[Gifts from patients: to accept or not?] / Cadeaus van patiënten: wel of niet accepteren?

Most physicians receive gifts from their patients during their careers, but what to think of these presents and how to react to them? For many years, generous patients led to uneasiness: they might expect special services from the physician; or other patients - who did not give anything - could feel disadvantaged over generous patients. These are good reasons not to be too keen on gifts. They still lead to uneasiness now, but the situation has nevertheless been reappraised as it goes against the general tendency to complain about everything: a token of appreciation is welcome. We should keep in mind that many patients have sincere intentions when giving presents. Just as in our clinical decision-making, we should trust our common sense when appreciating and accepting presents. However, verbal or written expressions of gratitude are preferable to physical presents since the former ones are far less complicated.

[Superglue instead of eye ointment; the sealed eye: often frightening and painful, generally ends well]. / Secondelijm in plaats van oogzalf.

BACKGROUND: Not infrequently, patients mistakenly put glue in their eye. This often induces considerable emotional and physical reaction. CASE DESCRIPTION: A 20-year-old man came to the Emergency Department at night because he had mistaken a tube of superglue for his eye ointment and instilled the glue into his right eye. All the glue was removed, as were most of his eyelashes. The glue-induced corneal abrasion healed completely and the patient did not sustain any permanent injury. CONCLUSION: Despite the considerable dismay and severe pain caused by mistakenly introducing superglue into the eye, most cases have a favourable outcome.

[Persistent, therapy-resistant conjunctivitis: consider infection with Chlamydia trachomatis]. / Persisterende therapieresistente conjunctivitis.

Conjunctivitis is a frequently diagnosed disease, usually caused by a virus. A less well-known cause is a chlamydia infection. This may result in missed diagnoses, delay of treatment and several complications. We present two cases of a persistent, therapy-resistant conjunctivitis in patients who were over 70 years of age. One patient had conjunctival follicles, characteristic of chlamydia conjunctivitis. The polymerase chain reaction tests of conjunctival samples from both patients were positive for chlamydia. Both patients and their sexual partners were treated with oral azithromycin. There was a treatment delay in both cases due to late recognition which was partially due to the older age of the patients. These cases illustrate that when a patient presents with persistent, therapy-resistant conjunctivitis, particularly if conjunctival follicles are present, chlamydial conjunctivitis should be considered and conjunctival swabs should be taken, no matter what the age of the patient.

[The eyes of Johann Sebastian Bach]. / De ogen van Johann Sebastian Bach.

Limited vision seems to have been Johann Sebastian Bach's (1685-1750) only physical problem. Myopia seems the most likely cause and he probably developed cataracts later in life. In addition to the cataracts, his worsening vision may have been due in part to some other eye problem. In 1750 Bach's vision became so poor that he had his eyes operated on by the travelling English eye surgeon John Taylor. Most likely the first operation was Taylor's standard couching procedure. About one week after the first operation, Bach was operated on again because of the reappearance of the cataract. Many painful and/or vision-reducing complications could have been induced by these intraocular operations: uveitis or endophthalmitis, secondary glaucoma, haemorrhage, retinal detachment, and even sympathetic ophthalmia. After the second operation Bach was blind. He died less than four months later.

[Health and death of Wolfgang Amadeus Mozart]. / Gezondheid en dood van Wolfgang Amadeus Mozart.

Not much is known about the medical history and cause of death of the composer Wolfgang Amadeus Mozart (1756-1791). Contrary to popular opinion, Mozart was not an exceptionally ill child and as an adult he generally enjoyed good health. At the age of 9 years he experienced a life-threatening illness, which was probably typhoid fever. On the left-hand side he had what has since become known as 'Mozart's ear', a pinna with under-development of the anthelical fold. His psychological condition gives rise to the notion that he was not exceptional, but that he responded to the events in his life in a normal manner. His terminal illness was characterised by edema of hands and feet, without any associated dyspnoea being described. The medical treatment was aggressive: enema, bloodletting on several occasions and treatment with a laxative substance. He was burried in an anonymous grave. The skull that was later ascribed to him was not his own, as no element of the denture fits with the tooth abscess he was known to have experienced. An overdose of mercury during the treatment of syphilis seems to be unlikely, as equally Henoch-Schönlein-purpura and the consequences of acute rheumatism. Trichinosis is a recent hypothesis which fits the terminal symptoms and the fact that Mozart was fond of pork. The diagnosis of his physician Closset was 'hitsiges Frieselfieber', which was possibly caused by one of the many infectious diseases prevalent at that time.