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Lewis Carroll's migraine experiences

1999; Elsevier BV; Volume: 353; Issue: 9161 Linguagem: Inglês

10.1016/s0140-6736(05)74368-3

1474-547X

Klaus Podoll, D Robinson,

Medical History and Innovations

The term “Alice in Wonderland syndrome” was coined to account for certain hallucinations peculiar to migraine,1Lippman CW Certain hallucinations peculiar to migraine.J New Ment Dis. 1952; 116: 346-351Crossref PubMed Scopus (110) Google Scholar, 2Todd J The syndrome of Alice in Wonderland.Can Med Assoc J. 1955; 73: 701-704PubMed Google Scholar and the name comes, of course, from Lewis Carroll's Alice's Adventures in Wonderland (1865) and its sequel, Through the Looking Glass (1871). Moreover, since Carroll suffered from migraine, Lippman1Lippman CW Certain hallucinations peculiar to migraine.J New Ment Dis. 1952; 116: 346-351Crossref PubMed Scopus (110) Google Scholar suggested that he had used his own migraine experiences as a source of inspiration for his two books, so it was said that “Alice trod the path of a wonderland well known to her creator”.2Todd J The syndrome of Alice in Wonderland.Can Med Assoc J. 1955; 73: 701-704PubMed Google Scholar This thesis was refuted3Blau JN Somesthetic aura: the experience of “Alice in Wonderland”.Lancet. 1998; 352: 582Summary Full Text Full Text PDF PubMed Scopus (10) Google Scholar on the grounds that migraine attacks were not mentioned in Carroll's diaries before 1885, when he noted having “experienced, for the second time, that odd optical affection of seeing moving fortifications, followed by a head-ache”,4Green RL The Diaries of Lewis Carroll. Cassell & Co, London1953Google Scholar the implied “first time” of this visual experience having occurred at an earlier, unknown date. Between 1885 and 1891, a total of five episodes with moving “fortifications” were recorded in the diaries4Green RL The Diaries of Lewis Carroll. Cassell & Co, London1953Google Scholar with only the first episode having been accompanied by headache, which strongly suggests a migraine aura without headache as the predominant form of migraine paroxysm in Carroll's experience. Two pieces of evidence, a drawing and a diary entry, which previously escaped notice, suggest that Carroll had already experienced visual migraine aura symptoms before the conception of his first Alice book, which was created in an oral version in 1862, produced in a hand-written version, Alice's Adventures Underground, in 1864, and finally published as Alice's Adventures in Wonderland in 1865. The figure shows the frontispiece of Carroll's family magazine Mischmasch,5Carroll L Das literarische Gesamtwerk. Verlag Jürgen Häusser, Darmstadt1998Google Scholar compiled between 1855 and 1862, which depicts figures already shown in his previous family journal The Rectory Umbrella (1854–55). In the carefully executed drawing of the standing man, parts of the head, shoulder, wrist, and hand are missing on the right side of the picture, the rounded border of the defect being similar to that seen in a negative scotoma. In a diary entry from Jan 12, 1856, Carroll noted: “Consulted Mr Bowman, the oculist, about my right eye: he does not seem to think anything can be done to remedy it, but recommends me not to read long at a time, nor at the railway, and to keep to large type by candlelight”4Green RL The Diaries of Lewis Carroll. Cassell & Co, London1953Google Scholar We believe it likely that Carroll's complaint about his right eye, which prompted him, in 1856, to seek medical advice from William Bowman, one of the most eminent ophthalmologists of his time, referred to a right-sided paracentral negative scotoma, as depicted in his frontispiece drawing from Mischmasch, the compilation of which he began in 1855. The nature of Bowman's medical advice suggests he suspected a functional disturbance due to the eye strain, resulting from reading an excessive amount or under adverse conditions. Considering Bowman's apparent failure in 1856 to achieve a more definite diagnosis for Carroll's visual complaints, it has to be taken into account that, despite the existence of some earlier reports in the literature, the visual manifestations of migraine did not attain a more widespread recognition in the medical profession before the 1870s. Since Carroll suffered from migraine aura symptoms before writing the Alice books, the thesis that at least some of Alice's adventures were based on Carroll's personal migraine aura perceptions gains further support. This thesis would explain the otherwise inexplicable similarities between the experiences described in the two Alice books and the semeiology of migraine aura symptoms both in the visual and somesthetic domain. This research was funded by a grant from the START programme of the Medical Faculty of the University of Technology, Aachen.