What Killed Jane Austen?: And Other Medical Mysteries (3 page)

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)

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 on 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.

In desperation a plea went out to Henry Thompson, a young ‘stone crusher’ who was making a name for himself in London. With the brashness of youth he had the offending calculus in his grasp first go. There was no bleeding or fever as the oxalic shards were ‘pissed away’, to use the contemporary vernacular.

Lack of infection puzzled him, but in ignorance of the bacterial cause of infection in these pre-Lister days, the reason was almost certainly due to the fact that the instruments used were brand new. Indeed Thompson was later to recall taking them out of their original wrapping paper in the royal bedroom. The lithotrites of the other surgeons glistened with the scarcely rinsed-away urine of a hundred previous sufferers.

Leopold gave the young man the right princely sum of £3,000. He was knighted by Victoria and became the toast of London.

In 1872 Napoleon III was living in exile in Chislehurst, London. He knew he had a bladder stone and that year it flared up. The by now Sir Henry Thompson was summoned. He crushed the stone under anaesthetic, but only got half away. The remainder became jammed in the passage between the bladder and the outside.

Another dash was undertaken. It was apparently successful, but urinary symptoms persisted. A third anaesthetic was deemed necessary, but just before the operation Napoleon collapsed and died. No huge hand-out or honours this time.

A post mortem showed the kidneys to be bags of pus and in the bladder there was still a fragment of stone.

To fail when treating royalty must cause the odd sleepless night as well as loss of face. Yet things are not as bad now as in the time of blind King John of Bohemia (1296–1346) who is said to have drowned all his surgeons in the Danube when they failed to restore his sight.

But other days, other mores. As for Sir Henry Thompson, he became very wealthy, was one of the first doctors in London to own a motor car, and collected porcelain, wrote novels, exhibited his paintings at the Royal Academy and generally basked in the sunlight of success.

(JL)

Gazing on the dead long after their demise seems to hold a macabre fascination. Look at the hype which surrounded the discovery of the tomb of Tutankhamen; Beethoven’s body was dug up twice to try and help diagnose his deafness after his ossicles had been misplaced by the pathologist, who was, incredibly, called Wagner.

Mainly out of curiosity, one set of graves which have been extensively ransacked down the years have been those of English monarchs. Let’s look at a few.

William the Conqueror died in Rouen, France, in 1087, ten days after being thrown from his horse. He was buried at the abbey he founded in Caen, northern France, in a stone coffin so small the body had to be bent double. On instructions from the Pope, the tomb was opened in 1522 and the body said to be found in a reasonable state of preservation. It was reinterred. In 1562, the abbey was pillaged by Calvinists, and the bones scattered, with the exception of one femur. This relic was preserved and reburied in 1642 under a monument, which in turn was demolished during riots in 1793. Despite heavy fighting in the area of Caen during the Second World War, the femur’s resting place was undamaged. However, it was opened in 1987, and a thigh bone was indeed found. It was reinterred.

William’s son, William Rufus, was shot by an arrow by person or persons unknown while hunting in the New Forest. Tradition has it that his body was trundled on a charcoal-burner’s cart to Winchester Cathedral for burial. The grave was opened in 1968, nearly 900 years on. Among the bones was an arrowhead.

Richard I (Richard the Lionheart) spent most of his time fighting abroad. His body was buried in 1199 at the feet of his father, Henry II, in Fontevrault, France. His heart went to Rouen Cathedral. In 1838 a small silver box, believed to contain the heart, was discovered in Rouen. When the box was opened, the contents may indeed have once been a heart, but by now were found to be ‘reduced to the semblance of a reddish leaf’, according to Brewer.

When Henry IV died in 1413 it was said his body and face were contracted by leprosy. But when viewed again in 1832, his face was in complete preservation and adorned by a full beard of deep russet colour. Henry’s face certainly was not leprous.