Lessons from a geriatric clinical case from the 19th century: a bridge to modern geriatric medicine

Abstract

Count Neipperg (1775-1829), the morganatic husband of Maria Luigia of Habsburg, Napoleon's former wife, presented with typical heart failure symptoms and died of bilateral bronchopneumonia. Neipperg's case is an example of the conflict in the medical field, which led to the birth of modern evidence-based medicine (EBM), and although Neipperg died almost 200 years ago, his case presents the same critical issues that more complex geriatric patients face today. First, the attending physicians provided divergent opinions without reaching an agreement. For example, Francesco Rossi correctly diagnosed heart disease by evaluating the patient's signs and symptoms, a clinical approach that is an early example of modern EBM. By contrast, Giacomo Tommasini made a misdiagnosis based on the philosophical principles of John Brown's vitalist theory, as reworded by Giovanni Rasori. Second, Tommasini's medical report also includes evidence of the Geriatric 5Ms for older patient care, such as multi-complexity, multimorbidity, medication, mobility, and the mind. Moreover, both physicians considered "what matters most" for the patient and his family. Third, the Count's status and political role were identified as the social and structural determinants of health (SSDoH) and used to justify the exceptional intensity of the health care provided. Subsequently, the ante litteram application of EBM and a clinical evaluation based on Geriatrics 5Ms principles anticipate current multidisciplinary management focused on the patient rather than a single disease. The systematic revision of past clinical cases not examined before could open new windows in the dissemination of the geriatric methodology and discipline.

Keywords: evidence‐based medicine; geriatric clinical case; geriatrics 5Ms; patient‐centered care; social and structural health determinants.

FIGURE 1

General Adam Albrecht Neipperg's portrait. Giovan Battista Callegari (Parma, 1785–1855). Source: Parma (IT), Museo Glauco Lombardi. © Museo Glauco Lombardi.

FIGURE 2

Timeline of Count Neipperg's medical history, listing symptoms, physical findings, attending physicians' diagnosis, and respective therapeutic approaches, in chronological order of appearance in historical sources. * Treatments are exhaustively listed in Supplementary Table S1; ** Unspecified date; NA, not applicable.

FIGURE 3

Mask for the cast of General Adam Neipperg's face (A) and hand (B). Both bilateral Bichat's fat pad wasting (A) and left‐hand edema (B) are evident in this image. Source: Museo Rocca Sanvitale, Comune di Fontanellato (Parma, IT).

FIGURE 4

Adam Neipperg's autopsy report. Source: With permission of the Ministero della cultura–Archivio di Stato di Parma.