Book Review

Post Mortem: Solving History's Great Medical Mysteries

N Engl J Med 2007; 357:949-950August 30, 2007

Article

Post Mortem: Solving History's Great Medical Mysteries
By Philip A. Mackowiak. 350 pp., illustrated. Philadelphia, American College of Physicians, 2007. $29.95. ISBN: 978-1-930513-89-1

Christopher Columbus returned to Portugal from his epic sea voyage with a cabin full of parrots. Perhaps one of them was infected with the bacterium Chlamydia psittaci and passed it on to Columbus, causing the reactive arthritis that afflicted the explorer from 1493 onward. If Columbus had been a carrier of the HLA-B27 cell-surface protein, he would have been susceptible to the disease. Not only would HLA-B27 account for the arthritis, but it might also reveal the location of Columbus's origin. At least, that is what Philip Mackowiak, the author of this fascinating book, believes, and he comes up with a more likely birthplace for Columbus than the accepted one of Genoa, Italy.

Not all the cases in Post Mortem are analyzed in as much depth as Columbus's illness because there is often little documentary evidence on which to base a diagnosis. No case is more frustrating to medical historians than the death of Wolfgang Amadeus Mozart at the age of 35 years, at the height of his powers. To what did the great composer succumb? Mozart himself thought he had been poisoned by arsenic; others have suggested mercury. In my own book, Elements of Murder: A History of Poison (New York: Oxford University Press, 2005), I argue that antimony was the cause of death. Mozart was a known user of tartar emetic (antimony potassium tartrate), which was regarded at the time as a cure-all. Mackowiak favors poststreptococcal glomerulonephritis on the basis of the composer's edema and unbearable body odor. He may be right. I enjoyed Mackowiak's use of musical metaphors to describe the development of the illness.

When Mackowiak turns to the lifelong illness of another great composer, Ludwig van Beethoven, his diagnosis again conflicts with mine. I believe that Beethoven died of chronic lead poisoning, on the basis of the high levels of lead that were found in samples of his hair. Mackowiak opts instead for syphilis, and indeed his reasons for this are well argued and convincing. I suspect that the composer suffered from both afflictions. This is the longest chapter in the book, reflecting as it does the difficulties of making a diagnosis, even when a patient's life is well documented.

Other well-documented chapters are devoted to Edgar Allan Poe and Florence Nightingale. Poe's early death is ascribed not to rabies, as some have speculated, but to intake of alcohol that was so excessive it caused repeated bouts of delirium tremens. Nightingale suffered greatly until old age, when she became relatively healthy. Her illness during the Crimean War, when she cared for sick soldiers at the front, is attributed to brucellosis she contracted from consuming goat's meat and milk products. But Mackowiak argues that the illness that troubled her for the next 30 years was post-traumatic stress disorder, and he thinks she may also have had bipolar disorder.

The final chapter is an examination of the death of Booker T. Washington, who was born into slavery and who was admired for his devotion to improving the lot of blacks. Investigations into the cause of his death have been helped by the publication of his medical records from the time just before his death, when he consulted leading New York physicians. His death was caused by severe hypertension (his blood pressure was 225/145 mm Hg) that had affected his kidneys, heart, and brain. What caused such high blood pressure? Mackowiak thinks that Washington's race, high intake of salt, and early social environment were to blame.

Not all the subjects Mackowiak pores over can be diagnosed so authoritatively, and in this respect the deaths of the Egyptian pharaoh Akhenaten, Pericles of Athens, Alexander the Great, and King Herod the Great clearly posed problems. Nonetheless, Mackowiak comes up with reasonable explanations. Post Mortem is an enjoyable read, and I look forward to a possible sequel; the illnesses of King George III, Napoleon Bonaparte, Charles Darwin, President Zachary Taylor, and even Adolf Hitler deserve the Mackowiak treatment.

John Emsley, Ph.D.
University of Cambridge, Cambridge CB2 1EW, United Kingdom
johnemsley38@aol.com