Internet Helps Solve a Medical Mystery

On April 10, two college students in Beijing transmitted a desperate request for help across the Internet and opened a new dimension in the practice of medicine:

"Hi. This is Peking University in China ...  A young, 21-year-old student has become very sick and is dying ...  Doctors at the best hospitals in Beijing cannot cure her ...  So now we are asking the world—can somebody help us?"

Somebody could.

The students, who described details of their friend's baffling symptoms, were soon flooded with 2,000 e-mail replies from physicians and researchers in 18 countries.

Less than three weeks after the computerized message-in-a-bottle was pitched into the electronic waves, a diagnosis was made and confirmed: Zhu Lingling had been poisoned by a heavy metal called thallium.

At a time when critics are bemoaning the proliferation of useless information and chatter in cyberspace, Ms. Zhu's case offers hope that the Internet's technology can harness worldwide medical resources to save more lives.

"Her legacy will be tremendous," said Dr. Rich Hamilton of the New York Poison Center, which already is planning its own World Wide Web site on the Internet to provide assistance to anyone who asks for it.

While issues about patient confidentiality, physician payment, and the ability to limit on-line access to health professionals have yet to be resolved, the possibility of rapidly transmitting information to a global audience for problem solving is tantalizing.

"Zhu's case has triggered something," said Li Xin, a graduate student in biomedical physics at University of California, Los Angeles. Li acted as go-between for American doctors and the parents of the patient, navigating through a sea of e-mail messages. "It will change the way medicine is practised."

A chemistry student at Peking University, Ms. Zhu was smart, successful and well-liked. In December of 1994, she began suffering from stomach pains and vomiting. Her hair began to fall out, leaving her bald within weeks.

Doctors had no answers for her, but a month later—again inexplicably—her hair grew back, and she recovered.

"After the second semester of school had started, on March 7, she got sick for the second time," said Dr. Daniel Valentino, Li's supervisor at the medical Imaging Division of UCLA. "She was admitted into the Peking University Medical Center and hasn't left since."

Once more, her hair fell out. She suffered dizziness and blurred vision, along with pain in her hands and feet. Soon the pain became a paralysis, spreading up her body to her diaphragm, preventing her from breathing on her own. She slipped into a coma on March 15.

Soon after her friends Bei Zhicheng and Cai Quanqing visited. Aghast at her condition, they turned to the Internet, an untried tool for emergency medical aid. Their electronic broadcast caught the attention of Li who, interested in the technology's potential for solving such unusual medical problems, assumed the role of detective.

Sifting through nearly half of the 2,000 responses, he found nearly 100 physicians and chemists who suggested thallium toxicity. He quickly transmitted the news to Ms. Zhu's friends, who in turn informed the Beijing doctors and the young woman's parents.

Specialists were brought in to test for the heavy metal. Urine, blood, spinal fluid, hair and nail samples were studied, and on April 28, the cause of her coma became clear.

"I got a call at 6 a.m. from Bei," Li said. "It was definitely thallium poisoning." She had nearly 100 times the normal amount of thallium in her blood, and 1,000 times more in her nails, he said.

"The hair loss was the big clue," said Dr. Hamilton of the New York City Poison Center, who had seen the message on the Internet. "Of all the possible heavy metal poisonings, thallium is distinctive because of that."

Dr. Hamilton used e-mail to advise Li, who passed along the information to doctors in Beijing. "It's not surprising the doctors there didn't think of thallium toxicity." Dr. Hamilton said. "There have only been sporadic reports of it."

After making the diagnosis, the next step was to find a treatment. All the toxicologists Li consulted—from Los Angeles to Colorado to New York—agreed: Ms. Zhu must be given a dye called Prussian blue, commonly found in chemistry labs.

Thallium molecules are trapped in the dye, and when Prussian blue is excreted from the body in urine and feces, so is the thallium. Dialysis would help the process along, cleaning the blood of the heavy metal.

By May 3, Prussian blue was being fed to Ms. Zhu through a tube in her nose. The thallium began to leave her body, along with the brilliant blue dye. At one point, even her perspiration was blue. As her thallium levels dropped, she began to get better.

"On May 30, she showed the first sign of some neurological recovery," Li said. "Her parents stood close to her bed, and her blood pressure and pulse went up. They went down again when her parents left. She was excited." Ms. Zhu remained in the intensive care unit until June 8, when she was moved to a regular ward because she finally could breathe without the help of machines. And now Beijing doctors still are using Prussian blue to clear the last of the thallium out of her system.