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.
Mr. and Mrs. Pepys
SAMUEL PEPYS, Father of the Royal Navy, and the one man—if indeed there were any one man—who made possible the careers of Blake and Nelson, died in 1703 in the odour of the greatest respectability. Official London followed him to his honoured grave, and he left behind him the memory of a great and good servant of the King in “perriwig” (alas, to become too famous), stockings and silver buckles. But unhappily for his reputation, though greatly to the delight of a wicked world, he had, during ten momentous years, kept a diary. It was written in a kind of shorthand which he seems to have flattered himself would not be interpreted; but by some extraordinary mischance he had left a key amongst his papers. Early in the nineteenth century part of the Diary was translated, and a part published. A staggered world asked for more, and during the next three generations further portions were made public, until by this time nearly the whole has been published, and it is unlikely that the small remaining portions will ever see the light.
Pepys seems to have set down every thought that came into his head as he wrote; things which the ordinary man hardly admits to himself—even supposing that he ever thinks or does them—this stately Secretary of the Navy calmly wrote in black and white with a garrulous effrontery that absolutely disarms criticism. In its extraordinary self-revelation the Diary is unique; it is literally true that there is nothing else like it in any other language, and it is almost impossible that anything like it will ever be written again; the man, the moment, and the occasion can never recur. I take it that every man who presumes to call himself educated has at least a nodding acquaintance with this immortal work; but a glance at some of its medical features may be interesting. The difficulties at this end of the world are considerable, because the Editor has veiled some of the more interesting medical passages in the decent obscurity of asterisks, and one has to guess at some anatomical terms which, if too Saxon to be printable in modern English, might very well have been given in technical Latin. Let us begin with a brief study of the delightful woman who had the good fortune—or otherwise—to be Pepys’s wife. Daughter of a French immigrant and an Irish girl, Elizabeth Pepys was married at fourteen, and her life ended, after fifteen somewhat hectic years, in 1669, when she was only twenty-nine years of age. Pepys repeatedly tells us that she was pretty—and no one was ever a better judge than he—and “very good company when she is well.” Her portrait shows her with a bright, clever little face, her upper lip perhaps a trifle longer than the ideal, bosom well developed, and a coquettish curl allowed to hang over her forehead after the fashion of the Court of Charles II. She spoke and read French and English; she took the keenest interest in life, and set to work to learn from her husband arithmetic, “musique,” the flageolet, use of the globes, and various accomplishments which modern girls learn at school. Mrs. Pepys imbibing all this erudition from her husband, while her pretty little dog lies snoring on the mat, forms a truly delightful picture, and no doubt our imagination of it is no more delightful than the reality was three hundred years ago. I suppose it was the same dog as he whose puppyish indiscretions had led to many a fierce quarrel between husband and wife; Pepys always carefully recorded these indiscretions, both of the dog and, alas, of himself. It is clear that the sanitary conveniences in Pepys’s house could not have been up to his requirements.
Husband and wife went everywhere together, and seem really to have loved each other; the impression that I gather from Pepys’s exceedingly candid description of her is that she was a loyal and comradely wife, with a spirit of her own, and a good deal to put up with; for though Pepys was continually—and causelessly—jealous of her, yet he did not hold that he was in any way bound to be faithful to her on his own side. So they pass through life, Pepys philandering with every attractive woman who came his way, and Mrs. Pepys dressing herself prettily, learning her little accomplishments, squabbling with her maids, and looking after her house and his meals, till one day she engaged a servant, Deb Willet by name, who brought a touch of tragedy into the home. In November, 1668, Deb was combing Pepys’s hair—no doubt in preparation for the immortal “perriwig”—when Mrs. Pepys came in and caught him “embracing her,” thus occasioning “the greatest sorrow to me that ever I knew in this world,” as he puts it.