Last Duke of Courland’s cause of death revealed

08:31, 10 January, 2017
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Peter BironThe last Duke of Courland and Semigallia Peter von Biron (1724–1800) departed this life in early January 217 years ago. Documents found in the European digital library have given Ieva Lībiete, medical historian and lecturer at RSU Institute of the History of Medicine the possibility to draw closer to the secret embraced by the dust of history as to the true cause of Duke’s death. Records reveal that the death of the Duke of Courland was caused by at that time so popular mercury treatment and not by some incurable disease as maintained previously.

Back in 1795 when the Duchy of Courland was enveloped in clouds of heightened political tension, Peter von Biron abdicated his throne against a substantial compensation from the Russian Empire in the amount of 2 million roubles for his Courland estate and left homeland together with his family to devote the twilight years of his life to travelling around Europe, acquiring residential estate and collecting art.

Following turbulent youth and two unsuccessful marriages, his new wife Dorothea dazzled European courtyards with her stunning beauty and wisdom. Peter von Biron enjoyed every advantage of his life – he was one of the richest men in Europe and despite of some inconvenience caused by the lost title and doubts as to his noble origin, he sorted everything out by huge amounts of money.

Despite the solid age (considering that the average life expectancy at that time was approximately 40 years) and unhealthy life style, the former Duke of Courland was in enviably good health what is confirmed by a document found by Lībiete in the archive. It is a letter dating back to October 1786 from William Bailey, physician to the Frederick the Great practicing in Berlin to one of the most outstanding medical practitioners of that time, a medical authority – the physician to the King of Scotland William Cullen, in which Bailey requested his eminent colleague for advice regarding treatment of some patient – a nobleman from Courland. Several facts disclosed in the letter leave room for the conclusion that the patient meant in the letter is Peter von Biron who had reached the age of 62. The letter contains a detailed description of his patient’s health condition and last two years’ anamnesis.

The patient was rather corpulent, suffered from digestive problems, dyspnoea, oedema, haemorrhoids, nosebleed and rash of unknown origin. According to the contents of the letter, the only issue that worried the patient himself was the ultimate one which he treated with excessive lemon juice, white vine and sugar baths. Bailey also expressed concerns as to the nobleman’s intemperate eating habits which could to certain extent contribute to his health disorders. The letter contains a comprehensive description of medicines received by the noble patient – including strong drugs and comparatively harmful substances – saltpetre, vitriol, camphor and even toxic lead and mercury preparations. Awful as it might sound, the medical preparations listed in the letter were 18th century “golden standard” of medicine.

Despite the intense treatment (obviously the poison doses were sufficiently large) the Duke lived for another long and buoyant 14 years and any further information regarding his health is found only in records dated with the year of his death. Lībiete had the luck of discovering these records in Czech and Polish archives. The last years of his life Peter von Biron spent in his estates in Silesia, at the current border of Czech Republic and Poland. The archives contain a letter written somewhere at the end of 1799 wherewith the abbot of Neustad’s Holy Order Monastery, monk Aductus Paul addresses Duke’s widow Dorothea with the request to pay Duke’s treatment costs. The letter gives some insight in the last months of Duke’s life. The monk does not specify what particular diseases have been treated, but notes that he has been repeatedly ordered to arrive at the nearby Nachod castle to relieve Duke’s pain together with the nobleman’s courtyard surgeon. They have succeeded to improve his health condition and the monk had won Duke’s favour. The recovery of the Duke was followed by a lavish party and beggars’ feast organized on the occasion.

Nevertheless soon after he fell sick again and the monk continued to treat him until the arrival of the owner of the nearby Gellenau castle von Mucius who “thanks to his agility succeeded to gain full trust of the Duke, who left the residence and purchased an apartment in Gellenau”. The helping hand of the dexterous friend von Mucius turned out fatal for the Duke, since he departed this life while staying at Gellenau. The Duke’s cause of death is revealed in two medical reports of Prague-based physicians retained to this day by the Czech archives.

For four months the Duke was zealously treated with large doses of laxative drugs and some alchemical substance – philosophic golden salt. Biron, most probably, could have survived this treatment as well, if not the “doll, impudent and brave charlatans” who gathered around his sick-bed in the middle of September and launched treatment of non-existent syphilis with mercury. The prescribed dose was too high and the symptoms of express poisoning appeared soon after. To correct the mistake the “charlatans” made the Duke take a strong laxative drug resulting in complete exhaustion. For over a week Peter von Biron suffered from severe effects of mercury poisoning and he died on 10 January 1800. On the last day of his life physicians from Prague arrived, however they could no longer help. The invited practitioners wrote a rather angry medical opinion, in which they turn with indignation to the non-identified “charlatans” who have groundlessly and opposite the principles of medical practice prescribed to the Duke mercury in fatal doses. Although the opinion contains a strong commitment to testify against these charlatans in court, there are no records proving the fact of anyone being brought to justice or sentenced.

ieva-libiete05According to Lībiete, “heroic medicine” is the hallmark of 18th century”. Each therapy required immediate effect what accounted for the dramatic nature of the chosen forms of treatment – bloodletting, pucking, purging, enema and also extremely strong or toxic substances whose side effects were interpreted as the treatment process. Although slightly different as in the antique times, sickness and health are still related to humoral theory according to which the functioning of human body is based upon a mix of four liquids: black bile, yellow bile, blood and phlegm. In the event someone fell ill, it was considered that the humoral balance has been destroyed, the quality has been lost or the circulation of these liquids in the body disturbed. Attempts to restore health were made by affecting these liquids. Bloodletting, most likely, was the most common procedure which, according to the historical records, was practised in Riga even at the beginning of the 20th century. Patients were treated with mercury to invoke salivation what was caused by mercury poisoning. Physicians interpreted it as the manner of getting rid of excess phlegm.”

In the 18th of century the number of educated medical practitioners per capita was extremely small and qualified medical treatment was available mostly to the well-off part of the society. The rest, commonly, were deprived of such a possibility and were forced to turn to self-proclaimed practitioners what allowed charlatanism to flourish. Nevertheless, it should be also noted that patient’s wealth frequently also accounted for particularly “heroic” treatment, since, first of all, they could afford it and secondly, numerous drugs and procedures gave the illusion of exquisite and costly treatment. Therefore in most cases the lucky ones were those who could not afford such treatment.

Lībiete notes that the story of Duke’s cause of death allows us to draw parallels with the contemporary perception of medicine, “Medical history teaches us to retain a critical perception of modern medical achievements. When reading lectures, I try to bring this idea also to my students. Although pure illusory we might have the persuasion of having arrived at the peak of knowledge and technologies, one should remember that it may turn out that in 10–20 years contemporary methods and perception of medical treatment will be perceived as completely outdated or even wrong. Historically the development of medicine has never been a curve with a constant up going trend; instead it is irregular, characterized by falls and rises and unexpected turns.”