Rosalie’s Causes of Death

After my previous post about Rosalie Booth, John Wilkes’ largely forgotten sister, I sough the help of a medical professional to help explain to me her recorded causes of death.  The only doctor I know personally is Dr. Blaine Houmes, who just so happens to also be an accomplished researcher of Abraham Lincoln’s life and death.  Therefore, I took a break from sending him pictures of this mysterious rash I keep getting, to ask him to comment on Rosalie’s ailments.  Though I was expecting only a few words from the good doctor translating “bulbar paralysis” and “progressive spinal sclerosis” into layman’s terms, he was gracious enough to provide a very detailed explanation of these conditions and his thoughts on Rosalie’s state of health.  Instead of merely putting his reply in the comments to that post, I feel his response is worthy of a post of its own. The following explanation is courtesy of Dr. Houmes, who has my sincerest thanks for his expertise and help.

“Bulbar paralysis and progressive spinal sclerosis are two different entities and exhibit all the imagination and florid naming that Victorian medicine documented for disease patterns they largely didn’t understand. Neurology back then was quite primitive. These two diagnoses found on the death certificate involve a great deal of speculation figuring out what exactly is meant, but some explanation might be useful.

On the bottom of the brain is the brain stem, inside the skull. The brain stem is the part of the spinal cord which is a transition zone between the brain and the spinal cord in the backbone. From each side of the brain stem there are twelve pairs of cranial nerves exiting to different parts of the head, neck and certain internal organs. The nerves generally have two functions—sensation and/or motor (for movement), and they send signals as to how we perceive and actually move/operate/feel things with and in our bodies.

The nerves are numbered I through XII, and are (with simplified function): I Olfactory (smell), II Ophthalmic (vision), III (eye muscles), IV Trochlear (eye muscles), V Trigeminal (chews), VI Abducens (eye muscles), VII Facial (facial movement), VIII Auditory (hearing and balance), IX Glossopharyngeal (swallows), X Vagus (swallows, speech, chest/abdomen organ function), XI Accessory (turns head/shoulders), and XII Hypoglossal (tongue muscles).

Bulbar paralysis is the end stage of Bulbar palsy, involving the nerves IX, X, XI, and XII. This can be caused by genetic disorders, blood vessel problems (such as bleeding from stroke or trauma), degenerative diseases (ALS which is Lou Gehrig disease), inflammation or infection (including Polio, Lyme disease, and Guillain-Barre syndrome), Cancer/tumors, Toxins (botulism is a prime example–which plastic surgeons have discovered has magical properties in the form of Botox, much adored by actors and actresses), and autoimmune disorders (where the body starts making antibodies against itself). Those suffering from this malady have problems speaking, chewing food, swallowing, choking on liquids/saliva and they drool. Many eventually die from aspiration of food/saliva or from pneumonia.

Progressive Spinal sclerosis is “probably” either spinal stenosis, Multiple Sclerosis (MS, “The great crippler of young adults”), or ALS (“Lou Gehrig” disease).

Spinal stenosis is usually from arthritis and aging, either narrowing of the spinal canal (inside of a vertebra, which protects the spinal cord) or the small hole (foramina) on each side of the vertebra where a spinal cord nerve exits to the arm, torso, leg. This is a chronic, progressive disease with much back and leg pain, numbness, and tingling for most. Not everyone will feel the symptoms even if they have the problem.

Multiple Sclerosis is a disease where the fatty insulation cover of nerves (like the insulation for electrical wires) is destroyed, leaving large holes, gaps, and scars called plaques, which disrupt nerve signals to and from the brain. The disease can be gradual, rapidly progressive, or stable. It usually starts in people living in colder climates, starting between the ages of 20-40,and is twice as common in women than men. It causes problems everywhere in the body (along with great pain), and usually starts with sensory or motor symptoms.

The challenge in determining Ms. Booth’s disease is wondering whether the cause of death is from a congenital disorder (such as cerebral palsy, which can occur during pregnancy, childbirth, or up to three years of age) or of later onset. Plus when one sees the word “invalid,” what exactly does that mean? Was it of psychiatric origin, such as depression which can periodically get better and then worse? Was it a fairly mild form of intellectual disability (the current politically correct term for what was formerly called mental retardation)? What other diseases did she have–diabetes, high blood pressure? Her death certificate (viewed with a poorly reproduced copy) notes the cause of death–if correctly read–involved a process evolving over “about ten years.” Perhaps she had both chronic problems and then suffered a heart attack or stroke as the final insult to her body. This is certainly plausible; while living with her young brother Joe the month before her death, she was still up and able to answer the door when a visitor knocked, and then faced a brick heaved at her, along with a fusillade of rocks aimed at the house. Her cause of death remains a mystery.”