What lay behind all this, only gradually realized even by those who were close to him, was the fact that Peter was seriously ill. His previous disorder still afflicted him, the tremors still shook his giant but weakening frame, and only Catherine, taking his head in her lap, could bring him peace. In recent years, he had suffered from a new, troublesome malady. As Jefferyes described it to London:
His Majesty has for some time had a weakness in his left arm which was occasioned at first by his being let blood by an unskilled surgeon, who, missing the vein, made an incision in the nerve that lies by it. This accident has obliged him ever since to wear a furred glove on his left hand, in which, as well as in the arm, he is often troubled with pains, and sometimes loses feeling in it.
And the years had taken their toll. In 1724, Peter was only fifty-two, but his huge exertions, his ceaseless motion, the violent excesses of drink in which he had indulged in his youth, had severely undermined his once magnificent constitution. At fifty-two, the Emperor was an old man.
Beyond these afflictions, he had a new illness, the one which eventually was to kill him. For some years, he had suffered from an infection of the urinary tract, and in 1722, during the summer heat of the Persian campaign, the symptoms reappeared. His doctors diagnosed strangury and stone, a blockage in the uretha and bladder caused by muscle spasms or infection. During the winter of 1-722-1723, the pain in the uretha returned. At first, Peter mentioned it to no one except his valet, and continued to drink and carouse in his normal way but soon the pain grew stronger and he had to consult his doctors. For the next two years, he was constantly in and out of pain. He followed the doctors' advice, swallowing their drugs and limiting his drinking to a little kvas and a very occasional glass of brandy. Some days he suffered and could scarcely attend to business; then for a while he would enjoy a period of respite when he could resume his normal activity.
Near the end of the summer in 1724, the disease reappeared and this time the symptoms were much worse. Unable to pass urine, Peter was in agony. His personal physician, Dr. Blumentrost, summoned a consulting physician, Dr. Horn, an English surgeon. To facilitate a passage, Horn inserted a catheter, repeatedly attempting to penetrate the bladder but obtaining only blood and pus. Eventually, with great difficulty, he managed to extract about a half a glass of urine. During this probing, unattended by anesthesia, Peter lay on a table, holding the hand of one doctor on each side of him. He was trying to be still, but so great was his pain that the two hands he held were almost crushed. Eventually, a giant stone was passed and the pain abated. Within a week, his urine began to pass in an almost normal way. He remained in bed for many more weeks, however, and not until the end of September was he beginning to walk around his room and impatiently awaiting the moment when he could resume his normal life.
At the beginning of October, the sky outside Peter's window was blue and the air was crisp, and he ordered his yacht to be moored in the Neva where he could see it. A few days later, despite his doctors' warning that he should not exert himself, he went out of doors. He went first to Peterhof to see the new fountains which had been installed in the park. Then, while the doctors protested even more loudly, he set off on a long and arduous tour of inspection. He began at Schulusselburg to celebrate the anniversary of the fall of that key fortress twenty-two years before. Then he proceeded to the ironworks at Olonets, where he was already strong enough to hammer out with his own hands a sheet of iron weighing more than a hundred pounds. From there, he went to observe the work on the Ladoga Canal, now proceeding rapidly under the direction of the German Munnich.
The tour lasted almost the whole month of October, and during it Peter felt twinges of pain and other symptoms of the disease, but they did not slow his progress. On November 5, he returned to Petersburg, but decided almost immediately to travel by boat to visit another ironworks and armament factory at Systerbeck on the Gulf of Finland. The weather was typical of early winter in the North: gray skies, high winds and rough, icy seas. Beyond the mouth of the Neva, Peter's yacht was approaching the fishing village of Lakhta when in the distance he saw a boat carrying twenty soldiers swept out of control by the wind and waves. As Peter watched, the boat was driven aground on a shoal. There, its keel stuck in the sand and the waves pounding its side, the little vessel began rolling back and forth, threatening to capsize. Those inside, obviously unable to swim, seemed incapable of doing anything to save themselves. Peter sent a skiff from his own yacht to assist, but his sailors were unable to refloat the grounded boat; the men inside, meanwhile, did little to help, being almost paralyzed by fear of drowning. Watching impatiently, the Emperor ordered his own skiff to take him alongside the grounded boat. Unable to come close because of the waves, the Emperor suddenly jumped into the sea, plunging into the shallow icy water up to his waist and wading to the stranded boat. His arrival and presence galvanized the desperate men. Responding to his shouts, they caught lines thrown from the other boat, and, with the help of other sailors now in the water beside the Emperor, the stranded boat was pulled and dragged off the shoal. Blessing themselves for their salvation, the survivors were taken ashore to recover in the houses of the local fishermen.
Peter returned to his yacht to strip off his wet clothes and dress in something warm before anchoring at Lakhta. At first, although he had been immersed in the icy water for a considerable time, it did not appear that this exposure had affected him. Enormously pleased at his exploit in saving lives and refloating the boat, he went to sleep at Lakhta. During the night, however, he came down with chills and fever, and within a few hours the pain in his intestine reappeared. He canceled his trip to Systerbeck and sailed back to St. Petersburg, where he went to bed. From that moment on, the disease never relinquished its fatal grip.
For a while, it seemed that Peter was once again recovering. At Christmas, he was well enough to make his traditional tour of the major houses of St. Petersburg in the company of his band of carolers and musicians. On New Year's Day, he was present at the customary fireworks, and on Epiphany he went out onto the ice of the Neva River for the traditional Blessing of the Waters, catching another cold during the ceremony. During these weeks, he also participated one final time in the celebration of the Drunken Synod, which assembled to elect a successor to the recently deceased "Mock-Pope" Buturlin. The election of a new "Pope" demanded the summoning of a conclave of "cardinals" to a hall presided over by Bacchus seated on a cask. Peter himself sealed up the "cardinals" in a separate room, forbidding them to emerge until they had chosen a new "Pope." To aid their deliberations, each "cardinal" was required to swallow a large spoonful of whiskey every fifteen minutes. The process took all night, and when the conclave stumbled out the following moming, an obscure officer had been chosen. That evening, this newly elevated dignitary celebrated at a banquet at which the guests were served the flesh of bears, wolves, foxes, cats and rats.
By mid-January, the coolness which had developed between Peter and Catherine because of the Mons affair appeared to have vanished. The Emperor and his wife went together to a harlequin wedding of a servant of one of his dentchiks. Later in the month, Peter attended assemblies at the houses of Peter Tolstoy and Admiral Cruys. But on January 16, the disease returned and compelled him to take his bed. Dr. Blumentrdst again called other doctors, including Horn. Probing gently, they found that Peter had an inflammation of the bladder and intestine so severe that they believed gangrene was present. Knowing no treatment which could arrest an inflammation so advanced, Blumentrdst and his colleagues sent urgent couriers to two famous European specialists, Dr. Boerhaave in Leyden and Dr. Stahl in Berlin, describing Peter's symptoms and appealing desperately for advice.