption of permanent teeth. The other critical problem, as already suggested by the presence of the gum abscesses, is recurrent infection. The adolescent Hanno says that "a wound that heals for other people in a week . . . takes four weeks with me. It just won't heal, it gets infected, gets really ghastly, and gives me all kinds of trouble." He dies of typhoid before the novel ends.
The hyper-IgE syndrome, formerly called Job's syndrome, is "characterized by recurrent staphylococcal skin abscesses, pneumonia with pneumatocele formation, and extreme elevations of serum IgE."4 Skeletal features include joint hyperextensibility and multiple fractures. Grimbacher et al. reported that nearly three fourths of their patients with the hyper-IgE syndrome had failure of shedding of the primary teeth. The syndrome affects both sexes equally. Most cases are sporadic.
If it is due to the delayed shedding of his primary teeth, the crowding of Hanno's secondary teeth, necessitating multiple extractions, is now a known feature of the hyper-IgE syndrome. Gum abscesses and repeated skin infections are some of the manifestations of the immunodeficiency that is part of the syndrome. Thus, it is reasonable to think that Hanno Buddenbrook had the hyper-IgE syndrome. The description of Hanno's medical problems may be another example of Mann's "describing symptoms which only later were attributed to a specific illness."5
Howard Fischer, M.D.
Children's Hospital of Michigan
Detroit, MI 48201
References
Disease, art, and life. In: Brennan JG. Thomas Mann's world. New York: Russell & Russell, 1962:37.
Dirckx JH. Disease and death in Thomas Mann's fiction. Pharos Alpha Omega Alpha Honor Med Soc 1988;51:23-27.
Mann T. Buddenbrooks: the decline of a family. Woods JE, trans. New York: Knopf, 1994.
Grimbacher B, Holland SM, Gallin JI, et al. Hyper-IgE syndrome with recurrent infections -- an autosomal dominant multisystem disorder. N Engl J Med 1999;340:692-702.
Sprecher T. Comments on Thomas Mann and medicine. Schweiz Rundsch Med Prax 2001;90:1235-1239.