Back to Front PageVOLUME 6, NUMBER 4

Clinical Detectives Uncover History’s Medical Mysteries

By Barbara A. Gabriel

An actor portraying the Roman Emperor Claudius is interviewed about the circumstances surrounding his death at the University of Maryland School of Medicine’s annual clinicopathological conference.

Philip A. Mackowiak, M.D., has always been interested in history. "Past is prologue; knowing where you’ve been helps you better understand where you are," says Dr. Mackowiak, professor and vice chair of medicine at the University of Maryland School of Medicine and director of medical care at the VA Maryland Health Care System. He also believes that studying medical history can serve as a good reminder that medicine is not all science and technology. "To be an effective physician, one has to understand the social and cultural milieu from which one’s patients come."

Dr. Mackowiak combined his interests while planning the annual clinicopathologic conference (CPC) sponsored by the University of Maryland School of Medicine and the VA Maryland Health Care System seven years ago. After reading a description of Edgar Allan Poe’s final illness, he realized that although there was much information on Poe’s medical history, the cause of his death had never been determined to everyone’s satisfaction.

Dr. Mackowiak decided that putting together the medical case history of this colorful literary figure would add to the intrigue of the school’s traditional CPC, in which an unknown subject’s problematic case history is presented to a clinician who works on the case and then makes a presentation in which he or she announces a final diagnosis.

As he prepared the medical case history of Poe, Dr. Mackowiak added to the traditional program a performance by an actor portraying the writer, who was interviewed about his habits and medical problems. The clinician’s unexpected diagnosis — rabies — captured the imagination of the general public. Major news outlets picked up the story, and a question about the diagnosis even made the television show "Jeopardy." "As a result of that conference, we entered into a new theory about Poe’s final days," Dr. Mackowiak says.

Poe was followed by CPCs on Alexander the Great (typhoid fever); Beethoven (syphilis); General Custer of the Battle of Little Big Horn fame (histrionic personality disorder); Pericles (typhus); Mozart (acute rheumatic fever); and, this February, the Roman Emperor Claudius.

It was Judith Hallett, Ph.D., professor and chair of the Classics Department at the University of Maryland and co-organizer of this year’s conference, who suggested Claudius. "I thought of Claudius because so many people are familiar with him and his neurological symptoms from the BBC series ‘I Claudius,’ " she explains. A victim of partial paralysis and a movement disorder, Claudius walked with a limp, drooled, and had trouble speaking clearly.

After the actor portraying Claudius was interviewed by the chief resident about his medical history and the circumstances surrounding his death at the age of 64 in 54 A.D., this year’s clinician concluded that the emperor’s demise was at the hands of his fourth wife, Agrippina, who fed him poisonous mushrooms to ensure that her son, Nero, would inherit the throne.

The conference also featured both historians and clinicians who put Claudius’ case in the context of his tumultuous family history. "Anyone studying the classics or medicine should remember that there’s a strong tradition of ancient medical diagnosis that we owe to the Greeks and Romans," Dr. Hallett says. "There’s a reason every physician takes the Hippocratic Oath."

So who’s up for the University of Maryland’s 2002 CPC conference? Dr. Mackowiak won’t offer any names, but he does acknowledge that every person examined thus far has been white, Western, and male. "We need more diversity in the conference, but constructing the case histories of historical figures who were not white or male has proven difficult due to a lack of information," he explains. "But I haven’t stopped trying."

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18 May 2001