The decline of Dom Pedro II's empire and health: neurophatogenic implications

Abstract

-The main objective of this paper is to know the medical doctors of the Emperor, the preconized treatment, and the knowledge about diabetes at that time, its repercussions on the Emperor´s nervous system, and the related political implications. A narrative revision was made, based on primary and secondary sources. Dom Pedro II was examined by the aristocracy of the medicine at the time, especially Jean-Martin Charcot, amongst the doctors of international reputation, and Cláudio Velho da Motta Maia, amongst the Brazilian doctors. Charcot diagnosed in the Monarch: mental stress, diabetic neuropathy, and a cerebral vascular lesion, probably a stroke, that he differentiated from other vascular obliterations elsewhere. He demonstrated his knowledge about diabetic neuropathy, possible topographical alternatives to justify the urinary incontinence, and Dom Pedro´s weakness in the legs. Throughout his illness, Dom Pedro II presented others manifestations that contributed to his physical fragility, and that, certainly too, to his political decline, deposition and the proclamation of the Brazilian Republic.KEY WORDS: diabetes, diabetic neuropathies, stroke, history, Brazil. O declínio do império e da saúde de Dom Pedro II: implicações neuropatogênicasRESUMO -O objetivo principal deste artigo é conhecer os médicos do Imperador, o tratamento preconizado e o conhecimento da ocasião sobre o diabetes, principalmente sobre suas repercussões no sistema nervoso do imperador e suas implicações políticas. Isso foi feito por uma revisão narrativa, baseado em fontes primárias e secundárias. Dom Pedro II foi examinado na ocasião pela aristocracia da medicina, a ressaltar Jean-Martin Charcot, dentre os médicos de reputação internacional, e Cláudio Velho da Motta Maia, dentre os brasileiros. Charcot diagnosticou no Monarca, além de tensão mental, neuropatia diabética e quadro vascular cerebral que ele diferenciou de outras obliterações vasculares em localizações diversas. Ele demonstrou o seu conhecimento sobre a neuropatia diabética, possíveis alternativas topográficas para justificar a incontinência urinária e a fraqueza nas pernas. Dom Pedro II, ao longo da sua doença, apresentou uma sé-rie de manifestações que contribuíram para a sua fragilidade física e certamente também para o seu declí-nio político, deposição e proclamação da República no Brasil.

Jean-Martin Charcot, father of modern neurology: an homage 120 years after his death

“…His drawings demonstrate the accuracy of his semiology -they contain everything that he so thoroughly and analytically described, placing the relevant and characteristic aspects of each disease within it 1,2,5 . To provide examples in his classes, conferences, and writings he used photographs and drawings that were many made by himself or his students 3,5,8 . In 1866, he inaugurated his innovative clinical lectures, the first series was on diseases in the elderly 2, 3,4 .…”

“…His worldwide notability came from the weekly Tuesday morning sessions, where he described clinical cases he had examined in the presence of the audience (André Brouillet's famous 1887 painting gave its atmosphere) and Friday lessons, where he presented didactic lectures prepared in advance 5,6 . When Charcot moved to the Boulevard St. Germain, he hosted weekly Tuesday soirées that gathered varied personalities, such as the Emperor of Brazil, who was also one of his clients 4,8 . Charcot diagnosed the emperor with mental stress (surmenage physique et intellectuel), diabetic neuropathy, and a cerebral vascular lesion (probably a stroke), which he differentiated from other vascular lesions elsewhere 8 .…”

“…When Charcot moved to the Boulevard St. Germain, he hosted weekly Tuesday soirées that gathered varied personalities, such as the Emperor of Brazil, who was also one of his clients 4,8 . Charcot diagnosed the emperor with mental stress (surmenage physique et intellectuel), diabetic neuropathy, and a cerebral vascular lesion (probably a stroke), which he differentiated from other vascular lesions elsewhere 8 . Some of his outstanding students were Paul Richer, Georges Fulgence Raymond, Edouard Brissaud, Pierre Marie, Joseph Babinski, Georges Gilles de la Tourette, and many others, including, Freud and Bechterew 4,6 .…”

Letters from Dom Pedro II to professor Brown-Séquard: imperial correspondence and neurophysiology

“…He consulted Charcot, in Paris in 1887, who diagnosed him as suffering from surmenage psycho-physique (neurasthenia), diabetes mellitus and probably a related peripheral neuropathy. His death certificate was signed by Professors Bouchard, Motta-Maia, and Charcot, on December 5 th , in 1891, at the Bedford Hotel, in Paris, with the cause of death recorded as pneumonia [8][9][10] .…”

Excessive daytime sleepiness of the Brazilian emperor Dom Pedro II probably due to sleep apnea syndrome

“…It was also recognized by his peers. Objective: To show that the obstructive sleep apnea syndrome (OSAS) was the probable cause of D. Pedro II's excessive daytime sleepiness [7][8][9] .…”