The lives of historical greats may be familiar, but their deaths are often enigmatic, chalked up to archaic complaints like “dropsy” or “pocks on the lungs.” Internist and infectious disease specialist Philip Mackowiak, a Master of the American College of Physicians, has spent years combing the historical record, seeking modern explanations for medical mysteries that are decades or even centuries old. He’s found that even extraordinary people are felled by ordinary diseases.
PATIENT: Christopher Columbus
DATE OF DEATH: May 20, 1506
SYMPTOMS: The patient had spent his last year confined to bed, suffering from intense, crippling joint pain. He had enjoyed excellent health until the age of 41, at the end of his first voyage to the New World.The nature of his illness is only partially known but seems to have involved an intermittent, though relentlessly progressive, arthritis that initially affected his legs more than his arms or hands.
OFFICIAL CAUSE OF DEATH: “Gotte,” at the time the generic term for arthritis.
• On his second voyage to the New World, he became ill again, with fever, delirium, and impaired vision. An attack of gotte incapacitated him for more than five months. Yet another episode, during a disastrous third New World voyage, caused excruciating pain in the leg and four days of high fever, accompanied by a painful, bleeding inflammation of the eyes.
• Remains believed to be those of his brother demonstrated fusion of thefourth and fifth vertebrae of the lower back, which might have been dueto arthritis of the spine, and incomplete spina bifida. Identicalabnormalities have been detected in the remains of one of Columbus’ssons, suggesting an inherited trait.
• A recent account suggests that Columbus concealed his heritage as the scion of a prominent Catalan family. If true, he would have been nearly twice as likely to have a genetic predisposition to arthritis as if he had come from Genoa, as most believe.
COULD IT BE...
Gout Early on, this arthritis is episodic and can include high fever. It affects joints of the lower extremities earlier than the hands or arms. However, gout most often attacks obese persons and those who drink alcohol; Columbus was “moderate, even modest” in eating and drinking. Acute attacks of gout typically last no longer than 10 days, not weeks to months. And gout doesn’t cause painful, bleeding eyes.
Scurvy was rampant in this age and sometimes caused hemorrhaging into the joints and eyes, producing symptoms similar to Columbus’s. However, he had none of its other classic features, nor did any member of his crew.
DIAGNOSIS: Reactive arthritis is most likely responsible for Columbus’s long agony and death. It develops as a consequence of an excessive immunological reaction to infection. The cardinal features of the disorder are inflammation of joints, inflammation of the outer membrane of the eyes and eyelids (conjunctivitis), and inflammation of the urethra (urethritis). Uveitis (inflammation of structures of the inner eye) can produce ocular complaints identical to those of Columbus. Vulnerability to such a form of arthritis has a genetic component—which may explain the fused vertebrae of the remains of his brother and son.