The 29th Historical Clinicopathological Conference
An American Colossus
On Thursday, December 12, 1799, the patient rode out on horseback to his farms in weather marred by rain, hail and snow. When he returned 5 hours later, he was wet with snow hanging from his hair and came to dinner without changing his clothes. Nevertheless, he appeared well when he retired for the evening.
The next morning the patient complained of a sore throat. Though a heavy snow had fallen overnight, he went out again in the afternoon to mark some trees he intended to have cut down. By then he had become hoarse but made light of it. When he was urged to “take something to remove his cold,” the patient replied: “You know I never take anything for a cold. Let it go as it came.”
Between two and three o’clock on Saturday morning the patient awoke feeling “very unwell.” He could barely speak and was having difficulty breathing. When offered a mixture of molasses, vinegar and butter to sooth his throat, he ”could not swallow a drop.” At the patient’s request, one of his overseers, removed approximately a half pint (250 ml) of blood from the patient’s arm.
A physician arrived between 8:00 and 9:00 am, examined the patient, and placed a blistering agent of cantharides (Spanish fly) on his throat. He then took some more blood from the patient (amount not specified) and ordered a gargle of vinegar and sage tea (which the patient was unable to tolerate) along with a mist of vinegar and hot water. Two hours later, the patient was bled again (amount not recorded) to no effect. A clyster (enema) was administered at noon, which produced an evacuation but no improvement in the patient’s symptoms.
Two additional physicians arrive, and after consulting with the first, bled the patient a fourth and final time [the amount reported as 32oz [960 ml)]. This time, according to a witness, “the blood came very slow, was thick, and did not produce any symptoms of fainting.” The patient could now swallow. Calomel & tarter emetic were administered without apparent effect. One of the physicians suggested opening the patient’s trachea to relieve his respiratory distress, but was over-ruled by his two older associates, who deemed the procedure too risky. Meanwhile, the patient told his doctors: “I believed from my first attack that I should not survive it.”
At 8:00pm, “blisters and cataplasms (dressings) of wheat bran [were applied] to the patient’s legs and feet.” Between 10:00 and 11:00pm, his “breathing became easier; he lay quietly…felt his own pulse and died.” He was 67 years old. His physicians diagnosed his fatal disorder as cynanche trachealis (inflammation of the tonsils, throat and/or trachea).
The patient’s enjoyed excellent health throughout his life, except for his final illness and the disorders summarized in the following table:
Table. The Patient’s Illnesses Prior to His Final One
1The duration of the patient’s dysentery suggests that he was infected with an intestinal pathogen capable of causing chronic recurrent colitis – possibly Entamoeba histolytica. One of the physicians who cared for him during his final illness, treated the dysentery with bleedings and Dr. James Powder (antimony).
2The abscess was deep and fast growing. Incision and drainage produced pus and dead tissue.
3Whatever the original illness, this one was complicated by tachypnea, chest pain and hemoptysis.
4This abscess appeared at the same site as the one of 2 years earlier and produced pus when lanced.