ONE OF THE MOST NOTORIOUS CASES in the history of bloodletting involved the treatment in the seventeenth century of England's Charles II. Because the king had no fewer than fourteen royal physicians, all under great pressure to save his life, he endured excruciating agonies in the name of medicine before he finally expired (presumably of a brain hemorrhage).

The ordeal began at eight o'clock on the morning of February 2, 1685. Charles was about to have his daily shave when he suddenly uttered a cry of pain and erupted into thrashing fits (most likely from a stroke that produced a brain seizure). A physician by the name of Edmund King, then a guest at Whitehall Palace, was summoned and applied "emergency treatment," that is, he let sixteen ounces of blood from a vein in the king's left arm. While this was occurring, messengers galloped off to fetch the king's chief physician, Sir Charles Scarburgh.

"I flocked quickly to the King's assistance," Scarburgh recorded in his diary, in which he detailed Charles' treatment. After consulting with six colleagues, Scarburgh concluded that the king was no better because the first doctor had taken insufficient blood.

Unfortunately for the king, he stirred, an "auspicious sign" taken to mean that he would benefit from more bloodletting.

Thus Scarburgh drew off an additional eight ounces by a method called cupping, in which the king's shoulder was cut in three places and three cylinders shaped like wine glasses were flamed to expel air then used as suction devices to draw out the blood.

Unfortunately for the king, he stirred, and this "auspicious sign" was taken to mean that he would benefit from more fluids being extracted from his body. This Scarburgh did with a "volumous Emetic" that induced retching vomiting; it consisted of poisonous antimony potassium tartrate (also used as a caustic corrosive for permanently dyeing cloth).

Again His royal majesty stirred, and this time he was given an enema to extract still more ill humors.

The patient regained consciousness. The doctors were ecstatic. Surely the king would benefit from more bloodletting.

The staff of physicians grew impatient with the king's lack of progress; he was unconscious. Charles was turned over and another enema administered, only two hours after the first; then he was flipped back and force-fed an oral purgative. When he still did not rally, the doctors shaved his head and smeared it with blistering camphor and mustard plasters.

The plasters contained cantharis — Spanish fly, the timeless aphrodisiac — which is readily absorbed through the skin and irritates the urinary tract, encouraging frequent urination and the loss of more humors.

The patient, who thus far had felt no pain, spontaneously regained consciousness. The doctors were ecstatic. Their treatment had worked! Surely the king would benefit from more of it. This was Scarburgh's reasoning when he administered another emetic to "bring up" the yellow humor (bile), and then blew a powder of Veratrum album, the poisonous rhizome of the white hellebore lily, up the king's nostrils to initiate paroxysms of sneezing — to, of course extract the phlegmatic (white) humor or mucus.

One would think that the king was by now humorless, but before he was permitted to go to sleep that night, he took the most massive purgative yet, to "keep the bowels open during the night." Which could not have given him much rest.

All of the therapy had been administered within a period of twelve hours. Charles was dehydrated.

The next morning, Tuesday, Charles was not only alive, but actually alert, though profoundly weak. "The blessing of God being approved by the application of proper and seasonable remedies," reasoned Scarburgh, who returned that day accompanied by eleven consulting physicians.

Eleven consulting physicians decided he would benefit from more bleeding, so they opened both jugular veins.

After examining Charles, they decided he would benefit from more bleeding, so they opened both jugular veins in his neck for ten ounces of "ill humors." Then, to prevent another fit, they gave him a sweet julep of "black cherry, peony, lavender, crushed pearls, and white sugar," which he must have appreciated.

But on Wednesday the king suffered more fits. He was bled, then given a draft made from the pulverized skull of an "innocent man" who had met a violent death. The treatment smacked of homeopathy in that "forty drops of extract of human skull were administered to allay convulsions," as Scarburgh wrote, thus attempting to cure a symptom with a "like" substance. Charles had a fitful night's sleep, though no more fits.

On toxic quinine the king grew gravely worse. The physicians were mystified. Charles was bled almost bloodless.

On Thursday, exhausted, dehydrated, and in great pain, the king was rebled, repurged, flipped onto his stomach for another enema, then given the miraculous Jesuits' bark. This was a much-touted preparation of the day, laced heavily with quinine. Its main champion in the 1630s was the Society of Jesus, or Jesuits.

With ministries throughout the world, the priests were called on to treat epidemics of malaria, and they had discovered that quinine palliated malarial fever, a remedy they encouraged the medical profession to make routine treatment. Its association with a religious order conferred upon it an aura of miracle, but it was inappropriate for Charles' condition, and on toxic quinine the king grew gravely worse. The phalanx of royal physicians were mystified.

On Friday Scarburgh wrote: "Alas! After an ill-fated night His Serene Majesty's strength seemed exhausted to such a degree that the whole assembly of physicians lost all hope and became despondent."

Though not defeated; they could not let a king die. Charles was bled almost bloodless, and, if that were not sufficient measure of the doctors' desperation, he was given an "antidote which contained extracts of all the herbs and animals of the kingdom." The known apothecary was exhausted. As was Charles, who could not hold up his head or swallow another draft, so one was, as Scarburgh recorded, "forced down the king's throat."

He grew breathless. Again he was bled. At eight-thirty Saturday morning his speech faltered and failed. At ten he was mercifully comatose. At noon he finally died, a testament to the stamina of the human body.

AFTERWORD:

Up until the close of the nineteenth century, being an eminent personage and being ill meant enduring the state of the art in arcane and torturous treatments and suffering an almost certain (and certainly needless) death. An insignificant peasant, on the other hand, unable to afford a reputable doctor, actually enjoyed the unrecognized privilege of retaining a fighting chance for recovery.