The Physician

Axel Munthe received a degree in medicine and philosophy from Uppsala University in 1876. He was then 19 years old. After graduation he traveled south because of his poor health – he is believed to have had tuberculosis (or consumption as it was then known) which would bother him for a long time – and visits for the first time Capri.

Afterwards he studied with the then well-known gynecologist Amadée Courty in Montpellier in Frankrike and received his doctorate in medicine in 1880 in Paris with a dissertation about uterine bleeding during birth. Munthe’s defence of his dissertation was controversial. The period for opposition was extended because of Munthe’s arrogant behaviour and because many of his sources were German, which irritated the French authorities.

Munthe was thus initially a gynecologist, but worked as a general practitioner during his entire professional life. Later on an interest in mental illness came to dominate. During the late 19th century methods for treating mental disorders varied greatly. Sigmund Freud, who was born one year before Munthe, in 1856, had still not developed psychoanalysis.

What was usually prescribed was exercise, cold baths, morphine, cocaine, and similar remedies. At mental hospitals treatment sometimes bordered on torture: for example the so-called long bath where a patient lay in a bathtub (filled with cold water) with a towel fastened above so the bather could not get out.

Also popular was hypnotism, which Axel Munthe thought he had a special talent for. He is said to have hypnotized both people and animals therapeutically (read more about the subject under Hypnos for Healing). This method was believed to have a calming effect on mentally disturbed patients who suffered from attacks and it was carried out with the laying on of hands.

The image of Axel Munthe changes from coquettish society doctor – only interested in how to gain prestige through his work – to the humanitarian friend of culture who cures the poor without pay. Munthe seems to have been a very conscientious doctor who visited his patients often, sometimes daily, and who often worked for no fee. Sometimes his patients had little money, such as his artist friends in Paris or the fishing folk on Capri. Within high society the code of honour meant not asking for a fee, but Munthe writes in one place that if he knows that a patient is rich, he expects to be paid eventually. He has also written (although we know that much of that which was written in “The Story of San Michele” was not true) that on several occasions he helped provide euthanasia.

Munthe said that if he couldn’t help the patient in life, the least he could do was to help the patient die.

The Friend of the Poor

Munthe volunteered to help during the typhus epidemic on Capri in 1881, during the cholera epidemic in Naples in 1884 and for the British Red Cross during the First World War. He is an artistic figure who plays the piano and sings, he has a broad interest in culture and later on becomes one of the most famous Swedish writers internationally. He also seems to have had an artistic view of his work. He sees his role as a doctor as a calling, and therefore often works without fee, he is just doing his duty. But he is probably also a careerist who at first fails in Paris and then vindicates himself in Rome.

From many accounts I draw the conclusion that Munthe was a doctor who in many ways exploited his patients’ dependence, both to climb the hierarchal ladder of the upper class and to get close to his female patients.

At the time the art of the physician still carried with it an aura of something supernatural, at the same time that there were deficiencies in the doctor’s own knowledge of illness and medicines.

Munthe became, like many other doctors within the neurotic upper class, something of a therapist with the power to inspire hope, but also with great power over their patients. Hypnotism gave Munthe an even more dominant position with his patients. It was only under his direction that patients could become healthy, which made them totally dependence on his presence. Munthe’s familiarity with his patients was also because of the social games of the aristocracy.

Contacts and personal relationships were the only road to a career. In addition the role of a physician in society included being spiritual partner and guest.

This naturally strengthened patients’ trust in the doctor and in questions of mental or psychosomatic problems this was probably a good start.

Personal Physician to Queen Victoria

When Axel Munthe received his medical degree in Paris he was only 22 years old, and the youngest medical doctor ever in France. Munthe practiced in Paris during the 1880’s. He mostly worked for the Scandinavian artist colony in Paris. He was hardly successful, least of all economically, which initially was also a problem in Rome, as we shall see. But the company made him a public figure, both in France and in Sweden, where the press wrote about the artistic life in Paris.

Munthe made several trips to Capri and to the Alps, and in 1884 traveled to Naples where he observed the cholera epidemic, counted the number of infected and dead, and wrote articles about these experiences that were published in the newspaper “Stockholms Dagblad”. In 1888 he settled down for the first time on Capri and became a village doctor for the poor islanders, who often couldn’t pay for treatment. On the other hand, Munthe received almost saint-like status on the island. Munthe was glad to be out of Paris and he enjoyed Capri and his work there. The artists in Paris hadn’t paid either, but Munthe’s biggest problem during this first period living on Capri was (as always) economic.

His desire to make a career among the upper class in Rome can very much have been to provide some economic stability – but I also believe it was a confirmation – at the same time that he longed to withdraw to Capri and treat the simple people there for free.

Perhaps it took some time for Munthe to abandon the desire for a career and understand that he was happier on Capri than in large cities, and that he could be of greater use there. On the other hand, he had already become the Swedish Royal Physician, which gave him an unrivalled status and a steady income.

In 1890 Axel Munthe opened a practice near the Spanish Steps in Rome and during the following year established himself by attracting ministers, lords and diplomats to his surgery, above all English and Americans. In1891 Sweden’s Crown Princess Victoria became Munthe’s patient, but despite this his economic problems continued.

It is very expensive for Munthe to look like a society doctor. He is forced to hire his own carriage, dress expensively, and have his surgery at a fine address.

As usual, everything was financed by Munthe’s good friend, the Norwegian diplomat, Georg Sibbern. Munthe’s continual poor economy may have been because he wasn’t that good with money. During the 1890’s Munthe had a spectacular career in Rome, but never forgot his mission as a doctor for the poor. Together with others he collected donations for soup kitchens, orphanages, and children’s clinics.

Axel Munthe and the Swedish-Norwegian Crown Princess Victoria met for the first time in 1891 when Victoria consulted him during a visit on Capri. In 1893 Munthe becomes her personal doctor. He is then only 36 years old, but is an esteemed and fashionable continental doctor and for this reason a good choice by the court. He received the commission not just because of his reputation but also because he was considered suitable as company and conversation for Victoria. Munthe says himself that he is an ignorant doctor who has just been lucky with his patients.

Victoria’s treatment consists mostly of Mediterranean food, exercise, and company, which is probably good medicine for depression (or weak nerves, as it was called); her marriage is very unhappy.

Even if Munthe didn’t hypnotise Victoria, did his method perhaps include influencing her by suggestion with the help of his own charisma and openness? As previously Munthe did not maintain a professional distance from his patient. Victoria was, as many others, very dependent on her doctor, and her problems were, besides consumption, also mental.

Munthe received the title “livmedikus” in 1903 and Victoria became Queen of Sweden in 1907. She came to spend much of the rest of her life together with Munthe, except during the First World War when Munthe, who could not imagine supporting the German side, worked with the British Red Cross, while Victoria was in Germany and Sweden. The queen and her livmedikus didn’t meet for seven years. Their relationship was, however, so long and intimate that it led to rumours that Munthe was Victoria’s lover. Judging from their letters to each other, this seems to have been true

Emil Strandberg
Department of Literature, Stockholm University