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Historic Trauma Cases: Edgar Allan Poe

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Many Causes of Death Possible

A letter by Dr. John J. Moran (Poe's physician while hospitalized) written to Mrs. Clemm dated Nov. 15, 1849, said Poe's answers were incomprehensible and implied she must have known about an obvious underlying medical condition that might have caused Poe's death.

Possible causes include: alcohol, brain congestion, cholera, epilepsy, porphyria, rabies, diabetes, toxic disorder and head trauma. Using the mnemonic for causes of unconsciousness, what would Poe's initial diagnosis be? (see Table below.)

Rabies - Rabies final stages commonly cause patients periods of confusion with tachycardia and increased respiratory rate and temperature. Median length of survival after onset of serious symptoms is 4 days (the same number of days Poe was hospitalized). However, it is possible for someone infected with rabies to go a year without major symptoms.

Alcohol Withdrawal - Poe abused alcohol and opiates drugs, and withdrawal symptoms can include tremors and delirium; however, Poe is believed to have been sober for at least 6 months before his death. It is also unusual for patients experiencing alcohol or opiate withdrawal to become acutely ill, recover briefly, then worsen and die.

Neurological Disease - In March 1847 (2 years before Poe's death), Dr. Valentine Mott, a prominent NY physician, wrote Poe "had some sort of lesion on the brain and suffered from brain fever." When Mott and his nurse cared for Virginia they noted "a twist in the poet's face that suggested to him a brain lesion" (Quinn & Rosenheim).

Brain Tumor - Poe's body was exhumed after 26 years so his coffin could be moved to a more prominent place in the Baltimore cemetery where he was buried. In an undated letter to the editor of the Baltimore Gazette, a "medical gentleman" claimed to have seen Poe's brain was in "an almost perfect state of preservation" and "the cerebral mass, as seen through the base of the skull, evidenced no signs of disintegration or decay, though, of course, it is somewhat diminished in size." The brain is among the first organs to liquefy, which is why Ancient Egyptians always removed it during mummification. A tumor, though, can calcify while the rest of the body decomposes and resemble shrunken brains.

Cholera - In a letter dated July 7, 1849, Poe wrote to Maria Clemm, saying, "I have been so ill, have had cholera or spasms and can now hardly hold the pen." Most patients with cholera suffer from severe, watery diarrhea, nausea and vomiting, muscle cramps, and dehydration, which can cause shock. Poe did not complain of any of these symptoms. In fact, he'd seemed fine to his friends and family when he left Richmond and upon arrival in Baltimore.

Rare Enzyme Disorder - Some speculate Poe had alcohol dehydrogenase deficiency disorder. Testing in 2000 of both Edgar and Virginia Poe's hair preserved by the Edgar Allan Poe Society in Baltimore revealed arsenic, lead, mercury, nickel and uranium levels, which rose and fell through the years. However, none of the levels were considered significant enough to contribute to his death.

Unanswered Questions

Even after more than 160 years, Poe's death remains a mystery. Had his illness occurred today, he would have received a head CT scan as well as a full metabolic workup and, likely, many other tests based on those results.

Because Poe's medical chart is not accounted for, there are no accurate records and no autopsy was done. What we know is based on interviews after his death. In death, Poe has in many ways written his best mystery of all.

Reference
Quinn, A. & Rosenheim, S. (1998). Edgar allan poe. Baltimore: Johns Hopkins University Press.

Cynthia Blank-Reid is a trauma nurse in Philadelphia.

Table: Causes of Unconsciousness
• A: alcohol or acidosis
• E: epilepsy, environmental or electricity
• I: insulin
• O: overdose
• U: uremia
• T: trauma
• I: infection
• P: poisoning or psychosis
• S: seizure, stroke or shock


Historic Trauma Cases: Edgar Allan Poe

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