Nurses have specialist knowledge which can be applied to various areas of study and various pursuits in which historical truth is sought.
As an amateur forensic researcher I outline my hobby here, and explain why it can bring a wealth of knowledge as well as contribute in a novel way to the understanding of historical medical events and biography. Due to continuing professional development being a requirement of nursing practice, such historical medical analyses constitute an effective and interesting way of accumulating professional development hours in self-directed research.
Such studies can also at times contribute positively to a re-evaluation of historical events in the form of retrospective analysis.
In 2011 I read the book ‘Unsettled Matters’ by Tom Bleecker (2011). The book, outlining the life and death of movie superstar Bruce Lee, was written by the second husband of Lee’s widow and was an examination of Lee’s life and untimely death.
How did the incredibly fit kung fu master, Bruce Lee, die suddenly at the age of 32 years?
Bleecker developed the hypothesis that Lee died as a result of steroid abuse. After reading ‘Unsettled Matters’ I reflected on Bleecker’s thesis and was troubled by the arguments that underpinned his conclusion. As a result of this I engaged in my own research and after some months of research and writing produced my own book ‘The Death of Bruce Lee: A Clinical Investigation’ (McKenzie 2012).
During my research I emailed Tom Bleecker and he very kindly responded. This resulted in an ongoing exchange of emails in which we debated the various possible causes of Lee’s death and allowed me to obtain further direct information from Mr. Bleecker.
A large number of causes have been proposed in relation to Lee’s death. Some suggestions are quite bizarre, such as that he was killed by a kung fu master using a deadly technique called Dim Mak (death touch), aggrieved by Lee’s teaching of kung fu to non-orientals.
Various more rational explanations include SUDEP (Sudden Unexplained Death in Epilepsy) or a drug hypersensitivity reaction. Indeed, the latter was the conclusion of the public Inquest that was held in Hong Kong subsequent to Lee’s death.
It was Professor Donald Teare, a renowned British forensic pathologist, who proposed the cause of death as being a hypersensitivity reaction (anaphylaxis) to a drug called Equagesic – a compound of Meprobamate and Aspirin.
Professor Teare was a forensic heavyweight, having first described sudden death due to hypertrophic cardiomyopathy as a clinical entity in 1958 (Teare 1958). Bruce Lee was a regular user of marijuanna but Professor Teare dismissed suggestions at the Inquest that Lee’s consumption of this drug was responsible for his death.
Due to the very high safety profile of THC (Tetrahydrocannabinol) Professor Teare famously responded that he considered the hashish found in Lee’s stomach at autopsy ‘no more relevant than if he had had a cup of tea.’
The inquest closed with a verdict of ‘misadventure’ being recorded. Professor Teare’s conclusion was that Lee died from cerebral edema (evident at autopsy) secondary to a hypersensitivity reaction to the Aspirin or Meprobamate contained in the Equagesic tablet he had ingested.
My own research into Lee’s death examined various critical points in the chronology and circumstances of his death. Ten weeks before Lee’s death, on 10 May,1973 Lee attended the film studios in Hong Kong that made his international blockbuster movie ‘Enter the Dragon’. He was required to re-record dialogue for the movie.
In order to have absolute background silence in the small dubbing room the air-conditioning in the room was switched off. The temperature in the small, enclosed space soared and after some 30 minutes Lee felt faint and had to leave the room. He went to the nearby bathroom where he fainted and started convulsing. An ambulance was called and he was rushed to hospital where the physicians recognised immediately the symptoms of cerebral edema and administered the osmotic agent Mannitol in order to reduce brain swelling. Fortunately Lee survived. Throwing himself back into his work Lee appeared to have recovered well, when on the night of July 20, 1973 his sudden death shocked the world. Lee was at the apartment of actress Betty Ting Pei and complained to her of feeling unwell and of having a headache. The actress gave Lee an Equagesic tablet in the belief that this would relieve his headache. Lee lay down in her bedroom to have a nap and never regained consciousness.
In my research into Lee’s death my own conclusion was that on 10 May, 1973, Lee had suffered an episode of heatstroke (McKenzie 2012). Strangely enough, no one else had considered this as a differential diagnosis at the time. During this episode, presumably secondary to his hyperthermia and emerging cerebral edema, he suffered a tonic-clonic seizure. This epileptiform seizure led many to assume that Lee suffered from epilepsy ie. as a chronic condition, but this was not the case.
The autopsy on Lee was carried out in Hong Kong by Dr Ray Lycette, a New Zealand trained physician and pathologist. Dr Lycette determined the cause of death as being due to cerebral edema, however, unlike the episode of heatstroke on 10 May,1973, there was no immediate apparent cause for the cerebral edema, and Dr Lycette initially queried some form of drug intoxication.
Tissue samples and Lee’s stomach contents were sent for toxicological analysis, however apart from the ingested hashish in Lee’s stomach there were no toxins or other illicit substances detected. Thus with inconclusive results a storm of claims and bizarre theories as to the cause of his death was unleashed, and continues to this day.
I personally consider Professor Teare’s conclusion as wholly credible, finding in my research neither foul play nor any evidence supporting alleged steroid abuse as being the cause of Lee’s death.
Having written and published ‘The Death of Bruce Lee: A Clinical Investigation’ I was contacted by a number of persons, some of whom disagreed strongly with the conclusions in my book and some who supported my thesis.
Tom Bleecker stuck to his hypothesis that Lee had died subsequent to steroid abuse and had suffered an Addisonian crisis which led to his death. Bleecker also hypothesised poisoning by an undetected toxin as a cause of death (Bleecker 2011).
Oddly enough, the definitive biography on the life of Bruce Lee had never been written and an American Rhodes Scholar and writer by the name of Matthew Polly was determined to amend that oversight of history. Polly had an interesting life, being the son of academics who fostered his academic potential, Polly had from an early age been a fan of Bruce Lee and had amassed a large amount of information about him. No doubt to the horror of his parents Polly decided to quit his academic studies and went to China to live at the famous Shaolin Temple where he trained in kung fu for two years.
His subsequent book on his experiences there, ‘American Shaolin’, was a bestseller, and he resolved to write the definitive biography of Lee’s life. There was no one better placed to do so, due to his kung fu training and knowledge of Lee. The result is the bestseller ‘Bruce Lee A Life’ (Polly 2017).
While writing this book Matthew contacted me to discuss the issues surrounding Lee’s death, having read my book and hearing of my research. Over a period of some months Matthew and I discussed, debated and further researched Lee’s death. In ‘Bruce Lee A Life’ Matthew expresses his thanks to me for assisting him in this specific area and acknowledges in his book my original contribution to understanding the causes of Lee’s collapse on 10 May, 1973.
Even an amateur forensic research nurse can make a positive contribution to historical forensic medical studies!
My other related area of interest is the Second World War and being fluent in German I have been able to study historical documents in their original form.
Recently I have been engaged in self-directed research into the health and medical history of Adolf Hitler.
Hitler ruthlessly strove to reach the pinnacle of political power in Germany and unleashed the events that led to the Second World War and the Holocaust. Huge amounts of disinformation and medical fallacy have surrounded his life story and my own research led me to clarify these and determine their historical veracity.
The definitive book on Hitler’s health and medical history is the book ‘War Hitler Krank?’ (‘Was Hitler ill?’) (Neumann and Eberle 2011) and this details his medical problems and examines the various rumours surrounding his health. One of the earliest and most pervasive myths about Hitler is that he suffered from unilateral cryptorchidism. This fallacy has persisted, despite physical examination of Hitler by doctor’s at various stages of his life reporting his genitalia as being completely normal.
An English language book of great value in understanding Hitler’s illnesses is ‘The Medical Casebook of Adolf Hitler’ (Heston 2007). This book was written by a husband and wife team, Dr Leonard L Heston, a physician, and his wife, Renate Heston, a nurse and fluent German speaker.
Dr Heston and Ms Heston delved into the available documentation that became available after the end of the Second World War. Although hindered by the fact that a full autopsy had never been possible on Hitler as, after committing suicide by the ingestion of poison and shooting himself, his body was burnt by his aides.
Hitler was a vegetarian, teetotaler and did not smoke. Although we may speak of Hitler’s ‘illnesses’, my research has led me to conclude that Hitler was in fact fundamentally in good health, however he was hypochondriacal. He also appeared to suffer in the latter days of the war side-effects from the cocktail of tablets, liquids and injections that his personal physician, Dr Theodor Morell, supplied him with.
From the current state of knowledge Dr Morell’s treatment of Hitler could be considered as quackery, subjecting Hitler to a regimen of medications, given in oral or injectable form, amounting to some 82 different medications during the period of 1936 to 1945 being regularly administered (Neumann and Eberle, 2011).
Hitler, however, tolerated Morell and considered him a superb doctor due to Morell’s treatment of Hitler’s eczema in the 1930’s. Towards the end of the war, under great stress from the losses incurred by the German forces on the battlefront and the encroachment of Allied and Soviet forces, Hitler aged visibly and developed a parkinsonian (or pseudoparkinsonian) tremor. A regimen of glucose injections, analgesic agents, hypnotics and stimulants seemed to sustain Hitler during the last days of the war, administered daily by Dr Morell.
The question of course arises as to whether Hitler suffered from any form of recognisable psychiatric disorder consistent with the diagnostic criteria of the Diagnostic and Statistical Manual of the American Psychiatric Association. Interestingly, Hitler had been examined physically and psychiatrically while awaiting trial in Landsberg Prison in 1923 on charges of treason. He was judged by the prison doctors as being fully fit to stand trial. I reviewed Hitler’s behaviour and his thoughts as expressed to those within his inner circle. This included the reading of ‘Erinnerungen’ (‘Memories’) (Speer 1969) an 832 page book by Albert Speer, Hitler’s architect, with whom Hitler was close. From my research I could not find any support for the thesis that Hitler suffered from a psychosis, and one that would explain his behaviour. He never displayed any Schneiderian first rank symptoms of schizophrenia or any other psychotic disorder. His anti-semitism was common within German society of that time, and driven by racist ideology that pervaded in infused the National Socialists of Germany. It was this ideology that led to the Holocaust and the murder of German citizens through the euthenising of intellectually disabled and mentally ill persons.
The Nazis referred to such individuals as ‘Untermenschen’ (‘sub-humans’). Hitler was not psychiatrically ill, he was simply evil. His personality displayed narcissistic and grandiose traits certainly. He viewed himself as a superior military commander, but led Germany into the feared two-front war with Allied forces in the West and Soviet forces in the East, unleashed through the disastrous invasion of Russia. In the last days, trapped in his bunker in Berlin, he instructed Speer to ensure that Germany was razed to the ground and its industry and infrastructure, such that actually remained, destroyed. Never able to see his own errors or mistakes he viewed the German people as being solely responsible for the defeat of the Third Reich and that they deserved this defeat, being unable to rise to his leadership. Speer fortunately had more sense to carry out this bizarre and totally destructive directive. Also, we must remember that the ethical and moral framework under Nazi rule became so perverted that some doctor’s conducted abhorrent medical experiments on concentration camp inmates. One may well wonder how those medical personnel involved were ever able to reconcile such vile and inhumane behaviour with their Hippocratic Oath. It seems that the mind has an infinite capacity for rationalisation, and some doctor’s justified their behaviour by viewing such individuals as a ‘cancer’ within society, and for the good of the society as a whole it was their duty to excise the cancer by whatever means necessary (Goldhagen, 1996).
Nurses also participated willingly in these crimes, operating within the perverted ethical and moral framework of Nazi pseudo-science and rationalising their murder of inmates and the disabled as providing them with a release from their suffering and a ‘cleansing’ of the genetic base of the Aryan race (eugenics).
Hitler received treatment during the war years from various specialists in addition to his personal physician Dr Morell. ECG tracings of Hitler were preserved from the war years and are documented in ‘The Medical Casebook of Adolf Hitler’.
An ECG report provided to Dr Morell had been written by a Dr Karl Webber who diagnosed coronary sclerosis reflected in abnormalities in Hitler’s ECG tracings (Heston 2007).
Subsequent to this, and in research for his book, Dr Heston had the ECG’s re-interpreted by two cardiologists who viewed the tracing deviations as minor, insignificant and ‘non-specific s-t changes’ (Heston 2007) Laboratory results documented by Dr Morell also make for fascinating reading. Hitler, referred to as ‘Patient A’ by Dr Morell, underwent various routine blood tests. Included in which was the Wassermann, Meinicke and Kahn test which proved negative. From this we can rule out that Hitler suffered from syphilis, or its more advanced form, neurosyphilis. Some quarters have suggested that neurosyphilis could have explained Hitler’s erratic behaviour, especially towards the end of the war, however, clearly such an explanation is not tenable. Various other health problems plagued Hitler which included headaches, flatulence, vocal cord polyps, eczema, abdominal cramps, borderline hypertension and tremor (Heston 2007). It is not clear whether these symptoms were primary afflictions or purely iatrogenic and caused by the extensive, powerful and adversely interacting regimen of substances administered by Dr Morell. In 1994 Hitler was treated for a rupture of his tympanic membranes as a consequence of the attempted assassination by Claus von Stauffenberg who had planted a bomb in Hitlers headquarters. His injuries were treated by Dr Erwin Giesing, an ear, nose and throat specialist. Hitler committed suicide on 30 April, 1945 and thus did not die of natural causes. Hitler’s behaviour and physical health was never an issue in the moral culpability of his crimes against humanity. He was not psychiatrically or medically unwell to a degree that would absolve him from moral responsibility for his actions and those of the Third Reich. His actions and behaviour stand as a warning to us all, that even among the most noble of professions, such as medicine and nursing, our moral compass and ethical framework can be perverted through ideology. Understanding this is another dimension of historical medico-forensic research.
For nurses interested in self-directed research, historical biographical analysis with a focus on medical disease is a fascinating field of study and one from which the nurse will learn much. It is an endeavour I highly recommend as an interesting way of expanding one’s clinical knowledge and facilitating the requirement of ongoing professional development.
Duncan McKenzie RN. is an Associate Nurse Unit Manager at The Melbourne Clinic in Richmond, Victoria.
References:
Bleecker, T, 2011, Unsettled Matters, Amazon Press
Eberle Hans-Joachim and Eberle Henrik, 2011, ‘War Hitler Krank? – Ein Abschließender Befund’, 2011, Bastei Lubbe Press
Heston L., Emeritus Professor, University of Washington The Medical Casebook of Adolf Hitler, 2007, iUniverse Press, New York
McKenzie R.N., Duncan A., 2012, The Death of Bruce Lee: A Clinical Investigation, Amazon Press
Polly, M., Bruce Lee A Life, 2018, Simon & Schuster Press
Speer A., ‘Erinnerungen’ (‘Memories’), 1969, Orion Publishing Group
Goldhagen, Daniel, 1996, ‘Hitler’s Willing Executioners’ Knopf Press 1966
Teare, Donald, 1958, Asymmetrical atrophy of the heart in young adults’, British Heart Journal, 20: 1-8
