How did the Russian Tsars die?

How is the health of a country connected to the health of its people? Until recently, scholars did not begin to research this question. Such archival material remained closed though it is unlikely that the Tsars' medical records were a guarded state secret. The idea to write a book about the health of Russian monarchs came about spontaneously, said Gennadiy Oshishchenko, the lead author and Russia's сhief іanitary шnspector, at a presentation commemorating the 125th Anniversary of Russia's Federal Protective Service. Medical stories about the Tsars were published by Media Press in a 325-page book titled, "Medicine and Russia's Imperial Authorities."

Sorrow killed Nikolay I

Historians were interested in studying the death of Nikolay I. He had been the picture of beauty – an athlete standing 190 centimeters tall. The Tsar was almost never ill and boasted a healthy physique. He carefully hid his ailments from everyone. When necessary, he hid in his office on a cot beneath his greatcoat waiting for an illness to subside. He did not smoke or drink wine – even at official ceremonies – and was not a ladies' man. At the age of 59, he passed away over three weeks during the peak of the Crimean War.

The rumor immediately spread that Nikolay I had committed suicide. Soviet historians enthusiastically took advantage of this assumption. In the 20th Century, no one questioned what had really happened to the Tsar, although 19th-Century almanacs depicted Nikolay I differently from Soviet textbooks.

As it turned out, on Jan. 27, 1855 Emperor Nikolay I fell ill with the common cold. On Feb. 9, he was feeling better and decided to attend the review of his personal regiments. He traveled on an open sleigh in a thin coat although the weather was -23°С. The next day he attended another review, and soon began coughing and fell ill. He might have lived had he not received word of the Russian soldiers' misfortune in the Crimean War.

"Nikolay Pavlovich died from sorrow – true Russian sorrow. He showed no signs of physical illness. His sickness came at the last minute and his death was the result of moral suffering conquering over his physical being," wrote Prince Meshcherskiy. He had the fever for a week before his health took a turn for the worse. He then sent his final dispatch to Moscow.

Rumors spread that the Tsar had been poisoned by Dr. Mandt, because he had been poorly embalmed. His face blackened and swelled as a result and so a closed casket ceremony was held in his honor. Only the postmortem examination could confirm or refute this theory. However, the protocol strangely vanished from Russia's medical history. Similar medical accounts convinced 21st-Century researchers that Nikolay I died of natural causes.

One Tsar dreamed of women, while another fantasized about his work

Women were literally the death of Nikolay I's son Aleksander II. Doctors told him on numerous occasions that his body's emaciation was due to his many love affairs. The 63-year-old Aleksander II died on March 1, 1881 from making love to his young wife Ekaterina Dolgorukaya. It was his final sexual act that caused the Tsar to be late for a scheduled regimental review. When he arrived, several assassins awaited him with bombs. After the first explosion the Tsar exited his carriage unharmed. The second explosion proved fatal. Aleksander II lost both his legs. He ended up dying from blood loss as a result of poor treatment of the wounds.

A well-known myth about drinking is rooted in Aleksander III

The corpulent, towering (193 centimeters) Aleksander III actually did not drink. He loved his work and had too little time to engage in such activities. He observed a peculiar diet 250 days of the year and suffered from obesity. He was an athlete, and although he spent a great deal of time laboriously cutting wood, he could not lose weight. He spent his entire time sitting and obsessively writing decrees, as he did not have a secretary. He also worked very long evenings, which worried his doctors. No one would have guessed that he would die at 49. In 1888, the Tsar and his family were involved in a train crash. Aleksander III severely injured his spine and kidneys, which resulted in the illness that killed him. The end drew near for Aleksander III with a common cold, which turned into pneumonia and led to kidney complications. In September 1894, he fell ill and died one month later of nephritis, paralysis of the heart and over-fatigue.

The Tsar's doctors were underpaid

"If you read the book, then you will not want to be a Tsar," joked Onishchenko at the press conference. And the reader will indeed think again about becoming an emperor – numerous members of the Russian royalty died simply from misdiagnoses, including Nikolay I's daughter Aleksandra, Aleksander II's son Nikolay, Nikolay II's brother Georgiy and the last empress’s younger sister Elizabeth.

According to the book, Russian medical workers have received low wages since the 19th Century. The Tsar's medics were all underpaid. Although they charged the highest prices for treating patients from the Winter Palace, it did not compensate for their losses from private practices.

"The duties of the Tsar's doctors – regardless of how flattering they may be – significantly distract from private practices and result in financial loss," the Imperial Court Ministry noted in 1894.

Interestingly enough, Russian Tsars did not wear glasses – this was not because they had superb vision. It was thought that a lorgnette would destroy the monarch's image. Glasses also could not be worn as they were a symbol of liberalism.

Russian Tsars were treated exclusively by German doctors with the exception of the two last monarchs. All court doctors were subject to detailed inspections before appointment.

In 1913, Dr. Danilevich was refused by Court Commandant Voeykov because he "attended Jewish houses of worship, where propaganda speeches were made among Jewish youth."

When the last Russian Tsar Aleksey was born, a sick hemophiliac, his illness became a state secret. Thus, loyalty to the Tsar became more important than professionalism.

A look at the Romanovs from a psychiatric point of view

Only once did doctors openly diagnose a member of the royal family as mentally ill. The diagnose was given to Duke Nikolay Konstantinovich, Aleksander II's cousin, because he had an affair with a young gymnast and spent his personal funds on irrational business projects in Central Asia.

Nikolay II was called mentally ill behind his back due to his voracious self-control, which many perceived as a mental illness. He also refused the Russian throne.

Chairman of the Third Duma Aleksander Guchkov, who received Nikolay II's abdication, openly asked: "Are we dealing with a normal, healthy individual?" But any sane person might ask such a question after learning that the Tsar killed as many as 1,400 pheasants per day, slaughtered 3,786 homeless dogs over 6 years, 6,176 cats and 20,547 crows. This was written in the Tsar's log of hunting trophies. In 1891, Nikolay II received a head wound from a police officer who was attempting to kill him. Perhaps this affected his mental well-being.

Another “diagnoses” of his illness was his marriage three weeks after his father's death. He did not mourning for one year as was the Russian tradition.

Doomed love

The book hints that Bismarck sent an ill fiancee to the Russian Court to prevent the birth of a healthy heir. Her name was Aleksandra Fedorovna. Her blood was said to be "infected with poison." Nikolay II's fiancee was genetically inclined to bearing hemophiliac offspring. She was in poor health and moved around by wheelchair.

Fedorovna's health declined further after giving birth to four daughters in a row when she desperately needed to bear an heir to the throne. Numerous charlatans offered her various recipes for bearing a male child. The French Dr. Phillip helped her to finally give birth to a boy Aleksey and Greorgiy Rasputin assisted taking care of the child.

Rasputin was right!