What Caused The Death of The Grand Admiral?
02 May 2009
Today, let’s turn back the clock nearly 200 years, to an important moment in medical history. At that time a certain disease was invariably fatal. It still can be without speedy diagnosis and treatment. But, if by chance, you’re in a specific English pub when this condition strikes, you’re lucky. The pub owner can make the diagnosis quicker than most physicians. I wonder if you can diagnose what happened on October 30, 1723.
Dr. Anthony S Patton, a retired surgeon in Salem Massachusetts, reports in the Harvard Medical Alumni Bulletin, that a celebrated Admiral of the Dutch navy, Baron Jan Gerrit van Wassenaer suffered from chronic stomach problems.
For three days he had fasted. But he had recovered sufficiently to enjoy a sumptuous lunch. This included veal soup, cabbage boiled with mutton, calf sweetbreads, spinach, duck, two larks, apple compote, bread and beer. This was followed by Moselle wine, a dessert of pears, grapes and sweetbreads. (I’d hate to add up the calories!)
Now he felt well enough to go riding with his son, but returned feeling ill again and decided to use his usual remedy for an upset stomach. The treatment consisted of swallowing several glasses of tepid water blended with musk thistle extract. It proved ineffective. So he swilled four more glasses. This was a bad decision, resulting in violent vomiting. Suddenly he emitted a piercing howl and doubled over in agony. He told his servants that something at the top of his stomach felt torn.
Immediately the Admiral’s family summoned James de Bye, a respected surgeon from the Hague. He ordered soft solution of oats to swallow and rubbed milk and corn preparations over the chest and abdomen which failed to end the pain. During this time the admiral’s brother rode to the city of Leiden to summon Hermann Boerhaave.
Boerhaave was so famous that letters from Asia reached him with the address, "The best doctor in Europe". He was head of Leiden’s medical school, at that time one of the world’s celebrated teaching centers in Europe.
Boerhaave was the first doctor to use the microscope and thermometer as tools of medicine. He was also a member of the Surgical Guild of Leiden. Quite an honour as Boerhaave was not a surgeon!
When the distinguished doctor arrived, the admiral’s pulse was weak, and in spite of huge amounts of liquid poured into him, he had not produced a single drop of urine. Boerhaave first suspected poisoning, but quickly concluded the symptoms did not point to this diagnosis.
He did know that the admiral was noted for lavish parties and for consuming enormous amounts of food, beer and wine at meals. Or as Boerhaave wrote, "The admiral is unable to observe the exacting niceties of moderation".
Boerhaave prescribed a globlet of wine and applied a lukewarm preparation of flour and milk to the painful areas along with a concoction made from wild poppies. But the agony continued.
Later Boerhaave noted that the skin covering the abdomen and chest became swollen and had an odd spongy feel to it. Finally as the pain increased the admiral, like one of his ships, rolled over in bed, became unconscious, and died.
Have you gleaned the diagnosis? Autopsy revealed a perforation of the esophagus (food pipe). Boerhaave had discovered the first recorded case of an esophageal rupture, due to forceful vomiting. Years later we know that chemicals and infection can play a role in this condition.
It wasn’t until 1947 that Dr. Norman Barrett, a famous surgeon at St. Thomas’s Hospital in London, was able to save a patient with an esophageal tear.
Dr Anthony Patton, recalls working in Devonshire, England when the local pub owner called, saying, "We’ve got a bloke who has overdone it and ruptured his swallowing tube". Why such diagnostic brilliance? The same thing had happened at his pub the year before. He was now the expert on what’s known as Boerhaave’s Syndrome, a problem that can occur from strenuous vomiting due to excessive overindulgence, bowel obstruction and even seasickness. So if you overindulge, make sure you’re in this Devonshire pub.
