Diagnosis of the Famous Dead: While most physicians devote their careers to the care of the living, some like to examine the medical mysteries of the past. History has left many medical questions, and not all the answers are clear.

One of the most intriguing historical medical mysteries is the cause of death of Herod the Great, the King of Judea. During his 36-year reign, he ordered the executions of one wife and three sons, and, according to the Bible, in an attempt to destroy the infant Jesus, he ordered the slaughter of the innocents. The historian Josephus described Herod's final illness as including muscular weakness, fever, intolerable itch, pains in the colon, ulceration of the intestines, bad breath, cough, and high-pitched breathing. Physicians have suggested that these symptoms could be caused by cancer of the intestine or pancreas, liver or kidney failure, diabetes, or sexually transmitted disease. The most recent attempt at diagnosis was presented in January 2003 by Dr. Jan Hirschmann, who suggested that Herod died of chronic kidney disease probably complicated by Fournier's gangrene (which results from an infection to the genitalia and the perianal region, usually due to bacteria and fungi).

Who, or what, killed Napoleon? In 1815, he was defeated at the Battle of Waterloo, and exiled to the island of St. Helena. His enemies, not wanting a repeat of his 1814 escape from exile on the island of Elba, concluded that he must die – but in a way that would appear to be from natural causes. Their plan was to administer several doses of arsenic.

In 1999, experts analyzed Napoleon's hair and concluded that he had been poisoned by arsenic. Since arsenic has a long history of use in medicine (it was used as a treatment for tuberculosis, syphilis, cancer, and other ailments), some physicians said that the arsenic in Napoleon's hair could be evidence of medicinal use, not poisoning. But the hair analysis showed periods of high doses, while medicinal use called for administration of tiny amounts. Still, other physicians dispute the evidence of poisoning, saying that Napoleon died of the same disease that had killed his father: stomach cancer. Perhaps this is why, in portraits, he was often depicted with his right hand resting on his abdomen.

A report in the December 1984 issue of the Southern Medical Journal attempted to diagnose Joan of Arc according to the Diagnostic and Statistical Manual of Mental Disorders III (DSM-III). Although Saint Joan heard voices, she couldn't be diagnosed as schizophrenic, because she didn't show the mental deterioration that is part of the schizophrenic diagnosis. Since she consistently referred to herself as "the maid," she didn't have a gender identity problem. Even the fact that she routinely wore armor and men's clothing couldn't lead to a diagnosis of transvestism because the DSM-III limited its description of cross-dressing to men. However puzzling Saint Joan may have been, officially, she was perfectly normal.

During the last years of his life, Oscar Wilde, one of the most brilliant writers of the Victorian age, suffered from a severely itchy skin condition (localized to his face, arms, chest, and back) and from painful ear disease. Wilde's vanity was part of his charm, and a recently published theory suggests that the skin condition may have resulted from repeated use of hair dyes to disguise the fact that he was going gray.

And Wilde's ear problem, according to the November 2000 issue of Laryngorhinootologie, is a tragic and ironic story. One Sunday in October 1895, while he was a prisoner in Reading Gaol (Wilde had been convicted of sodomy and was jailed from 1895 to 1897), Wilde felt ill and begged to be allowed to stay in bed. The prison doctor, considering Wilde a malingerer, forced him to attend chapel service, where he collapsed and suffered a concussion and skull fracture involving the right ear. Wilde continued to have severe ear pain, and, in 1900, he visited a Paris surgeon for relief. The surgery led to a fatal case of meningitis. The sad irony is that the surgery may have been a mastoidectomy of a type pioneered by Wilde's father, William Wilde, the most distinguished otologist of his time. The surgical procedure is still known as Wilde's incision.

People have long been fascinated by Leonardo da Vinci's Mona Lisa. Her enigmatic smile has been the subject of debate for centuries, even leading Sigmund Freud to speculate that the painting was actually da Vinci's self-portrait. But others have also tried to diagnose her smile. One 1989 theory suggested that the famous expression resulted from changes in facial muscles – partial degeneration followed by regeneration – that occur after Bell's palsy. But the most disappointing diagnosis of all may be that in the November 1992 issue of the Journal of Forensic Science: she is not smiling at all, rather her expression is one common to people who have lost their front teeth.

Some mysteries are better left unsolved.

Diagnosis of the Famous Dead

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Samuel D Uretsky, PharmD

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