A 14-year-old girl born in Brazil who moved to Europe at a young age presented with weakness and a dull feeling in her right hand. The symptoms had been progressive over a period of one year. Initially, she had diminished sensation of her right index finger. This gradually progressed to affect the whole of her right hand, which eventually became numb. She was right-handed and could no longer use a pen for writing. Otherwise, her history was unremarkable.

A 49-year-old man noticed a diminished sensation in his feet. Two months later, climbing stairs became difficult due to proximal muscle weakness of his legs. Over the next three months, sensory disturbances and both proximal and distal weakness progressed in arms and legs requiring the use of a walker or a wheelchair. Besides COPD, he was previously in a healthy condition. Based upon ancillary investigations, he was initially diagnosed with chronic inflammatory demyelinating polyneuropathy (CIDP), had received a course of intravenous Ig (IVIg), and was subsequently treated with high-dose corticosteroids (60 mg/day). He did not smoke or use drugs such as nitric oxide.

A previously healthy, very active 68-year-old man, who usually cycled over 100 km several times a week, noticed progressive tingling in his feet and lower legs that increased over several weeks. This was followed by progressive weakness in the arms and legs exceeding a period of eight weeks. After three months of progression, weakness became so severe that he could not even walk without help. He did not use drugs or drink alcohol.

Chapter 3 uses the letters of Gregorios Antiochos to explore the scholar’s body. Antiochos, who experienced chronic illness from a young age, combined his own bodily feeling with gender discourses to create a subversive image of the scholar which challenged ideals of military masculinity. He juxtaposed the strong body of the soldier, forged through physical exercise, to the frail body of the learned man hunched over his books, and declared his preference for the latter. He also expressed his own relationship with books and the furniture that facilitated his scholarly work, in disability terms: his cane, staff, armrest and guides. When at points the connection with scholarship was severed, Antiochos felt truly disabled. A body in crisis emerged that was assailed by unwanted becomings, prime among them the possibility of becoming-horse and losing his rationality. Despite this emphasis on reason, speech and self-determination, Antiochos’ letters present us with unexpected configurations of human and non-human bodies which blur the lines between organic and inorganic and help decentre man. In doing so, they posit the Eastern Roman scholar with his books and study furniture as a kind of antipode to the Western knight and his horse.

The prime ministers all play chess on a multi-dimensional board, prey to challenges that vary in type and intensity over time, some of which are new and growing, and others constant. The most skilful negotiate their way through these constraints, turning them to their advantage, and refuse to be defined by adversities. The least able are swallowed up by them. We first consider institutional restraints, the checks and balances they face, some dating back to 1721, before considering variable constraints, which have made and destroyed premierships, and have rendered even the best-qualified incumbent a cornered animal.

• Acute spinal cord compression results from impingement on the spinal cord due to a variety of etiologies, including neoplasm, hemorrhage, infection or other structural abnormality at any vertebral level.

• Any patient who presents with a history of trauma, intravenous drug use (IVDU) or immunocompromised state with associated neurological deficit and/or back pain should be evaluated for acute cord compression.

• Neoplastic disease is rarely confined to a single location; therefore, the entire spine should be evaluated when metastatic disease is suspected.

This chapter establishes that Augustine held that the sins of Christians were venial sins and that these sins were always committed through weakness or ignorance, with the result that Christians remained virtuous while they committed these sins. In contrast, the sins of non-Christians were always damnable sins and these were committed through pride. Through a study of Augustine’s account of the theft of the pears, and of Adam and Eve’s Fall, this chapter shows that Augustine thought that sinning through pride could take two different forms, and that this supported his view that anti-social, other-harming actions (like theft or murder) were not inevitable in the earthly city.

This chapter shows how the push for profit and dominance, and the dynamics of slavery, affected white southerners’ dealings with elderly “masters.” As enslavers aged, they could be forced to fight against the rising generation who looked at them and saw dependency and submissiveness, instead of autonomy and mastery. These traits – and general binaries of power/powerlessness – were understood as bound up with the racializing discourse of slavery and the gendered dynamics of patriarchy. Elderly enslavers – both men and women – sometimes came to believe that advanced age was a relation of powerlessness that marked them as closer to enslaved than enslaver and which served to unsettle existing power relations in the community. Those who fought against such depictions confronted communal perceptions of their inability to enact mastery, and these battles had particular emotional effects. Cross-cultural scholarship argues that communal assumptions of incapacity can be humiliating, and this chapter emphasizes how aged enslavers grappled with these perceptions. These old slavers are not objects of pity, but their experiences reveal the culture of exploitation that drove antebellum slavery.

This chapter has two correlative aims: on the one hand it seeks to complicate the customary conception of Byron as a figure of strength, and on the other hand it challenges the commonplace pejorative understanding of levity as a matter of frivolity, irreverence, or licentiousness, by drawing attention to other, more positive forms of lightness that also play a vital role in Byron’s comic masterpiece. More particularly, by reflecting on Don Juan’s ‘three graces’ (the Duchess of Fitz-Fulke, Lady Adeline, and Aurora Raby), the chapter highlights three contrasting models of levity: the carnivalesque, the courtly, and the eschatological. One of the surprising things that emerges from this consideration of the poem’s intermingling of sexual, socio-political, and religious forms of lightness is an underlying posture of epistemological weakness, which both fosters and is fostered by a sceptical openness to possibilities.

It is humbling to be human. Humilitatem and humanitas have always been connected. So, Shakespeare’s characters know when they are "not gentle, not humble" [Love’s, 5,2,617]. But living in an age of service, their creator was also conscious of the fine line between humility and humiliation. Persistently, his plays therefore stage the "Cinderella" scenario of a "proud humility" [All’s Well, 1,1,172], as if he had internalized the self-abjection by which power abases itself in "the gown of humility" [Coriolanus, 2,3,36]. Almost all of Shakespeare’s references to humility describe it as an act. Hence, "I have sounded the very base-string of humility" [1Henry IV, 2,5,5], reports his most winning king. In staging his own "abject position," as a professional "waiter" on the mighty, "our humble author" [2Henry IV, Epi, 23] thereby seems to anticipate modern skepticism towards the false modesty of the "humbled visaged" [Love’s, 2,,34], the "meekness and humility" that is "cramm’d" with "arrogancy, spleen and pride" [Henry VIII, 2,4107-108]. This chapter on humility argues that Shakespeare’s dramatization of the supposed virtue has never been more relevant than in our own populist times, when the clown prince dives into our hearts, "with humble and familiar" smiles [Richard II, 1,4,25-27].

As the population continues to age, clinicians will increasingly encounter neurological conditions in routine clinical practice. Neurological problems in the elderly have a profound impact on quality of life and can at times be life-threatening. Diagnosis and management of geriatric neurological problems is complicated by often vague presentations and the presence of comorbid conditions, as well as complex physiology and pharmacology in this age group. Moreover, when caring for these patients it is of utmost importance to have a holistic approach and include family and caregivers when developing care plans. In this chapter we review muscle weakness, sensory loss, seizure disorders, and headaches in the elderly patient. Causes, impact on quality of life, and available treatment options are discussed. Other topics including delirium, dementia, cerebrovascular disease, and gait disorders will be covered elsewhere.

A 45-year-old woman, gravida 2, para 2, postoperative day 0 following a vaginal hysterectomy for menorrhagia due to uterine fibroids calls for assistance after falling when attempting to ambulate. At the completion of her procedure, her Foley catheter was removed. She attempted to ambulate to the bathroom but experienced a fall onto the bed when she attempted to bear weight on her left leg. She describes numbness of the left thigh. Her surgery was difficult due to the presence of multiple uterine fibroids but had no unusual complications. Estimated blood loss was 315 mL and operative time was 2.5 hours. She has a medical history of diabetes and tobacco abuse and a past surgical history of vaginal hysterectomy. She is currently taking metformin and has no known drug allergies.

Key Learning Points

1. 1. Around 40 per cent of patients develop clinically detectable muscle weakness known as intensive care unit-acquired weakness (ICU-AW) that can lead to long-term functional deficit.

2. 2. Accurate diagnosis of ICU-AW can be achieved through nerve conduction studies, electromyography, muscle biopsy and ultrasound of muscle cross-sectional area; however, more commonly, a clinical diagnosis is made using the Medical Research Council (MRC) Sum Score of muscle strength.

3. 3. Prevention and timely management of sepsis is the optimal way to mitigate the risk of ICU-AW.

4. 4. Minimising sedation, optimising pain relief, encouraging spontaneous breathing, early mobility and family engagement are the foundations of best quality care.

5. 5. Rehabilitation should start early after admission to the intensive care unit and continue to at least 3 months after hospital discharge.

Mary Wollstonecraft challenges the social disablement of women by promoting a vigorous and curative feminism that establishes women’s qualifications for equality by virtue of their capacities. She associates female weakness with inutility and social degradation and promotes bodily and physical independence as ideals. Misogynistic cultures weaken the bodies and minds of women, Wollstonecraft asserts, and she petitions for women to develop (and be permitted to develop) their physical and intellectual abilities rather than to perpetuate a culture that is focused on the aesthetics of women’s bodies. Significantly, she suggests that it is absurd that weakness is treated as something aesthetically desirable in women. She concludes that society cannot maintain women’s social inutility as an aesthetic, as it is detrimental to social progress. Wollstonecraft’s implied theory of deformity (which links it to moral degradation) is articulated through its acknowledged opposite, beauty. These views are, however, incompatible with the compassion, sympathy, and sensibility Wollstonecraft expresses when considering deformity more directly.

While the defence of princely legitimacy had to respond to certain legal and social standards, this technical reality did not act as a fixed template for its eventual performance. This chapter examines the practical and rhetorical aspects of three components of Jeanne’s legitimacy over the course of her whole career: her status as the rightful heiress of Brittany, her exercise of princely rights and responsibilities, and her responses to the disunity of the duchy. Although Jeanne’s claims were rooted in broadly accepted social expectations, not only could her assertions of legitimacy diverge from those of her husband and her predecessors, but she foregrounded different aspects of her status before different audiences; at the same time, other aspects of her official position remained constant even across the major shifts in her political circumstances. Recognizing princely legitimacy as a moving target expands our understanding of what constituted an effective response to a position of weakness, and tempers the ‘ideal’ prince of medieval (and modern) theory with constructions of power more adaptive to the concurrent pressures of princely relationships and authority.