When Edgar Allan Poe died in this town in 1849, newspapers gave the cause of death as "congestion of the brain" and "cerebral inflammation," archaic terms that suggest doctors had no definitive explanation but believed Poe's death was related to a severe neurological disorder. ("We have no idea what killed him, but the poor guy sure had gone bananas.")
Now Dr. R. Michael Benitez's fresh review of the case tends to support the idea that, in the last four days of his life, Poe's central nervous system was under attack by a vicious viral disease. The University of Maryland cardiologist believes rabies killed the dark-eyed author of "The Raven," and Benitez appears to make a convincing case.
But not, of course, without qualification.
"No one can say conclusively that Poe died of rabies, since there was no autopsy after his death," Benitez says. "But the historical accounts of Poe's condition in the hospital a few days before his death point to a strong possibility that he had rabies."
And he might have got it from cats.
(Before we go any further, it should be noted that, when he was handed the case for review, Benitez did not know it was Poe's. The case was presented to him, under the initials "E. P.," at a regular weekly meeting of physicians at the University of Maryland Medical Center. He was assigned to make and explain a diagnosis, based on available facts. Benitez did not learn the dead man's identity until the end of his review, though he suspected the case was an antique because of its conspicuous lack of lab data -- no CT scans, no MRIs. The facts of the case, and how Benitez reached his conclusion, are detailed in the latest issue of the Maryland Medical Journal.
Poe is Baltimore's coolest dead celebrity -- he's buried here, thus a civic treasure -- and the name of our new NFL team was inspired by his most famous poem. So some of the facts of his life and death (especially his death) are well known. Allow me to exhume a few: While passing through the city in late September 1849, Poe vanished for five days into Baltimore's crowded, noisy and dangerous streets. He turned up on Oct. 3, muttering incoherently and dressed in filthy and peculiar clothes in the first-floor saloon of a hotel in what is now Little Italy. Taken to Church Hospital (then known as Washington Medical College) on Broadway, he spent nearly four days, as his doctor put it, talking with "spectral and imaginary objects on the walls."
It's important to note that Poe wasn't constantly whacked out.
At times, he was delirious, at times in a coma. He perspired heavily and suffered wide variations in pulse rate. At other times, he was alert, tranquil and oriented, breathing normally. Despite the widely held belief that Poe was in a drunken stupor, he showed no signs of alcohol use when he was admitted to the hospital. (He had joined a temperance league in Richmond several months earlier and had abstained from drinking, according to medical records.)
Though his condition seemed to improve for a time, by the evening of his third day in the hospital Poe became combative and delirious again, calling out the names of family, friends and somebody named "Reynolds." He had to be restrained.
On the fourth day, he died. His last words were, "Lord, help my poor soul." He was 40 years old. Cause of death was listed as "congestion of the brain," certified by the city health commissioner and reported in the press.
Biographers and other historians have attributed Poe's death to several things, though alcohol withdrawal is the one most commonly proffered.
Benitez's recent review of the case marks the first time we've heard the possibility that Poe was infected with rabies.
What got Benitez to that belief?
An exhaustive process of elimination, for one thing. He compared descriptions of Poe's on-and-off delirium with delirium associated with trauma, vascular disorders, epilepsy, infections (even yellow fever and malaria), alcohol and opiate withdrawal. He found no delirium-marked disorder to so perfectly match the Poe case as rabies.
"Rabies encephalitis is marked by the acute onset of confusion, hallucinations, combativeness, muscle spasms and seizures, all NTC of which may occur in periodic fashion," Benitez writes. "Between episodes, patients may be calm and lucid. The disease is almost always lethal; median survival from the onset of overt symptoms is four days."
In the final stages of rabies, its victims experience on-and-off confusion, wide swings in pulse rate, and surges in perspiration and respiration. Hydrophobia, a fear of water, is a classic sign of rabies. Poe's doctor noted that his patient refused alcohol while in the hospital and drank water "only with great difficulty."
Though accounts of the days leading to Poe's death make no mention of exposure to rabid animals, Benitez notes that rabies sometimes has a long incubation period; studies have shown that less than a third of infected humans remember being bitten.
"I believe our patient died from rabies and that his initial exposure was distant and forgotten," Benitez concludes.
(Poe, it turns out, loved household pets, especially cats. In the 1840s, there was no animal inoculation against rabies.)
Dr. Philip A. Mackowiak, vice chairman of the Department of Medicine at UM Medical Center, says he agrees with Benitez's finding; rabies was the most likely cause of Poe's death.
"But the definitive cause," he says, "will remain a mystery."
Unless, of course, we dig the guy up.
Do I hear a second?
Pub Date: 9/11/96