What Killed Jane Austen?: And Other Medical Mysteries

by George Biro

  The gouty arthritis that had killed his father Charles also ravaged Philip. By his mid-thirties, he had his first acute attack; within a decade, the gout had become chronic.

  As his health grew worse, so did his political fortunes. Marshall Dale believes that Philip saw his gout:

  … as God’s rebuke to a servant who was not properly diligent in the holy work of exterminating heretics and winning converts to the one true faith. His disease… largely explains the unspeakable cruelties inflicted by a man who was not basically inhumane upon the hapless victims of the Spanish Inquisition.

  Some 35 years after his first attack of gout, Philip’s episodes gradually became more frequent and more severe.

  By his late sixties, one arm was nearly useless; one knee was rigid, and he could only just hobble around. But no one ever heard him complain.

  By the age of 70, he was nearly bedfast; he could neither dress nor toilet himself.

  His surgeons bled him over and over. To drain his swollen knee, they reportedly inserted threads which produced open, weeping sores. Infection wasted his frail body.

  Philip did not want to die in Madrid, but in the Escorial—the palace, church, monastery and school that he himself had built to honour God—about 40 kilometres away. To save him the agony of a jolting coach, litter-bearers carried him all the way.

  From his couch in the Escorial, Philip could draw comfort from the sight of the altar.

  Bedsores and ulcers now made it too painful to move him at all; the stench kept away most visitors.

  While the sun rose on 13 September 1598, Philip II, King of Spain for 42 years, clutched his father’s crucifix. As the children of his seminary began to sing Mass, he won final release from his sufferings.

  (GB & JL)

  Marie Antoinette and Louis XVI of France – and sex

  The year 1993 saw the 200th anniversary of the beheading of Louis XVI (21 January) and his Austrian wife, Marie Antoinette (16 October). To compile an essay on the medical history of beheading would be difficult, its swift finality leaves no room for conjecture, but aspects of the royal couple’s earlier life together do provide us with a few fascinating clinical morsels.

  In 1768 Marie Antoinette became betrothed to Louis, then Dauphin of France. She was 13 and he 14 years old. Marriage could not take place until after her first menstrual period, and as this did not manifest itself until February 1770, the ceremony was delayed until May that year.

  She was an attractive young woman, petite, blonde, and amiable. He was gawky, overweight, uncouth, painfully self-conscious, and described by the Austrian envoy as showing ‘only limited intelligence. Nature seems to have refused him everything’. His only accomplishments seem to have been an ability to hunt stag and to make locks in his private forge.

  Not a propitious beginning, but worse was to come.

  The nuptial bed was blessed by the Archbishop of Rheims; and King Louis XV, the groom’s grandfather, gave Louis his nightshirt. As the monarch was a well-known lecher whose string of conquests had included Madame Pompadour and Madame Du Barry, it may not have had much wear.

  The couple retired, and, half dreading, half curious at what was to come, Marie Antoinette waited. And waited. The bulky form beside her lay still, asleep. Night after night the same ritual was repeated. The chambermaids searched the dauphine’s bedclothes in vain for the telltale signs of loss of virginity, and the coy beginning soon became a matter of common gossip.

  Spies from the Viennese court reported back that Louis was ‘very much like a eunuch in his figure, and possibly a eunuch in fact’. The royal doctors were consulted and made reassuring noises, considering he was not yet mature and that in time, together with the right food and exercise, all would be well.

  To handle the royal genitals seems to have been outside the doctors’ brief, for they missed the vital clue—the unfortunate bridegroom’s phimosis. This is an inability to retract the foreskin or prepuce; during an erection, constriction of the penis by its non-retractable skin sheath causes excruciating pain. The remedy is a fairly simple operation.

  So, not having the gumption to seek help, the youth opted out of his marital duties altogether. Mind you, there was no anaesthetic then, and the thought of knives flashing so close to the crown jewels would have caught the breath of even the most insensitive lad. So a stalemate was produced by name and by nature.

  To her credit, Marie Antoinette maintained her composure, at least outwardly. The two apparently discussed the problem, and surgery was agreed upon. But Louis decided to postpone things until his 16th birthday, 23 August 1770; and then, wham.

  Louis’ birthday came and went. The surgeon was not called and the shared virginity persisted.

  There was similar vacillation when he became king in 1774. As the surgeon spread out the instruments, the terrified patient fainted (surely that would have been just the moment to act!).

  After seven barren years, Marie Antoinette’s eccentric brother, Joseph, decided to journey from Vienna and sort them out. For the first time here was someone who did not mince matters. After a heart-to-heart he wrote to his brother that Louis was able ‘to have strong well conditioned erections’, but not complete the act. ‘He introduces the member, stays there without moving for perhaps two minutes, withdraws without ejaculating but still erect, and says good night.’ Pain for Louis, disappointment for Marie Antoinette and frustration for both.

  The forthright Joseph went on in his blunt way: ‘This is incomprehensible because with all that he sometimes has nightly emissions, but once in place and going at it, never; he says plainly that he does it from a sense of duty but never from pleasure. They are two complete blunderers.’ He wanted to whip Louis ‘so that he would ejaculate out of sheer rage like a donkey’.

  Joseph persuaded the dauphin to have the dreaded operation and advised his sister thereafter to entice her husband into bed in the afternoon when he still had energy; as later, after a meal, he would flag. Her brother then went off to reaffirm his faith in human nature by sampling the delights of the Parisian demimondes.

  Now, with the prodding of his brother-in-law, the deed was done, and when all was healed the seven-year-old marriage was finally consummated.

  At the end of August 1777 Antoinette wrote to her mother: ‘more than eight days since my marriage was perfectly consummated; the proof has been repeated and yesterday even more completely than the first time.’ Smiles all round. Eventually, she went on to have four children, but only one survived to adulthood.

  But Marie Antoinette had other medical problems. When writing to her mother her whimsy was always to use the euphemism ‘General Krottendorf’ when referring to her periods, and from her correspondence it is apparent that she had no menses for the first four months after arriving in France. With the upheaval and subsequent sexual stresses that is not perhaps surprising.

  But the reverse happened when Marie was incarcerated in her dank cell in the Conciergerie from 2 August 1793, when she suffered from menorrhagia, or excessively heavy periods. To add to her overall ignominy the queen, by now 37 years old and white haired, had to beg for linen rags from her attendant to help staunch the flow. The maid tore up her own chemises for the purpose.

  On the day of her execution the queen asked the guard if she could change her stained petticoat in private. He refused, so she took it off in front of him, rolled it up and stuffed it into a chink in the cell wall. The cell today is as she left it, chill and austere; I am not so sure about the undergarment.

  As she left to mount the tumbrel, the queen felt a need to go to the toilet. Her hands were unbound by Sanson, the executioner, and she relieved herself against the prison wall and before a clutch of bemused onlookers. Her humiliation was complete. It was sealed by her being trundled to the scaffold, where waited an inglorious end to a tragic and unfulfilled life.

  (JL)

  Did a mutant enzyme make George III mad?

  History has not dealt kindly with King George III. At school we learnt
that his decision to transport convicts led to British colonisation of Australia, and that he lost the American colonies and then his wits. But historian John Clarke has called him ‘the only Hanoverian who could be called a genuinely decent and good man’.

  George was 22 when he succeeded to the English throne in 1760. Twenty-eight years later, soon after turning 50, he wrote to his prime minister, William Pitt, saying that on 11 June he had suffered ‘a pretty smart bilious attack’ which forced him to bed.

  At the end of June, Sir George Baker, President of the Royal College of Physicians, advised rest at Kew. The king also had a spell drinking the waters at Cheltenham in Gloucestershire.

  But in July 1788, a month later, George suffered pain in the face and had persistent insomnia. In October, he had severe pain in his abdomen; Baker gave a purgative and opium, and reported that the king was in an uncharacteristic ‘agitation of spirits’.

  His condition worsened; more colic and constipation, muscular weakness, intractable, incessant talking, excitement, confusion, fits, failing eyesight and hearing.

  According to J.H. Plumb

  He talked faster and faster and rarely slept. The Prince [of Wales, George’s son] was sent for and the King tried to throttle him. George III’s condition deteriorated rapidly and his death was expected. The Prince sat up waiting for it for two nights in succession, fully dressed … The King did not die, but they had to put him in a strait-jacket, and no one thought that he would rule again.

  The king knew he was ill. Just like other patients of his day, he suffered not only the disease but also the cures: emetics, purges, bleeding, blistering, cupping and leeching.

  By November, George was reported to be ‘under an intire alienation of mind’ and considered to be mad. The King’s disability became public knowledge. The Stock Exchange panicked.

  Parliament pressed the royal physicians for a diagnosis, but they could not agree. At last the Chancellor and royal family called in over their heads Francis Willis, who was both a clergyman and a keeper of a madhouse.

  Willis brought a strait-waistcoat, his son John and three keepers.

  They controlled the king by intimidation, coercion and restraint. If George refused food or even threw off his bedclothes, Willis clapped him in a ‘winding sheet’, or tied him to what George bitterly called ‘his coronation chair’.

  The Countess of Harcourt, Lady of the Bedchamber to the Queen, wrote: ‘The unhappy patient … was no longer treated as a human being … He was sometimes chained to a stake. He was frequently beaten and starved, and at best he was kept in subjection by menacing and violent language.’

  The Willises minimised his ‘excitement’ by solitary confinement; not even his wife, Queen Charlotte, could visit without their approval.

  They treated George’s resistance to his treatments as part of his illness. In today’s terms, they simply blamed the victim. But we must not judge them by our own standards; their approach was typical of madhouse-keepers of their day.

  By January 1789, the need for a regency was obvious. But when the bill was with the House of Lords, the king started to improve.

  When George went bathing at Weymouth, an enthusiastic band followed him into the sea to play ‘God Save the King’.

  He remained well for the next 12 years, but had further brief attacks in 1801 and 1804. Yet, in his first 72 years of life, all George’s periods of mental incapacity hardly totalled six months when added together.

  But in 1810, George was reported to have suffered ‘a decided return of his former malady’, and never regained his health again.

  ‘His Majesty’s adherence to certain erroneous notions with some degree of consistence partakes of the true character of Insanity,’ noted Dr William Heberden the younger.

  Parliament enacted the regency of the Prince of Wales (the future King George IV).

  Marshall Dale has a poignant description of George’s last years: ‘Stone blind and stone deaf and, except for rare lucid intervals, wholly out of his senses, the poor old King wandered from room to room of his palace…’

  What caused the king’s recurrent episodes? Some historians said the stresses of monarchy overtaxed George’s modest abilities and caused his breakdowns. Some said he had manic-depressive psychosis (now also called bipolar mood disorder).

  But in the 1960s, two British psychiatrists, Ida Macalpine and Richard Hunter, claimed that George III had porphyria, a metabolic disease, in which patients show an excess of porphyrin in their blood and urine. Most forms of porphyria are inherited.

  The two psychiatrists supported this diagnosis by newly unearthed medical evidence of the king’s health, and an extensive review of George III’s ancestors and descendants.

  Macalpine and Hunter scanned 13 generations over 400 years for evidence of porphyria among the ancestors and descendants of George III, and found ‘the purple thread of porphyria running through the royal houses from the Tudors to the Hanoverians, and from the Hanoverians to the present day’.

  In all, Macalpine and Hunter diagnosed porphyria in 15 members of these three royal houses. These include Mary, Queen of Scots, her son James I of England (James VI of Scotland), Queen Anne, Caroline Matilda, Queen of Denmark (sister of George III), George III himself and four of his own 15 children (including the Prince of Wales, who became King George IV).

  On the Prussian side, there was Frederic the Great and his father Frederick William I.

  Coming to the 20th century, Macalpine and Hunter found four living descendants, analysis of whose urine and stools confirmed porphyria.

  Dr Lindsay Hurst has extended the Macalpine hypothesis. He believes that royal porphyria can be traced even further back, to Henry VI of England (1421–71) and Charles VI of France (1368–1422).

  But some experts reject Macalpine and Hunter’s diagnosis of porphyria altogether. In a letter to the British Medical Journal, Dr Geoffrey Dean wrote: ‘I shall end more firmly by promising to eat my hat … if the authors can produce convincing evidence that they are right.’

  We can never be sure.

  Whatever their cause, George III’s attacks did have one benefit; John Clarke has said: ‘The sympathy aroused by the royal malady opened people’s minds and eyes to the whole field of derangement and stirred the national conscience about the the poor and mad.’

  (GB)

  Some royal operations

  One of the more memorable deathbed lines in history is when Caroline, the dying wife of George II, turned to him and gasped: ‘I want you to marry again,’ to which he replied: ‘Never. I’ll never marry again. I’ll just take mistresses.’ Despite his poorly timed insensitivity, he had the good grace to be weeping at the time.

  Caroline’s troubles started on 9 November 1736 with abdominal pain and vomiting. She was blistered, and given Sir Walter Raleigh’s Cordial and Duffy’s Elixir, popular patent medicines of the time. Enemas were returned without result. Indeed, everything that could be done for a queen was done. Short, that is, of actually examining her to try to find out what was really wrong. If the attendant doctors could have brought themselves to do this basic medical manoeuvre, all would have been revealed.

  After three days of useless treatment, a surgeon was called and for the first time a hand was put on the abdomen. To his horror an enormous strangulated hernia was there for all to see and wonder at.

  The surgeon elected to incise the mass. A thin trickle of discoloured fluid escaped, but produced no relief.

  Two more days passed, the wound edges began to mortify and turn black, and the court despaired for the queen’s life. It was on this, the fifth day, that her husband uttered his immortal words.

  Two days later, the bowel burst, flooding the royal mattress with excrement. Caroline, 55 years old and mother of eight, bore the suffering with great fortitude and died on the tenth day.

  George was as good as his word. He never did remarry, though he lived for another 24 years. All told he reigned for 33 years, was the last British king to appear o
n a battlefield (Dettingen in 1743), and was the patron of George Frederick Handel, who composed a variety of well-known pieces in his honour. George II’s greatgrandson, George IV, is well known to medical history for harbouring an enormous infected sebaceous cyst on the back of his head. It first appeared in 1820 and when the festering wen became too noisome for decent society, the foremost surgeon of the day, Astley Cooper, was called.

  He took one look, refused to operate for fear of spreading the infection to the brain, and withdrew. It was one of the shortest consultations in regal history.

  The king took it in good part, but a year later Cooper was summoned again, this time to see his majesty in the Pavilion at Brighton. He arrived by coach from London in the middle of the night to be told the monarch insisted that the offensive lesion be incised there and then. Treating a sebaceous cyst at 3 a.m. was not the eminent surgeon’s idea of a night out, and he bravely refused the royal command.

  The next day they returned together to more familiar ground in London. There Cooper dissected out one side, passed the scalpel to his assistant, who did the other, while the king sat quite still. Astley Cooper’s reward was a baronetcy (it is uncertain whether honours were heaped on the second surgeon, despite his doing half the job).

  In 1862 the 72 year old Leopold I of Belgium went to see his niece, Queen Victoria. While staying at Buckingham Palace he was seized with the torturing pain of bladder stone. The queen’s surgeon, Sir Benjamin Brodie (later to have a special type of abscess named after him) told the visitor to go home and send for Europe’s best lithotomist, or stone remover, Dr Jean Civiale of Paris.

  Civiale came with his patent lithotrite to crush the offending item. He had two goes, failed to grasp the illusive calculus, but did succeed in inducing bleeding, pain and fever.

  The well-favoured Dr Bernhard von Langenbeck was then summoned from Berlin. He applied the lithotrite four times. More haemorrhage and rigors, to say nothing of acute discomfort, but still no ping in the bucket.