It was a pork chop in the library! Doctors unravel famous historic deathsBy Los Angeles Times, adapted by Newsela staff Date: 02.09.16 Grade Level 8Word Count 919

BALTIMORE, Md. — Oliver Cromwell died 357 years ago. Recently,several dozen physicians convened in Westminster Church in Baltimore,Maryland, to figure out what caused the English statesman's death.

Cromwell is famous for dethroning an English king and brutally beating down Catholic uprisings in Ireland in the 17th century. He brought togethera divided British empire, and then at 58 years old, he died.

The doctors in Maryland did not have Cromwell's body, so they had to figure out what caused Cromwell's death without modern medicine, or even an autopsy. At the time he died, an embalmer noticed that the blood vessels in Cromwell's brain seemed to be too full, and his spleen had a buildup of oily sludge. Today doctors associate that with sepsis, pus-forming bacteria in blood vessels and tissue.

A Little History, A Little Medicine The doctors are attending the University of Maryland medical school’s annual Historical Clinicopathological Conference. Typically, after a patient dies, doctors try to make sense of a patient's symptoms when compared with lab results. In medical school, these exercises help doctors and medical students practice their skills. But in this case, the doctors are also piecing together a historical figure’s cause of death. It is a puzzle that combines medicine, historical research, disease detection and guesswork. 

Dr. Sanjay Saint works for the Veterans Affairs Healthcare System in Ann Arbor, Michigan. He concluded that Cromwell died of malaria, a disease caused by an infected mosquito, only found in the British Isles at the time. Cromwell's condition was made worse by salmonella bacteria, which gave him typhoid fever, another easily spread disease. “It is the ultimate whodunit," Saint says. "The reason we go into medicine is to help patients. There’s also that part of playing detective, of being curious about a mystery and wanting to figure it out.”

A new kind of sleuth also weighed in on Cromwell’s death. While Saint hit his books, computer scientists from the U.S. Department of Energy fed Cromwell’s medical history into a network of supercomputers called Oak Ridge Graph Analytics for Medical Innovation (ORIGAMI). A software program processed 27 million medical articles and came up with an answer in 4.5 seconds. It was virtually the same conclusion that Saint did after weeks of research and deliberation — that Cromwell had malaria. For Saint, the unexpected competition was a reminder of his limitations.

Doctor Sleuth Vs. ComputerHowever, Dr. Eliot Siegel, who worked on the ORIGAMI project, notes the astonishingly efficient brainpower physicians bring to the task of figuring out illness. He says, “Who would I rather have making a diagnosis? It would be hands-down Dr. Saint." On the other hand he says, “If you told me there was a mystery disease and no one had any ideas about it and we needed some new insight ... I like the computer.”

Dr. Jan Hirschmann works at the VA Puget Sound Health Care System in Seattle, Washington. He got into medical detecting nearly 20 years ago, when he was invited to lecture on the death of Wolfgang Amadeus Mozart. The Austrian composer died in 1791, just before his 36th birthday. 

Many music historians assumed the composer died of heart failure, one thought that Mozart had been poisoned, and others suggested various types of organ failure. Hirschmann did not think any of those were correct. Mozart’s family letters showed that he was healthy before developing a fever and rash, and the symptoms, along with physicians’ notes and diary entries, pointed to some sort of outbreak. The only illness

that matched Mozart’s symptoms was trichinosis, a disease caused by eating undercooked meat, usually pork. 

Mozart's Fatal SupperHirschmann had one big problem: He did not know what Mozart ate. He was looking through a book on Mozart and found a letter that held a clue. The composer was writing to his wife when he was interrupted by a servant bringing dinner. He wrote, “And what do I smell? Pork cutlets! Che gusto. I eat to your health.” The letter was dated Oct. 7, 1791, and Mozart fell sick 44 days later, the time it typically takes for trichinosis symptoms to set in. Hirschmann presented his findings to a fascinated audience, and later published them in the Archives of Internal Medicine. He says, “I call it the smoking, or not-so-smoking, pork chop."

The discovery got him noticed by Dr. Philip Mackowiak, a University of Maryland epidemiologist who studies disease and who has published two books on historical medical mysteries. Mackowiak says, “Physicians are hungry for liberal arts outlets.” Mackowiak also says that students of the liberal arts are interested in medicine, and conducting postmortems on historical figures seemed like the perfect opportunity to enrich the lives of both groups.

Akhenaten, Beethoven, Lincoln and LeninFor example, in 2007, physicians, historians and mystery enthusiasts considered how Abraham Lincoln’s gunshot wound to the head might have been treated in modern times and whether the 16th president would have lived. Their conclusion was that he would have lived, although he probably would have been disabled.

Those at the recent Historical Clinicopathological Conference learned other things in addition to how Oliver Cromwell died. After death, blood vessels in former Soviet Union dictator Vladimir Lenin’s brain were so calcified that they sounded like stone when tapped with tweezers. In addition, the Egyptian Pharaoh Akhenaten probably had a hormone disorder that made him look like a woman. Also, the disease syphilis, which can be passed to a child in the womb, was probably why the composer Beethoven was deaf.