Which diseases did Russian tsars suffer from?

Tuberculosis (TB)

In the early 19th century spittoons, an accessory we often come across in classic Russian literature, stood in every room of any palace and were intended for more than just spitting after chewing tobacco, a popular activity at the time. In the drawing room of Empress Maria Alexandrovna there were as many as four spittoons – the empress not only endured typhoid but also suffered from a consumptive cough.

In imperial residences consumption was a dreadful illness because in the 18th-19th centuries people did not understand the bacterial nature of the disease and, as a consequence, didn't know how to protect themselves against it. The infection could be spread by the ubiquitous spittoons, as well as by ordinary people with open symptoms of tuberculosis visiting the palace. TB was one of the most widespread infectious diseases of the time. According to Professor Igor Zimin, in 1822 the future Emperor Nicholas I (1796-1855), styled Grand Duke Nikolay Pavlovich at the time, was engaged in some matter with General Vasily Perovsky; the latter's doctor came to examine him and the doctor coughed up blood. After the meeting, the Grand Duke proceeded to his wife's chambers as if nothing had happened. And this was Nicholas I, who took the health of his loved ones very seriously! Presumably because of his youth, he didn't realize yet how dangerous his behavior was; in 1831, during a cholera epidemic, Nicholas, already Emperor, was to be much more cautious.

Catherine I (1684-1727) died of tuberculosis at the age of 43. She had developed shortness of breath, fever and chest pains several years before her death. In April 1727 her fever intensified and on May 5 the Empress began to cough up blood mixed with pus; she died on the evening of the following day. Other members of the Imperial Family also died of tuberculosis – for instance, the sister of Emperor Peter II, Natalia (1714-1728) – as well as imperial grandees such as Alexander Menshikov (1673-1729). Empress Elizabeth Alexeievna (1779-1826), the consort of Alexander I (1777-1825), suffered from a consumptive cough.

At the court of Nicholas I, starting from the 1830s, donkeys began to be kept for their milk, which was used as an anti-tuberculosis treatment. Nevertheless, real remedies to help fight tuberculosis would be researched and devised only at the turn of the 19th-20th centuries. In 1844, Nicholas I's daughter Alexandra Nikolaevna (1825-1844) and, in 1899, the brother of Nicholas II, George Alexandrovich (1871-1899), died of tuberculosis.

Typhoid fever

It is striking that everyone – from paupers to emperors – used to catch typhoid, or "spotted fever", in Tsarist Russia. This intestinal infection caused by a specific type of Salmonella bacterium was a frequent guest in imperial residences. And all because of poor sanitation. For example, the palace kitchen only stopped taking water directly from the Neva (the river on which St. Petersburg, the capital of the Russian state from 1712 until 1918, stands) in 1868, while mineral filters and urns for boiling water were only installed in the Winter Palace (the residence of the Russian Emperors) in the second decade of the 20th century! And we are talking here only of the water used by the Imperial Family. But, besides them, numerous servants, valets, stokers and porters lived in, and bustled in and out of, the Winter Palace. The common folk and acquaintances that came to see them in their tiny rooms had a very careless attitude to personal hygiene and as a result, the palace was teeming with lice, bedbugs, cockroaches and, of course, mice, whose squeaks used to wake up even the emperors.

It is not surprising then that in these conditions Maria Alexandrovna, the spouse of Alexander II, their son Alexander III (in his youth) and the latter’s daughter Xenia Alexandrovna all caught typhoid fever. Nicholas II was very gravely ill with typhoid in the autumn of 1900 – at some point the Tsar was in such a bad way that the question of the succession was even discussed. 

He first had a digestive upset on Oct. 22, 1900, and almost immediately the Emperor's temperature rose to 39-40 degrees Celsius (102-104 degrees Fahrenheit). The high temperature and severe headache, coupled with food poisoning, continued until Nov. 12. Against this background, discussions started in high places about who should succeed: The four-year-old daughter of the Tsar, Olga Nikolaevna, or the unborn child with whom Alexandra Feodorovna was pregnant at the time (the child was the future Grand Duchess Anastasia Nikolaevna).

The Emperor actually received no treatment. Initially, doctors were afraid to diagnose the disease for a long time and then they argued about what medication to prescribe. After Nov. 13 the Tsar’s temperature started coming down and on Nov. 30, for the first time, Nicholas spent half an hour on his balcony. "It was sunny, warm and still… Thank God my typhoid was mild and I didn't suffer at all during the whole time. I had a strong appetite and now my weight is increasing noticeably every day…" Nicholas recovered but six months later, in May-June 1901, little Olga came down with typhoid.

Bladder and kidney diseases

Bladder stones caused the death of Peter the Great (1672-1725) who was known for his love of food and his heavy drinking. The Tsar's urinary disorder started in 1721 and already in 1724 he developed the inflammation that was to lead to his death in January 1725, following excessive drinking over Christmas. A few days before he died, the Emperor’s bladder was cut open in an attempt to alleviate his suffering.

Anna Ioannovna (1693-1740) didn't lead a dissipated life and didn't like alcohol. However, one day in 1740 she complained about a bad pain in her lower back and then began to cough up blood. On Oct. 5 she lost consciousness during dinner in the palace and died three weeks later. An autopsy showed that the cause of death was kidney stones and blockage of the bladder.

Alexander III, who died in 1896 at the age of just 49, also suffered from nephritis (kidney inflammation) in the last years of his life. In July 1894 civil servant Vasily Krivenko saw him at a formal dinner: "My neighbors and I were struck by his sickly appearance, the yellowness of his face and his tired eyes." General Nikolai Epanchin wrote in August 1894: "He found it difficult to drag one foot after the other, his eyes looked cloudy, and his eyelids were lowered… The Emperor's kidneys are not functioning properly, and doctors believe this is largely a result of his sedentary lifestyle." The doctors diagnosed the Tsar with protein in the urine – a symptom of nephritis – and told the Tsar that the affliction was practically incurable. "Does it really matter for the Emperor?" was Alexander III's response.

The Tsar refused to follow any of the doctors' recommendations and worked himself to exhaustion every night, as if in an attempt to finish as many things as he could. He could hardly sleep anyway and had no appetite. The Emperor tried to carry on with his usual lifestyle. He continued to hunt and, while out hunting in Belovezhskaya Pushcha on Sept. 7, 1894, came down with a cold. He was prescribed a warm bath (28 degrees Celsius/82.4 F) but the Emperor, who always tended to feel too hot, opened the cold water and lay under it for a while. He then fainted and suffered bleeding from the throat. After the Emperor felt a little better, on Sept. 18, 1894, the Imperial Family left for a holiday in Livadia, Crimea.

But the Tsar didn't get better: He had swollen legs, shortness of breath, insomnia, and exhaustion. The once robust Tsar was turning into a shadow of his former self before everyone's eyes. Famous physician Nikolai Velyaminov tried in vain to help the Emperor in the last months of his life, but the Emperor didn't comply with any of his doctors' instructions. "His head was tiny, the size of a fist, and his neck thin, and this great hulk of a man had the back of his head missing because he had lost so much weight; his coat hung loosely on him, as on a hanger; and there was nothing left of his famous shoulders, his Herculean chest, and powerful torso… It all became clear to me – this was a dying man," wrote Velyaminov. The Emperor died in Livadia on Oct. 20. The day before his death he found the strength to dress, go to his desk, read a Defence Ministry order and sign it.

The mystery malady of the first Romanovs

Four of the Romanov tsars who ruled in the 17th century suffered from illnesses that had related symptoms. They found walking difficult and painful for some reason – the tsars, according to the written records, had "ailing legs".

In the case of Mikhail Feodorovich (1596-1645), the symptoms of the disease appeared soon after he reached the age of 30. In the summer of 1627 he complained to his father: "The ailment in my legs has got worse from riding, Sire, and I am carried to my carriage and back in a chair." The German physicians Wendelinus Sybelist and Johann Bülow looked after the Tsar’s health and were paid royally for it (up to 400 rubles per annum, which was the income of a boyar). In 1643 the tsar came down with erysipelas and then quinsy (an inflamed throat), but his doctors issued diagnoses like "the stomach, liver and spleen are debilitated from much sitting, from cold drinks and from melancholia, that is to say dejection". In 1645, when he was on his way to morning service, the Tsar began to complain that his "innards are being racked" and the following night he died. His doctors diagnosed "water sickness" as the principal cause of death.

Dropsy (ascites) is a build-up of liquid in the peritoneal cavity which is very frequently the result of cirrhosis of the liver. The course of the disease is long and severe. The condition is invariably accompanied by swelling of the legs, and ascites can lead to complications such as peritonitis (inflammation of the abdominal membrane) – and consequently stomach pains. Enlargement of the abdominal cavity causes high blood pressure, and the inflammation results in a high temperature.

Mikhail Feodorovich complained of just such symptoms. It has to be said that his doctors prescribed Rhenish wine with herbs "to clear mucus" – it is difficult to imagine anything worse for dropsy than alcohol. 

Alexei Mikhailovich, the son of the first Romanov Tsar, suffered all his life from high blood pressure and obesity. He liked to be bled, and blood-letting eased his condition. He was also afflicted with edema and complained of stomach problems. He died in 1676 quite suddenly. After developing high temperature, the Tsar deteriorated over several days, took icy baths and demanded kvass [fermented beverage made from rye bread] so cold that ice particles clinked against the sides of the glass. The next sovereign, Feodor Alexeyevich (1661-1682), was "carried on a chair" to attend his father’s funeral – he also had "ailing legs" from childhood and at 14 years old could hardly walk because his legs were so swollen.

The swelling in the legs is traditionally attributed by many historians and researchers to scurvy, or a deficiency of vitamin C. But was it really the case that the tsars, who were served refined dishes and always had fruit and vegetables on their dining table, particularly in the second half of the century, had such a lack of it in their diet? There was always cabbage in one form or another on the tsar’s table - which contains more vitamin C than lemons. Tsar Feodor's menu for the Dormition Fast (late August) was as follows: "Raw and heated cabbage, salted milk agaric and orange agaric mushrooms, both raw and heated, dishes made with berries, currant compote, rose hip compote." Lemons and even oranges were also to be found among the foods served to the tsars. Meanwhile, Feodor Alekseyevich died at the age of 21 - also of "scurvy", while his younger brother Ivan Alexeyevich (1666-1696), who co-reigned with Peter, also had "ailing legs", suffered from oedema and died at the age of 29.   

What was this "mysterious malady" which foreign physicians referred to as "debility", "dropsy" or "scurvy"? One thing is noteworthy - all the Romanovs who suffered from it lived in apartments in the Kremlin in Moscow. It may be recalled that Peter [the Great] was the son of Alexei Mikhailovich with his second wife, Natalya Naryshkina (1651-1694), who was 19 at the time of their marriage. She was no fan of "cloistered apartments" - the secluded way of life of the Russian tsarinas and princesses - and preferred the freer set-up in the palace at Preobrazhenskoye. In this she was followed by her son Peter, who hated the Kremlin and lived in Preobrazhenskoye and Lefortovo, and then swapped Moscow for St Petersburg altogether. 

Researchers believe that the first Romanovs were laid low by poor metabolism. Could the early Romanovs have been poisoned? It’s not really likely in light of their abnormally fussy attention to food and frequent change of doctors, who constantly tasted their food and drink. One theory is that it was all the result of the lead inner lining of the wooden pipes of the palace plumbing (there was no running water at Preobrazhenskoye). Could substances resulting from the chemical breakdown of lead, ingested by the tsars along with their drinking water, have produced the unexplained symptoms? Or was the cause perhaps a hereditary disease of the kidneys? It should be remembered that Peter died of renal and urological complications, although he didn’t show signs of dropsy, oedema or obesity. Whatever the case, only a post-mortem examination and analysis of the remains of the first Romanovs, particularly Feodor and Ivan Alexeyevich, might be able to reveal the truth.