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Lobelia: The controversial death of Ezra Lovett?

by Paul Bergner

Medical Herbalism 10(1-2):27-28

The only case of death supposedly due to lobelia appearing in the medical literature of North America is that of one Ezra Lovett, who allegedly died by lobelia poisoning at the hands of Samuel Thomson in Massachusetts in 1807. The death was the basis of murder charges against Thomson two years later. During his trial, testimony about his treatment of Lovett was entered into evidence. After the prosecution had presented its evidence, the judge found that no basis had been established for charges of murder or manslaughter. Thomson was not required to present defense witnesses, and the jury found him innocent of the charges. The outcome was unsatisfactory to Thomson, who had hoped to present rebuttal witnesses, claiming that much of the testimony about his treatment of Lovett had been fabricated in such a way as to make him appear to be reckless in his treatment of patients. In a subsequent civil lawsuit against the physician responsible for the charges against him, Thomson did enter into legal record his rebuttal against the prosecution witnesses in the murder trial   Thomson’s witnesses testified that he was away from the town where Lovett lay ill from Wednesday afternoon until Sunday afternoon, and that he had not been present with Lovett for at least twelve hours before his death. The unrebutted testimony in the murder trial was seized upon by conventional physicians, entered into the medical literature in the writings of Bigelow (1810, 1817) and Barton (1817), and has been parroted uncritically in conventional reference texts ever since.

This testimony appears to be the origin of the rumor that lobelia can cause stupor, coma, convulsions, and death.

Even accepting the prosecution testimony in the murder trial, it appears unlikely that lobelia could have been responsible for the death. Conventional physicians had control of the patient for the last 12-14 hours of his life, and even by their account, Thomson supposedly had administered no medicines for about 24 hours. The toxicity of lobelia is supposedly similar to that of nicotine (Osol and Farrar; Lampe) Nicotine, taken orally or absorbed through the skin, acts quite rapidly. Death may occur suddenly early in the intoxication, and recovery from acute intoxication is rapid (Lampe). James Thacher, the primary reference for lobelia toxicity, says that it “frequently kills within five hours” (Thacher, 1810).It thus seems unlikely, even if possible, that lobelia would have killed Lovett 24 hours after administration of the last dose.

Notably missing from the prosecution account of the case is a record of the treatment given by the physicians during the last day of the patient’s life. Conventional physicians of the day usually administered such treatments as bloodletting, mercury, and other mineral poisons, which themselves may produce death. The treatment during the last day of George Washington’s life, nine years before the death of Ezra Lovett, illustrates standard medical practice of the day. Washington had been exposed to cold rain, and come down with alternating fever and chills and a sore throat. Here is the treatment he received, as narrated by historian Barbara Griggs:

“. . . They at once sent for a bleeder in the neighborhood, who took twelve ounces of blood from his arm. Next morning, Washington was no better, and Dr. James Craik, his personal physician, arrived at 11 o’clock. It was the start of a grim medical marathon. Dr. Craik . . . sent for two other physicians to join him in consultation. Meanwhile he ordered two more “copious” bleedings; a blister was applied to Washington’s throat; two doses of mercury were given him; and a cathartic injection was forced up his rectum – all to no avail: Washington’s breathing became more painful and labored. . . . they had already drawn perhaps three pints of blood from a sick and ageing man [but] . . a fourth bleeding was ordered. This time, no less than thirty-two ounces of blood were drawn off; . . . a third dose of calomel [mercury] – ten grains – was now given him, followed by several doses of tartar emetic (antimony); vapors of water and vinegar were blown around his throat; to the fiery blister on his throat was added a bran-and-vinegar poultice, and more blisters were strapped to the soles of his feet. . . . Late on Saturday night, barely twenty-four hours after he had woken with a chill and a sore throat – he breathed his last.”

The doctors had drained about half the blood from Washington’s body, and administered doses of mercury that would be considered poisonous today. According to Griggs, such was not unusual medical treatment, even as late as the 1860s. Unfortunately we have no record of the treatment Lovett received during his last twelve hours. During this time he was under the care of a Dr. Howe, a member of the Regular school of medicine who employed the type of methods used on Washington. Howe was the only physician in Thomson’s trial to give evidence against him, and may not have been an objective party in the death.

The prosecution testimony also says little of the nature of the illness from which Lovett suffered. Thomson called the condition a “bad cold,” which was severe in its early stages and which took a turn for the worse after several days. By the time he arrived, Lovett had a fever, with stiff neck, and was in a stupor, a grave combination of signs by the standards of modern medicine. It was apparently an infectious disease, and a potentially fatal one, because Lovett’s mother had died a short time before from an illness with the same symptoms.  The immediate diagnosis suggested by these symptoms is bacterial meningitis. Delirium and convulsions may occur in meningitis, and death occurs in 70-100% of untreated cases, often from respiratory collapse. Thomson states that members of the household suspected that the disease was typhus fever. Epidemic louse-borne typhus fever typically manifests with a high fever for about five days. After this, a rash appears. Throughout the illness, neurological symptoms such as headache, stupor, coma, and convulsions may predominate, and general and increasing malaise is usually present.  Death from renal failure occurs in about 60% of untreated patients toward the end of the second week, the precise time of Lovett’s death. Neither Thomson nor the prosecutors specifically mention the cutaneous symptoms (rash) typical of typhus, but the other symptoms and the duration of the illness are consistent with louse-borne typhus. Thomson administered treatments before the conclusion of the five days typical before the appearance of a rash, and might have altered the course of the disease.     It is thus possible that the stupor, coma, convulsions, respiratory collapse, and death attributed to lobelia in the early nineteenth century medical literature, and parroted uncritically ever since, were actually the symptoms of infectious meningitis or louse-borne typhus.
 

Copyright 2001 Paul Bergner