Neapolitan medical opinion

The Royal Neapolitan Physician Francesco Buonocore’s opinion was translated from the Italian and interpreted by Dr. Ornella Piazza in 2009. Dr. Buonocore was born on Ischia in 1689 and died in Naples in 1768. He built the 200-bed Casino sul Lago on Ischia in 1735, where the prince resided during the cure conducted by Dr. Gian Andrea D’Aloisio who prescribed 42 baths in the waters of the famous Gurgitello springs.

[In translation] “The Crown Prince, first son of the King of Poland, Elector of Saxony, accompanied Her Majesty the Queen in her happy journey, with the aim, among the others, to try our Springs (Bagni) qualities. He arrived in Naples the 22nd of June and I was among those who had to express their opinion about His Royal Highness’ illness and about its proper care.

The medical consultation was organized for the 2nd of July: the Count of Wackerbarth told us any information which could be useful to fix a first idea of the problem which was explained by Dr Filippo Violante, physician of the Royal Family of Saxony.

I could read a medical report of the very erudite Mr Heucher and I could hear the whole pathological anamnesis thanks to Mr Violante [who accompanied the prince to Naples]: I prefer not to repeat the narration but I think it is sufficient to report briefly what was possible to conclude from the medical inspection of the Prince’s body and from the other doctors’ trustful account.

When I learned all the Prince’s anamnesis details, we passed to observe his body. His bones appeared normal in size, shape and symmetry. The lumbar vertebrae were far from normal position because of an easily discernable and evident preternatural, muscular and tendon contractions. Nutrition and hydration state were normal.

The main alterations were in the muscle apparatus, with contraction of gluteus and popliteus and shortening of tendons such as His Royal Highness could not physiologically stretch his legs. This evident tendon shortening, the stiffness of it (at physical inspection) and a sort of associated dryness prevented the Prince from standing or walking, since it is clear that lumbar muscles and the other muscles devoted to these activities (standing and walking) are immune from lesion.

The left part of the body is the most affected while on the right side there is a more severe involvement of the upper extremity than of the leg. The left arm and in particular the hand cannot move quickly or harmoniously and naturally.

These were the results of the clinical inspection of the Prince’s body and our conclusion is that the illness of the Prince is among the “convulsive diseases”. For convulsive disease we mean a nervous disease as it is originated in the nervous system even if it affects the muscles and the tendons.

About the origin we are uncertain. I learned that the Queen, Mother of His Royal Highness, while pregnant suffered a shock observing an injured animal dying and hearing the beast crying, she was moving in an uncontrolled, generalized, way. Nobody ignores the effects that the maternal mental status exercises on the foetus; about this topic, as well as the daily common observation we have the expert opinion of the erudite philosophers Ludovico de la Forge and Mallebranche: that is to say a strict correlation exists between the mother and the embryo and an exchange of “emotions” pleasant and unpleasant may intercourse. The foetus “fantasies” rarely affect the mother while the emotional alterations starting in the mother body, which are harmless for her, when reach the susceptible foetus can impress upon it relevant consequences. The strange and unusual sight could cause confusion and agitation in the mother’s brain and shake the baby’s nervous system, causing an epileptic or convulsive attack in the foetus. Since an insult applied to the nervous system, once established, can be intrinsically repetitive (even in absence of new external stimulations) it is possible that during the intrauterine life, the epileptic attack manifested itself more times, causing the increase and stabilisation of the muscle and nerves disease.

Once born, the Prince showed rolling eyes, twisted hands and arms and almost paralytic legs. The child grew up and all the parts become bigger but did not develop happily; years passing by, few things improved while many other defects became clear: the inferior limbs paralysis, the general weakness, the nose bleeding, a long slight consuming fever followed by the recovery, a nasty cough, the sweat. The Prince was followed and helped by very good doctors who achieved some successes, which it is evident since his health improved in comparison with the past.

With these premises, what is the prognosis of His Royal Highness? Considering the nature of the nervous tissue and the length of the illness and the scarce results of the therapies implies complete recovery is impossible, I have to admit this, in spite of my wishes and for the love of the truth. On the other hand, it is true that growing up His Royal Highness’ health has improved and this was obtained by the exercise (I admired the attention and the care of the Count of Wackerbart in attending the Prince): the legs are more and more fluid every day. With the aim of obtaining strength and confidence in movements, in agreement with all the physicians, I proposed the use of the very famous Bagni of Ischia and mainly the very appreciated Gurgitello sources, which are suggested by our doctors in similar cases and which qualities are certified by the every day experience. This source has the proper concentration of minerals which are believed able to solve, reduce and eliminate (the toxic agents) and their richness is suitable to cure nervous illnesses originated from convulsions.

The Bagni (baths) must be taken for a long period but with interruption of some days between two following applications to reduce collateral effects. Moreover, since His Royal Highness suffered in other times from bleeding and fever, it is important to avoid the excess of heat, measuring the water temperature by a thermometer and using it only at very moderate temperature to minimize his sweating. I prescribed the application of mud from the Gurgitello spring to the most suffering parts: the knees and the left arm. To relax the tendons under the knees I prescribed dog-oil or earthworm-oil. If the thermal waters prescribed were somehow deleterious, I suggested the Bagni of Fontana, to alleviate and dilute the effects of the minerals, considering the sweetness and placidity of this spring Fontana.

This is what my weak intelligence was able to suggest for the advantage of the Royal Prince; I do not say anything about his life style since His Royal Highness has as teachers and intendants the very clever doctor Violante, physician of the Saxon Royal Family, and the excellent Count Wackerbarth, a very careful man, and I pray God they are able to assist and help His Royal Highness.

Napoli 14 Luglio 1738

Francesco Buoncore

Physician of the King

and First Doctor of the Kingdom”

L'Infermo Istruito dal Dottore D. Gian-Andrea D'Aloisio, 1757

L’Infermo Istruito dal Dottore D. Gian-Andrea D’Aloisio, 1757