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An Historic Puzzler


This month in “Flashback:” a medical mystery and competition. This following is an actual case described by Theodore Tronchin. Dr. Tronchin routinely made diagnoses without seeing patients and based on descriptions of signs and symptoms included in patients’ letters. This makes this month’s written diagnosis “contest” all the more relevant.

Review Dr. Tronchin’s case below and see if you can make the diagnosis based on the information provided. E-mail your diagnosis to Physician Editor Jamie Newman at The deadline is Tuesday, April 4. We’ll select a winner at random and publish their response in a future issue of The Hospitalist.

Dr. Theodore Tronchin

Dr. Theodore Tronchin

The Case

You move to Paris in 1752 to practice medicine. You are consulted on the following case:

A 42-year-old man complains of abdominal pain. Four weeks prior to this visit he noted a gradual onset of diffuse cramping abdominal pain. The illness began with a sensation of generalized weakness, cold sweats, and nausea. He had several episodes of emesis. He was constipated, and his stool was occasionally streaked with blood. He had increased thirst and mild dysuria. He also had a mild, nonproductive cough.

Subsequently, he noted a mild tremor of his hands and occasional difficulty focusing his eyes. In the past few days, he had experienced weakness in his knees and arms (noticeable when he tried to stand from a sitting position) with a mild tingling in his feet but no loss of sensation.

The patient reports no unusual childhood illnesses and has been inoculated against smallpox. He was seen by another provider several weeks ago for gonorrhea. He does not drink alcohol excessively and both of his parents died in a carriage accident.

On exam the patient appeared pale, weak, and tremulous. His pulse was slightly weak but regular. He experienced some soreness to his mouth and gums without loss of teeth. His breath was slightly fetid, his teeth were intact, the gums were tender, and the tongue was coated whitish green. His abdomen was bloated but not tender. His grip was weak as were his legs, though they seemed intact to sensation.

What is your diagnosis? TH

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