Recently, Dr. Benitz, a cardiologist and assistant medical professor of medicine at the University of Maryland Medical System, published a paper in the September issue of the Maryland Medical Journal dealing with a clinical review of a 39-year-old man. After review, Benitz concluded that this man died of rabies. The man Benitz reviewed was the famous American author Edgar Allen Poe. Poe died on October 7, 1849 and for over a hundred years it was thought he had drank himself to death.

Benitz concluded this after he was presented with the records of the case without the date or the name of the patient. Benitz published paper had many loose ends along with inconclusive thoughts. And Benitz came up with many of his conclusions without proper medical evidence and excluded certain diseases not known at the time of Poe's death. Benitz's paper was poorly written with little thought of the era of Poe's death.

The symptoms presented to Dr. Benitz were: "EP was admitted to the hospital for observation. He was initially unresponsive and remained so until approximately 3:00 a.m., when he developed tremulousness and delirium and began having visual hallucinations. He was noted to be drenched with perspiration and to have wide variations in his pulse rate. He remained in this state for the next 28 hours ... Results of a neurologic examination showed the patient was alert, oriented and appropriate ... He had no recollection of how he had arrived at the hospital or of the events leading up to his illness ... Because of his improving status, he was transferred to the ward room. Here, his physicians attempted to treat him with alcohol, which he vehemently refused. He soon worsened and by the evening of the third hospital day, his mental status became clouded .... He drank water with great difficulty. By late evening, he was again delirious, became combative, and required restraint. He remained in this state ... until his death on the fourth hospital day."

In addition, Dr. Benitz gave a history of the patient as it was presented to him, "EP worked as a writer. He had no-known allergies, coronary artery diseases, diabetes, or other systemic illness, and was taking no medication. He had cholera three months before the current hospitalization ... he had a history of alcohol abuse ... and there was no reported history of seizures or delirium tremor. The patient smoked tobacco on a regular basis and was sexually active with women." From these results Dr. Benitz thought it would be best if he examined all diseases with the symptom of delirium since when he is "faced with a challenging case he tries to distill its basic features." Benitz developed the possibilities of death containing neurologic causes of delirium and systemic causes of delirium.

The cause of Poe's death is most often thought to be alcohol withdrawal. Though there were other possible theories, this is the most probable considering the symptoms and patient's history. Alcohol withdrawal symptoms, paralleling Poe's, include tremors, autonomic hyperactivity, delirium, and seizures. Symptoms usually occur within five to ten hours of withdrawal. This usually does not cause death if treated properly. However, the doctors did not even look at this as a possibility. It was also known that Poe had abstained from drinking for six months, and he did not smell of alcohol when admitted to the hospital. However, due to Poe's state of unconsciousness, it would have been impossible for the doctors to know he hadn't drank in six months.

The diagnosis of rabies contains critical faults. Rabies is almost always deadly with average survival usually about four days. However, there were no signs of animal bites on Poe. It is rare that rabies is transferred in any other way. If Poe had sustained an animal bite, the scar or bruise from the animal would have been present.

There are other causes that may be the answer to Poe's death. Neurological causes of delirium include trauma, vascular disorders, neoplasia, epilepsy, and CNS infections. Benitz rejected death by trauma because there was no physical evidence of trauma. However he also stated that Poe may have sustained head injuries and have internal injuries from a time of drunkenness, and this may have caused no recollection. Benitz gave no further explanation other than he believed this cause was unlikely. Vascular disorders would have most likely been associated with trauma, hence vascular disorders were thrown out along with trauma. Neoplasia would also be associated with trauma, therefore, it was likewise rejected with trauma. Epilepsy was another possible cause of death.

The systemic causes of delirium include metabolic, endocrine, nutritional, hematological, infectious, and toxic, disorders which hinder the workings of the body. Metabolic causes of death are acute intermittent porphyia, which is characterized by delirium and occurs in a cyclical course. However, Benitz ruled this out because he believed it would be unlikely for Poe to experience acute intermittent porphyia at age 39. There was, however, no reference of acute intermittent porphyia in the examination, so it is possible he had unrecorded previous episodes. Nutritional causes of delirium were previously mentioned, however, they were also ruled out because Poe had been thought not to have drunk alcohol or taken an opium in recent times. Hematological causes of death by delirium include leukemic infiltration.

Another major fault in the review of Benitz was the fact that he faulted the doctors trying to establish Poe's cause of death for not performing lab work for many causes of death. The technology at the time of Poe's death was rather primitive, therefore, these people could not have performed any tests on Poe. Benitz faulted these people for not diagnosing unknown diseases.

Dr. Benitz's report was inconclusive in many areas and had many loose ends. The cause of Poe dying from alcohol withdrawal was rejected on Poe's word, who was unresponsive at the time of his admittance. Other conclusions were drawn without proper evidence. Benitz drew his conclusion of rabies as the cause of death when it had the same symptoms as the majority of other causes. Benitz drew all his possible causes of death using only a single symptom.

Benitz rushed to this conclusion when there wasn't even evidence of rabies transfer to Poe. He failed to find the proper time-frame for death and hence tried to fault doctors for unknown diseases, as well as trying to look for lab work to complete his work. He failed to take into consideration the time of Poe's death. u