Dr. Mackowiak has become
so interested in history and the deaths of
famous people that he is reinventing
himself as a medical historian

By his own admission, Dr. Philip A. Mackowiak was not the best student as a youngster. He especially gave little thought to history. But through history Dr. Mackowiak has put an indelible mark on medicine.

Dr. Mackowiak, 59, is director of medical care at the Veterans Administration Maryland Health Care System in Baltimore. An expert in infectious diseases, he is credited with debunking a fact so widely taken to be gospel that it stood for more than a century—that normal body temperature is 98.6 degrees Fahrenheit. What’s more, the medical school drew international recognition after he organized the first Historical Clinicopathological Conference 11 years ago when he became interested in Edgar Allen Poe’s mysterious death.

Dr. Mackowiak has become so interested in history and the deaths of famous people that he is reinventing himself as a medical historian. “I am still an administrator and a teacher; and I still see patients,” he says. “But I have devoted a lot of my free time to reading and thinking about history.” History, for Dr. Mackowiak, is a road map that “helps one regardless of profession by understanding where one came from.”

“History helps us understand where other generations have been. Through it we develop a respect for them and a greater appreciation for our own shortcomings,” he says. History has strengthened Dr. Mackowiak’s appreciation of medicine.

“The art of medicine is something we are spending much less time with,” he says. “The art of medicine means just sitting down with a patient and getting to know them. I don’t know whether we are losing it, but we have less time to contemplate it.”

Two people taught Dr. Mackowiak the art of medicine. One was his father, Stephen C. Mackowiak, ’37, a general practitioner who ran his practice out of the family’s basement. The other was Theodore E. Woodward, ’38, a medical school icon. Dr. Woodward was chairman of the department of medicine from 1954 to 1981 and an expert in infectious diseases. He also was nominated for the Nobel Prize for Medicine.

Dr. Mackowiak was the third of six children. His family had a summer cottage near Dr. Woodward’s. The families grew close, and Dr. Mackowiak became best friends with Dr. Woodward’s son, Craig. In college, Dr. Mackowiak’s grades were not the best, but Dr. Woodward saw something special in the young man and helped him along. “I wouldn’t have gotten in if it wasn’t for him,” Dr. Mackowiak says. “He was invaluable. There is no way I could really pay him back; he gave me a start in medicine.”

After graduating in 1970, Dr. Mackowiak did a two-year residency in internal medicine at Maryland. Then, he joined the Center for Disease Control. He left Baltimore with his wife, Connie Lynn, for New Orleans where he worked in Louisiana as an epidemic intelligence service officer. The couple lived in the French Quarter where they expected to find paradise. “We opened the door to the apartment that we took sight unseen and cockroaches went running in a hundred different directions,” Dr. Mackowiak recalls.

Investigating outbreaks of diseases proved more rewarding than apartment life. Dr. Mackowiak became involved with a spectacular outbreak of vibrio parahaemolyticus gastroenteritis after people ate bad shrimp at a shrimp boil. Then, around 1972, he helped probe the largest outbreak ever investigated of hepatitis after people consumed contaminated oysters.

After conducting a nutrition survey in Bangladesh for the CDC, Dr. Mackowiak joined the University of Texas Southwestern Medical School faculty in Dallas in July1974, and began investigating synergistic infections. He was named professor of medicine in1987, and become interested in fever and its importance as a defense mechanism. He returned to his alma mater in 1988 as associate chairman and professor of medicine at the VA.

His research into fever only became more intense. One question he thought needed to be answered was a simple one: What is normal temperature? For more than 100 years people associated it with 98.6 degrees Fahrenheit. The man behind this measurement was Dr. Carl Wunderlich, a German physician who recorded the temperatures of thousands of patients.

Dr. Mackowiak conducted his own study taking the temperature of about 150 healthy volunteers. He found that temperatures varied depending on the time of day, the time of year, the sex of the patient or whether the person was exercising.

Wunderlich never suggested that there was one normal temperature, but his findings of 98.6 stuck and ended up in medical school text books. It also was sharply different from Dr. Mackowiak’s average temperature of 98.2 degrees.

Dr. Mackowiak continued his investigation. Sometimes he was amazed by his good luck. While attending a presentation by Dr. Woodward at the Mutter Museum in Philadelphia, a museum official told him it had one of Dr. Wunderlich’s thermometers.

Dr. Mackowiak was shocked, and asked to borrow it. He brought it back to Baltimore and discovered that the thermometer was calibrated a degree-and-a-half centigrade higher than the ones used today and in Wunderlich’s day. Wunderlich also measured temperatures by taking them in the armpit, which should have made them lower than oral temperatures.

“It was almost surreal,” Dr. Mackowiak says of finding the thermometer. “It just seemed to fit together in a neater package than was believable.”

It has been that way with the Historical Clinicopathological Conference, too. Eleven years ago, Dr. Mackowiak read an account of Edgar Allen Poe’s bizarre death. He thought it would make an interesting clinicopathological conference. “It was such a terrific success.” Dr. Mackowiak says. Since then he has hosted nine other conferences plumbing the depths of history to debate the mysterious deaths of Alexander the Great, Beethoven, Mozart and Claudius. He even revisited the trial of Joan of Arc to determine if she was mentally competent for her alleged criminal acts. About 250 people attended. The conference “has become my passion,” Dr. Mackowiak says.

He is preparing others as he steps deeper into his new passion—medical history. “I am just in the business of being fulfilled intellectually and professionally,” Dr. Mackowiak says. “I guess what I have tried to do throughout my career was something Dr. Woodward suggested—become an expert on something during your career with the goal of knowing more about that something than anyone in the world.”