Thinking of Olga

My mother was born in 1921, and her younger sister, Olga, was probably born in 1923. A few years later, Olga, a toddler, contracted Typhoid Fever. You will probably recall that a decade earlier, Mary Mallon was spreading Typhoid Fever among the well-to-do on the East Coast of the US. The earliest antibiotic was probably Salvarsan – an arsenic-based anti-syphilis drug with no activity against Salmonella. The Sulfa drug class would not be discovered until the mid-1930s.

My aunt Olga, aka Olgita (an affectionate diminutive), was sick with Typhoid Fever for months, my mother said. When she finally recovered from the infection, she was a specter of her former self. Shortly thereafter, she became blind, according to my mother. The doctors said that it was a complication of the Typhoid Fever that she had survived.

Susan and I studied Typhoid fever in medical school just as every medical student does, and I even saw a case during my clinical rotation in Internal Medicine during an outbreak attributed to an infected worker in a local tortilla factory in San Antonio, if I recall correctly. Later, as a VA physician, I diagnosed an Army veteran returning from a vacation in Mexico with the same disease. I referred him to the nearby VA Hospital, and he was managed properly and recovered. In none of my studies or practice did I ever encounter blindness as a complication of Typhoid fever.

I woke up a couple of mornings ago thinking about Olgita and how strange it seemed that she would have become blind as a consequence of Typhoid fever. Mom was a pharmacist and an excellent historian. I had no reason to doubt her report regarding Olgita’s blindness, but it was not something in my medical experience or knowledge base.

I resorted to looking for information on the net – NLM, PubMed, Google, CDC, NHLBI, and other sites. Google brought up lots of current knowledge regarding the disease but nothing regarding blindness. The same was true for the CDC web site. It was PubMed and NHLBI that were the most informative.

It turns out that blindness related to Typhoid Fever was reported as far back as the late 19th Century (circa 1893). Typhoid Fever related blindness occurs some days or weeks after the infection. It is not so much a direct consequence of the infection as it is a result of the body’s immune system reaction to the infection. This autoimmune complication causes a retinitis (inflammation of the retina) that can affect all layers of the retina including the optic nerve. In the worst cases, it causes blindness.

More recently, this complication of Typhoid Fever has been reported in the third world, and it has been treated successfully with Prednisone. Prednisone is a synthetic corticosteroid that is four to five times stronger than the hydrocortisone that our own adrenal glands produce. Hydrocortisone was first characterized in the mid 1930s, and the development of immunology and the understanding of autoimmunity would take a few more decades after that. Alas, Olgita’s blindness would not benefit from any of this medical progress; it simply came too late to help her.

When I was quite young, my mother told me that when Olgita was a young child, she had a cat and a dog. I do not remember their names. The cat was an object of affection, a pet, that she cherished. The dog was a loyal helper and ally. When Olgita wanted to pet the cat, she called the dog and told it to find the cat. The dog obediently searched the house until it found the cat, grabbed it by its scruff, and brought it to its mistress. As a young child, I loved this story.

This interaction with her non-human allies, I think, defined Olgitas later relationships with her seeing-eye service dogs. There were many. I remember only a few, and they were mostly Shepherd mixes that she had procured through the US Lighthouse for the Blind over the decades. There was Gulliver, and Rusky, and others whose names have disappeared from my memory. Every one of them was fiercely loyal and devoted to her. I was allowed to speak to them but not to pet them. They were working dogs – not pets.

Olgita may have been indulged by her family, but they also had high expectations for her – blindness was just a bit a bad luck – not an excuse for a lack of success. When I first met my aunt Olgita, she was giving private lessons in her home. She was fluent in Spanish, English (lucky for me), and French. She taught English and French as well as Braille to private students. Like her brother and my mother, she was an accomplished classical pianist. Later in life, she became a schoolteacher for students with disabilities including blindness and deafness. As her career came to a close, she became the principal of a school for children with multiple disabilities. She was quite a gal.

Outside the family piano studio, Olgita had a small desk on which sat an Olivetti M20 typewriter. It was a beast. I know because one year, on Spring break from middle school, I pounded out a book report on Herman Melville’s Moby Dick on that mechanical monster. Olgita was a proficient touch typist, and she wrote letters to her sighted friends both local and abroad using that machine. I didn’t understand how incredible a feat this was until many years later.

My last visits with Olgita, my favorite aunt, were on a couple of trips that Susan and I took to the Yucatan. We took Mom and Olgita as our guests to experience the ancient Mayan ruins, to see the Mexican National Museum of archeology, and to visit Cancun. It was before the rise of the drug cartels and the now commonplace kidnappings. She seemed to enjoy these experiences no less than to we. Mom, Susan, and I were her eyes on those trips. The dog stayed home.

My aunt Olga and Mom have both passed from this world. My life was enriched by having each of them as I grew up – even now years after my aunt is gone, I have learned a bit of medicine that I did not know until today.