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Old 03-15-2007, 09:22 PM
Sattua is offline
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What did Tom Pepys die of?


On this day in 1664, Samuel Pepys' brother Tom died. The diary entry describing his death is here:

http://www.pepysdiary.com/archive/1664/03/15/

The doctor who was brought in says that Tom was suffering from a case of smallpox that had gone untreated. The other people present, including Samuel, say that he doesn't have a single mark on him except for an ulcer in his mouth. Tom apparently died from asphyxiation, his throat being so full of "phlegm and stuff" that he couldn't breathe.

Was the doctor right, and Tom died of some kind of strange smallpox side-effect, or is there another likely diagnosis?
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Old 03-15-2007, 09:48 PM
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Quote:
Originally Posted by Sattua
On this day in 1664, Samuel Pepys' brother Tom died. The diary entry describing his death is here:

http://www.pepysdiary.com/archive/1664/03/15/

The doctor who was brought in says that Tom was suffering from a case of smallpox that had gone untreated. The other people present, including Samuel, say that he doesn't have a single mark on him except for an ulcer in his mouth. Tom apparently died from asphyxiation, his throat being so full of "phlegm and stuff" that he couldn't breathe.

Was the doctor right, and Tom died of some kind of strange smallpox side-effect, or is there another likely diagnosis?
Perhaps epiglottitis, or else a closed space abscess of some sort...for example a peritonsillar abscess out of control (sometimes called Quinsy back in the day).

The muffled voice and trouble handling saliva are suggestive of a rapid local infection in the back of the throat. The ulcer might have been either the place the infection started or the place it was trying to drain out of.

It's not smallpox.
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Old 03-15-2007, 10:06 PM
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Dispepysia?
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Old 03-15-2007, 11:13 PM
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Originally Posted by Askance
Dispepysia?
Excellent!
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Old 03-15-2007, 11:24 PM
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Quote:
Originally Posted by Askance
Dispepysia?
Or maybe diary-rhea?
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Old 03-16-2007, 02:55 AM
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Askance, KarlGauss, pinkfreud: Not another pepy!
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Old 03-16-2007, 09:35 AM
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Correct me if I'm wrong, but when someone of that generation simply said "pox", didn't they mean syphilis? (ISTR that the "small" in "smallpox" is actually to distinguish it from syplilis, the "great" pox. ) Samuel Pepys seemed especially concerned that Tom having pox was a reflection on his character, which wouldn't make sense with smallpox.
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Old 03-16-2007, 10:06 AM
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This was my impression as well, reinforced by this sentence: "the Doctor and I having first by ourselves searched my brother again at his privities, where he was as clear as ever he was born..."

But it doesn't sound like syphilis is what carried him off.
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Old 03-16-2007, 10:09 AM
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I sort of thought that too, but when you look at the entry and click the word "pox" (which is linked) it takes you to a discussion of smallpox. So I got confused.

Indeed, they all seemed offended that the doctor suggested Tom had "pox." It would make sense if it were syphilis.

From what I understand about syphilis, it can rot you six ways to Tuesday if given long enough to do so, especially four hundred years ago, when it was a much nastier disease than it is now.
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Old 03-16-2007, 10:14 AM
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I think he died of "having a poorly understood condition in an era of relative medical ignorance."
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Old 04-24-2007, 09:59 AM
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Last night, Mystery Diagnosis featured the case of a young woman who started with a sore throat, then got a tonsillar abscess, then got a brain abscess. The syndrome had a name, which I've forgotten, but the jist of it is that you get a sore throat from anaerobic bacteria (that are in the mouth of any normal person) which then take hold and get into your blood stream. Apparently it was common enough that most doctors knew about it, before the era of antibiotics. Then for a long time antibiotics basically suppressed it entirely, and many doctors now don't know about it--except that, because antibiotics are becoming less and less likely to be prescribed for simple issues like a sore throat, the syndrome is resurging.

And it would fit with what Tom Pepys went through.
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