Louisville Medicine Volume 64, Issue 11 | Page 14

- Enter Cangrande della Scala, Lord of Verona (1291- 1329): On 18 July, 1328, the Lord of Verona made a trium- phant entrance into the city of Treviso. This was the crown- ing achievement in his long struggle to conquer the entire region of Veneto (Northern Italy). However, soon after his en- trance he became seriously ill and contemporary accounts describe fever, vomiting and diarrhea after drinking pollut- ed water from a local spring. He took to his bed on the 22 of July and five days later died. Rumors of poisoning soon arose. In 2004, 700 years later, Congrande’s tomb, in the church of Santa Maria Anti- gua in Verona, was opened to allow complete examination. The very heavy stone lid of the sarcophagus was raised and a well preserved body appeared. The autopsy showed him wrapped in precious silk textiles and still wearing some clothes. His legs were extended and he was on his back with his arms folded across his chest and in the tomb was his sword. He was extensively studied by digital radiography and CT. Food was found in his esophagus and gut. Other diagnoses included: Chronic sinusitis, mild diffuse arthritis, emphysematous bullae in his lungs. The autopsy was performed by opening the abdomen from sternum to the pubis. Several organs remained well preserved. He had a small amount of atheromatous plaque on his aorta. The analysis showed that the contents of his stomach and feces were filled with chamomile and black mulberry as well as digitalis purpura (Foxglove). Chamomile was used as a sedative and an antispasmodic and black mulberry as an astringent. Foxglove was the poisonous plant. The digitalis leaves were very high in his gut and his feces. The conclusion was the Lord of Verona was poisoned and his symptoms were classic of digitalis intoxication. The chamomile and black mulberry were suggested to have covered up the taste of the digitalis. The perpetrators of this crime remain to this day 12 LOUISVILLE MEDICINE unknown; some perhaps have accused rival Italian rulers, his own heirs, or even his personal physician, who was executed shortly after Congrande’s death: the ultimate price for having your patient die. The 19 other herbs Mother Hutton added to her tea probably eased the bitter taste of digitalis. Thus, 400 years before Withering, the toxic effects of Foxglove were well known. An interesting example of “nothing new under the sun.” Ed. Note: The one thing they drilled into every new medical intern at Grady Hospital (then and now): “Never, ever, stop an old lady’s digitalis.” They said nothing of Lords. Dr. Weiss practices Cardiovascular Diseases with Medical Center Cardiologists.