2009

16th Annual CPC

John Paul JonesThis patient is credited with having given the U.S. Navy “its earliest traditions of heroism and victory.” He was born in Kirkbean, Scotland, in July 1747, went to sea as an apprentice at the age of 13, and spent the next three decades “riding the whirlwind and directing the storm” of a life aboard sailing ships. As far as we know, he was in good health until age 26, when a severe fever sent him to bed for 16 days and left him “much reduced.” He recovered, and except for psychological highs and lows bordering on manic-depressive disorder, which troubled him throughout his life, seems to again have been well for seven years.

At age 33, after many months at sea, the patient complained of eyes so sore he was almost blind and for a time so incapacitated he was unable to visit friends on shore. His behavior then was “Qweeg-like, suspicious and slightly dotty,” and though only in his 30s, he felt like an old man. Three years later, during service in the West Indies, a severe attack of “tropical fever” caused him to travel to a Moravian sanatorium in Bethlehem, Pennsylvania, for “cold bath” treatments, which seem to have cured him. He had had similar illnesses previously. However, nothing more is known of their character or treatment or at what ages they occurred.

At age 41, the patient developed “bronchial problems” during a grueling overland trip from Hamburg to Copenhagen under extremely cold conditions in an open carriage. From Copenhagen, he traveled to St.

Petersburg through ice floes in a small open boat to take command of a Russian fleet, arriving exhausted, sick, and depressed. The illness lingered on for months. Although its specific characteristics are unknown, it is believed to have involved the lungs, in that afterwards, the patient had a persistent “hacking cough” and “gray visage.”

Not much is known of the patient’s family history. His father worked as a landscaper, his mother as a housekeeper. He had an older brother (a tailor) who died at age 36 of unknown cause. Two sisters survived him. Nothing is known of their medical histories.

At the height of his career, the patient was one of America’s most celebrated naval commanders. Although an aggressive captain of military vessels, he was never wounded in battle. He was well-proportioned, though small of stature (5’5″), with a handsome face, soft voice, easy, polite manner and a fertile mind. He never married and had no known offspring. His social life consisted of a tangle of love affairs involving myriad women ranging from prostitutes to grand dames. He avoided hard spirits but “in good weather” would drink three glasses of wine after dinner.

Shortly before his 45th birthday the patient’s physical decline accelerated with mounting anorexia, yellowing of his skin, and swelling of his legs and abdomen. He coughed constantly, producing much mucus and complaining of difficulty breathing. He died alone in his room two weeks after his 45th birthday, face down on his bed with feet on the floor. The cause of death listed on his burial certificate was “dropsy of the chest.”

His body was pickled in alcohol, placed in a lead-lined coffin and interred in a Protestant cemetery at the outskirts of Paris. An autopsy performed 113 years later showed only a “spot” in the left lung consistent with healed bronchopneumonia (devoid of tubercle bacilli) and shrunken kidneys, which on microscopic examination contained numerous fibrotic glomeruli and thickened arterioles. The heart, liver, spleen and gall bladder were normal.


2009 Participants

Matthew R. Weir, MDMatthew R. Weir, MD, is professor of medicine at the University of Maryland School of Medicine as well as attending physician and director of the division of nephrology, department of medicine, at the University of Maryland Medical System. His primary research interests include the use of antihypertensive therapy for the treatment of diabetic nephropathy, hypertensive renal injury in African Americans, and preventing allograft nephropathy in transplant recipients. He has written more than 400 manuscripts and book chapters about these topics and has edited two books, Medical Management of Kidney Transplantation and Hypertension. Dr. Weir earned his medical degree from the University of Virginia, completed his internship and residency training in medicine at the Waterbury and Yale-New Haven Hospitals in Connecticut, and received nephrology training at the Brigham and Women’s Hospital, Harvard Medical School, in Boston. He has been a member of Maryland’s faculty since 1983.

Lori Lyn Bogle, PhDLori Lyn Bogle, PhD, is an associate professor of history at the United States Naval Academy in Annapolis where she teaches a variety of courses on social cultural military topics. She received her BA from Missouri Southern State College in 1991 and a PhD from the University of Arkansas in 1997. Her first book, The Pentagon’s Battle for the American Mind: The Early Cold War (2004), examined the military’s traditional role in establishing and maintaining the contours of the American character and will. That study led to her current monograph, Selling the Navy on Theodore Roosevelt’s use of publicity and modern sociological principles to convince the American public of the need to acquire an offensive fleet (Texas A&M Press pending publication). She has written numerous articles and has edited a five volume collection of essays on the cold war.

Final diagnosis