Examples of case studies for historical clinical pathologic

Daily Record, The (Baltimore), Aug 9, 2003 by Nancy Kercheval

The patient, who constantly sought attention from a very early age when he was an impulsive show-off and prankster, cried upon leaving his mother, but was thrilled by the killing of men and animals. He had at least one extramarital affair and became an avid hunter and compulsive gambler.

Diagnosis: histrionic personality disorder

Patient: Gen. George Armstrong Custer

The 64-year-old male patient, who conquered Britain, crushed a plot to overthrow his government and survived a variety of physical ailments, passed out during a banquet where he had consumed large quantities of wine and food, including his favorite dish of mushrooms.

As he regained consciousness, he complained of severe abdominal pain.

In his earlier life, he suffered from milk allergy and frequent febrile illnesses, as well as malaria, measles, erysipelas and colitis.

A weakness of both legs kept him from venturing far without assistance. And he had tics and jerks of his head and hands, and a stammer and drooling which became more pronounced when he became excited.

He ate and drank to excess, often falling asleep right after dining. His heartburn became so severe he talked of suicide.

His father died of trauma at 28; his mother committed suicide at 73. His brother died of a mysterious disease and his sister was executed for adultery.

He was married four times, had numerous extramarital affairs and was the father of three children.

After his last meal, his voice was hoarse and indistinct, he stammered and his neck muscles were enlarged. Vomiting was induced, but his condition deteriorated quickly with signs of confusion, unremitting abdominal pain and fecal incontinence. Death came 12 hours after his illness.

Diagnosis: acquired dystonia, probably congenital, and acute cholinergic mushroom poisoning complicated by either dystonic crisis or pulmonary aspiration

Patient: Claudius I

The 69-year-old politician, soldier, builder and philanthropist was brutal, unpredictable, paranoid and cruel enough to order the executions of his wife and three sons.

He presented with chronic low-grade fever, edema, abdominal pain, itching, insatiable hunger, shortness and foulness of breath, convulsions and gangrene of his genitalia. During the next few months, his overall physical and mental health began to deteriorate.

Convinced he was going to die, he attempted suicide, but was stopped.

During his lifetime, he had 10 wives and 14 children. His mother's cause of death was unknown; his father was poisoned by enemies.

Until his death, his physical health was excellent; his mental health was not as he suffered from paranoia and mean-spiritedness.

Diagnosis: Chronic renal failure, complicated by uremia and Fournier's gangrene

Patient: King Herod

At the age of 35 years, the female patient was in Scutari, Turkey, working 20 or more hours a day as an army nurse and hospital administrator under exhausting conditions.

At one time she and just 38 nurses cared for 4,000 troops suffering from battle wounds, cholera, diarrhea, dysentery, typhoid, typhus, brucellosis, frostbite and gangrene. Eventually, 3,000 of her patients would die.