Volume 4, Issue 2 - Summer 2012
George Dunea, MD
Hektoen Institute, Chicago, Illinois, United States
A king in exile: Charles II, ca. 1653
King Charles II of England, son of Charles I, grandson of Henri IV of Navarre and Marie de Medici, and great grandson of Mary Queen of Scots, was 18 years old when his father was deposed and executed on January 30, 1649. He reigned as king of England from 1660 to 1685.
Charles was tall, six feet two inches, surprisingly so since his father was short and his mother “positively tiny”; and it was thought that he had inherited a dark complexion from his maternal grandmother, Marie de Medici, “a true saturnine tint,” “a strain of very dark swarthy Italian blood,” a throwback to his Italian ancestors, the Medici Dukes of Tuscany.”1
During Oliver Cromwell’s rule Charles spent a decade in exile in France, Germany, and the Low Countries, especially in Bruges, at times in poverty, devoid of funds and hope. After the restoration of the monarchy in 1860 he reigned for 25 years, during which life at court was an “unceasing flagrant and brazen scandal” in the context of “a life of lust and self-indulgence which disgraced a Christian throne, and in an Asiatic court would have been veiled in the mysteries of the seraglio.”2 He had several mistresses, ate to excess, and drank heavily. At the time of his death, in February 1685, he was 55.1
The events of his death, as recounted by Lord Macaulay in his classic History of England,3 were amplified in 1909 by Dr. Raymond Crawfurd in a detailed monograph4 and more recently by Antonia Frazer in her 1979 biography.1 These writings are of great medical interest, shedding much light on how medicine was practiced at the end of the 17th century—and it was certainly not evidence-based.
According to Macaulay, “the King’s death took the nation by surprise.” He seemed to be in good health, had taken good care of his health even in his pleasures, had played tennis in his youth, and was expected to have a long life and robust old age. He rose early, “was, even in the decline of life, an indefatigable walker,” generally passed several hours a day in the open air, and would be seen by the public striding among the trees in St. James' Park, playing with his spaniels and feeding his ducks. “These exhibitions endeared him to the common people, who always love to see the great unbend.”3
Yet there had been subtle changes in his health. He had become less active, was troubled by gout, and had developed a leg ulcer. His temper had become worse, and trifles now would irritate him. Nothing however seemed to be really amiss until Sunday, February 1, 1685. That evening he complained of not feeling well, but said he expected this to pass and ate his usual hearty meal, including a couple of goose eggs, later blamed by one of his attendants for what was to follow. Contrary to his usual custom, he slept badly, tossing and turning and muttering in his sleep.1, 4
When he awoke the next morning, his groom found him “looking pale as ashes and ghastly, unable or unwilling to say a single word . . . his face pale as death . . . speechless . . . . either silent or stopping in the middle of speaking as if he had forgotten what he intended to say.”4 He took a little sherry and his barber was about to shave him, when he uttered a loud cry, staggered, and fell into one of his attending lord’s arms unconscious. A doctor who happened to be present but had no lances “opened a vein with a penknife” and removed 16 ounces of blood from his arm—a task for which he was to receive 1,000 pounds but was never paid.1, 4
Within minutes of the king’s first convulsion a whole host of doctors had come flocking in. Fourteen of them deliberated, “contradicted each other and themselves.” Some thought his fit was epileptic; some pronounced him apoplectic; then they decided to call his complaint a fever, and to administer repeated doses of bark of quinine. But one physician protested, assuring the queen that his brethren would kill the king among them.1, 3
What followed was horrendous.1 Macaulay wrote that he was tortured like an Indian at a stake.3 He received some 58 drugs,1 this attested by the preserved prescriptions, written in Latin, some signed by as many as 14 doctors.3–5 He was bled repeatedly until his very last day. On the first day, three cupping-glasses were applied to his shoulders, “quickly followed by scarification deep enough to affect a fuller and more vigorous revulsion” and yield another eight ounces of blood.4 Red-hot irons and pungent blistering agents were applied to his shaven head, plasters of combined spurge and Burgundy pitch to his naked feet.1, 4
“To free the stomach of all impurities and by the same action to rid his nervous system of anything harmful” he was made to swallow strong emetics—an orange infusion of the metals made in white wine, white vitriol dissolved in compound peony water, antimonials, and zinc sulphate.4 To further give strength to his loaded brain and divert the humors from his head he received various combinations of cowslip flowers and spirit of sal ammoniac.4 Sneezing powders of white hellebore root were inserted in his nostrils to relieve the pressure of humors on his brain.1,4 He was mercilessly purged and attacked with enemas of sacred bitter power, cream of tartar, syrup of buckthorn, rock salt, and orange infusion of the metals supplemented by antispasmodic julep of black cherry water; oriental bezoar stone from the stomach of an eastern goat; and spirits of human skull.1 These and other prescriptions, in Latin and also translated into English and appended with the specific names of the specific physicians authorizing them, can be found in Sir Charles Scarburgh's account.5
Throughout his illness the king was fed light broth and ale made without hops as nourishment.4 His urine became scalding from what the use of blistering cantharides “would inevitably set up”; this was counteracted by an emulsion of barley with liquor ice, sweet almond kernels, and melon seeds, sweetened with white sugar, to which was added a mild laxative of sacred tincture and followed by another enema of rock salt, sacred power, and syrup of buckthorn. To stave off thirst but at the same time move the bowels, he received best manna with cream of tartar dissolved in barley water. His mouth and tongue became inflamed and swollen by the scalding medicines, which was counteracted with a gargle of inner bark of elm, syrup of mallow, and barley water. Also, his teeth had been damaged while his mouth was held open to prevent him biting his tongue during convulsions. Bleeding was continued, but some difficulties were encountered in finding a vein.1, 3
There are at least eight surviving descriptions of his illness by eyewitnesses—attendants and noblemen, the French and Dutch ambassadors, several prelates, and the first physician to the king, Sir Charles Scarburgh.4 The king recovered his speech after the first seizure but had another one on Tuesday. By Wednesday morning he was better, to the great relief of the 75 lords, counselors, surgeons, bishops, and servants assembled in his bed chamber; but towards the evening he became worse, breaking into a cold clammy sweat, then a fever. By noon on Thursday he was in a desperate state. At about four o'clock he had further and more violent convulsions, which rendered him speechless, but he was conscious to the full during intervals.
On Friday at dawn he was described as still being in full possession of his faculties, apologizing to those who stood round him all night for the trouble he had caused them and saying that he had been a most unconscionable time dying.3 “With death slowly stealing on him he spoke often and tenderly to those around him,” was seized at seven o'clock with urgent breathlessness, at 8:30 his speech began to fail, and at 10 o'clock he lay unconscious, expiring shortly after without any renewal of convulsions.4
So what did the much tormented king die from? Not poisoning, despite the rumors of foul play that always surround the deaths of the great,3 nor mercury poisoning from his experiments in his laboratory, nor malaria caught from the ducks in Saint James’ Park, as postulated by a dean of the Calcutta Medical College. Apoplexy was the doctors’ official verdict, meaning a stroke, yet he was never paralyzed and recovered fully between seizures. The doctors who “opened the body” after his death found a large amount of fluid in the ventricles of the brain and an enlarged heart, with the liver, spleen, and kidneys full of blood.4 From the recorded history Raymond Crawford (1909) concluded that the king’s symptoms were classical of terminal uremia—renal failure from what in those days was called the small granular kidney from Bright’s disease.4 This is plausible, especially as Charles had suffered from gout, epidemic in those days among the port drinking upper classes of England, generally caused by lead salts added to sweeten the wine. The so-called saturnine gout was often accompanied by chronic kidney failure. The precise cause of the king’s death may forever remain unknown. But at least one may confidently state that he (as perhaps even some patients almost 400 years later) was not particularly helped by the therapeutic regimens in fashion at the time.
GEORGE DUNEA, MD, FACP, FRCP, FASN is the president and CEO of the Hektoen Institute of Medicine. He is also a professor of medicine at University of Illinois at Chicago, the medical director of Chicago Dialysis Center, and founding chairman emeritus, Division of Nephrology, Stroger Hospital of Cook County. He also serves as Editor-in-Chief of Hektoen International.