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Maximilien de Robespierre was one of the most influential and best known figures in the French Revolution. A lawyer and politician who was guillotined in 1794, he might also have been the first described case of the rare immune disorder sarcoidosis.
The first case of the disease had been published over 100 years after the subject of this latest discovery, in 1877 by a pioneer in the understanding of the autoimmune disorder, Sir Jonathan Hutchinson.
He described a 58-year-old coal-wharf worker with purple, symmetrical skin plaques on the legs and hands.
The much earlier case of the executed French revolutionary leader has now been published by forensic scientists in the current December 20th issue of The Lancet.
With documents detailing his medical and other history to hand, the scientists carefully examined and reconstructed Maximilien de Robespierre's "death mask" to reach their retrospective diagnosis, ruling out other possible explanations, such as tuberculosis and leprosy.
The death mask had been famously created by Madame Tussaud after his death at the guillotine.
In piecing together their diagnosis of the condition in which the body attacks its own tissues and organs, the authors say "several clinical signs were described by contemporary witnesses." These include:
The authors add that "he also had permanent eye and mouth twitching and the symptoms worsened between 1790 and 1794."
Philippe Charlier, a forensic anthropologist based in Montigny-le-Bretonneux, France, and Philippe Froesch, a visual forensic specialist based in Barcelona, Spain, have published their digital reconstruction of Robespierre's face in their correspondence piece to The Lancet.
The historical diagnosis brought to life for this major 18th century figure is one "that includes all these symptoms" listed above and is specified further as "diffuse sarcoidosis with ophthalmic, upper-respiratory-tract (nose or sinus mucosa), and liver or pancreas involvement."
The authors even suggest details of how Robespierre's condition might have been attended to:
"We do not know which treatment was given by his personal physician Joseph Souberbielle, but fruits might have been included (in view of his very high consumption of oranges) along with baths and bloodletting."
The relevance of the work is not confined to interest in political or medical history - it may contribute to the understanding of sarcoidosis, whose cause remains to be fully understood today.
"Although sarcoidosis was first described in 1877 by British physician Sir Jonathan Hutchinson, here we show that a multidisciplinary - medical and anthropological - examination of famous figures might improve our understanding of the disease," the authors say at the end of their publication.
Information from the US National Heart, Lung and Blood Institute, gives a description of sarcoidosis. Lumps known as granulomas form in various organs as a result of immune system cells clustering together, and can cause damage to vital functions.
The rare condition is most likely to affect the lungs and the lymphatic system, and the American Lung Association cites "prevalence estimates ranging from less than 1 to 40 cases per 100,000 population."A study published in the June 2013 issue of the Journal of the American Medical Association contributes to improving the diagnosis of sarcoidosis.
Written by Markus MacGill
Copyright: Medical News Today
Not to be reproduced without the permission of Medical News Today.
Robespierre: the oldest case of sarcoidosis? Charlier P, Froesch P, The Lancet, 2013, volume 382, issue 9,910, page 2,068 (DOI: 10.1016/S0140-6736(13)62694-X).
A historical sketch; life and time of Jonathan Hutchinson (1828-1913), the first sarcoidologist, Sharma OP, Shigemitsu H, Sarcoidosis Vasculitis and Diffuse Lung Diseases, 2008, volume 25, pages 71-75.
The pioneers of sarcoidosis. In: Mihailovic-Vucinic V, Sharma OP, Atlas of sarcoidosis: Pathogenesis, diagnosis, and clinical features. Springer, 2005.
Sarcoidosis. In: American Lung Association, State of lung disease in diverse communities 2010. Information published online, accessed December 24th, 2013.
What is sarcoidosis? US National Heart, Lung and Blood Institute. Information published online, accessed December 24th, 2013.
Visit our Immune System / Vaccines category page for the latest news on this subject.
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9 Mar. 2014. <http://www.medicalnewstoday.com/articles/270626>
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