The Case of the Middle-Aged General With a Fatal Postnuptial Hemorrhage

Albert B. Lowenfels, MD; Doris B. Lowenfels, MLS


April 20, 2006


Chief Complaint

The patient complained of a severe upper gastrointestinal or nasal hemorrhage. He died within approximately 12 hours of onset of the hemorrhage.

Present Illness

The patient was a 47-year-old man, of short stature, broad-chested, and with a swarthy complexion. He was polygamous and just before the onset of the present illness, he celebrated his most recent marriage with a banquet, during which he consumed large amounts of alcohol. At the conclusion of the banquet, the patient and his new bride retired to private quarters. The following day, his military advisors became concerned because he failed to reappear. To their astonishment and dismay, when they finally entered the wedding chamber, they discovered that the general had died. He was covered with blood and his bride was weeping at his side. There was no external evidence of violence, and presumably he died from a fatal gastrointestinal or nasal hemorrhage.

Past Illnesses

The patient had no known previous illnesses, although he may have had prior episodes of nasal or upper digestive tract bleeding. In all other respects, he was vigorous, with excellent strength and coordination.

Social History

The patient was a nonsmoker and known for his frugal habits, although he was thought to be a heavy drinker. He traveled widely in Europe.

Mental Status

He was a possible sociopath (antisocial personality disorder) on the basis of evidence that he murdered his brother.

Family Medical History

One uncle died supposedly of stomach problems brought on by gluttony, and another uncle died after being struck by lightning. Otherwise, nothing is known of family medical history except that one son broke an arm in a fall from his horse.

Who was the patient?

  1. General Eisenhower

  2. Attila the Hun

  3. General Charles de Gaulle

  4. General Pershing

  5. Napoleon Bonaparte

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What is the most likely cause of death?

  1. Epistaxis (nasal hemorrhage)

  2. Blood dyscrasia

  3. Bleeding esophageal varices

  4. Assassination

View the correct answer.


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