‘Her body was opened,’ writes Bossuet, ‘among a large concourse of physicians and surgeons and all sorts of people, because, having begun to feel extreme pain when drinking three mouthfuls of chicory water, given her by the dearest and most intimate of her women, she said at once that she was poisoned.’ It was with the same idea that the English ambassador attended the operation along with an English physician and surgeon.
After having shown that Madame could not have been poisoned, it remains to settle what disease it was of which she died. Our task is simplified by the marvellous study in which Littré proved that she succumbed to an acute peritonitis, the immediate and inevitable result of the perforation of the stomach by an ulcer. This study, Dr. Paul Le Gendre tells us, is the finest extant example of a retrospective medical demonstration. We have it now under our eyes; but we find it condensed by the pen of the most elegant writer of our time, M. Anatole France, who will allow us to borrow this quotation: ‘Littré, an expert in medical observation, does not hesitate to diagnose a simple ulceration of the stomach, which Professor Cruveilhier was the first to describe, and which Madame’s physicians could not recognise because they knew nothing about it. It is unquestionable that for some time Madame had been suffering from abdominal pains after her meals. The liquid she took on June 29 brought about the perforation of the ulcerated wall, and this caused the terrible pain in her side and the peritonitis which we have mentioned. The physicians who opened the body found, indeed, that the stomach was pierced with a little hole; but as they could not account for the pathological origin of this hole, they fancied after the event that it had been made inadvertently during the autopsy, “upon which,” says the surgeon of the king of England, “I was the only one to insist.” The incident is reported as follows by the Abbé Bourdelot: “It happened by misadventure during the dissection that the point of the scalpel made an opening at the top of the ventricle, and many of the gentlemen asked how it came about. The surgeon said that he had done it by accident, and Monsieur Vallot said that he had seen when the cut was made.”’
Littré objects, with reason, that it is difficult to make inadvertently an incision with the point of a pair of scissors—there is no question of a scalpel—in a tough and distended membrane like the stomach during an autopsy. The illusion of the physicians present at the operation is the more easily explained because in that lesion, as it is now known, the edges of the opening are perfectly clean and sharp, very regular, so that the hole seems to have been made artificially. Jaccoud points out ‘the very sharp delimitation of the ulcer, the absence of inflammation, and of peripheral suppuration.’ ‘The section of the tissues,’ writes Monsieur Bouveret, ‘is so clean that, to adopt a classical comparison, the ulcer appears as though cut out with a punch.’ It varies in dimensions from the size of a lentil to that of a five-franc piece.
M. Anatole France admirably explains the state of mind of the physicians who drew up the report of the autopsy. ‘The French physicians were afraid of finding in the viscera of the princess indications of a crime which might throw suspicion on the royal family. They dreaded even everything which lent itself to doubt, and thereby to malevolence. Knowing that the least uncertainty as to the cause of death or the condition of the corpse would be interpreted by the public in a sense that would ruin them, they had reasons of self-interest and the zeal of fear to urge them to explain everything. Now, in their inability to connect with a normal pathological type a lesion unknown to them all, and perhaps suspicious to some, it was much to their advantage to explain this enigmatical wound as an accident during the autopsy. And we can understand their believing what they wished to believe. The English surgeons, as ignorant as they, accepted their conclusion in default of a better.’ ‘The fact is,’ says Littré in conclusion, ‘that they were bound to find a hole, and they did find it. All dispute was silenced in the presence of three things: the sudden attack, the peritonitis, and the presence of oil ['and of bile,’ adds Dr. Le Gendre] which the reports of the autopsy show to have been in the lower bowel.’ In the lower bowel was found, indeed, a substance which the reports of the French physicians describe as ‘fat like oil.'[13] It was, in fact, oil—the oil which Madame had drunk as an antidote, and which had been discharged from the stomach.
Further, even supposing, against all probability, that the hole had actually been made accidentally by young Félix, who was the operator, all the details of Madame’s health known before death, and the details revealed by the autopsy, are so conclusive in favour of the diagnosis of a simple ulcer ending in perforation, that we should be led to the admission that there must have existed, in another part of the wall of the stomach, another small hole which escaped the notice of the physicians and surgeons present at the autopsy. There would have been nothing surprising in this, for their attention was not directed to this point. It might even be supposed that the scissors of Félix, if they had really cut the wall of the stomach by inadvertence, only increased the size of the natural perforation already existing. Allowance must indeed be made for the state of putrid softening in which the organs are bound to have been, the corpse having remained exposed all through a day of intense heat.
‘To sum up, before June 29, there were gastric pains caused by ulceration; on the 29th, bursting of the ulcer and acute peritonitis.’ Peritonitis is distinctly indicated by the reports. Such are the conclusions of Littré: Dr. Paul Le Gendre, a most competent authority, unhesitatingly confirms them, as also does Professor Brouardel, who writes as follows: ‘Admitting ulceration of the stomach, all the phenomena supervene with classic exactitude.’
If we refer to the works of the celebrated Cruveilhier, who was the first to describe simple ulcers, we find by an interesting coincidence, in the very case he presents as a type, the closest correspondence with the illness of Madame, and a fresh proof of the soundness of Littré’s opinion.
‘Now since the complications following perforation of the stomach and rapidly causing death,’ writes Cruveilhier, ‘supervene suddenly, and sometimes directly after taking food or drink, the question of poison has been raised pretty often. I have never seen a more remarkable case in this respect than that of a coalman, aged twenty-three, and of an athletic vigour, who, carrying a sack of coal, stopped at an inn and drank a glass of wine. He went on his way; but a few minutes afterwards was seized with horrible pains, was attended first at his own house, then carried dying to the hospital of the Faubourg Saint-Denis; his case showed every indication of peritonitis through perforation, and he died three hours after his admission to the hospital, in full consciousness. I was able to get from his own lips the valuable information that he had been suffering from his stomach for several months, and that digesting his food was always painful. The Coal-dealers’ Society, convinced that their comrade was the victim of poison, and that the agent of the poisoning was the glass of wine taken immediately before he was attacked by these symptoms, decided to bring an indictment against the wine-merchant, and with this end required the autopsy to be made in presence of a deputation from their body. It was a case of spontaneous perforation through a simple ulcer in the stomach.’
The ‘estimate’ of Littré (to use the phrase he himself uses to describe his work) is thus confirmed in every way. Loiseleur thought fit to object the rarity of the case. That is no argument: the case may be rare and yet have been that of Madame. And besides, Loiseleur makes too much of its rarity. Brinton estimates that perforation of the stomach in cases of simple ulcer occurs in thirteen per cent., and that it is most common in women under thirty. Madame was twenty-six.
Loiseleur admits peritonitis, but thinks it was inflammation supervening on a chill. ‘Why,’ he writes, ‘does Littré pass by in absolute silence the last words in the statement of Madame de la Fayette, quite as grave and significant as the first?—“As it was extremely warm, she wished to bathe in the river. Monsieur Yvelin, her chief physician, did all he could to prevent her; but in spite of all he said, she bathed on Friday, and on Saturday was so ill that she did not bathe,” and further on: “She walked in the moonlight until midnight.”’ There is only one drawback to Monsieur Loiseleur’s theory, but that is a serious one: peritonitis as an original malady, and especially peritonitis through chill, which Loiseleur wishes to substitute for the disease diagnosed by Cruveilhier and Littré, is no longer recognised by modern science. ‘The last cases which were thought to be of this kind,’ says Dr. Paul Le Gendre, ‘were perforations of the appendix.’