An Example of Death by Shock: The Assassination of Empress Sisi and the Anarchist
Prof. Dr. Kadircan KESKİNBORA
Bahcesehir U. Faculty Member of Faculty of Medicine
Shock is not just the psychological state of a person who has experienced a serious event. In medical literature, the word shock means something very different. It means interruption of blood circulation. Constant blood flow is necessary and vital for every organ. Blood pressure is needed for this. The drop in blood pressure so low that the organs receive too little oxygen for too long and all its disastrous consequences is called "shock".
The cessation of blood flow does not affect every organ at the same rate. When blood circulation stops, first the brain and kidneys fail to perform their duties. Consciousness decreases and urine production stops. This is followed by the intestines, lungs, liver and heart. A state of shock that lasts too long causes multiple organ failure (MEF). To understand the mechanisms of shock, we first need to know that there are small muscles in the walls of the arteries in our body. Thanks to these small muscles, our blood vessels can open and narrow. The medical names for this are vasodilation (vascular expansion) and vasoconstriction (vascular constriction). In this way, blood pressure is adjusted. Our heart can also adjust blood pressure by beating faster or slower or pumping blood more powerfully.
Blood pressure consists of three basic units: blood vessels, blood, and the heart, which pumps blood into the vessels. All three units can cause blood circulation to stop. For this reason, we can talk about three types of shock. First, the stoppage of blood circulation can originate from the heart, such as cardiac infarction, heart valve rupture or injury to the heart. This is called cardiogenic, or “heart-induced” shock. Secondly, dehydration or not enough blood to pump due to bleeding can cause blood circulation to stop. This is also called hypovolemic shock, or “insufficient volume” shock. In both cases, the arteries reflexively constrict (vasoconstriction) to increase blood pressure. This occurs thanks to the nerves going to the blood vessels and the secretion of adrenaline from the adrenal glands. The third type of shock is caused by the opposite, vasodilatation. Toxic substances paralyze and damage vascular walls; Therefore, blood pressure drops, pressure regulation is disabled, and fluid leaks into the tissues. This is called septic shock. Toxic substances that cause septic shock usually come from bacteria or dead tissues, as in burns, gangrene or blood poisoning. Blood loss during surgery (hypovolemic) and overload of the heart (cardiogenic) may also cause shock.
The story we will tell now tells about the interesting shocking experience of a beautiful and special woman that ended in a disastrous way.
Daughter of the Bavarian duke, wife of Emperor Franz Joseph I, Empress Elisabeth of Austria was one of the most talked about women in Europe. Elisabeth, who was crowned queen of both Austria and Hungary, was known for opposing the rules of the aristocracy. He drew attention with his support for freedom and his love for Hungary.
The activist murderer was Luigi Luccheni. He was probably sure that on the morning of September 10, 1898, he had quickly and decisively pushed the small, triangular file all the way into the woman's breast, as he had planned. However, when the 60-year-old queen stood up, put on her hat and continued walking, she must have had doubts. The 25-year-old anarchist had observed the outcome of his assassination with increasing astonishment. But he breathed a sigh of relief when two police officers arrested him for murder. Apparently he succeeded.
When asked for the reason, the Italian defendant would declare that he wanted to kill anyone from the royal family. His victim had been seen by paparazzi at the Hotel Beau Rivage overlooking Lake Geneva a few days before the incident, and Luigi had read about it in the newspaper. The woman was in every respect the Lady Diana of her time; While she was a simple princess, she had a fairy-tale marriage with the handsome prince of an important country. With her marriage to the 23-year-old Emperor Franz Joseph in 1854, when she was 16, she suddenly became the empress of the powerful Habsburg Empire, which stretched from Russia to Milan, from Poland to Turkey.
The popularity of the beautiful Empress Elisabeth of Austria would reach its peak thanks to the Sisi films, released in 1955 and portrayed by the beautiful actress Romy Schneider. However, Sisi lived a less fairy-tale life than what is implied in the movie. Elisabeth had a psychic eating disorder that we would now call “anorexia nervosa.” The woman weighed 46 kilos in her youth. She would also wear a tight corset to accommodate her “slim waist size.” His waist circumference was not even 50 centimeters, which meant a diameter of 16 centimeters. She was wearing a tight corset when she left her hotel in Geneva to go to the Montreux ship on September 10, 1898.
Her lady-in-waiting, Countess Irma Sztaray von Sztâra und Nagy-Mihaly, who accompanied her that day, later testified to the police that her majesty was suddenly attacked by a man while walking on the quay and immediately fell to the ground. However, the empress immediately stood up, said that she had nothing, and continued walking so as not to miss the ship. On the ship, her face turned white and she fainted. She soon regained consciousness and asked what happened. The ship was sailing offshore and the captain was told to turn back. The maid of honor loosened the empress's corset to make her feel more comfortable, and the empress fell unconscious again. At that moment, the countess noticed a blood stain the size of a "Silver Florin" on the dying queen's undershirt. The ship docked and Elisabeth, who was probably dead at that moment, was carried to the hotel by the crew on a makeshift stretcher made of two oars. At the hotel, Elisabeth's death was confirmed by a doctor who opened one of the arteries in her arm. There was no blood in his veins. It was 14.10.
The autopsy revealed an 8.5 centimeter-deep stab wound at the level of the fourth rib from the left, piercing his entire lung and heart, and internal bleeding. How was it possible for someone with such a serious injury to his heart not to miss the Montreux ship?
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Our body has different control and reserve systems to find temporary solutions to major problems. The fact that sixty-year-old Elisabeth survived for such a long time with a punctured heart shows, first of all, that she was in good general condition. She was indeed a healthy woman. She was not overweight, grew up in the mountains, never smoked and rode horses all her life. His good condition explains why all the organs and systems in his body continued to work well after the assassination.
Naturally, the incident frightened Elisabeth. She also didn't want to miss the ship. This state of excitement stimulates a certain part of the nervous system, called the orthosympathetic nervous system, which instantly puts a woman's body on alert. Heart beats faster, more blood is pumped to the muscles, and adrenal hormone is secreted into the blood. The name of this hormone literally comes from the Latin wordsad(upper) andren (kidney). The adrenaline hormone in question was present in high doses in Elisabeth's blood, strengthening the effects of the orthosympathetic nervous system wherever it reached. All these developments must have given Elizabeth enough energy to board the ship.
Sisi passes out only on the ship. The reason is shock, in other words, the blood pressure is disabled. The first organ affected by low blood pressure is the brain, which needs the most oxygen and nutrients. This is why he faints, that is, loses consciousness, and this is the first sign of shock. Although it is possible, but unlikely, that the drop in blood pressure began with blood loss from the heart, that is, blood loss from hypovolemic shock. Internal bleeding caused by a punctured heart would be so severe that it would not be possible for Elisabeth to walk even a hundred meters. Blood loss must have been prevented by another factor and shock must have occurred in another way.
Sisi developed "cardiac tamponade". “Tamponade” means to push or put pressure. In cardiac tamponade, blood leaking from the wound in the heart fills the space between the heart muscle and the sac surrounding the heart (pericardium). The pericardium is not very elastic. Because Luigi's file is very thin, the hole in the pericardium does not widen. That's why blood can't escape easily. In this way, although blood loss is limited at first, the pericardium puts excessive pressure on the heart due to blood accumulation. Thus, even a small amount of blood loss can have disastrous consequences on the function of the heart. The shock Elisabeth experienced in the first stage must have been caused by heart compression, not excessive blood loss. Cardiogenic shock most likely occurred in the first stage, as a compressed heart cannot pump enough blood.
As a result of decreased heart function, blood pressure decreases and low blood pressure is observed in several points of the body. There is a type of blood pressure sensor in the large arteries leading to the brain on both sides of the neck. Here, blood pressure is measured instantly and reported to the brainstem. The orthosympathetic nervous system is stimulated from the brain stem. The stimulated nervous system constricts blood vessels in all parts of the body to raise blood pressure. Low blood pressure also affects the kidneys. The kidneys keep fluid reserves in the body, and if we had the opportunity to ask her, Elisabeth would probably say she was very thirsty.
The bridesmaid explained that her fog had turned very pale. The pink color on our skin is caused by blood circulation. Facial pinkness not disappearing may be caused by anemia due to excessive blood loss. However, constriction of blood vessels can also reduce blood flow to the skin. The pale yellow color of the fainting empress is parallel to cardiogenic shock. A person can also turn pale with fear due to the blood vessel constriction mechanism that occurs with the stimulation of the nervous system. The bridesmaid was probably blonde, just like Elisabeth.
In cardiac tamponade, heart function decreases twofold. The heart consists of a hollow muscle that fills with blood and contracts to pump blood. In cardiac tamponade, the heart muscle can pump blood, but it cannot be filled sufficiently due to the pressure on the outer cardiac membrane. There is a decrease in the amount of blood to be pumped in the next heartbeat. But something else also comes into play. The strength of the heart muscle is largely related to an optimum blood level. Therefore, in cardiac tamponade, the heart not only pumps less blood, but also pumps less powerfully. Because of this, Elisabeth faints on the ship. Despite this, she regains consciousness in the arms of her bridesmaid after a short time. This was due to the horizontal position he assumed when he fainted. Thus, the blood flow from the legs and abdomen to the heart is strengthened. Because it no longer needs to flow upwards and against gravity. In this way, the lady's horizontal position made it easier for the heart to fill with blood, and the heart was able to pump more blood, especially more powerfully.
Minutes pass. During this time, a large amount of blood is likely to leak into the chest cavity through the small hole in the outer membrane of the heart. Because this was also determined after the autopsy. So how is it that Sisi still isn't dying and can talk to her maid of honor?
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The answer to this medical conundrum probably lies in the corset. The tight corset's compression of the abdomen and hips caused more blood than normal in her upper body. When the bridesmaid loosens the corset, her blood reserve suddenly disappears and the blood spreads throughout her body again. Thus, relatively less blood remains around the heart.
After the corset is opened, there is a decrease in the fullness of the heart again. The body no longer has an emergency plan. The blood vessels are already maximally constricted and the heart rate has reached its maximum; Judging by his age, his heart was probably beating 160 times per minute. If the heart itself did not receive enough oxygen due to shock, a final catastrophe may have followed. The problem is first felt by the electrical current of the heart muscle. Normally, this current ensures that the heart beats regularly and in a coordinated manner and pumps blood at an optimum level. A fatal conduction disorder may occur due to lack of oxygen. The heart begins to beat, but this is nothing more than an inefficient and chaotic contraction of the heart. The woman dies.
Even if Elisabeth had been rushed to hospital rather than by ship, it is not certain whether surgery would have been attempted. It has been four years since the death of world-famous professor Theodor Billroth, who had a say in this field in Vienna for many years, but his words were considered the gold standard in surgery for a long time. He was adamant about heart surgery. The professor in question had threatened the surgical world without any convincing justification: "Surgeons who attempt to operate on the heart can no longer hope to be respected by their colleagues." However, two years after Billroth's death, a surgeon, Ludwig Rehn, had the courage to stitch an incision wound for the first time. Although Rehn's patient, who suffered a sword blow to his heart, survived the surgery, it would take many years to continue the development of the field of cardiac surgery without fear.
Thanks to stunning advances in the new branch of surgery, if Elisabeth were alive now, she might have a chance of surviving the stab wound in her heart. The distance between Quai du Mont-Blanc, where he was assassinated, and the current Hôpitaux Universitaires de Genève is 2.5 kilometers. The hospital can be reached within ten minutes by an ambulance. However, for a good result, provided that bystanders provide initial shock treatment at the dock or pier. As soon as the corset was removed and Sisi fainted, the bridesmaid should have started CPR immediately. Making the breastbone rise and fall in a rhythmic movement turned the ribcage into a large pump, so that the empress's blood pressure could be kept at the same level. Heart massage is a very tiring practice. The bridesmaid's pale face would soon turn red. So they would have to have other people take over and continue the massage until the ambulance arrived. Ambulance personnel would immediately insert a breathing tube and insert an IV into a vein, because injecting liters of fluid into the blood vessels is the most effective shock treatment. The heart could be given an electric shock with a defibrillator to force it to return to a normal heart rhythm when it fibrillates. Adrenaline was given through a serum and oxygen through a breathing tube, and the woman was prepared for transfer to the hospital. At that time, a surgical team was formed in the hospital and a cardiopulmonary bypass device was prepared in the operating room. When he is lying on the operating table, the sternum is cut vertically with a saw to connect the device tubes; The device would be allowed to take over the heart's pumping and lungs' breathing duties. Surgeons would pour ice water into the ribcage to stop and cool the heart palpitations, and the surgery would begin. But all this was unthinkable in 1898.
Sisi had fallen victim to the “propagandist by action”, a strange philosophy within anarchism. Thus he was included in an elite group; Tsar II of Russia between 1881-1913. Alexander, King Umberto I of Italy, French President Sadi Carnot, and Greek President William McKinley were also killed by individual anarchists.
Luigi Luccheni was sentenced to life imprisonment and committed suicide in his cell in 1910. His brain was preserved for use in science. However, in 2000, it was decided that there was nothing to investigate in the brain of this villain, and he was buried in Wiener Zentralfriedhof, where Beethoven and Billroth were also buried.
By tradition, Sisi's body, like other members of the Habsburg empire and kingdom, was buried in the Kapuzinergruft cemetery in Vienna. However, as in his wife's family, his internal organs were kept in the Stephansdom crypt, and his stabbed heart was placed in a silver cup in the Augustinerkirche church. However, it is possible to see Luigi's rasp in the Sisi Museum in Hamburg. The eyelet dress is in the National Museum in Budapest, without a corset.
SISTY SYNDROME
The ugly face of capitalism also exploits health. Pharmaceutical companies that want to sell more drugs do not hesitate to portray minor complaints that do not require treatment as serious illnesses.
The main diseases used by pharmaceutical companies for these purposes are mental and neurological diseases. In particular, 'sexual dysfunctions' such as erection problems in men and sexual reluctance in women are diseases that are favored by pharmaceutical companies.
"Sisi Syndrome", which was first mentioned in 1998 with a full-page advertisement of the pharmaceutical company Smith Kline Beecham, is one of these made-up diseases. This new disease, which was brought to the agenda with the claim that it was a special type of depression, was called Sisi Syndrome, and an attempt was made to add 'nobility' to it. Because Sisi is the short name of Austrian Empress Elisabeth, not our 'transgender Sisi'. Empress Sisi is a very loved and respected person among the people.
Who wouldn't want to catch the disease named after a much-loved, noble queen, instead of an 'unlikeable' disease called depression? In fact, if what is written is true, they first wanted to name this disease after Princess Diana, but they gave up. God has protected us, because otherwise, perhaps several hundred million people in the world today would have suffered from Princess Diana Syndrome.
Although many psychiatrists do not accept the existence of such a disease, the disease has become so well-known and adopted, especially in Germany, that doctors from the company claim that today 3 million Germans have Sisi Syndrome. On the other hand, Sisi Syndrome is not common in non-German-speaking countries of the world. In any case, no one expects the disease of a German nobleman to be seen in other races. I think it goes without saying that Sisi syndrome is an expensive drug that needs to be used for a long time, produced by the company that made that advertisement.
Resources:
1) van de Laar A. Under the Knife: A History of Surgery in 28 Surgeries. Trans. Gürer E. Istanbul, Koç University Publications, 2016:54-61.
2) http://insanvesanat.com/haber-bahtsiz-guzel-457.html access: 2.2.2018
3) http://blog.milliyet.com.tr/imparators-da-aglar-/Blog/?BlogNo=152083 access: 3.2.2018
4)http://www.haber7.com/saglik/haber/167534-ilac-firmalari-hastalik-uyduruyor access:3.4.2018