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Historic Grand Rounds
To Diagnose His Disease, 'Poe' Visits NIH

By Melanie Modlin

NIH gets its share of famous guests — Presidents, astronauts, TV personalities. But a visit from the late writer Edgar Allan Poe? Quoth the Raven, "Never before."

On Dec. 3, the father of the mystery story (played by actor David Keltz) sought help in solving the mystery of his own morbidity and death. The riveting session — the first in NLM's "Historic Grand Rounds" series — took place in a packed Lister Hill Auditorium.

"How and why, you may well ask, have I now made this heroic leap from the grave — out of space, out of time — to be with you today at the National Library of Medicine?," Poe asked, pacing about in a black frock coat and cravat. "Let it suffice that I am here through the sheer force of my will, for the singular purpose of imploring you, learned researchers and librarians, to determine the mysterious cause of my recurring illness and death."

Poe then set forth his symptoms in a spellbinding, 40-minute solo turn. Drawing from his writings, the author whose words have haunted us all told how he had been haunted by all manner of health problems.

Edgar Allan Poe came to NIH to clear up the mystery of his own death. He seemed satisfied with the diagnosis: carbon monoxide poisoning from gas lighting. (Actor David Keltz portrayed Poe.)

In the aptly named tale, "Loss of Breath," for example, he noted, "The sensations of my illness were much like those of a man upon the gallows: I heard my heart beating with violence — the veins in my hands and wrists swelled to nearly bursting — my temples throbbed tempestuously — and I felt that my eyes were starting from my sockets...Confusion crowded upon confusion like a wave upon a wave."

Next, with a piercing gaze and florid gestures, Poe acted out his masterpiece, "The Tell-Tale Heart." The audience heard the story differently than ever before, this time listening for clues about the author's health. For example, this revelatory passage: "TRUE! — nervous — very, very dreadfully nervous I had been and am; but why will you say that I am mad? The disease had sharpened my senses — not destroyed — not dulled them...And have I not told you that what you mistake for madness is but over-acuteness of the senses?"

Poe described other physical sensations — dull lethargy, hemi-syncope or half swoon, numbness, chills, dizziness, inertia. One of his doctors said he had "excessive nervous prostration and loss of nerve power, resulting from exposure" — although to what he did not say. One said Poe's "disease affected the encephalon, a sensitive and delicate membrane of the brain." Others theorized about heart disease.

Whatever his health problems, the writer revealed, they always grew worse when he lived in urban areas. During those periods, he felt "horrors haunting my mind, body and soul," a state of mind similar to that of Roderick in "The Fall of the House of Usher." When Poe lived in relatively rural Richmond, Va., or moved to upstate New York, his symptoms abated.

In his later years, Poe lived in Baltimore. When he died there on Oct. 7, 1849, no autopsy was performed. However, the city health commissioner listed the cause of death as "congestion of the brain."

Next, the house lights came up and Edgar Allan Poe put the audience to work. Was the commissioner right? Were any of Poe's doctors on the mark? Did the author likely die of some other cause?

Audience members took a stab. Heavy metal poisoning? Drugs? Alcoholism? Encephalitis? A brain tumor or lesion? Bipolar disorder? (One even suggested, as delicately as possible, syphilis.) Poe patiently dismissed each one based on his previous research or experience. Then a tall bearded man raised his hand.

He said he was Albert Donnay, an environmental health engineer, and told Poe he believed he was poisoned by repeated exposures to gas lighting in Baltimore, Philadelphia and New York. Donnay said he first presented the theory at a meeting of the American Chemical Society in 1998 and first published it in the International Journal of Toxicology in December 1999.

This was the big "ah ha!" The one-man show had been a two-man show from the beginning, with Keltz and Donnay in cahoots. Now Donnay took the podium and presented his findings, complete with slides.

Carbon monoxide (CO) poisoning was unnamed in Poe's day, its symptoms not recognized as a distinct disorder in American medicine until 1869. Its discovery was claimed independently by two physicians, who proposed the same new name, "neurasthenia," from the Greek roots meaning "nervous weakness," to describe it.

Donnay revealed a map of the United States comparing cases of neurasthenia with the average number of gas companies. The correlation looked indisputable.

Some of the most engaging moments came when modern-day Donnay interacted with 19th century Poe. Poe asked whether neurasthenia existed in the 21st century, since gas lighting has gone away. Donnay said that, unfortunately, the syndrome persists even though we have switched to using less toxic natural gas. "We also stupidly started installing ovens without exhaust flues and building attached garages without exhaust fans," Donnay observed. "As a result, millions are still being gas- poisoned in their homes." Donnay is a carbon monoxide specialist working to develop CO detectors for use in motor vehicles. He is also affiliated with the HUD-funded Healthy Homes project at the University of Maryland School of Nursing.

Donnay said he had painstakingly analyzed the symptoms described in Poe's writings; all seemed consistent with gas light poisoning. He also analyzed the U.S. presidents who lived in the White House when it was gas-lit, from 1848 to 1891. Eleven of the 12 showed a neurological abnormality associated with CO poisoning, in which one eye droops lower than the other, while the mouth slants down the other way. (President Abraham Lincoln, a "drooper," complained of the same symptoms that bedeviled Poe: chronic fatigue, recurring headaches and blurred vision.) Pictures of Edgar Allan Poe show the same facial droop.

Poe couldn't resist asking Donnay whether anything could have saved him from death by carbon monoxide poisoning. The researcher said that if his case had been detected in time and diagnosed correctly, he probably could have been saved by today's standard treatment for the condition. It calls for moving patients to fresh air immediately and providing 100 percent oxygen as soon as possible.

Donnay then commended Poe for writing the first and many subsequent detailed descriptions of carbon monoxide poisoning. "Unfortunately, doctors still have trouble assessing symptoms such as these that they cannot see or hear for themselves. But thanks to you, we now know that chronic CO poisoning has a unique Tell-Tale Face, which should make it much easier for doctors to recognize this syndrome from now on," he said in closing. Poe seemed pleased to have been of help and grateful for Donnay's diagnosis.

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