George Washington's Recurrent Health Problems and Fatal Infection Re-examined.

George Washington's medical history has been recounted so many times and with such consistency that it seems that nothing new remains to be said about the panoply of disorders that plagued him during his life. The same can be said for the particular one that carried him off at age 67. We know that he had small pox, dysentery, recurrent attacks of malaria, and a host of other infections during his long and spectacularly productive career. His teeth were a source of unrelenting distress despite his assiduous attention to dental hygiene; and terminally, he developed a rapidly progressive upper respiratory infection, which killed him in little more than a day and a half despite the best medical care available.

Imaging a Fever-Redefining the Role of 2-deoxy-2-[18F]Fluoro-D-Glucose-Positron Emission Tomography/Computed Tomography in Fever of Unknown Origin Investigations.

Growing evidence suggests that 2-deoxy-2-[18F]fluoro-D-glucose (18FDG)-positron emission tomography/computed tomography (PET/CT) is a useful imaging technique for the evaluation of fever of unknown origin (FUO). This imaging technique allows for accurate localization of foci of hypermetabolism based on 18FDG uptake in glycolytically active cells that may represent inflammation, infection, or neoplasia. The presence of abnormal uptake can help direct further investigation that may yield a final diagnosis. A lack of abnormal uptake can be reasonably reassuring that these conditions are not present, thereby avoiding unnecessary additional testing. Insurers have not routinely covered outpatient 18FDG-PET/CT for the indication of FUO in the United States. However, data published since 2007 suggest early use in FUO diagnostic evaluations improves diagnostic efficiency and reduces costs. Clinicians and insurers should consider 18FDG-PET/CT as a useful tool when preliminary studies are unrevealing.

How fever is defined in COVID-19 publications: a disturbing lack of precision.

OBJECTIVES: Fever is the single most frequently reported manifestation of COVID-19 and is a critical element of screening persons for COVID-19. The meaning of "fever" varies depending on the cutoff temperature used, the type of thermometer, the time of the day, the site of measurements, and the person's gender and race. The absence of a universally accepted definition for fever has been especially problematic during the current COVID-19 pandemic. METHODS: This investigation determined the extent to which fever is defined in COVID-19 publications, with special attention to those associated with pregnancy. RESULTS: Of 53 publications identified in which "fever" is reported as a manifestation of COVID-19 illness, none described the method used to measure patient's temperatures. Only 10 (19%) publications specified the minimum temperature used to define a fever with values that varied from a 37.3 °C (99.1 °F) to 38.1 °C (100.6 °F). CONCLUSIONS: There is a disturbing lack of precision in defining fever in COVID-19 publications. Given the many factors influencing temperature measurements in humans, there can never be a single, universally accepted temperature cut-off defining a fever. This clinical reality should not prevent precision in reporting fever. To achieve the precision and improve scientific and clinical communication, when fever is reported in clinical investigations, at a minimum the cut-off temperature used in determining the presence of fever, the anatomical site at which temperatures are taken, and the instrument used to measure temperatures should each be described. In the absence of such information, what is meant by the term "fever" is uncertain.

Death in the White House: President William Henry Harrison's Atypical Pneumonia.

Historians have long maintained that pneumonia killed William Henry Harrison (1773-1841) just 1 month after he became the ninth president of the United States. For more than a century and a half, it has been alleged that the aged Harrison caught a fatal chill the day he was sworn into office while delivering an overly long inaugural address in wet, freezing weather without a hat, overcoat, and gloves. However, a careful review of the detailed case summary written by his personal physician suggests that enteric fever, not pneumonia per se, was the disorder that carried off "Old Tippecanoe." Two other presidents of that era, James Knox Polk and Zachary Taylor, also developed severe gastroenteritis while in office. Taylor's illness, like Harrison's, proved fatal. In all 3 cases, the illnesses were likely a consequence of the unsanitary conditions that existed in the nation's capital during most of the nineteenth century.

Death of a medical colossus: The course, cause and fatal outcome of Avicenna's colic.

Abu-'Ali al-Husayn ibn Abdallah ibn-Sina (known in the West as Avicenna) is revered in much of Asia as one of history's greatest physicians. And yet, few westerners know of him, his iconic Canon of Medicine or the role he played in preserving ancient Greek medical knowledge following the sack of Rome. We briefly review Avicenna's impressive legacy and provide what to our knowledge is the first critical examination of the illness responsible for his death at age 58 years.

Akhawayni and the first fever curve.

By the time of Hippocrates the typical paroxysmal fever patterns of tertian (every 48 hours) and quartan (every 72 hours) fevers caused by malaria were known. Through the ensuing centuries, ancient Greek, Roman, and Persian physicians made additional contributions to the understanding of fevers. By the end of that era, there was a working definition of what constitutes a fever, the distinction between fever as a symptom and fever as a disease, an elaborate classification scheme for multiple types of fever, hypotheses as to the causes of fever, and methods for diagnosing and treating fevers. Based on the definition of fever at that time, the 10th century ce Persian physician Akhawayni created fever curves hundreds of years before they were routinely used in the clinical setting. In Hidayat al-Muta'allimin fi al-Tibb, Akhawayni describes a system for fever curves and draws fever curves for tertian and quartan Fevers, as well as the double tertian, double quartan, and triple quartan fevers. In this work we examine the history of fevers in the ancient world and the first description of the fever curve.

Simon Bolivar's medical labyrinth: an infectious diseases conundrum.

According to history books, tuberculosis was responsible for the death of Simon Bolivar at the age of 47 years in 1830. The results of an autopsy performed by Alexandre Prospère Révérend, the French physician who cared for him during the terminal phase of his illness, have long been regarded as proof of the diagnosis. On careful reanalysis of Bolivar's medical history and post mortem examination, we reach a different conclusion. On the basis of several critical clinical, epidemiological, and pathological features of his fatal disorder, we conclude that either paracoccidioidomycosis or bacterial bronchiectasis complicating chronic arsenic intoxication was more likely responsible for his death than was tuberculous "consumption."

Prior pandemics. looking to the past for insight into the COVID-19 pandemic.

COVID-19 is not the world's first pandemic, not its worst, or likely to be its last. In fact, there have been many pandemics throughout history with lessons for the current one. The most destructive pandemic of all time, at least in terms of the number of people killed in the shortest time, was the "Spanish flu" pandemic of 1918/1919. Why did it happen? What lessons did it teach us? And could it happen again? These questions are addressed in the context of the current COVID-19 pandemic and several other nearly equally devastating pandemics of earlier times.

Defining Fever.

Although the term "fever" is used liberally in clinical publications, we provide evidence that it is rarely defined in terms of the minimum temperature used to qualify as a fever, the type of thermometer employed in measuring patients' temperatures, or the site at which temperatures are taken. We maintain that in the absence of such information, the term "fever" is meaningless.

Why Temperature Screening for Coronavirus Disease 2019 With Noncontact Infrared Thermometers Does Not Work.

Coronavirus disease 2019 screening can evaluate large numbers of patients while reducing healthcare exposures and limiting further spread of the virus. Temperature screening has been a focal point of case detection during the pandemic because it is one of the earliest and most frequently reported manifestations of the illness. We describe important factors to consider of screened individuals as well as the measurement process and current outcomes. Optimal temperature-based screening involves both individual and environmental factors as well as reconsideration of the current fever threshold.

The death of John Paul Jones and resurrection as 'father of the US Navy'.

John Paul Jones, 'father of the US Navy', died under mysterious circumstances on July 18, 1792. Although his remains were resurrected and autopsied 113 years later, the cause of his death has yet to be explained fully. In this detailed review of his clinical history and autopsy findings, we conclude, as have others, that Jones died of kidney failure of undermined etiology. Although 'interstitial nephritis' was diagnosed by the prosectors who performed his autopsy, we believe glomerulopathy (possibly IgA nephropathy) was more likely responsible for his kidney failure and that his death was due to a cardiac arrhythmia or some other complication of uremia.

Akhenaten and the strange physiques of Egypt's 18th dynasty.

Akhenaten was one of Egypt's most controversial pharaohs, in part because of his strange appearance in images produced after he had declared Aten, the Sun-disc, his one-and-only god. Whether these were symbolic representations or realistic ones that indicate a deforming genetic disorder is the subject of continuing debate. The authors present evidence that the bizarre physical features portrayed in these images are not only realistic but were shared by many members of Egypt's 18th Dynasty. The features are best explained by either 2 different familial disorders-the aromatase excess syndrome and the sagittal craniosynostosis syndrome-or a variant of the Antley-Bixler syndrome caused by a novel mutation in one of the genes controlling the P450 enzymes, which regulate steroidogenesis and cranial bone formation.

The last days of Sala al-Din (Saladin) "noble enemy" of the third Crusade.

Saladin, "noble enemy" of Richard the Lionheart and victor at the battle of Hattin, died suddenly in 1193 A.D. at the age of 56. The clinical information preserved in the historical record is insufficient to render a definitive diagnosis for Saladin's final illness, and yet, it contains enough details to narrow the list of possibilities to just a few and also to critique his treatment in light of the medical concepts of his day.

Goya's Lost Hearing: A Twenty-First Century Perspective on Its Cause, Effects and Possible Treatment.

Francisco Goya produced over 1,800 works during his long career, which earned him a reputation as one of the greatest artists of modern times. When he was 47, he developed a mysterious illness that destroyed his hearing, and for the next 35 years left him "deaf as a stump." Of the diagnoses proposed to date, Susac syndrome is the one most consistent with what little we do know of the character of that illness. If he were alive today, given the severity of his hearing loss, Goya would be treated with a cochlear implant, which might restore his ability to communicate in spoken language, though probably not to the level preceding his 1793 illness.