The 30th Historical Clinicopathological Conference

This Years Event

Last Repast
May 3, 2024 | 1:30pm
Davidge Hall


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The 2024 Program

Our annual conference is devoted to the modern medical diagnosis of disorders that affected prominent historical figures. Below is the case presentation for this year’s program.

The 30th Historical Clinicopathological Conference

Last Repast

This patient is revered for having fomented a religious revolution against the dominant religious tradition of Brahmanism. He rejected the caste system, sacrifices, and the authority of the Vedas. He promoted moral enlightenment through selfless endeavor. His gospel continues to resonate with millions throughout the world today more than 2,000 years after his death. It advocates a comprehensive love for all creatures intertwined with a belief in reincarnation. It stresses a “Middle Way” between a life of indulgence and one of harsh austerity in developing understanding in religious as well as secular matters through personal experience.

The patient was born in the Terai lowlands of India, near the foothills of the Himalayas, during the 6th century B.C.E. His people were members of the Gotama clan of the Sakya tribe. Tradition has it that his family belonged to the second of the four Indian castes—the aristocratic warrior caste known as the khattiyas. However, some scholars doubt that a caste system actually existed among the Sakya during the patient’s day.

Only fragments of the patient’s life were recorded for posterity. In fact, no attempt was made to piece together the details of his life story into a continuous narrative until more than 400 years after his death. Moreover, the first narrative, as well as other later versions, are embellished with fanciful details that make it difficult to separate fact from legend. Nevertheless, certain key elements of the patient’s life and medical history are reasonably well established.

He is reported to have been extraordinarily gifted both mentally and physically, excelling in subjects and activities as diverse as mathematics, wrestling, poetry, archery, and music. He had curly blue/black hair with a snow-white tuft in the middle of his brow, a broad, smooth forehead, and a prominent lump jutting out of the front of his skull. His eyes were black, his teeth perfectly white and 40 in number. His chest and shoulders were broad and his skin soft and golden. His arms reached to his knees when he stood erect. His fingers and toes were long and webbed, his nails rounded. He had a powerful gait with a tendency to veer to the right when he walked. On looking backwards, he would turn his whole body “as an elephant does.”

  In his youth, the patient sought spiritual enlightenment through extreme austerity as a means of subduing his appetites and passions. First, he practiced breath control, holding his breath for longer and longer periods. Then he turned to self-mortification through an extreme fast, during which he consumed as little as one spoonful of bean soup a day for six years. Before abandoning the experiment, he was so debilitated mentally and physically that “when the sun fell on him, he did not move into the shade… [and had become] so weak, so feeble and thin that when they put grass and cotton in the openings of his ears, it came out through his nostrils.

Only fragments of the patient’s medical history are available for analysis. Reportedly, he was raised in a luxurious home by doting parents. Nothing is known of the health of his father, and of his mother, all we know is that she died of an unknown cause just seven days after the patient’s birth. 

As per the patient’s health as a youth, we know only that at some time during midlife, he was treated with “lotuses mixed with various medicines” for “a disturbance of the humours of his body.” On another occasion, he was treated for a backache thought to be the result of “an affliction of the wind.”

Presumably, his health was otherwise robust until the end of his eighth decade, when he became ill while preaching in far northeast India. One ancient source attributed the illness to a chronic gastric upset, possibly dysentery, but the precise details of disorder are long forgotten. Apparently, there was abdominal pain, the exact location of which is not recorded, so severe that that patient sensed his condition was terminal and predicted his demise exactly three months hence.

During the ensuing three months the patient traveled extensively, although at age 80, he complained of feeling like an old “worn out cart…that could only be kept going with much additional care.” Whether his symptoms recurred during that time, is not known. The onset of the final phase of his terminal illness began when a lowly metalworker prepared for him a meal consisting of sweet rice, cakes, and a quantity of sūkara-maddava  (variously translated as dried boars flesh, “pig’s delight,” soft rice, and an elixir). When the meal was served, the patient instructed his host to serve the sūkara-maddava to him alone, which he said only he could digest, and to bury in a hole any of the dish that was left. As soon as the patient had eaten, he became violently ill with sharp abdominal pain reminiscent of his prior episode of “dysentery.” Although apparently “conscious and awake” he was unaware of his surroundings and appeared exceedingly pale. He walked to a nearby river where he bathed and drank. Feeling exhausted, he laid down on his right side and progressed through the four stages of deep meditation before dying on precisely the day he had predicted three months earlier.


Colleen Christmas, MD

Eyal Aviv, PhD