HISTORY OF MEDICINE

MEDICAL HISTORIES FOUND IN MEMOIRS OF QUEEN MARY OF , PART THREE

Călin Bumbuluţ1, Andrei Bumbuluţ2, Alina Daniela Negru1, Rumelia Koren3

1SCM dr Bumbuluţ-dr Balaj, Satu Mare, România, 2Faculty of Medicine, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj Napoca, România, 3Department of Pathology, Hasharon Hospital, Petah Tikva, and Sackler Faculty of Medicine, Tel-Aviv University, Israel

Address for correspondence: Dr. Bumbuluţ Călin Satu Mare, str. Bobocului UK 30-440258 E-mail: [email protected]

Received: 01.10.2016 Accepted: 30.10.2016 Med Con March 2017 Vol 12, No 1, 43-48

Abstract

Mary, Queen of Romania, born as Maria Alexandra Victoria of Saxa-Coburg and Gotha (October 29, 1875, Eastwell Park, Kent, England, July 18, 1938, Sinaia Pelişor, Kingdom of Romania), was princess of Great Britain and Ireland and the consort of King Ferdinand. Her memoirs are an important source of informations including medical ones, but also a surprising literature, which proves a writerly talent. Our approach aims at an incursion into the medical informations contained in the memoirs of Queen , to our knowledge being the first attempt of its kind. Keywords: Queen Mary, medicine, typhoid fever, Figure 1. Prince Carol (left); Prince Ferdinand, appendicitis, gout, cholera, vaccine, serum, immunology King Carol I and Prince Carol (right)

We continue the incursion in Memoirs of Queen A medical story from the beginning of the XXth Mary, second volume, with events from around the century, has had the lead starring the future King of early twentieth century. Great Britain, with the occasion of his coronation, is Typhoid fever, the scourge of the nineteenth century disclosed with discretion to us, by the Queen Mary: and of the early twentieth century, is affecting one by “The Coronation of King Edward VII (our note, of Great one, the members of the Royal Family, namely the first Britain, Figure 2) had also a tragic moment, because a son of the Princess (Figure 1): “(...) Carol was sick of serious illness had struck the sovereign in the very hour of typhoid fever (...) and almost died. (...) Carol didn`t die, the largest glory; therefore it was necessary to be postponed but, like his father, he had a long and difficult convalescence the date of the ceremony. (...) but just at that moment, he (...). Besides, there were only two months until the birth of could not be with us, and was forced to surrender to the my third child”. [1] knife of a surgeon. His life hung in the balance (...)” [1].

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Figure 2. King Edward VII of Great Britain

Figure 4. King Carol I

1887. He advocated the operative treatment of appendicitis, although he advocated delaying surgery until a quiescent interval had been reached. In this first operation, Treves did not in fact remove the appendix; he merely straightened out a kink and then closed the abdomen, though his practice soon changed with the removal of appendices. He pointed out that the term ‘typhlitis’, implying inflammation of the caecum, was usually a misnomer, since it was inflammation of the vermiform appendix that was important. By 1901, Figure 3. Sir Frederick Treves Treves had removed a thousand appendices. Treves has also found fame in the case of Joseph Initially, the coronation of Edward was scheduled Carey Merrick (1862–90), better known as the Elephant for June 26, 1902, but two days earlier Eduard was Man. Merrick was disfigured by a congenital condition diagnosed with appendicitis. His physicians in that until recently was thought to have been due to attendance called for Sir Frederick Treves (Figure 3) and neurofibromatosis, but was probably Proteus syndrome he operated to drain the abscess. The operation was made [3]. After the First World War, Treves moved to at a time when the death rate of appendicitis was high Switzerland with his family. He died on 7 December [2]. Two weeks after the operation, it was announced 1923, most probably from peritonitis. that the King is out of danger, and Edward VII was “King Carol, at the end of his life, was often sick; he crowned on 9th August, 1902; Treves was rewarded with was suffering from an acute liver disease, very complicated, the title of baronet [2,3], and the operation for which often it has caused a great pain, but rarely forced him appendicitis entering into the usual medical practice. to stay in bed. Gradually, he loosened awful; he had to follow In 1875 Sir Frederick Treves (1853–1923) was a strict diet, which took away much of his power” [1]. qualified as a Member of the Royal College of Surgeons. It seems that The medical condition of the King After a job as House Surgeon at the London Hospital, (Figure 4) was originally the base of the rise of the great he became Resident Medical Officer at the Royal politician Ionel Bratianu (Figure 5), besides his special National Hospital for Scrofula at Margate in 1876. His merits: “He endure this state of health (our note - King research on scrofula, the origin of which puzzled him, Carol I) with the stoicism that distinguished him in all, would be published as a book entitled Scrofula and its but there were periods when he was so ill, that any task Gland Diseases in 1882, the very same year that Robert became a painful trial, and then it was only natural to Koch demonstrated that it was due to a bacillus [3]. He prefer to work with people who understand him by a word, became a Demonstrator of Anatomy in the medical and were not loosing from their thought his age (...) I school attached to the London Hospital and built up his remember that the king told me in a row: (...) “in this reputation as a teacher and writer and a leading surgeon. time, the work with Ionel Brătianu for me is a rest; he has Treves had a particular interest in the condition known a welcoming mind, he is following my thought until the as perityphlitis. He operated on his first case on February end, he understanding my desires without talking, and he

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Figure 5. Ionel Bratianu in his younger years (left), and at maturity (right)

is not in eternal opposition to me” (...) In 1908, the health of Sturdza crumbles; he rolled his resignation from the leadership of the Liberal Party and withdrew from public life, and Ionel Brătianu reached Prime Minister (...)” [1]. “Aunty gladly play the role of a sister of charity and always told us all that she did for the King. It was between the beings that look an interest almost morbid for all that involves the health, doctors or medicine. Always boast the Figure 6. News in the Tribuna newspaper, Arad, 1906 benefits of a new regimen or a new curative method, of a new treatment, a new drug, but nevertheless it was a King Carol will visit Bad Gastain only for two years, then matchless nurse, and her patience at the bedside of a patient he gave up treatments at this resort, due to the opening was boundless. for mass tourism, the result of the appearance of the new Apart from the specialists called from time to time in railway, just at the time when Marie Curie was able to consultation, of course, the King had a treating doctor, test the healing capabilities of the radon. grizzled by the age, General Dr. Theodory. It was a great A proof of the concerns of the royal family of the skilled military, as well the personal friend of Aunty and a Sovereign’s health, is the consultation made by dr. good musician, but, alike , he was aging Noorden from Vienna in 1906, which took no less than as well, and Uncle had sometimes instinctive desire to ask four days to diagnose “a chronic catarrh of the stomach, the help from of a younger and powerful man. But at the with hyperclorhidia and consecutive erosion of the mucosal Court, the doctors, as well all the items, are hard to push of this organ”. The news were published by Romanian into place; each had clung to his post, and only after an media, including in Transylvania and in the Official unhappy accident made an invalid from the old doctor, was Gazette, which publishes regular newsletters on the called a younger doctor: dr. Mamulea” [1]. health of the King (Figure 6). In 1902, the King Carol I was treated for gout at Bad Carl Harko von Noorden (13 September 1858-26 Gastein, Hotel Kaiserhof, where he was already expected October 1944) (Figure 7) was a German internist, born by the General Dr. Theodory. He will return in 1903 in Bonn and educated in medicine at Tübingen, when Prince Dimitrie Sturdza, the Prime Minister, was Freiberg, and Leipzig (M.D., 1882). In 1906 he was also treated at thermal waters, for spine aches, at appointed professor of medicine at the University of Heilstollen; the sanatorium housed in a former gold Vienna. Von Noorden made special researches on mine, for the treatment of ankylosing spondylitis, the albuminuria in health, metabolism, diabetes, diseases of illness that also the Romanian Prince suffered from. The the kidney, dietetics, etc. chief physiotherapist of the sanatorium was the Romanian “Dr. Mamulea was the chief of the hospital in Sinaia; Dr. Elena Martea, originating from Mediaș. A telegram when it comes into our lives, he came for good and stood from that time was announcing: “The King Carol of beside Carol until the finish. Aunty received him with open Romania, make wanderings at the time when the rain ceases arms, he reached slowly the friend whom she confessed to, or decreases, accompanied by his doctor, Dr. Theodori...”. and was in many respects a comfort to her.

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Figure 7. Prof. Dr. Carl Harko von Noorden

We felt happy when we saw her trusting in a man so worthy; we knew that doctor Mamulea will give only safe and well-done advices. This new spoiled man of the Court was a new type of blue-eyed Romanian, with a well set personality, which nothing could disturb; a man who knew how to silence, and a man who maintained his calm opinion without leaving himself swinging in fleeting winds. Quiet, dependable, phlegmatic, it was impossible to drag him from beside the right path, and he was doing his work quietly. It was for the Figure 8. The death certificate of King Carol I, King a great comfort, and also for my husband, around published in the press whom he remained until the last day of his life” [1]. Besides, Dr. Ion Mamulea, signed the death stand absolutely motionless, uttered an awful sentence: “Do certificate (act) of the King Carol I on 27 September not forget that you have now in your foot a gun, and that 1914 (Figure 8), where the age of the doctor was also the slightest movement can download the gun into the stated: 41 years, so on the entry into the service of the heart...” (...) when the cure was finished, I made in passing Royal House he was about 35 years of age. a visit to Spain (...) Unfortunately, I was not fully recovered; At the age of 37, the Queen Mary was pregnant for during in the long time I was lying down, I gained more the last time: “Before I was born the sixth and final child weight than the aesthetic request, which grieved me terribly. of mine, Mircea, I did not feel healthy as usual, and during I was still lame and I had to walk with a cane in hand; my Autumn visit at my mother in 1912, I had to obey even besides, the soles of the feet, because of the long time that I to the doctors care, thing that filled me with wonder and spent in bed, became too feeble. Any trip or visit to a with bitterness” [1]. museum was for me a excruciating pain (...)” [1]. The complications of pregnancy are redoubtable, The Second Balkan War is presented in the Memories and the therapeutic means at that time were basically not so much by military actions, also restricted in non existent, practically they resume to absolute rest, to amplitude, but especially through the impact of the prevent the secondary embolism: “Mircea was born in diseases that decimated the soldiers, especially cholera, January 2013, but I didn’t recover after his birth, so fast as this being the revealing condition for the one who will usual, and I was doomed to stay at bed more three oppressive become in the First World War “The mother of the months because of a painful phlebitis. The disease appeared wounded”: We didn’t have any fighting, but our troops, to me always as a personal insult, something that could when were on the enemy ground, they greeted an enemy just happen to others but not for me. Apparently, I was obeying as terrible as a cannon: the cholera. (...) I can not retain patiently, but in my soul, I wasn’t conciliated with the myself to consider the contact with cholera as a new turning humiliation of staying in bed. Because of this unpleasant point in my life path. It was my first initiation into suffering happenings, I could not enjoy with my last born, as I enjoy in its broadest meaning, something unknown to me before, the others, because I was lying on my back, motionless (...) and of which no doubt I heard people talking, but as But Dr. Romalo, our family doctor, a small man with something away, which I was not destined to ever meet” [1]. caustic spirit and sharp tongue, very devout, but very bitter The Army Medical Service was not prepared to cope in his words to convince me with the unyielding need to with the situation. Medical supplies from the ambulance

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wagons contained quinine and bitter salt, digitalum for heart disease, and a medicine used to stop uterine bleeding in women; this “equipping” being the consequence of the corruption of those charged with the supplying: “Cholera brings with it the fear. The lightning swiftness and the virulence which hits and knock their victims, and the way that manifest, have something that shakes the strongest nerves. In this somewhat abandoned hospital on the Bulgarian land, I find many of our soldiers almost forget and dying from a lack of doctors and medicines. (...) It was missing all: doctors led a fight in which the defeat was waiting for them, which filled us with consternation and daze” [1]. Figure 9. Alexandru Slătineanu Despite warnings from doctors, the first preventive measures were taken only later. The pride of the experimental sepsis, being the discoverer of the revival commanders who were not hearing the arguments of the phenomenon of the ophthalmic reaction at tuberculin. reservists doctors, was exceeded, sometimes only by He follows the Faculty of Medicine in , becoming stupidity: to a doctor who had demanded a ban on the MD in 1901 with the thesis Septicémie expérimentale par use of contaminated wells, a colonel replied him with le cocco-bacille de Pfeiffer. Essais d’immunisation blatantly drinking a glass of water, dying three days later. (Experimental sepsis by Pfeiffer’s coccobacillus. The deaths were so numerous (“people were dying like Immunization Tests). It has specialized in bacteriology at flies”, said a campaign doctor) that every night they were the in Paris alongside , transported and buried in mass graves. At one time it was working in the laboratory of Ilya Mechnikov. Back in used to transport the deads in the wagon with which the country, he occupied from 1902 the position of they brought bread for the soldiers, “the carts cannot go lecturer at the Department of Experimental Medicine, emptied”! “The patients halls were some huge barracks of the Faculty of Medicine in . In 1903 without sufficient light, stifling when the sun was burning, occupied through contest the position of secondary and wet when it rains. The patients lay on straw mattresses, doctor of the Hospitals from Bucharest, and became side by side, with a trail of mud that separated both rows of later, in 1907, chief physician of Filaret Tuberculosis beds. We had no mattresses and almost no linen” [1]. Sanatoria. Subsequently, he was transferred to Iaşi, In the early days of the epidemic, despite its size, we where he was appointed Professor at the Department of could do nothing in terms of healing. The schools were Bacteriology at the University of Iași in 1912. He held transformed into hospitals, where patients were divided positions in the Ministry of Public Health being the into those with a definite diagnosis of cholera, and the General Secretary during the period while Ioan suspect ones: “Another weight over the others was the need Cantacuzino was Minister, and director of the Health to isolate them from the other soldiers in the camps nearby, Service. Alexandru Slătineanu was a founding member for fear not to spread the disease. An individual could not (1905) of the Journal of Medical Sciences, that has be demobilized until it was investigating the status of every published numerous studies, and for his connection to person” [1]. the art world, we should be grateful to him for initiation Only after eight days of the start of the scourge of the collection of the current Museum of Art among the soldiers came Dr. I. Cantacuzino with the Collections, and for the drawing in charcoal ”The Carrot serum necessary in the fight against cholera: “I encountered Puller”, drawed in 1885 by Vincent van Gogh, which with Dr. Jean Cantacuzino and with his help, Dr. was purchased from the store of the famous art dealer Slătineanu, who was “in a tour of inspection”, both being Ambroise Vollard, the drawing being the only work by terrified by the hardships they faced. (...) Elena Perticari Vincent van Gogh from a museum in Romania. accompanied me also (...) a woman fearless and full of The level of lethality caused by cholera is closely patriotism. Her father, Dr. Davilla, was being the chief of related to the date of the outbreak, and to the possibilities military health care, which he had established as well” [1]. of response from authorities. The mean lethality level Alexandru Slătineanu (5th January 1837 to 27th calculated was around 40%, with fluctuations due to November 1939) (Figure 9) was Professor of bacteriology several factors. A large number of deaths reported to the at the University of Iaşi. number of sick, is recorded in the first weeks of He is known for his work on polio, typhoid and outbreaks evolution. According to official data of the sero vaccination, developing original studies on time, 11.586 troops were ill with cholera, 1,611 of

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Figure 11. Prof. Figure 12. Prof. Dr. Mihai Ciucă Dr. Nicolae Gheorghe Lupu Figure 10. Professor Alexandru Slătineanu, in the Campaign Hospital. Image from familial archive of Professor Şerban combat cholera and malaria in Romania. His older Nichifor, licensed under the Creative Commons Attribution- brother, Alexander Ciucă (23rd August 1880 – 8th March Share Alike 3.0 1972), follows the career of a veterinarian. “I managed to make friendship also with the Doctor whom died, that is more than ten times that those killed Lupu and Doctor Cădere, two young with ideas a little too in the fighting, though representing a mortality of advanced (...)” [1]. 13.9%, which means that the intervention of medical Dr. Nicolae Gheorghe Lupu (24th February 1884 - service was decisive: „The most valued students by Dr. 30 April 1966) (Figure 12) is one of the most important Jean Cantacuzino worked in a wooden building at the end representatives of the Internal Medicine in Romania. of the field. Here they had prepared their provisional lab in He made contributions, especially in the which they worked like servants day and night, preparing physiopathology of pulmonary sclerosis, jaundice, blood serums and making all the such necessary analyzes in diseases, endocarditis, typhus, angina pectoris, epidemic period” [1] (Figure 10). hypertensive disease, etc. Its clinical research was „TheCiucă’s brothers were among the top of their group combined with those experimental, developing the (our note – of the collaborators of Ion Cantacuzino), physiopathological research. Between 1907 and 1913 he true apostles fighting for the good of humanity” [1]. collaborated in the Laboratory of Experimental Dr. Mihai Ciucă (18th August 1883 - 20th February Medicine with Prof. Dr. I. Cantacuzino. In 1931, he 1969) (Figure 11), finished the Faculty of Medicine in was appointed titular Chair of Pathology, with a special Bucharest in 1907, pledging then as a doctor at the contribution in reorganizing morgue services in the Military Hospital. major hospitals of Bucharest. He has published Since 1905, he worked as a volunteer in the numerous works of pathology, hematology, and internal Laboratory of Experimental Medicine, founded in 1901 medicine. In 1938, is full Professor at the Colentina by Ion Cantacuzino, and starts experimentation and Hospital Medical Clinic, which in 1949 became the research on infectious diseases and immunology. He Institute of Internal Medicine, being the first institute works at the Institute of Serums and Vaccines, founded of Internal Medicine, which he lead up to his death. and led by Ion Cantacuzino, and in the microbiology laboratory led by Victor Babeș. In the Romanian military campaign of 1913, and References then from 1916 to 1918 during the War of National Reunification is enrolled as a military doctor and will 1. Maria, Regina României. Povestea vieţii mele, Ed. advance to the rank of colonel in the reserves. He RAO, Bucureşti, 2013, Vol II, pag 158-9, 223, 306- obtained a PhD in medicine, and entered into University, 9, 318-21, 327-9, 331-2. first as an assistant at the Faculty of Medicine, then, on 2. Mirilas P, Skandalakis, JE. Not just an appendix: Sir the recommendation of his mentor Ion Cantacuzino, is Frederick Treves, Archives of Disease in Childhood appointed Professor of hygiene at the same University in 2003;88:549-552, doi:10.1136/adc.88.6.549. 1921. Dr. Mihai Ciucă introduced in our country the 3. Ramachandran M, Aronson JK. Frederick Treve’s first antituberculous vaccination and participates directly in surgical operation for appendicitis, J R Soc Med decision making and implementation of measures to 2011;5(104):191-197.

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