Post mortem: Essays, historical and medical

WHEN the Empress Isabel was pregnant with the child which was to be Philip II, she bethought her of the glory that was hers in bearing offspring to a man so famous as the Roman Emperor, and she made up her mind that she would comport herself as became a Roman Empress. When, therefore, her relations and midwives during the confinement implored her to cry out or she would die, the proud Empress answered, “Die I may; but call out I will not!” and thus Philip arrived into the world sombre son of a stoical mother and heroic father. Doubtless she thought that she would show a courage equal to his father’s, hoping that the son would then prove not unworthy. Though she was very beautiful, as Titian’s famous portrait shows, she seems to have been a gloomy and austere woman, and Charles, being absent so long from her side at his wars, had to leave Philip’s education mainly to her. His part consisted of many affectionate letters full of good and proud advice. Yet Philip grew up to be a merry little golden-haired boy enough, who rode about the streets of Toledo in a go-cart amidst the crowds that we are told pressed to see the Emperor’s son. The calamity of his life was that Charles had bequeathed to him the kingdom of the Netherlands. Charles himself was essentially a Fleming, who got on exceedingly well with his brother Flemings, Reformation or no Reformation; they were quite prepared to admit that the great man might have some good reason for his religious persecution, peculiar though it no doubt seemed. But Philip was a foreigner; and a foreigner of the race of Torquemada who, so they heard, had so strengthened the Inquisition less than a century before that now it was really not safe to think aloud in matters of religion. So the Dutch rose in revolt under William of Orange, and the Dutch Republic came into being. Philip was only able to save the southern Netherlands from the wreck, which ultimately formed the kingdom of Belgium. Philip always thought that if he could only get England on his side the pacification of the Netherlands would be easy; so, at the earnest request of Charles, he married Mary Tudor, a woman twelve years older than himself, a marriage which turned out unhappily from every point of view, and has wrongly coloured our general opinion of Philip’s character. The unfortunate attempt to conquer England by the Armada, a fleet badly equipped and absurdly led, has also led us to despise both him and his Spaniards, whence came the general English schoolboy idea that the Spanish were a nation of braggarts ruled by a murderous fool, whose only thirst was for Protestant gore. But this idea was very far from being true. Philip was no fool; he was an exceedingly learned, conscientious, hard-working, careful, and painstaking bureaucrat, who might have done very well indeed had he been left the kingdom of Spain alone; but had no power of attracting foreigners to his point of view. He always did his best according to his lights; and if his policy sometimes appears tortuous to us, that is simply because we forget that it was then thought perfectly right for kings to do tortuous things for the sake of their people, just as to-day party leaders sometimes do extraordinarily wicked things for the sake of what they consider the principles of their party. Unfortunately for Philip he often failed in his efforts; and the man who fails is always in the wrong.

He was constantly at war, sometimes unsuccessfully, often victoriously. Unlike Charles he did not lead his armies in person, but sat at home and prayed, read the crystal, and organized. After the great battle of St. Quentin, in which he defeated the French, he vowed to erect a mighty church to the glory of St. Lawrence which should excel every other building in the world; and for thirty years the whole available wealth of Spain and the Indies was poured out on the erection of the Escorial, which the Spaniards look upon as the eighth wonder of the world, and who is to say that they are wrong? Situated about twenty miles from Madrid, in a bleak and desolate mountain range, it reflects extraordinarily well the character of the man who made it. Under one almost incredible roof it combines a palace, a university, a monastery, a church, and a mausoleum. The weight of its keys alone is measured in scores of pounds; the number of its windows and its doors is counted in hundreds; it contains the greatest works of many very great artists, and the tombs of Charles V and his descendants. It stands in lonely grandeur swept by constant bitter winds, a fit monument for a lonely and morose king. Its architecture is Doric, and stern as its own granite.

The character of Philip II has been described repeatedly, in England mainly by his enemies, who have laid too much stress on his cruelty and bigotry. Though he was fiercely religious, yet he loved art and wrote poetry; though he would burn a heretic as blithely as any man, yet he was a kind husband to his four wives, whom he married one after the other for political reasons; though he was gloomy and austere, yet he loved music, and was moved almost to tears by the sound of the nightingale in the summer evenings of Spain. His people loved him and affectionately called him “Philip the prudent”; they forgave him his mistakes, for they knew that he worked always for the ancient religion which they loved, and for the glory of Spain.

Unlike Charles his father, he was austere in his mode of life, and always had a doctor at his side at meals lest he should forget his gout. He was a martyr to that most distressing complaint, no doubt inherited from his father. He lived abstemiously, but took too little exercise; it would have been better for his health—and probably for the world—had he followed his armies on horseback like Charles, even if he had recognized that he was no great general.

His death, at the age of seventy-two, was proud and sombre, as befitted the son of the Empress Isabel, who had scorned to cry when he was born. We can understand a good deal about Philip if we consider him as spiritually the son of that proud sombre woman rather than of his glorious and energetic father. In June, 1598, he was attacked by an unusually severe attack of gout which so crippled him that he could hardly move. He was carried from Madrid to the Escorial in a litter, and was put to bed in a little room opening off the church so that he could hear the friars at their orisons. Soon he began to suffer from “malignant tumours” all over his legs, which ulcerated, and became intensely painful, so that he could not bear even a wet cloth to be laid upon them or to have the ulcers dressed. So he lay for fifty-three days suffering frightful tortures, but never uttering a word of complaint, even as his mother had borne him in silence for the sake of the great man who had begotten him. As the ulcers could not be dressed, they naturally became covered with vermin and smelled horribly. Stoical in his agony, he called his son before him, apologizing for doing so, but it was necessary. “I want,” he said, “to show you how even the greatest monarchies must end. The crown is slipping from my head, and will soon rest upon yours. In a few days I shall be nothing but a corpse swathed in its winding-sheet, girdled with a rope.” He showed no sign of emotionalism, but retained his self-control to the last; after he had said farewell to his son he considered that he had left the world, and devoted the last few days of his life to the offices of the church. The monks in the church wanted to cease the continual dirges and services, but he insisted that they should go on, saying: “The nearer I get to the fountain, the more thirsty I become!”

These seem to have been his last words; he appears to have retained consciousness as long as may be.

Let us reason together and try if we can make head or tail of this extraordinary illness. The first certain fact about Philip II is that he long suffered from gout, apparently the real old-fashioned gout in the feet. In the well-known picture of him receiving a deputation of Netherlanders, as he sits in his tall hat beneath a crucifix, it is perfectly evident that he is suffering tortures from gout and wearing a large loosely fitting slipper. These unfortunate gentlemen seem to have selected a most unpropitious moment to ask favours, for there is no ailment that so warps the temper as gout. When a man suffers from gout over a period of years it is only a matter of time till his arteries and kidneys go wrong and he gets arterio-sclerosis. We may take it, therefore, as certain that at the age of seventy-two Philip had sclerosed arteries and probably chronic Bright’s disease like his father before him. Gout, Bright’s disease, and high blood-pressure, are all strongly hereditary, as every insurance doctor knows; that is to say, the son of a father who has died of one of these three is more likely than not to die ultimately of some cognate disease of arteries or kidneys or heart, all grouped together under the name of cardio-vascular-renal disease.

But what about the “malignant tumours”? “Malignant tumour” to-day means cancer of one sort or another, and assuredly it was not cancer that killed Philip. Probably the word “tumour” simply meant “swelling.” Now, what could these painful swellings have been which ulcerated and smelt so horribly? Why not gangrene? Ordinary senile gangrene, such as occurs in arterio-sclerosis, neither causes swellings, nor is it painful, nor does it smell nor become verminous; but diabetic gangrene does all these things. Diabetes in elderly people may go on for many years undiscovered unless the urine be chemically examined, and may only cause symptoms when the arterio-sclerosis which generally complicates it gives results, such as sudden death from heart-failure, or diabetic gangrene. Thus a very famous Australian statesman, who had been known to have sugar in his urine for many years, was one morning found dead in his bath, evidently due to the high blood-pressure consequent on diabetic arterio-sclerosis.

Diabetic gangrene often begins in some small area of injured skin, such as might readily occur in a foot tortured with gout; it ulcerates, is exceedingly painful, and possessed of a stench quite peculiar to its horrid self. It does not confine itself to one foot, or to one area of a leg, but suddenly appears in an apparently healthy portion, having surreptitiously worked its way along beneath the skin; its first sign is often a painful swelling which ulcerates. The patient dies either from toxæmia due to the gangrene, or from diabetic coma; and fifty-three days is not an unlikely period for the torture to continue. On the whole it would seem that diabetic gangrene appearing in a man who has arterio-sclerosis is a probable explanation of Philip’s death. The really interesting part of this historical diagnosis is the way in which it explains his treatment of the Netherlands. What justice could they have received from a man tortured and rendered petulant with gout and gloomy with diabetes?

Charles V had taken no care of himself, but had gone roaring and fighting and guzzling and drinking all over Europe; Philip had led a very quiet, studious, and abstemious life, and therefore he lived nearly twenty years longer than his father. Possibly when he came to suffer the torments of his death he may have thought the years not worth his self-denial: possibly he may have regretted that he did not have a good time when he was young, but this is not likely, for he was a very conscientious man.

When Philip lay dying he held in his hand the common little crucifix that his mother and father had adored when they too had died; his friends buried it upon his breast when they came to inter him in the Escorial, where it still lies with him in a coffin made of the timbers of the Cinco Chagas, not the least glorious of his fighting galleys.

Arterio-sclerosis, high blood-pressure, hyperpiesis, and chronic Bright’s disease—all more or less names for the same thing, or at any rate for cognate disorders—form one of the great tragedies of the world. They attack the very men whom we can least spare; they are essentially the diseases of statesmen. Although these diseases have been attributed to many causes—that is to say, we do not really know their true cause—it is certain that worry has a great deal to do with them. If a man be content to live the life of a cabbage, eat little, and drink no alcohol, it is probable that he will not suffer from high blood-pressure; but if he is determined to work hard, live well, and yet struggle furiously, then his arteries and kidneys inevitably go wrong and he is not likely to stand the strain for many years. Unless a politician has an iron nerve and preternaturally calm nature, or unless he is fortunate enough to be carried off by pneumonia, then he is almost certain to die of high blood-pressure if he persists in his politics. I could name a dozen able politicians who have fallen victims to their political anxieties. The latest, so far as I know, was Mr. John Storey, Premier of New South Wales, who died of high blood-pressure in 1921; before him I remember several able men whom the furious politics of that State claimed as victims. In England Lord Beaconsfield seems to have died of high blood-pressure, and so did Mr. Joseph Chamberlain. Mr. Gladstone was less fortunate, in that he died of cancer. He must have possessed a calm mind to go through his furious strugglings without his kidneys or blood-vessels giving way; that, and his singularly temperate and happy home-life, preserved him from the usual fate of statesmen.

Charles V differed from Mr. Gladstone because he habitually ate far too much, and could never properly relax his mental tension. His arterio-sclerosis had many results on history. It was probably responsible for his extreme fits of depression, in one of which it pleased Fate that he should meet Barbara Blomberg. If he had not been extraordinarily depressed and unhappy, owing to his arterio-sclerosis, he would probably not have troubled about her, and there would have been no Don John of Austria. If he had not had arterio-sclerosis he would probably not have abdicated in 1556, when he should have had many years of wise and useful activities before him. If his judgment had not been warped by his illness he would probably never have appointed Philip II to be his successor as King of the Netherlands; he would have seen that the Dutch were not the sort of people to be ruled by an alien. And if there had been no Don John it is possible that there would have been no Don Quixote. Once again, if Philip had not been eternally preoccupied with his senseless struggle against the Dutch, it is probable that he would have undertaken his real duty—to protect Europe from the Turk. When one considers how the lives of Charles and his sons might have been altered had his arteries been carrying a lower blood-tension, it rather tends to alter the philosophy of history to a medical man.

Again, when we consider that the destinies of nations are commonly held in the hands of elderly gentlemen whose blood-pressures tend to be too high owing to their fierce political activities, it is not too much to say that arterio-sclerosis is one of the greatest tragedies that afflict the human race. Every politician should have his blood-pressure tested and his urine examined about once a quarter, and if it should show signs of rising he should undoubtedly take a long rest until it falls again; it is not fair that the lives of millions should depend upon the judgment of a man whose mind is warped by arterio-sclerosis.