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Diagnosing some very, very old patients

New ACP book "Post Mortem" solves historic medical mysteries

By Stacey Butterfield

Whenever Philip A. Mackowiak, MACP, holds a clinicopathological conference, his case histories attract more than the usual clinical interest. From diagnosing post-traumatic stress disorder in Florence Nightingale to uncovering the cause of Beethoven's hearing loss, Dr. Mackowiak, a medical historian, applies his medical expertise and historical scholarship to the undiagnosed illnesses of famous historical figures.

Post Mortem: Solving History's Great Medical MysteriesIn his new book, "Post Mortem: Solving History's Great Medical Mysteries," Dr. Mackowiak shares his intriguing findings with the general public. The book, recently published by ACP, includes case histories of Alexander the Great, Joan of Arc, and Edgar Allan Poe, among others. Dr. Mackowiak launched the book during a "Meet the Author" session on Friday afternoon.

The book's cases are adapted from annual Historical Clinicopathological Conferences, hosted by Dr. Mackowiak since 1995. The conferences, which are held at the University of Maryland Medical School in Baltimore, have attracted a range of attendees, from physicians and historians to high school students. The cases reflect "a unique approach to history in which the medical disorders of important historical figures are dealt with as something more than a footnote to their lives-illnesses which in many instances profoundly affected not only the lives of these famous patients but also their legacies," said Dr. Mackowiak.

The book's conclusions may surprise some clinicians and historians-in five of the cases, Dr. Mackowiak advocates entirely new diagnoses, including hypertension as the cause of Booker T. Washington's death. He also examines questions like these: Did Egyptian pharaoh Akhenaten really look like a "humanoid praying mantis"? Why did Joan of Arc hear voices?

The book devotes significant attention to the lives and accomplishments of its subjects, while working within the standard format of a clinical case presentation. For each patient, the history of the illness in question is given first, followed by the subject's past medical history, social history, family history and physical examination, based on historical records.

The book gives a thorough overview of historical situations, while bringing the subjects to life with vivid details about their lives and illnesses. In his analysis of the Roman Emperor Claudius, for example, Dr. Mackowiak writes, "he gave Rome enlightenment, justice and hope, and also trammeled her with barbarism, corruption and despair" but later explains, "While emperor, he suffered only from attacks of heartburn…he hardly ever left the dining room until both stuffed and soaked."

Dr. Mackowiak spent more than 10 years researching the histories of the patients in the book, collecting historical information about symptoms and past attempts at diagnoses. "In virtually all of them, I would like to have had more information," said Dr. Mackowiak. However, he added, "I believe they each contain enough clinical information to diagnose the mysterious disorders of these 12 famous patients with reasonable certainty."

In addition to thorough research, Dr. Mackowiak bases his answers on his own expertise as an internist specializing in infectious disease, particularly fever, infections, and epidemiology.

He worked as an epidemic intelligence officer with the CDC before joining the faculty of the University of Maryland School of Medicine. Dr. Mackowiak is the author of more than 150 articles and editorials as well as the book "Fever: Basic Mechanisms and Management." He is receiving a Mastership from the College at Internal Medicine 2007.

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