Death Takes Little Bites

A series of tiny blood clots forms in a man's brain while he sleeps. He is unaware that anything has happened, goes on living. But he is a victim of what Dr. Walter C. Alvarez calls "one of the commonest diseases ... a slow petering out toward the end of life."

Few doctors recognize it as a common and distinct disease. It is high time they did, writes Dr. Alvarez in the current issue of Geriatrics. And when Dr. Alvarez speaks, doctors listen respectfully, for the immensely popular Mayo man is one of the shrewdest diagnosticians in the U.S.

The brains of victims of this creeping apoplexy are found, after death, to be covered with hundreds of "infarcts" where a tiny blood clot has choked off the surrounding tissues. (As an old lady once told Alvarez: "Death takes little bites.") Symptoms: overnight the victim ages quickly, becomes querulous, may lose his self-respect, may deteriorate morally.

Physicians, says Alvarez, too often dismiss such patients as neurotic or hypochondriac, argue that a stroke is impossible without such classic signs as muscular weakenings or loss of feeling in parts of the skin. But Alvarez insists that the brain can sustain thousands of tiny strokes with no symptoms beyond changes in personality. Nothing can be done to cure such patients, he admits, but doctors can emphasize that strokes may be far apart.

A notable case, Alvarez suspects, was that of Woodrow Wilson at the Paris Peace Conference. One day he felt unwell, was thought to have a cold. Suddenly he changed from a considerate man to a fussy one, impatient, suspicious, convinced he was being spied on.

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