Phar Lap and duodenitis-proximal jejunitis ☆

The causes of controversial deaths or illnesses of famous persons are often debated long after the time of death of the individual. The historical Clinical Pathological Conference (CPC) meets annually to discuss these cases. In the past, the deaths of Edgar Allan Poe, Alexander the Great, George Custer, and Pericles have been discussed. At the 7th CPC, it was suggested that Herod the Great died of a combination of kidney disease and an unusual genital infection.1 It was also reported that Claudius died from eating mushrooms containing muscarine. The mushrooms were given to Claudius by his wife to make way for her son Nero to take the throne.2 Dr. J.V. Hirschmann at the 7th CPC suggested that Mozart’s death was caused by trichinosis acquired by eating undercooked pork cutlets.2 At the 6th CPC, Dr. Faith Fitzgerald stated that at least 118 different diagnoses including poisoning, murder, syphilis, and kidney failure had been suggested for Mozart’s death.3 She concluded that Mozart may have died of rheumatic fever. Fitzgerald said, “There is no way to definitively know exactly what caused Mozart’s death. Clinical pathological conferences are a common way to teach clinical thinking. Examining notorious cases of the past is extremely valuable for doctors, medical students, and the general public because it teaches skeptical inquiry and it’s fun.” The same reasoning could be applied to horses. Phar Lap would be an excellent example. Phar Lap was born in New Zealand in 1926. His racing career, started in 1929, was primarily in Australia. Phar Lap won 37 of 51 races, including 14 consecutive races in 1930 to 1931. In 1932, he went to North America and won the Aqua Caliente Handicap. He was scheduled to enter more races in the United States, but he died on a ranch near Marlo Park, CA, on April 5, 1932. The cause of his death has been controversial. William Nielsen, the Australian veterinarian who traveled to America with Phar Lap, first suggested Phar Lap had been poisoned by eating alfalfa or barley covered with dew.4 Neilsen later suggested acute gastric enteritis caused by a toxin was the cause of death. Others claimed that Phar Lap died of impactive colic. Rumors of poisoning by gangsters were popular. Accidental poisoning was considered a possibility. Trees on the ranch had recently been sprayed with lead arsenate. It was also suggested that his handler, Tommy Woodcock, had accidentally given Phar Lap an excess of a tonic that contained arsenic. Traces of arsenic were found in tissues, but it was concluded that the amount was small and not likely to have killed the horse. A team of veterinarians at the University of California Davis4 concluded that the death was “caused by a colicky condition manifesting itself in the form of an acute inflammation of the stomach and intestines. The factors responsible for the acute inflammation have not been determined.” There is a more recent diagnosis. As reported by Armstrong and Thompson,4 Dr. John Van Veenendaal concluded in February 2000 that Phar Lap died of anterior enteritis (duodenitis–proximal jejunitis). He ruled out colitis X because the lesions were mainly in the upper intestinal tract. He thought the gastric ulcers previously reported were probably incidental. The small amount of arsenic in the tissues was not unusual because many tonics such as Fowler’s Solution contained arsenic. Dr. Van Veenendaal reported that the consistent signs of duodenitis-proximal jejunitis (DPJ) are fever; acute abdominal pain with rapid deterioration to depression; and, without intensive supportive therapy, death from enterotoxic shock, severe dehydration, and respiratory problems from acute distention of the stomach and upper small intestines. He wrote, “The salient words in William Nielsen’s report on the post mortem examination are: The signs present were those of acute gastric enteritis brought about, in my opinion, by some toxic substance, the toxic substance causing same I am unable to say.” Van Veenendaal concluded, “The disease syndrome, now known as DPJ was not described in the literature until the early 1980’s. Nielsen would not have been aware of this disease but his summation of the cause of death was correct.” Armstrong and Thompson4 concluded, “Despite the diagnostic techniques and treatment options available today, duodenitis-proximal jejunitis kills close to 70% of horses stricken by it. Phar Lap had no chance. The disease had not been discovered in April 1932, so it was never considered as a possible cause of the taking of a hero. As the disease was unknown, so was the treatment. Phar Lap’s death was tragically premature and painfully sudden. No amount of care could have prevented it; no skill would have stopped it.” Armstrong and Thompson4 may have been overly pessimistic about the chances of survival of horses with DPJ today. From Cornell University, Ithaca, NY. Address reprint requests to H.F. Hintz, Cornell University, Department of Animal Science, Morrison Hall, Ithaca, NY 14853-4801. Copyright 2002, Elsevier Science (USA). All rights reserved. 0737-0806/02/2206-0011$35.00/0 doi:10.1053/jevs.2002.35610