Diagnosing disease--hundreds of years later

by Tara Smith     Department: Culture

As epidemiologists, we typically investigate outbreaks and diseases in the present, be it a multi-state foodborne outbreak or a few cases of disease locally. We approach this in a variety of ways: take biological samples when possible, detail symptoms, try to figure out the cause of the illness. The samples can really assist in this: we can look either for the presence of an infectious organism itself, or look for evidence that it had been there, such as antibodies.

Even with present-day disease, however, it's not always easy to determine the cause of a disease or outbreak. Imagine, then, how much more difficult it can be to diagnose one that happened a hundred years ago, or a thousand. Sometimes we get a lucky break and run across samples that we can still use, such as the discovery of a mass grave in Athens that led to a potential cause of the plague of Athens, an epidemic that took place from ~430-426 BC and was described by historian Thucydides. Molecular analysis of dental pulp from these bodies suggested that the causative agent could have been a bacterium related to Salmonella enterica serovar Typhi. A similar method has also been used to provide molecular evidence that Yersinia pestis was indeed the cause of Black Plague.

In addition to outbreaks, diagnoses of historical figures are also of interest to epidemiologists. For example, epidemiologists, medical doctors, and historians have long been interested in Adolf Hitler's health (or disease), speculating he suffered from a variety of different conditions, including syphilis. Closer to home, it's been suggested that Abraham Lincoln suffered from a number of diseases, including Marfan syndrome. A more recent paper has put forth an idea that Lincoln may have been suffering from a mild case of smallpox while delivering the Gettysburg Address. While this couldn't be tested with biological samples that remain from Lincoln, these samples could be tested for the presence of a number of different genetic diseases to confirm or refute the various diseases that have been attributed to Lincoln.

This type of tissue analysis was carried out last year in the case of Holy Roman Emperor Charles V. Investigators used a 450-year old portion of Charles V's pinkie to suggest he suffered from gout--which could have led to his abdication of the throne.

Finally, these retrospective analyses aren't limited to actual outbreaks or individuals. Both Shakespeare and Edgar Allen Poe have been the subject of multiple scientific papers musing about diseases afflicting their characters. In the spirit of the recent holiday season, even the cause of Tiny Tim's pathology has been investigated.

Many of these diagnoses are little more than speculation (especially if we don't have a specimen to back them up), but it's a fun game to play nevertheless--and who knows when we may run across something that will allow us to confirm our speculations.

Tags: Disease, literature, outbreak