Apr. 29, 2010 Could one of South America's greatest military figures have died from a deadly poison, rather than the tuberculosis assumed at the time of his death in 1830? The mysterious illness and death of Simon Bolivar -- known as "El Libertador" or "The Liberator" -- is the medical mystery in question at this year's Historical Clinicopathological Conference (CPC), sponsored by the University of Maryland School of Medicine and the Veterans Affairs (VA) Maryland Health Care System in Baltimore.
This conference is devoted to the modern medical diagnosis of disorders that affected prominent historical figures. Venezuelan President Hugo Chavez has taken a personal interest in Bolivar's death, and the Venezuelan embassy in Washington will send representation to Friday's conference.
Simon Bolivar, born in 1783 in Caracas, Venezuela, is one of the most influential generals in the history of South America. Bolivar, who died of a mysterious illness at age 47, led the long struggle that freed South America from three centuries of Spanish rule. Bolivar established the nation of Bolivia -- previously part of Peru -- in 1825, and the new country was named in his honor. Now, French Guyana is the only South American nation that remains a colony.
The Embassy of the Bolivarian Republic of Venezuela in the United States will send two representatives to the conference: Counselor Regzeida Gonzalez and Raquel del Rocio Gasperi, director of the Technical and Scientific Unit at the Office of the Public Prosecutor of Venezuela, who was part of the country's Presidential Commission to investigate the death Bolivar.
During the conference, John Dove, MBBS, a Bolivar scholar and orthopedic surgeon from Scotland, will describe Bolivar's accomplishments and the somewhat controversial role he has played in South American history.
"Bolivar ended 300 years of colonization in South America," says Dr. Dove. "He was a liberator and a brilliant hands-on commander. The figures speak for themselves. Bolivar covered more than 80,000 miles and spread the idea of freedom over an area greater than one and a half times the diameter of the earth."
Dove's fellow presenter at this year's CPC is Paul G. Auwaerter, M.D., M.B.A., associate professor and clinical director in the Division of Infectious Diseases in the Department of Medicine at the Johns Hopkins University School of Medicine. Dr. Auwaerter has taken on the challenge of unraveling the mystery of Bolivar's death.
When Bolivar died on December 17, 1830, it was believed he was succumbed to consumption or tuberculosis, a common condition of the day. He had suffered a long illness with a variety of symptoms -- frequent bouts of loss of consciousness, skin darkening, extreme weight loss, coughing, exhaustion and persistent headaches.
Dr. Auwaerter, in his careful review of Bolivar's case, has concluded the general's killer was likely not tuberculosis. Rather, Dr. Auwaerter sees evidence of a more sinister cause of death -- chronic arsenic poisoning that led to a serious respiratory illness. Considering the many attempts on Bolivar's life throughout his career as a revolutionary, Dr. Auwaerter says he has considered the possibility that the death was an assassination. But most of the signs and symptoms point to slow, chronic poisoning, the kind that might result from drinking contaminated water. Such environmental contact with arsenic would have been entirely possible, Dr. Auwaerter says.
"Bolivar spent a lot of time in Peru, and there have been Colombian mummies found there that have tested positive for high levels of arsenic," he explains. "That indicates the possibility that the water in Peru may have had unusually high levels of the naturally occurring poison."
But that's not all, he adds: "Bolivar was known to ingest arsenic as a remedy for some of his ongoing illnesses -- recurring headaches, wasting, hemorrhoids and his chronic episodes of unconsciousness. Arsenic was actually a common medical remedy of the time. In fact, it has recently been discovered that a contemporary leader of Bolivar's, George III, had super-high levels of arsenic in his body tissue and air. It seems he had been treating himself with it."
While the possibility of an assassination certainly adds intrigue to Bolivar's story, "It's unlikely this was acute poisoning," Dr. Auwaerter explains. "What I'm finding is more consistent with chronic poisoning because of symptoms such as his skin darkening, his headaches, his extreme weight loss. His whole body is really falling apart at the end. He lived for quite some time like this. I believe it's likely he would have succumbed to tuberculosis much earlier than he did. The idea of gradual arsenic poisoning is a good explanation to link all these symptoms together."
Dr. Auwaerter began his search by considering the nature of the illness that ultimately led to Bolivar's demise. For the last two weeks of his life, he was emaciated and weak and coughed constantly, producing large amounts of green sputum. The autopsy found signs of green fluid in the lungs and in the heart. Bolivar's doctors concluded he died of tuberculosis because of the respiratory aspect of this final illness.
"This was an era where there was really no ability to confirm that someone had died of tuberculosis," Dr. Auwaerter says. "That green fluid in the lungs and heart is very suggestive of a bacterial infection called bronchiecstasis, which was very common at the time. The green pericardial fluid is very unlikely to represent tuberculosis."
Bolivar also appeared to have had a tumor in his lungs that caused him to be severely hoarse, with a voice so quiet he could hardly be heard for the last six months of his life. Lung cancer could be another complication of chronic poisoning, Dr. Auwaerter adds.
"It's very hard to be definitive here," he explains. "I have to say that tuberculosis is not an unreasonable explanation for his death. But, at the end of the day, there are a lot of features of this illness that argue against tuberculosis. If the body were ever to be exhumed, there would be a lot of things to look at. Arsenic testing on Bolivar's tissue and hair could answer some of our questions."
"Whereas Dr. Auwaerter makes a compelling case for chronic arsenic intoxication complicated by bronchiectasis and lung cancer, I have no doubt that the controversy regarding the ideology of the general's fatal illness will continue until his remains are re-examined using modern diagnostic techniques," Philip A. Mackowiak, M.D., M.B.A., professor and vice chair of the Department of Medicine of the University of Maryland School of Medicine and Chief of the Medical Care Clinical Center of the VA Maryland Health Care System. Dr. Mackowiak founded the annual CPC in 1995, and the program has since examined the lives and deaths of famous figures such as Edgar Allan Poe and Abraham Lincoln.
"Medicine is very much a field of detective work," says E. Albert Reece M.D., Ph.D., M.B.A., interim president of the University of Maryland, Baltimore, John Z. and Akiko K. Bowers Distinguished Professor and dean, University of Maryland School of Medicine. "Ordinarily, our world class faculty here at the School of Medicine are solving mysteries in the realm of human health in the laboratory and in the clinic. The CPC is a chance for our colleagues in medicine to apply our skills to history, and to revisit the state of our field centuries ago. It reminds us how far we've come, and how the groundbreaking discoveries we make every day will revolutionize medicine for future generations."
Dr. Auwaerter says he enjoyed the challenge of taking on the Bolivar mystery. "I've done a lot of background research to put these ideas together," he says. "I'm not a historian, so this is not usually my thing. But this is just the sort of puzzle I like thinking about."
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