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The case is a 40-year-old man who was brought to the emergency room in early October for evaluation of lethargy and confusion. He was traveling from Richmond to Philadelphia when he became ill and was found unconscious under the steps of the Baltimore Museum on Baltimore Street in the late afternoon. He was apparently well when he left Richmond at 7 AM. There was no evidence of trauma, and the patient did not smell of alcohol. History. This man worked as a writer. He had no known allergies, coronary artery disease, diabetes, or other systemic illness, and was taking no medication. He had had cholera three months before the current hospitalization. In addition to a history of depression and possibly of opiate abuse, he had a history of alcohol abuse. However he had abstained from drinking for the past 6 months and there was no reported history of seizures or delirium tremens. The patient smoked tobacco on a regular basis and was sexually active with women. There were no known pathologic work exposures. Hospital course: The man was admitted to the hospital for observation. He was initially unresponsive and remained so until approximately 3 AM, when he developed tremulousness and delirium and began having visual hallucinations. He was noted to be drenched with perspiration and to have wide variations in his pulse rate. He remained in this state for the next 28 hours. Early in the morning on the third hospital day, he became tranquil. Results of a physical examination showed a well-developed white male who was calm and appropriate. His skin was warm and diaphoretic. His pulse rate was in the 50s and “thready.” Results of a neurologic examination showed the patient was alert, oriented, and appropriate. There was no tremor and he followed commands appropriately. The patient said he felt “miserable,” but denied specific pain. He did complain of mild diffuse abdominal discomfort and headache. He had no recollection of how he had arrived at the hospital or of the events leading up to his illness. Because of his improving status, he was transferred to the ward room. Here, his physicians attempted to treat him with alcohol, which he vehemently refused to drink. He soon worsened again and by the evening of the third hospital day, his mental status became clouded. He was noted to have shallow, rapid respiration and diffuse weakness. He drank water only with great difficulty. By late evening, he was again delirious, became combative, and required restraint. He remained in this state, calling out for family and friends, until his death on the fourth hospital day. Differentials, gentlemen? So what do you think ultimately happened here and who is this? If you know me well enough, it won’t surprise you to hear that according to the decor of my house, I think it should be Halloween all year long. So as much as I wanted to save this story for October, I thought it was as good a time as any to discuss the mysterious death of Edgar Allen Poe as it pertains to medical history. Do either of you know how he may have died off the top of your head? I’m not the first to do this sort of case study thing. In fact, the case I gave here was entirely excerpted from a pathology conference that took place in 1996.
A little background on Edgar. Born in Boston in 1806 and did a bit of writing in his life. He also spells his middle name “Allan” with an A in the middle which is weird to me for some reason. Nevertheless, Poe is a huge figure in American literature. He’s associated with macabre fiction and some consider him to be the founder of the detective genre. He’s a notable short story writer and poet but have you even read and appreciated his literary criticism? My inner English-major literary critic and pedantic self would point out that his fiction, though iconic, is a bit formulaic in execution. But that doesn’t matter because he nailed it as far as creating a whole mood of writing that young angsty me and all of my fellow English-major nerdy goth friends will always have a fond place for the Raven and the Telltale Heart because it’s just so good. How could it not be? He was the child of two actors making him an ultimate theater-kid. Notably his father abandoned the family when Poe was 4 years old and his mother died from tuberculosis when he was 5 years old. An uncle ultimately raised him and gave him the official name “Edgar Allen Poe” because he would have been otherwise called just “Edgar Poe” and “hello, my name is Ed Poe” just wouldn’t carry the same literary weight. Many people also know some of the salacious things about EAP. Like, say, that he married his 13 year old cousin which–I know it was a different time–but all of that just seems skeezy. He dallied around in some college at the University of Virginia and eventually dropped out of West Point, turning his career to writing and the rest was history. So here’s the historical account of EAP’s demise. On Sept. 27th, 1849, Edgar traveled from Richmond, VA to Philadelphia where he was supposed to arrive to critique the poetry of Marguerite St. Leon Loud, a writer who has four names and punctuation within their name and writes poetry, a statement of fact that can be a joke in and of itself. He takes the train which passes through Baltimore. He was supposed to continue on to New York after all of the difficult poetry critiquing, but he did not make it because of dying in Baltimore. In his personal life, aside from having a creepy if not criminal marriage, Poe has been described as having an on and off relationship with Laudanum–the opium alcohol mixture so popular among people of the time. If you enjoyed the series, Deadwood–and you should have–you will be familiar with this medication and its abuse potential. You will also be benumbed to lots of old west swearing. There are varying accounts as to whether Poe was a drinker. Nothing seemed to suggest a heavy alcohol problem in terms of volume, but rather that he (and his sister oddly enough) may have been very sensitive to alcohol, being described as appearing heavily intoxicated and ill after a single drink. For some reason he would do that on occasion but apparently had joined the Sons of Temperance movement just prior to his death. They were not known for wild parties I would like to point out. So Poe arrived in Baltimore on Sept 27th and goes missing for a week. Nobody sees him. Then on the evening of October 3rd, 1849, a guy named James Walker happens to be standing on the street when he comes across a disheveled man in ill-fitting clothing lying in the gutter. Walker is like, “Oh, that’s Edgar Allen Poe” and he doesn’t look too good, I’d better get help.” Help comes in the form of dispatching a letter–albeit with most haste–that same evening. 911 or a true sense of medical urgency had not been invented yet. Walker, finding Poe in bad apparent shape, asks if he knows anyone in Baltimore and Poe gives him the name “Snodgrass.” Though Poe appeared to be altered or in some sort of stupor, that was actually a real name for Joseph Snodgrass (who, some articles suggested, was a physician as well as a magazine editor familiar with Poe). Snodgrass receives the following letter: Baltimore City, Oct. 3, 1849 Dear Sir, There is a gentleman, rather the worse for wear, at Ryan's 4th ward polls, who goes under the cognomen of Edgar A. Poe, and who appears in great distress, & he says he is acquainted with you, he is in need of immediate assistance. Yours, in haste, JOS. W. WALKER To Dr. J.E. Snodgrass. So EAP ends up in the hospital as per the case in the beginning and ultimately dies. There are many theories which we’ll talk about. Trauma or Assault? Finding a guy disheveled and altered in a gutter could certainly mean trauma. This is as true today as it was in 1849. One theory were that he could have been the victim of some unspecified “ruffians” in the streets of Philadelphia. Today those ruffians are known as the “two dudes” who roam around the streets causing all manner of trauma on unsuspecting people who definitely are telling the truth about what they were doing. None of the accounts I found suggested any outward head trauma stuff but certainly other areas of injury might be possible. There was also a book suggesting that Poe was murdered by the brothers of his wealthy fiancee, Sarah Elmira Shelton that he was going to apparently marry after some point, but he was still married to his cousin, Virginia–I don’t know all the details here, nor do I care to. Apparently the brothers of the new fiancee were not happy and may have murdered him somehow by making him drink or whatnot. Not a lot of support for this one but it’s salacious so why not consider it? Alcohol or Substance Related? We mentioned that Poe had an intermittent relationship with alcohol and this was suggested as an issue on and off in his life. Again, he seemed to be unable to tolerate small amounts. When he disappeared for a week, some stories suggested he may have met up with some old friends and gone out drinking before reappearing in bad shape. Some of these articles suggested the theory that he was encouraged to drink enough to die. It’s mentioned that he’s sensitive to alcohol and there are conditions such as alcohol dehydrogenase deficiency–indeed genetic–that could make one become very ill or intoxicated out of proportion to their intake, but it typically takes large amounts of alcohol quickly to die from so-called alcohol poisoning. Mixing alcohol with laudanum could certainly kill somebody, but this would be in the form of respiratory arrest, not days of stupor and intermittent hallucination. This theory was also perpetuated by Snodgrass, his editor after Poe’s death. Snodgrass was a member of the temperance movement and suggested binge drinking was at play. Interestingly some forensics were done on Edgar by sampling his hair for heavy metals–lead was a common contaminant in wine and alcohol at that time and collected in hair. Many think Snodgrass had it out for Poe in a sort of self-promotional self-righteous way. Not cool if true. Voter Fraud? A subset of the trauma / assault theory is that he may have been a victim of voter fraud in a practice called “cooping.” Philadelphia politics were rough, it seems, back then. Probably still are–I’ve never voted there. Apparently there were roving gangs (ruffians or otherwise) that would kidnap people, force them to vote, change their clothes, force them to vote again with a forged identity, and repeat the process with intermittent forcing of alcohol. Where Poe was found was apparently outside a polling station on Election day. This was–and perhaps still is–a leading theory to explain his death, including his 1870’s biographer, J.H. Ingram. Given his suspected low tolerance for alcohol, perhaps there’s something here? Brain Tumor? This theory has my favorite supporting evidence–not because it’s true, necessarily, but because it’s got a dark Naked Gun kind of flair to it. 23 years after Poe’s death they want to put a statue there at his grave so they decide to move the body. When they dig up the coffin and lift it, apparently it falls apart due to decay. Poe’s body is similarly in bad shape and when his skull falls out, a worker commented that it’s as if he heard or felt a lump of something rolling around inside it. While some newspapers at the time said it was his brain, 23 years later it was definitely not brain tissue. It could have been a calcified tumor, however. Not sure a brain tumor would explain the entire story and it’s pure speculation at this point because nobody, as far as has been said, wanted to open up the skull at the time. I would have wanted to, but I’m a weird guy. Also possible he did have a brain tumor that had nothing to do with any of this. Flu? His official diagnosis was reportedly “phrenitis”. The Phren prefix refers to “mind”. So that’s mind-itis. I want to write that in a chart. We don’t use this term anymore and would now probably refer to the symptoms of phrenitis as encephalitis or meningitis. This is often due to infection–be it viral or bacterial–and means inflammation of the brain, the lining of the brain, or both in the case of meningoencephalitis. It’s a bad thing, medically speaking. This raises the question as to whether Poe might have had symptoms of brain inflammation–probably more akin to encephalitis which tends to give people altered sensation or hallucinations or both. What could do this? A helluva lot of viruses both common and rare. October is the beginning of flu season so some speculation is that he may have developed influenza related encephalitis and pneumonia. Apparently in Richmond, before leaving for Philly, he did visit his doctor complaining of illness. The Smithsonian magazine quoted that “His last night in town, he was very sick, and his [soon-to-be] wife noted he had a weak pulse, a fever, and she didn’t think he should take the journey to Philadelphia.” She was probably also worried about ruffians. So if he did have influenza and pneumonia, he might have been septic. A high fever could give you hallucinations and brain swelling–encephalitis–can make you seem to go in and out of consciousness and whatnot and can certainly lead to death. It does not make you wear other people’s clothes, however. Rabies: Returning to that pathology conference, Dr. Benitez hypothesized that this may have indeed been rabies encephalitis. Noting there was no animal encounter in the story, there is not always one mentioned. Just waking up in a room with a bat is indication to give someone rabies prophylaxis injections because often a bite from a rabid bat may not be visible, nor felt. For the record I think bats are super cute and I enjoy watching them do bat things from my porch, but I do not invite them into my home for this reason. The other scary thing is that rabies is a very, very slow moving virus. If bitten in an extremity, the virus, which gets absorbed into the skin and makes its way to the nervous system, can take up to a year to appear with symptoms–at this point it has traveled super slowly from the nerve in the arm or leg into the brain. With modern medicine, the first person to survive rabies did so in 2004. We should probably save that story for a future episode, but I can’t resist pointing out that she was saved by a treatment plan now called “the Milwaukee Protocol.” Milwaukee brought you Pabst and survival from rabies. You’re welcome. Poe had many of the symptoms of rabies including lethargy, confusion, a waxing/waning sort of downward spiral, and as was mentioned, there was perhaps some difficulty taking fluids and water. Those infected with rabies have severe pain with swallowing and often are salivating because they can’t even swallow their own spit. That spit is rife with rabies virus as well so a bite from an animal perpetuates the horror of this illness. So that is the story of Edgar Allan Poe and his suspected actual cause of death, probably because there was no autopsy and this happened a long time ago. Sources: https://blog.oup.com/2014/10/edgar-allan-poe-death-diagnosis/ https://archive.hshsl.umaryland.edu/bitstream/handle/10713/6824/EdgarAllenPoe_1995.pdf?sequence=1&isAllowed=y https://cvm.missouri.edu/quoth-the-raven-it-was-actually-rabies/ https://www.smithsonianmag.com/history/still-mysterious-death-edgar-allan-poe-180952936/ https://www.biography.com/authors-writers/edgar-allan-poe-death https://www.mdhistory.org/here-at-last-he-is-happy-the-death-and-burial-of-edgar-allan-poe/ Max Doctor with a mustache.
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Mary Mallon was born in 1869 in Cookstown, County Tyrone, in what is now Northern Ireland. She emigrated to the United States at the age of 15, a common choice for women like her in the late-1800s. After living with her aunt and uncle for a time, she eventually settled into her career as a cook for wealthier families. Over the course of seven years, Mallon worked as a cook for eight affluent families in the New York City area. This was a good job for someone in her position as it would have paid far more than, say, being a maid or laundry worker. Mallon never showed any signs or symptoms of illness, but over the years of her employment, seven families she worked for contracted typhoid fever. A deadly pattern formed. Mallon would move into a new household, and within a few weeks of her arrival, people would be seriously ill with typhoid fever. 1906: multiple ill people with typhoid in a house in Long Island. Long island public health could not identify the cause of the outbreak so the homeowner hired George Soper of New York's health department. Mary Mallon had just started working as a cook for the family 3 weeks prior to the outbreak. Soper looked at the files regarding outbreaks and noticed that Mary Mallon worked at each of the houses and the outbreaks started shortly after her arrival. She refused to wash her hands while cooking because she "didn't see the point". Soper went to the house to tell Mallon about his findings and offered her free medical care and asked for samples for testing. She chased him out of the house with a rolling pin. Soper sent a medical team to the house and she fled. Police searched for her for 3 hours. At this point she had infected 22 people and one little girl had died from the infection. Soper offered to release her if she had her gallbladder out or stopped working as a cook. She refused both and was labelled a "menace to society". She was banished to Riverside Hospital for Communicable Diseases on north brother island to live in solitude. She was there for 3 years and was ultimately released by a new health comissioner after many failed legal attempts. She eluded authorities for 5 years and continued to cook. She was found cooking at Sloan Maternity Hospital in New York where 25 new cases of typhoid fever had been reported. She was sent back to North Brother Island where she spent the rest of her life. She died on 11/11/1938 after 26 years of forced isolation. She infected 51 people, 3 of whom who died. By the time she died New York health officials had identified more than 400 other healthy carriers but no one else was forcibly confined. Sources: - Journal Article: The Sad and Tragic Life of Typhoid Mary - Wikipedia: https://en.wikipedia.org/wiki/Mary_Mallon - The Story of Typhoid Mary is Way Sadder Than You Think - PBS (NOVA) Documentary on YouTube: Typhoid Mary: The Most Dangerous Woman Dr. Mike (aka Dr. Provolone) |
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