Whether it is a mysterious fever or sudden incapacitation – even today, diagnosing quite what has carried someone off can leave doctors scratching their heads. But every year a group of academics gather to embrace an even tougher challenge: casting a verdict on how and why some of the most famous names in history died. From Florence Nightingale to Charles Darwin, and from Lenin to Cromwell, academics have pored over the historical accounts to scrutinise treatments and in some cases offer up a cause of death.
Now experts have turned the spotlight on the 12th-century sultan and nemesis of the crusaders, Saladin, to reveal the cause of the Kurdish military hero’s demise at the age of 56 in 1193 AD. “It’s difficult to work it out because there is essentially no information – there are no tests and the historical accounts are a little questionable, and there isn’t much anyhow,” said Dr Stephen Gluckman, professor of medicine at the University of Pennsylvania School of Medicine, noting there are only a few fairly reliable details – including the two week duration of Saladin’s illness. The case is the latest to be raised at the annual meeting of the Historical Clinicopathological Conference in the US. “Nobody else does anything like it, as far as I know. It’s unique,” said conference director Dr Philip Mackowiak of the University of Maryland, adding that the conference brings together academics from across medicine and the arts. The goal, he says, is to teach the history of medicine and educate trainees on principles of diagnosis. “And number three is entertainment,” he said. While historical accounts describe how Saladin’s final illness involved sweating, attacks of “bilious fevers” and headaches, quite what the cause of the sickness was has long been a matter of debate, with suggestions including tuberculosis meningitis. Now Gluckman, who was asked to examine the case, says he’s weighed the evidence, and the concluded the culprit was the bacterial infection, typhoid. “It is based on what the common diseases were at that time, and of those who were fatal, and of those, which were fatal in a period of around two weeks,” said Gluckman, adding typhus is another possibility. But the diagnosis is not without doubt. Mackowiak admits that there is no evidence Saladin had abdominal pains – a common symptom of typhoid – but said the historical record is written by non-medical people, and often after the event. Dr Tom Asbridge, a medieval historian from the Queen Mary University of London, who will give a lecture at the conference on Saladin’s successes at the battle of Hattin and re-capturing Jerusalem, said the sultan’s death might have scuppered plans for a pivotal campaign. “If you see it from the perspective of the Muslim world, [Saladin’s] death is quite tragic because he fought long and hard and in a very committed manner through what we call the third crusade… and that’s the crusade that is led by none other than the new king of England, Richard the Lionheart,” he said.
Among previous figures to have their deaths scrutinised at the conference is Florence Nightingale who spent decades in poor health before her death at the age of 90. While there have been rumours the mysterious malady was syphilis, others have categorically ruled it out. “There is no justification for that diagnosis, her symptoms were not in any way consistent with syphilis,” said Mackowiak. “Her severe disorder cleared up on its own after for 30 years wreaking havoc physically and psychologically – and as far as I can tell she never had a sexual relationship with anyone,” Mackowiak says it is likely Nightingale had four conditions: bipolar disorder, the bacterial infection brucellosis – then known as Crimean fever – as well as post-traumatic stress disorder, and, later on, dementia.
Abraham Lincoln’s death from a bullet fired by the actor John Wilkes Booth has also been examined. “The question was if Lincoln had been shot [in 2007], how would he have been treated by our current shock trauma units…and what would the likely outcome have been,” said Mackowiak, noting that the conclusion was that Lincoln would have survived and, possibly been well enough to continue as president. But ultimately, says Mackowiak, the conference is not about offering a conclusive diagnosis. “I couldn’t say that any of the cases that we have discussed, and this is the 25th, are closed, because we don’t have any definitive test results for obvious reasons,” he said.
Credit: Nicola Davis for The Guardian, 5 May 2018.