One way many physicians and physicians-in-training hone their diagnostic skills is by attending clinicopathological conferences (CPCs). CPC attendees get a patient's clinical summary, which contains all sorts of information that will prove useful in cracking the case. A CPC isn't supposed to be easy-to-solve mystery, but rather a deductive reasoning workout. This workout may be a routine part of some physicians' lives, but there is one CPC is anything but routine. The Historical CPC is strictly VIP — reviewing the deaths of historical figures.
Hosted by the University of Maryland School of Medicine, the Historical CPC has met annually since 1995 to review the case of a historical figure. Charles Darwin, Edgar Allan Poe, Florence Nightingale, Akhenaten, Joan of Arc, and President Abraham Lincoln have all been patients in recent years. This year's case was Vladimir Lenin, whose cause of death was known. Why, then, was Lenin selected? Case presenter, neurologist and neuropathologist Dr. Harry Vinters, explained the choice in a press release:
"What happened to Lenin is not a mystery," Dr. Vinters says. "The autopsy findings and history are classic of stroke. But our question is, what was the cause of those strokes in a relatively young and otherwise healthy man?"
In order to answer that question, Dr. Vinters first had to assemble a clinical summary for Lenin, a task that for many historical figures is no simple feat. Dr. Philip A. Mackowiak, creator of the Historical CPC, has detailed the challenges of producing clinical summaries for historical figures in his book Post-Mortem: Solving History's Great Medical Mysteries:
…the historical records from which clinical summaries are derived differ in important respects from contemporary medical records. In most cases, the only available medical histories were written by non-physicians, whose appreciation for and description of important clinical details was limited.
In some cases, medical histories were almost certainly distorted
for personal gain or in deference to political agendas.
Some accounts were written years after the fact, and fading memories may have taken a toll on their accuracy.
Finally, there is the reluctance of those who look for answers in the medical records of history's illuminati to accept ordinary diseases as causes of the deaths of extraordinary persons, as well as a penchant for diagnosing disorders that are the particular interests of those proffering diagnoses.
In Lenin's case, evidence of ordinary ol' atherosclerosis (hardening of the blood vessels) was noted by Dr. Vinters as a contributor to Lenin's demise. Why Lenin developed atheroscleriosis seems the mystery. Lenin didn't have most major significant risk factors for atherosclerosis (smoking, obesity, and high blood pressure). As Dr. Vinters explained in a press release, Lenin was known to have one risk factor:
"He led an extremely stressful life," says Dr. Vinters. "People were always trying to assassinate him, for example. We all know what stress is, but everyone reacts to it differently. It is not clear how it affected him."
The exact cause of Lenin's cerebrovascular disease is still a mystery, but the Historical CPC has stricken one possible cause of cerebrovascular disease off the list. Dr. Vinters explains in a press release:
"Meningovascular syphilis has distinct characteristics in the brain. The infarcts, or strokes, are usually very small in syphilis. I didn't see evidence of that. The other vessel that is usually affected by syphilis is the aorta, and that characteristic is not described in the autopsy, either. It is very unlikely that he would have had syphilis."
Ruling causes out, adding other causes in - just standard practice for any CPC. This CPC just happens to count some of history's most influential figures as its patients.