1723 was a tough year for Baron Jan Van Wassenaer. In this episode, we look at how a Dutch physician used basic medical principles to discover one of medicine’s more unusual and often dangerous conditions. Now, the disease bears his name.

The Great Retch 

Episode 2

Meet Herman 

There was a reason Dr. Herman Boerhaave was the go-to-guy for the Dutch Royalty. A renowned physician, chemist, and botanist at the time, Boerhaave's Syndrome is only one aspect of the doctor's impressive resume. He is noted to be the first chemist to isolate the compound urea from urine and the first to apply thermometers and microscopes in a clinical setting. 

Being raised in a Protestant home, Herman initially studied to be a pastor like his father, but ultimately decided to pursue his degree in philosophy instead. Only after this was completed in 1689 did his work in science and medicine actually begin. He quickly distinguished himself at the Academy of Harderwijk in large part due to his interdisciplinary view of medicine: with heavy influence from Rene Descartes and Isaac Newton, he described the human body as a complex combination of simple machines. He maintained the physico-mechanical view of anatomy was dictated by the self-regulation of fluid, pressure and chemical reactions. This was a grandiose departure from the mysticism that dominated medicine at the time. 

It was this notoriety and focused thinking that landed Dr. Boerhaave as the Royal physician to Baron Jan Van Wassenaer, Prefect of Rhineland and Grand Admiral of the Dutch Fleet. 

Portrait of Dr. Herman Boerhaave (1668 - 1738)

Clinical Vignette

A 44 year-old male presents at ER with a tearing pain emanating from his chest and lower back. He is a recovering alcoholic, but has recently relapsed. After a particularly long bender, his wife has brought him in to the hospital and reports excessive vomiting. 

 

Clinical Presentation: 

- Vomiting 

- Chest pain 

- Subcutaneous emphysema 

- Odonyphagia (difficulty swallowing) 

- Cyanosis (bluish tint of skin)

- Dyspnea (difficulty breathing) 

- Fever 

The patient is immediately placed on IV fluid therapy given that he is unable to drink water. A plain chest radiography shows pleural effusion in the left pleural cavity. It appears his lungs have some fluid in them! Our resident has an aching suspicion of Booerhave's Syndrome, but wants to confirm so she orders a CT chest scan (with contrast). Our patient is placed on antibiotics immediately given risk of sepsis. There is a ton of naturally living bacteria and we can't risk that spreading to other organs, causing infection. 

The patient is rushed to the OR for emergency surgery where the 2 cm perforation is repaired via thoracotomy. 

Further Reading

For radiology cases of Booerhave's Syndrome: 

https://radiopaedia.org/articles/boerhaave-syndrome?lang=us

For more information on the disease itself: 

https://www.ncbi.nlm.nih.gov/books/NBK430808/

For more information on Herman Boerhaave himself:

https://www.newworldencyclopedia.org/entry/Hermann_Boerhaave

https://www.whonamedit.com/doctor.cfm/2404.html

For more information on the esophageal repair: 

https://www.youtube.com/watch?v=NzWpPBLW1CQ

Note: the youtube link shows the surgical operation and may be upsetting to some audiences. 

For images on this page:

https://en.wikipedia.org/wiki/Herman_Boerhaave#/media/File:Herman_Boerhaave_by_J_Champan.jpg

All images are free to use and share and not under copyright protection. 

Credits

Hosts: Wafik and Jessica Sedhom

Guest appearances: Nate Zeile as Baron James van Wassenaer, Alex Moersen as Dr. Herman Boerhaave

Written and Produced by: Wafik and Jessica Sedhom

Edited by: Wafik Sedhom

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