Retrospective diagnoses of conditions affecting historical individuals

Abstract

It has been proposed that the biblical description of the death of King David: ‘‘Now King David was old and stricken in years, and they covered him with clothes, but he gained no warmth’’ (1 Kings 1:1), represents the first documented case of hypothermia [1]. However, it is well recognised that the diagnosis of hypothermia is one of the exclusion that relies upon integrating an adequate history, death scene review and autopsy examination [2]. Classically, hypothermia is manifested by confusion and paradoxical undressing (in as many as 21% of cases), the latter believed to be related to terminal failure in hypothalamic temperature control with peripheral vasodilation [3, 4]. Thus, had King David truly been suffering from significant hypothermia he may well have resisted the addition of further clothing. In fact, on the basis of the scant information provided in the Biblical description, it is equally possible that the king suffered from a wide variety of other problems including some form of internal haemorrhage with resultant shock, or from sepsis. Other problems arise in basing diagnoses on supposed physical characteristics of individuals. For example, the suggestion has been made that Richard III the last Plantagenet king of England, could have been a pituitary dwarf due to a difficult breech delivery [5]. This was based in part on his alleged withered arm that may have been due to a congenital brachial palsy from birth trauma. It is, however, well recognised that Richard’s hump and withered arm were later Tudor embellishments [6], and certainly do not represent substantiated findings upon which to base credible medical opinion. The retrospective diagnosis of illnesses and conditions affecting historical individuals is quite a popular activity. However, the current cases demonstrate that this must be undertaken cautiously as sufficient information necessary to formulate an accurate differential diagnosis is often not available, historical ‘fact’ may be anything but, and treatments described (as in 1 Kings 1:2) may have been nonstandard and somewhat idiosyncratic.