What killed Charles II?

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Terence Doyle writes…

Charles II, at the age of 54, laid down his earthly crown for an immortal one at noon on Friday February 6th 1685. His last illness is surely the best documented case history in the seventeenth century. There were multiple eyewitness accounts. The official version was penned by the Chief Royal Physician Sir Charles Scarburgh and later transcribed in The Last Days of Charles II by Raymond Crawfurd, (Clarendon Press, Oxford, 1909). It makes disturbing reading.

Charles was an apparently healthy man, reputed to have had thirteen mistresses and fifteen illegitimate children. On Monday morning, February 2nd 1685, while at his ablutions, he suffered a seizure with convulsions and temporary slurring of speech. Two physicians were on hand and one, Edmund King, withdrew 16 ounces of blood (450ml) from the king’s right arm, apparently with immediate relief. Six more physicians soon arrived and removed another 8 ounces with cupping glasses applied to deep scarifications in the shoulders. He was then given both an emetic and a purgative to empty his stomach and bowels. This was followed by two enemas and further purgatives. Then, according to the official account, Praeterea ut nullum lapidem immotum reliquerent (to leave no stone unturned) blistering agents were applied all over his head, after his hair had been shaved.

It was then decided to relieve the pressure of the humours on the brain by inducing sneezing, with a powder of white hellebore roots and later Sal Ammoniac applied to the nostrils. So as to keep his bowels active at night, more laxatives were given two hourly. At the same time, to counteract the scalding of his urine, from the Cantharides in the blistering drugs, a soothing emulsion of barley with liquorice was given. Et ne quid intentum relinqueretur (so as to leave nothing untried), plasters containing Spurge and Burgundy Pitch were applied to the soles of his feet.

On Tuesday he was bled ten ounces from the jugular veins. On Wednesday he was given further laxatives but that night he became so ill that his doctors prescribed Spirit of Human Skull (40 drops). This was commonly used in convulsive disorders and thought to act through the power of suggestion, since the skull had to be from someone who had died violently. On Thursday the King’s ministers were asking just what was wrong with him – a piece of intelligence the doctors themselves would have been happy to have. It was then suggested that he was suffering from intermittent fever and so was given syrup of Chinchona (Jesuit’s) bark three hourly, according to a prescription signed by 14 doctors.

On the morning of Friday 6th he was bled again and given an extract of a very large number of herbs, powdered oyster shells and Goa stone. This latter was a concretion (bezoar) formed in the stomach of an East Indian goat and was believed to have mystical ability to counteract poisons and strengthen the vital powers.  By mid-morning he was severely short of breath compelling him to sit upright. By ten he was comatose, and at noon he died.

On Saturday 7th an autopsy was performed, presumably because the illness was unexplained. The results of the autopsy are well documented.

 In Cerebri Cortice Venae et Arteriae supra modum repletae. (The veins and arteries on the brain surface were abnormally full).

Cerebri tum ventriculi omnes serosa quadam materia inundati, tum ipsa substantia consimili humore haud leviter imbuta. (The cerebral ventricles were filled with a kind of bloody material and the brain substance contained a similar humour).

The lungs were Sanguine referta (congested with blood). The heart and abdominal organs were unremarkable.

Crawfurd confidently sums this up with: ‘From these accounts one may assert with considerable confidence that his death was due to chronic granular kidney (a form of Bright’s disease) with uraemic convulsions, ‘He was a large eater and mainly of albuminous food. Alcohol he had taken freely, at times to gross excess: he had been the slave of sexual passion’ (p. 16).

This is manifestly incorrect. At autopsy the kidneys were normal and so Bright’s disease (chronic glomerulonephritis) is most unlikely. Overindulgence in eating, alcohol and sex, although lamentable, rarely results in death. The clinical history sounds like cerebral bleeding, probably subarachnoid. This is due to leakage from an arterial aneurysm, minor at first but irritating to the coverings of the brain. Charles remained conscious and there was no limb weakness. The first subarachnoid haemorrhage has an increased likelihood of a second more catastrophic bleed after a few days, this time into the brain substance. This pattern fits Charles’ clinical course. Just before he died he became severely short of breath. This is likely to have been caused by neurogenic pulmonary oedema, sometimes associated with intracerebral events. Finally, the autopsy findings state that the cerebral ventricles were filled with bloody fluid and a similar kind of material in the brain substance. This is just what would be expected in subarachnoid and secondary intracerebral bleeding.

Who performed the autopsy is not recorded. However, since Richard Lower had much the most experience of intracranial examination after working with Thomas Willis, he must have been involved.

Despite theoretical advances in medical science at this time, practical treatment as shown in the King’s management was still rooted in humoural theory. Towards the end of his illness Charles made his famous remark about being an unconscionable time a-dying, which sounds more like a prayer for deliverance than an apology.

 

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