The Case of the Prolific Poet with a Crooked Foot

Albert B. Lowenfels, MD; Shevaun Mackie Doyle, MD

Disclosures

August 22, 2008

The Case: Medical, Family, and Personal History

The patient was male, the only child of a mother who was in her early 20s when he was born. He was full-term, the delivery was normal, and, on examination, he appeared to be normal except for intact birth membranes and a deformity of the right foot. A few days after his birth, his mother took the baby to see a noted surgeon who examined the deformed foot and suggested corrective footwear. In addition to examining the baby's foot, the physician inoculated the patient against smallpox. Possibly because of financial problems, the mother ignored the physician's suggestion for corrective footwear. As a result, the boy received no treatment until he was 11 years old. At that time, his mother took him to see another surgeon, who again recommended a corrective shoe and leg brace. The child was fitted with an orthotic device, which was extremely painful and failed to correct the deformity.

His mother was obese and died at age 46; his father died at age 36 from suspected tuberculosis.

As he grew up, the patient tended to put on weight which added an additional strain to his deformed leg. Weight-control measures included steam baths and stringent dieting. Throughout his life he remained self-conscious about his deformed leg. As an adult, he moved with an abnormal "sliding" gait, relying on a cane to improve his walking.

Events Associated With the Patient's Death

At age 22, he developed high, recurrent fevers thought to be malaria. He was also diagnosed with gonorrhea and hemorrhoidal disease. At age 31, he had a convulsion. Another occurred shortly before his death, at age 36, which was associated with a high fever. Excessive bloodletting by his physicians undoubtedly hastened his death; the combined blood loss from venesection and the application of leeches during the last few days of his life has been estimated to be about 2.5 liters.

An autopsy was performed, which confirmed the obvious presence of a deformed foot and ankle. The foot was turned inwards, and the leg was atrophied and shorter than the normal leg. The other main finding was evidence of alcohol abuse, the liver being smaller, firmer, and lighter in color than normal.[1]

Who was the patient?

  1. Shakespeare

  2. George Gordon Byron

  3. Edgar Allan Poe

  4. Omar Khayyam

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What is the most likely diagnosis of the birth defect?

  1. Congenital tuberculosis

  2. Spina bifida with involvement of the lower extremities

  3. Clubfoot (talipes equinovarus)

  4. Overlooked birth fracture of the ankle

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Which physician did the patient's mother originally consult after the patient's birth?

  1. Ambrose Pare

  2. William Harvey

  3. René Laennec

  4. John Hunter

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