Santiago Fernández Menéndez analyses in the “Estudio de la enfermedad de Fernando VI” (University of Oviedo), the medical condition that affected the son of Felipe V in his last year of life.

The final years of Felipe V‘s reign were severely marked by his psychological problems; he probably suffered from bipolar disorder, and the Court became a strange place, where meetings with ministers were held in the wee hours of the morning and the King sometimes believed he was a frog. Its heir, Ferdinand VI, not only continued with his follies but took them to the next level in what historians have called “the year without a king”, where the country fell into misrule and the health of the Bourbon monarch worsened.

Three hundred years later it is still difficult to make a complete diagnosis of the pathology that tormented a man who in his youth had not shown signs of suffering serious problems. The numerous symptoms that he showed in his last year, from epilepsy attacks to uncontrollable erections, complicate the task undertaken by Santiago Fernández Menéndez in his doctoral thesis.

A melancholic young man

Born on September 23, 1713, the future Fernando VI was the fourth son of Philip V with María Luisa de Saboya, having ahead in succession to the kingdom Luis, Felipe Pedro and another brother who died shortly after birth. The young infant grew up without a mother, who died five months after his birth, and with the mistrust of Philip V’s second wife, Isabel de Farnesio, who preferred to promote infants of her own.

Ferdinand VI as a Boy, by Jean Ranc

Ferdinand VI as a Boy, by Jean Ranc

Fernando’s education went through some ups and downs given the contempt of his stepmother and his status as a second in the line of succession. He was essentially a melancholic boy, lover of the arts, and music. The Count of Salazar served as his guardian, but neither he nor his clique could improve his position in the Court. The ascent to the throne of his brother Luis I did it for a few months, but at his death the Crown did not pass to Ferdinand but returned to the King, at the insistence of Isabel de Farnesio, because of the criticism of a nobility who understood that an abdication it is never reversible. That same year, 1724, the Court of Castilla proclaimed Fernando Prince of Asturias, although Farnesio blocked his right to attend the Council of State meetings as heir to the kingdom.

In January 1729, Ferdinand married Bárbara de Braganza, daughter of the King of Portugal, and belonging to the dynasty that, in Austrian times, had risen up against the Spanish Empire to achieve independence from the Portuguese country. Like him, the Portuguese princess was educated, with a pleasant character, fluent in six languages ​​, and a great lover of music since she was a child. Her smallpox-marked face and bulky figure didn’t stop her personality charms from making a pleasant impression.

Fernando and Bárbara fell deeply in love and lived isolated from the Court during the reign of Felipe V at the will of the royal stepmother. When, in 1733, they were able to reside in Madrid, an iron marking was imposed on them that included the limitation that they could only be visited by four people a day, and they could not eat in public or go for a walk. Perhaps Farnesio believed that if Ferdinand were ignored, he would simply disappear at some point.

“Peace with England and war with no one”

At the death of Philp V in 1746 the situation turned completely, so that Isabel Farnesio had to leave the palatial dependencies and was isolated from the political world. A year later Isabel would complain that the sanitary cord around her was getting bigger: “I would like to know if I have lacked something to correct it”. To which the new king, in a show of character, replied: “What I determine in my kingdoms does not admit consultation of anyone before being executed and obeyed.”

Barbara de Braganza, by Jean Ranc

Barbara de Braganza, by Jean Ranc

During the 13 years that his reign lasted, Fernando continued with the reform program initiated by his father. His bid for neutrality in Europe helped give the public coffers a breather: “Peace with England and war with no one”, he used as a political guide. In addition, in those years the economic recovery materialized after the years of collapse of the last Austrias and the Cadastre was created to know the reality of the country. Only the tax reform promoted during his reign was met with the direct rejection of the nobility. However, its most controversial measure was the large raid against the gypsies authorized in the summer of 1749. On the same day, some 9,000 Spanish gypsies were arrested, who were subjected to all kinds of abuse.

Even so, no king can finish his work until he assures his descendants, which turned out to be a failure for Fernando since he was impotent, like Henry IV or Charles II. A genital condition prevented him from ejaculating and having children. The matter was not so serious, meanwhile, that it had still young brothers who could take control of the country, as it finally happened with the future Charles III.

His brother inheriting the Crown entered into his plans, but not the process of dementia that he suffered in his last years.

Queen dies and King loses his mind

Although the monarchs had never been in good health, it was not until 1758 when the deterioration in the health of Queen Bárbara de Braganza forced the couple to move to the Palace of Aranjuez in an attempt to improve their respiratory problems. Far from this purpose, that same summer the Queen died probably as a result of abdominal cancer and left Fernando alone, with increasingly erratic behaviour. Throughout his life, he had suffered several periods of inactivity with a depressed mood, but that melancholic character accelerated that summer. That marked the beginning of what is known as the year without a king.

But what disease was hidden behind his madness? Alzheimer’s? A bipolar disorder like your father? Psychiatric approaches to the case have traditionally hypothesized that what started as “an adjustment disorder with depressive symptoms reactive to the death of his wife” led to a major depressive disorder. In his doctoral thesis “Study of King Ferdinand VI’s disease”, (Estudio de la enfermedad del rey Fernando VI (in Spanish), University of Oviedo) Santiago Fernández Menéndez has reconstructed the King’s clinical history between August 1758 and August 1759 to give an almost definitive answer that departs from the classic diagnoses.

The same day that the Queen died, without waiting for the funeral, Ferdinand took refuge in the Villaviciosa de Odón castle, where he went hunting and was happy the first days. However, in early September the King began to be aggressive, depressed in spirit and the obsession with death arose in his mind. Andrés Piquer, a doctor of the period, points: “He suffered from extreme fears, believing that every moment he would die, either because he felt he was drowning, or because he was internally destroyed, or because he was going to have an accident […]”.

Other symptoms appeared in the following weeks: apathy, insomnia, neglect in personal hygiene, and religious obligations, … Sharing some extravagances with his father, Ferdinand insisted on adding new nonsense to court life. He started biting people and pretending he was dead or a ghost. His assistants were constantly assaulted and were afraid of their own physical integrity. About this, Andrés Piquer refers: “He was furiously vehement, angering himself to the point of executing things very improper to his goodness and character”. In addition to running or dancing in his underwear, head butting and biting, he liked to laugh at his assistants and refused to sleep on his bed, so he improvised a stretcher with two chairs and a stool every night.

Fernando VI, by Louis-Michel van Loo

Fernando VI, by Louis-Michel van Loo

“Ferdinand VI’s disease was clinically characterized by behavioural disorganization, loss of cognitive abilities and epileptic seizures”, explains Fernández Menéndez in the aforementioned work, among whose pages he thoroughly analyses the different diagnoses that the authors of then and today have left written. After ruling out that he suffered from bipolar syndrome (like his father), autoimmune encephalitis, a Creutzfeldt-Jakob disease, tuberculosis of the central nervous system or Alzheimer, as is often speculated, this doctor believes that his problem was caused by a “progressive lobe dysfunction front right. From the aetiological point of view, the possibilities are multiple. A neoplastic lesion seems the most probable”.

If the injury was the result of a tumour, a blow, or another question, it is impossible to know due to the lack of data. “It is not possible to establish an aetiology for Ferdinand VI’s disease since it is a distant event in time and the total absence of what is now considered a regulated complementary study. However, from a syndromic point of view, it can be established with a high level of certainty that Ferdinand VI suffered from a rapidly progressive right focal neurological disorder”, he concludes.

The year without a King

From Italy, the future Charles III insistently asked to use “respectful violence” to reduce the patient. Here’s the question, with no apparent answer, exactly what respectful violence is to a man who just bit your nose. However, in early 1759 this “violence” was less and less necessary because the King became bedridden and weaker. Beginning in the spring, dementia affected his speech, to the point that he was barely able to articulate a disordered speech.

“The highest clinical expressiveness of behavioural symptoms occurred in February. Since then the behavioural changes in Ferdinand VI have been flattened, especially since April 1759. From the point of view of the cognitive situation, on the other hand, it can be concluded that by the end of November 1758 the King no longer had a good capacity of judgment ”, points out Fernández Menéndez in his thesis.

Digestive and respiratory problems accelerated its deterioration in a short time. The appearance of blood on sputum was described in July. “Fernando VI entered a situation of epileptic decompensation in August 1759. He finally died correlated for that reason on the 10th of that month,” says Fernández Menéndez about those last days. At this point, his long absence had disturbed the people to the point that satirical verses ran furiously through Madrid:

“If the King has no cure
What are you waiting for or what are you doing?
Very soon it will be a year
That without seeing your king
You are subject to a law
Son of continuous deception.”

The 46-year-old Monarch’s health reached critical levels as a result of his malnutrition and respiratory problems. Lack of human affection was also key to accelerating this deterioration. As Santiago Fernández Menéndez appreciates, “Ferdinand VI must have suffered a lot during his illness, the doctors only demonstrated his diagnostic and therapeutic ignorance, and all of this worsened the political tensions that occurred in the context of an absolutist king, without descendants and inability to govern”.

His brother Charles III, son of Isabel de Farnesio, inherited the kingdom. He was the third son of Philip V who reigned in Spain.

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