Historical Notes

Brigham Young's Death: A Proposal for a Different Diagnosis

Brigham Young is the American Moses and is so characterized by historian Leonard Arrington in his exhaustively researched book Brigham Young: American Moses, published in 1985 Brigham Young had earned that appellation by leading the first contingent of Mormon emigrants across the central plains from Missouri to the Valley of the Great Salt Lake in 1847. Thirty years later, in 1877, Brigham Young, age seventy-six, was dead after suffering an acute intestinal illness for six days

Newspaper accounts of the time state the cause of the leader's death as "cholera morbus." What is "cholera morbus"? At the time of Young's death it was a nonspecific term used to denote a variety of acute abdominal catastrophes characterized by diarrhea, cramps, and vomiting. The term is not used in present medical terminology and has no relationship to the cholera epidemics in some parts of the "world

What, then, is the diagnosis in present medical terminology? An excerpt from Dr Arrington's book states, "A medical historian who has carefully considered the notes kept by his doctors suggests that what they called 'cholera morbus' was, in reality, the as-yet-unidentified condition of appendicitis. Brigham expired from the infection produced by a ruptured appendix."

The clinical and pathological condition we now know as appendicitis was first described and so named in 1886 by Dr. Reginald Fitz. It has been generally accepted that Young died of a ruptured appendix. An article by Dr. Lester E. Bush, Jr., entitled "Brigham Young in Life and Death: An Overview" and published in the Journal of Mormon History also suggests that a ruptured appendix was the cause ofYoung's death.

I propose a different cause of death Other excerpts from Dr Arrington's book tend to support my thesis. Those excerpts, plus some medical probabilities and a little medical conjecturing, lead me to a different diagnosis, one that I think is more likely in this particular instance My proposal is not unique, however Others have proposed the same diagnosis

In 1876 Brigham Young was in his seventy-sixth year. He had been very active in his last year of life attending to the improvement of the administration of the priesthood units of the Mormon church He apparently suffered from rheumatism and arthritis and had some urinary distress due to an enlarged prostate Overall, however, he was in fairly good health for a man of his age Just a few days before his death on August 29, he had been bathing in the Great Salt Lake "for the first time in several years and enjoyed it exceedingly."

Dr Arrington's book also reports that early in 1877 Young had said his health was excellent He said, "I have not for years endured the labor of speaking at Conference and public meetings as well as I have done at this last Conference and of late. I have spoken at each meeting in the Ne w Tabernacle the last two Sundays with no bad effects to myself The pain which I have so frequently suffered from in my stomach after speaking to large congregations, has troubled me but very little of late."

Young was known as a forceful speaker with a powerful voice. He sometimes became "wrought up" and pounded on the pulpit. Marks he made by pounding are still evident on one pulpit in the St. George temple. When he spoke to large congregations he had no access to amplifiers and had to increase the volume of his voice. Those vigorous activities may have been physically taxing to the aging leader.

I have already noted the abdominal pains he suffered after speaking to large congregations I think those pains were due to "intestinal angina," a manifestation of ischemic bowel disease, an impairment of the blood supply to the intestines due to the narrowing of the mesenteric arteries.

Brigham Young was apparently well on Thursday, August 23, 1877. He attended a meeting with bishops in the Council House in Salt Lake City, but in the afternoon he felt an "inclination to vomit." At his home later in the day, at about 11 p.m., he became suddenly and violently ill with abdominal cramps, vomiting, and diarrhea, the "cholera morbus" of the time.

Acute appendicitis usually does not begin suddenly and violently. It usually begins insidiously and becomes gradually worse over a period of time. The violent, acute onset ofYoung's "cholera morbus" is not typical of the onset of appendicitis Also, appendicitis is characteristically a disease of young people Admittedly, it can occur in a seventy-six-year-old, but it is not common in older people.

For several months Brigham Young had suffered episodes of abdominal pain, which may well have been "intestinal angina" due to impaired circulation caused by the "hardening" of his mesenteric arteries, those arteries that supply blood to the intestines. Those narrowed intestinal arteries can suddenly become blocked, just as the coronary arteries that supply the heart can suddenly become blocked, thereby causing an acute heart attack Whe n the mesenteric arteries become blocked, an acute abdominal catastrophe known as acute mesenteric artery thrombosis (blood clot) occurs. This is characteristically an older person's disease. In Brigham Young's time the condition would be a catastrophe and uniformly fatal.

In his article, Lester Bush considers five possible causes of Brigham Young's death, including acute mesenteric artery thrombosis. H e also mentions acute arsenic poisoning, acute pyelonephritis, diverticulitis, and acute appendicitis He quickly eliminates the first three possibilities, and I agree. However, acute mesenteric artery thrombosis cannot be so easily eliminated. Acute appendicitis and acute mesenteric artery thrombosis remain as the two most probable causes of Young's death

Critical to my thesis are the differences in the onset of acute appendicitis and acute mesenteric artery thrombosis. Acute appendicitis typically is of insidious, gradual onset, while acute mesenteric artery thrombosis is typically sudden and dramatic in onset After the first twenty-four to forty-eight hours, however, the two diseases would be expected to follow similar courses, leading to gangrene of the bowel or appendix, necrosis and perforation of the appendix or bowel, leaking of intestinal contents into the peritoneal cavity, peritonitis, possible abscess formation, possible Gram-negative sepsis, shock, and death Thus, the mode of onset is the key to the diagnosis in this case.

Brigham Young's illness was sudden, violent, and dramatic in onset, a clinical picture more typical of acute mesenteric artery thrombosis. Therefore, I am of the opinion that acute mesenteric artery thrombosis more likely than rupture of the appendix to be the cause of the leader's death

A Hamer Reiser, Jr., M D Salt Lake City

Sources:

Leonard J. Arrington, Brigham Young: American Moses (New York: Alfred A. Knopf, 1985).

Lester E Bush, Jr., "Brigham Young in Life and Death: An Overview," Journal of Mormon History 25 (1977)

Ralph T. Richards, M. D., Of Medicine, Hospitals, and Doctors (Salt Lake City: University of Utah Press, 1953)