Emily Boyle
Dublin, Ireland

The sudden recovery of paralyzed patients is as thrilling as it is unlikely and has often been memorably portrayed in books and film. Some paralysis, such as occurs after spinal cord injury, is permanent. However, gradual physiologic recovery from a paralyzing condition such as a stroke is well recognized, usually with intensive physical therapy and optimal medical management.¹ Still, recovery varies among patients.² In other conditions, neurological recovery may be more rapid, such as in Guillain-Barré syndrome or conditions where neurological impairment fluctuates, such as clinically isolated syndrome (CIS) or relapsing-remitting multiple sclerosis.³

Unfortunately, the scenario of a wheelchair-bound patient suddenly regaining the power to walk occurs only in fictional situations, often with religion or magic playing a role. Unusually rapid recovery from apparent paralysis occurs in two well-known children’s novels and may be explained by the fact that in both cases, the nature of the paralyzing condition is not clear. In Francis Hodgson Burnett’s famous children’s book The Secret Garden, the miraculous recovery of one of the characters is the climax of the plot.⁴ The protagonist, Mary, is suddenly orphaned at the beginning of the book and sent from India to England to live with her uncle. She soon discovers a cousin, Colin, who has been essentially bed-bound since childhood from a mysterious illness. When we first meet Colin he is twenty, but cannot walk or stand and needs help getting washed and dressed. The exact nature of his illness is not clear, although a few red herrings are thrown into the plot. We learn that he suffered from both typhoid and rheumatic fever as a child, which could potentially have caused long-term effects such as chronic fatigue, breathlessness, and muscle wasting.^5,6

There is also a suggestion that he may have some sort of spinal pathology. Colin says his father was worried that he would become a “hunchback.” He mentions wearing a metal brace when he was younger, and at another point refers to having a “bad back.” This would suggest a diagnosis of scoliosis or kyphosis. However, as the story progresses, it becomes clear that his immobility is unlikely to stem from a neurological condition, but rather from muscle atrophy with a behavioral element.

Colin was almost certainly born prematurely. When his mother was pregnant, she fell from a tree in the garden and died the following day after giving birth to him. Although not specified, the trauma may have caused her to go into labor. Prematurity might explain why Colin was seen as a sickly, frail child by the household. We also learn that after he was born, Colin’s father was so distressed by the sudden death of his wife that he took no interest in his son: “he had raved like a madman because the child was alive and the mother was dead. He had refused to see it.”

It seems then that Colin was ignored and essentially abandoned by his father and brought up by household staff. They were probably overly protective given his physical frailty, and it appears he was never allowed to walk but was kept in bed. There were other factors in his delayed development. He had no contact with other children his own age and was raised by adults who were probably anxious not to displease his father. Therefore, he was indulged in every respect. He frequently overheard other adults discussing his condition and predicting his death and may have started to believe this himself.

At least one doctor realized there was no physical reason that he could not walk and implied his disability was psychological. Later in their friendship, Mary gives a succinct assessment of his physical ailments when she refers to Colin as a “hysterical half-crazy little hypochondriac.” Mary is someone who at last is willing to speak openly to him. When he demands that she inspect his “deformed” back, she tells him, “There’s nothing the matter with your horrid back—nothing but hysterics!” Colin starts to realize that his physical condition can potentially improve and is not fatal. With encouragement from Mary and her friend Dickon, he ventures outside the house for the first time in his life. At first they take him out in a wheelchair, but after several outings he stands unaided, then starts to walk in the climactic scene of the book. By the end of the story, he appears to have made a full recovery. This recovery, both mental and physical, is attributed to the magic of the secret garden.

In Johanna Spyri’s novel Heidi,⁷ there is a similar dramatic recovery and story arc. Heidi is also orphaned as a child, and in the first part of the book she is sent as a five-year old to live with her grandfather in the Alps. He has a reputation as a gruff man but warms to Heidi, and they develop a loving relationship. However, as she is unschooled and growing up illiterate, at the age of eight her aunt sends her to live with the Sesemanns, a wealthy family, to serve as a companion for their daughter, Clara, with the hope that it might also benefit Heidi’s education and social standing. Clara is also an invalid. When we first meet her in the book, she is twelve and unable to walk. However, she is not a reclusive, spoiled character like Colin. She lives openly with her father and seems to be agreeable and obedient, if a little prone to low moods. She uses a wheelchair, spends most of her days reclining on an “invalid couch,” and is wheeled on this from room to room. She is able to sit up, feed herself, and attend lessons, but is unable to walk. She is frequently carried from couch to chair and seems to need help with dressing and washing. There is never a clear explanation offered for her condition.^7,8 There is no mention of childhood illnesses or accidents, and as her parents, like Colin’s, are wealthy, one can assume that the best of medical care would have been available to her. She has periods of ill-health during the book, and at one stage is sent to the baths, a traditional cure for all ills.⁹

Her recovery in the book happens in a similar fashion to Colin’s. Developing a friendship with Heidi improves her general mood. She later goes to visit Heidi in the Alps and says she has never spent so much time in the fresh air before. The combination of alpine breezes and healthy food seem to make her physically stronger. Heidi’s grandfather starts encouraging her to try to stand and take weight on her legs and at first, she finds it difficult and painful. Then one day, after spending three weeks staying in the Alps with Heidi, they go out for the day. Heidi’s friend Peter, who has become jealous of the friendship between Clara and Heidi, secretly pushes Clara’s wheelchair down the mountain, breaking it. This, together with Clara’s desire to be more independent, motivates her to start walking, initially with help from Heidi and Peter. Although she struggles in the beginning, it is clear that her legs are not actually paralyzed but more likely deconditioned from never being used normally. She makes a full recovery and in a similar scene to The Secret Garden, her father is overjoyed to see her walking unaided when he comes to visit.

If we assume that there was never actual neurological or musculoskeletal pathology preventing Colin and Clara from walking, their miraculous recoveries seem more credible. However, both would have had pronounced muscular atrophy from years of disuse, and at the time we meet them in the books, would have been physically incapable of normal mobility. While there are serious medical causes of muscle atrophy in children such as spinal muscular atrophy, physiological atrophy occurs when muscles are not used. This is frequently seen in adults after periods of severe illness or immobilization.⁹ The loss of mechanical load leads to a decrease in muscle protein synthesis, and the condition can be exacerbated by dietary deficiencies.^9,10 Disuse atrophy is also seen in environmental conditions such as space flight. A period of disuse of even ten days can be sufficient to result in decrease in muscle synthesis and loss of skeletal muscle mass.^10,11 The treatment for this is physical activity, including resistance training and nutritional optimization.^10-12 Recovery is better in younger patients¹² such as Colin and Clara. The time frames in the books may be optimistic, however. Colin is fully cured in two months, and Clara starts walking within three weeks.

Both characters’ recoveries are spurred on by new friendships and motivation resulting from an improved mood. Although holistic medicine is a modern term,¹³ it is clear that addressing all aspects of health is important in both these stories, as it is in real life. Recovery can be achieved, even without a secret garden.

References

1. Machumpurath B et al. “Rapid neurological recovery after intravenous tissue plasminogen activator in stroke: prognostic factors and outcome.” Cerebrovasc Dis. 2011;31(3):278-83. doi: 10.1159/000322564. Epub 2010 Dec 21.
2. Grefkes C, Fink GR. “Recovery from stroke: current concepts and future perspectives.” Neurol Res Pract 2020; 2 (17). https://doi.org/10.1186/s42466-020-00060-6
3. National Multiple Sclerosis Society. “Types of Multiple Sclerosis.” https://www.nationalmssociety.org/What-is-MS/Types-of-MS
4. Burnett FH, Tudor T. The Secret Garden. 1st Harper Trophy ed. New York: HarperCollins, 1987.
5. Rai, Sudheer. “Chronic Typhoid: Complications and Long-term Effects.” October 11, 2023. https://hinjawadi.rubyhall.com/chronic-typhoid-complications-effects/
6. Watkins DA et al. “Global, regional, and national burden of rheumatic heart disease, 1990-2015.” N Engl J Med 2017;377(8):713-22.
7. Spyri J, Howell T. Heidi. New York: Wanderer Books, 1982.
8. Willis, Jeanne. “Going beyond the edelweiss: How Jeanne Willis retold Heidi for a new generation.” BookTrust, December 4, 2019. https://www.booktrust.org.uk/news-and-features/features/2019/december/going-beyond-the-edelweiss-how-jeanne-willis-retold-heidi-for-a-new-generation/
9. Gianfaldoni S et al. “History of the Baths and Thermal Medicine.” Open Access Maced J Med Sci. 2017;5(4):566–8. doi: 10.3889/oamjms.2017.126.
10. Nunes EA et al. “Disuse-induced skeletal muscle atrophy in disease and nondisease states in humans: mechanisms, prevention, and recovery strategies.” Am J Phys-Cell Phys 2022; 322(6): C1068-84.
11. Mitchell CJ et al. “Impact of dairy protein during limb immobilization and recovery on muscle size and protein synthesis; a randomized controlled trial.” J App Phys 2018; 124(3); 717-28.
12. Benjamin T Wall, Luc JC van Loon. “Nutritional strategies to attenuate muscle disuse atrophy.” Nutr Rev 2013; 71(4):195-208. https://doi.org/10.1111/nure.12019
13. Gordon JS. “Holistic medicine: advances and shortcomings.” West J Med1982;136(6):546-51. PMID: 7113200; PMCID: PMC1273970.