Case Study
A middle-aged man presented with facial flushing and fever a number of days after receiving in a box in the mail, which when opened, released a sharpened spring designed to puncture the recipient. On examination, he was noted to have "dark crusts" on his lips, to have a tremor and dysphonia, and appeared moribund.
The physician attending the patient believed him to be suffering from Tapanuli fever, also known to him as "the black death of Formosa." Fortunately, the leading expert on this disease was residing nearby, and the attending physician presented the case to him. The expert, while in Asia, had previously recovered the etiologic organism in pure culture on gelatin and had experimentally demonstrated its rapid lethality.
The expert, however, on visiting the patient and noting him to apparently be near death, reacted strangely. He forced the patient to recall receipt of the box and the sharpened spring. The expert then informed the patient that he himself had sent it and that it was the source of his illness.
The patient, however, immediately recovered from his apparent illness and had the expert arrested.
Comment by Stan Deresinski, MD, FACP
The physician’s name was Watson and the name of the "patient" was Holmes and the episode took place in "The Adventure of the Dying Detective" by Sir Arthur Conan Doyle. The subject of the lethal experiment had been the expert’s nephew and Holmes, suspecting a homicide, had entrapped the expert (and fooled Watson) with what must have been a performance worthy of an Academy Award, if such had existed at the time.
Speculation has continued on the etiology of "Tapanuli fever" ever since. Vora expands1,2 on a previous suggestion that the disease was meliodosis.1 Infection with Burkholderia pseudomallei is endemic in southeast Asia, having been first identified in 1912 in drug addicts in Rangoon (now Yangon), and the perpetrator of the biological attacks was owner of a Sumatran plantation. Furthermore, B pseudomallei infection is known to be transmissible by direct inoculation and can be rapidly lethal. As pointed out by Vora, B pseudomallei has been identified by the CDC as an agent with potential use in bioterrorism. Doyle’s use of the postal service as a delivery mechanism has also proven to be prescient.
Dr. Deresinkski, Clinical Professor of Medicine, Stanford; Associate Chief of Infectious Diseases, Santa Clara Valley Medical Center, is Editor of Infectious Disease Alert.
References
1. Vora SK. Sherlock Holmes and a biological weapon. J Roy Soc Med. 2002;95:101-103.
2. Sodeman WA Jr. Sherlock Holmes and tropical medicine: a centennial appraisal. Am J Trop Med Hyg. 1994;50:99-101.
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