[Karen Blixen and her physicians].

In March 1941, two months after her wedding, Karen Blixen was diagnosed as having syphilis in the second stage. She was treated initially with mercury and later on in Denmark with salvarsan. Years later she received more treatment with mercury, salvarsan and bismuth, but in fact she was cured already in 1915 and told so by her venerologist Carl Rasch. However, she did not believe him, and several physicians, including well-known specialists in internal medicine and neurology told her many years later that she had to accept the diagnosis tabes dorsalis, i.e., syphilis in the third chronic stage. This paper claims, based on her medical records from several hospitals, that her physicians' attitude resulted in the delay of right treatment for her real disease for many years and led to at least one unwarrented surgical procedure (chordotomy). In 1956 she finally received surgical treatment of her stomach ulcer which for many years had caused her attacks of abdominal pain. The procedure was delayed for ten years because of a lumbar sympathectomy, which removes the pain for some years but not the ulcer itself, nor the bout of vomiting. Many doctors (and biographers) have been puzzled by her life-long bowel symptoms. It was often called tropic dysentery, in spite of the fact that this diagnosis was never confirmed by stool analyses. Instead it is suggested that most likely the Baroness caused the symptoms. She misused strong laxatives during her whole adult life. She did not tell her doctors about this until very late in her life and then it was far too late. Many times barium enemas showed a severe chronic condition with dehaustration and dilatation. The reason for her misuse was the fact that she was afraid of gaining too much weight. She used amphetamine during her life in Denmark after her return in 1931 in order to reduce her appetite, and probably she used Chat in Africa. She also constantly smoked cigarettes which in combination with minimal food intake facilitated the development of her stomach ulcer. It is concluded that Karen Blixen would have had a much better life, if communication between her and her physicians had been better. She should have told them and they should have been better to listen to that which was unsaid.