Medical knowledge in 1861 was in fact very limited in its ability to provide an accurate diagnosis of a whole range of gastroenteric fevers, irritation or inflammation, which have since been described and individually named. Prince Albert’s typhoid-like symptoms may well have been a feature of acute deterioration of a chronic gastrointestinal inflammation (often referred to by Victorian doctors as ‘catarrh of the stomach’), which had been developing over a long period of time. This would have been characterised by periods of remission during which he felt fairly well, followed by acute bouts or flare-ups, when the symptoms became very marked and at times intolerable. This might well account for Albert’s frequent complaints about painful stomach cramps, vomiting and diarrhoea, as well as toothache or inflamed gums, which could well have been symptomatic of a chronic (meaning long-standing) condition. There seems little doubt that his poor health was aggravated by his excessive workload, his inability to sit still for long, eat properly without rushing his food or take adequate rest. Periods of stress in both his official life and his private one with the Queen – notably her bouts of post-natal depression and the excessive burden of her hysterical grieving when her mother died – would have made matters worse. Insomnia and worry, both of which Albert was plagued by, may have lowered not only his physical resistance, but also his mental state, leading to clear phases of apathy and depression. The only palliatives available for insomnia were ether-based proprietary drugs such as Hoffman’s Drops – a popular, but highly addictive medication that was used for everything from coughs to croup and low fever.5 They would have done nothing to relieve the Prince’s symptoms, which collectively could be expected to exacerbate any underlying chronic condition. After the Prince caught a severe chill from his soaking on two consecutive days – inspecting the buildings at Sandhurst on 22 November 1861, followed by a day’s shooting in the rain on the 23rd – the symptoms he complained of (chilliness, general aches and pains, waves of fever and sensations of cold running down the back alternating with bouts of heat) were all scrupulously noted by Queen Victoria. These are non-specific symptoms of infection, which could have been a predisposing factor to, or a feature of, a final and terminal deterioration in the insidious condition that had been present for at least the last four well-documented years of his failing health, and probably for much longer. Medical science knew even then that ‘influenza opens the door to enteric fever so frequently that there would seem to be some relation between the two’.6
Two days after Prince Albert died, the first intimations of disquiet among medical practitioners were sounded, suggesting that perhaps officials at Windsor had not been entirely honest with the public over the circumstances of the Prince’s illness, its diagnosis or treatment. In a letter to The Times on 16 December, headed ‘The Medical Treatment of the Late Prince Consort’, the pseudonymous correspondent ‘Medicus’ asked:
When so valuable a life as the late Prince Consort’s is taken by the particular disease stated, would it not be as well to publish for the satisfaction of the general body of the medical profession, as well as the public, an account of the treatment adopted by the acting responsible physicians who prescribed for and attended on his late Royal Highness from the commencement to the deplorable close of his illness?
It was a perfectly reasonable question and soon afterwards the Morning Chronicle reported that ‘Information with respect to the fatal illness of the late Prince is being anxiously looked for, as well as the details of the medical treatment.’ What is more, the medical profession, according to the paper, was divided in its opinion, although not for the first or last time. Doubt had been expressed ‘in many quarters’ that the Prince’s treatment had been ‘scarcely sufficiently vigorous, and that too much reliance was placed upon the previously sound constitution and temperate habits of the sufferer’. The paper was then bold enough – considering the Queen’s deep sensitivity at the time – to express the one thought uppermost in every medical mind: ‘The profession generally have been naturally anxious that a post-mortem examination should take place, but to such a proceeding Her Majesty expressed her decided unwillingness.’7
It is not surprising that the Queen resolutely refused to agree to such a thing, considering how traumatised she was by Albert’s death, let alone the thought of his corpse being so horribly violated. This fact alone would have put pressure on the royal doctors to give a definitive diagnosis, for if any official doubts had been expressed about the cause of the Prince’s death, a post-mortem might, legally, have been called for and would undoubtedly have sent the Queen into hysterics. It is possible of course that the doctors had indeed suspected something long-term or more deep-seated: if a post-mortem had proved this to be the case, they would also have been open to accusations of culpability through their perceived mismanagement or misdiagnosis of Albert’s condition. In any event The Lancet called for an official account of the Prince’s illness to be published, given that the unexpected rapidity with which he had sickened and died had run so counter to official bulletins that had played down the seriousness of his condition. The Lancet also raised the question of ‘the discrepancies and manifold imperfections’ in those bulletins. It was therefore with some disappointment, early in 1862, that the journal was obliged to announce, ‘We are officially informed that the authentic and coherent account of the illness of the late Prince Consort, for which the profession and the public have manifested an anxious desire, will for the present be withheld.’ Once again the palace had blocked freedom of information on the subject. The British medical profession remained far from satisfied, with The Lancet again echoing the view of many practitioners that such an omission ‘leaves open to various conjectures a matter on which there should rest no shadow of doubt’.8 The demands for clarification were, however, short-lived and rapidly receded in the light of the Queen’s extreme grief. To persist on this point was deemed insensitive and intrusive.
On the medical fringe, however, accusations of mismanagement rumbled on. In January 1862 the British Journal of Homoeopathy criticised the attendance of four medical practitioners, feeling that this may have prompted a compromise in the treatment methods chosen: ‘Under this heavy infliction of medical advice, the Royal patient had hardly a chance of recovery; for it is scarcely to be supposed that an intelligent or intelligible plan of treatment would be pursued under the direction of so many, and perhaps such opposite opinions.’ In summary, the journal could not imagine the Prince’s death occurring under ‘the mild and efficacious medication’ of homoeopathy. The Temperance movement too had its own uncompromising opinions. In an article entitled ‘Alcoholic Medication’ in the Irish Temperance Journal, John Pyper strongly criticised the constant dosing of the Prince with brandy during the last six days of his life. When a system was weakened by fever, Pyper argued, it needed rest – not alcoholic stimulation. ‘Stimulation is not nutrition and the stimulant in fact becomes a depressant.’ In the Prince Consort’s case, ‘keeping a person up’ was ‘a sure method of sinking him down’. The alcohol had merely provoked a ‘still greater expenditure and waste of vital power’. In Pyper’s view, any physician administering alcoholic stimulation was committing ‘a grave, and also a grave-filling error’. A strong, hale man such as the Prince should not have died of ‘gastric fever’. The opinion was of course misguided, though shared by many medical commentators at the time. Not being privy to the Prince’s long-standing physical decline, they would have expected him – like similar men of his age ‘of vigorous and athletic frame, a moderate liver, and with every thing conducive to health around him’ – to have recovered from a bout of typhoid fever.9 Pyper concluded that the ‘gastric fever’ had been complicated in the final stages by pulmonary congestion. This is reasonable enough, but pulmonary congestion is a pre-terminal event in any fatal condition as the heart fails or pneumonia develops.
Concerns about the Prince’s treatment were not only posthumous. It is clear that Baron Stockmar, the person who knew Prince Albert best of all (from both
a personal and medical point of view) had been greatly alarmed by Albert’s failing health and his increasing malaise when he had seen him in 1860. By the end of that year Albert had endured a two-month attack of sickness, diarrhoea and pain; when he fell ill again in November 1861 Stockmar had sent regular messages to Windsor enquiring anxiously about the Prince’s health. He had found the replies that he received evasive and unsatisfactory. Knowing that the royal family’s medicines were supplied by the pharmacist Peter Squire of Oxford Street, he wrote directly to Squire, asking for details of the medication being prescribed. Correspondence between them on this matter has sadly not survived, though Squire’s prescription book for the period reveals supplies of the antispasmodic and anticholinergic belladonna, a popular remedy for gastrointestinal disorders. No details of the amounts prescribed survive, nor is there (among all the other medications) any real sense of a concerted therapeutic regime for a specific condition in November to December 1861.10
Stockmar could of course do nothing from a distance, but whether or not accusations of gross mismanagement of the Prince’s illness can be levelled at the royal doctors is still subject to debate. Lord Clarendon had, throughout, been scathing in his assessment. ‘Nothing shall convince me that the Prince had all the assistance that medical skill might have afforded,’ he wrote. Doctors Holland and Clark, in his opinion, were ‘not even average old women; and nobody who is really ill would think of sending for either of them’. As for Jenner, he was a ‘book physician’ who ‘had had little practice and experience’. William Gladstone certainly had no faith in Jenner and said that if he were his own doctor, he would ‘get rid of him at once’. The vigour of the invective against the royal doctors by members of the government is in striking contrast to the pallid criticism of them elsewhere, but strong opinions are often founded on uncertainty. At least, however (and at Palmerston’s stubborn insistence), another practitioner – Dr Watson – had been called in. ‘But Watson (who is no specialist in fever cases),’ Lord Clarendon observed, ‘at once saw that he came too late to do any good, and that the case had got too much ahead to afford hope of recovery.’ Jenner was very much the parvenu at court and still on trial. He would by necessity have been obliged to kowtow to Dr Clark’s perceived superior wisdom and experience after twenty years in the job as the senior royal physician. Albert’s fatal illness was his baptism by fire as a royal physician and, whether or not he was certain of the typhoid diagnosis – and the evidence suggests that he was extremely uncertain – typhoid fever can be difficult to diagnose even today, since it can be mimicked by several other illnesses marked by fever.
The biggest scorn, perhaps inevitably, has been heaped on Sir James Clark: he was incapable of treating ‘a sick cat’, in Clarendon’s view, and had not just a past history of misdiagnosis, but also a habit of predicting recovery shortly before a patient died. He managed this unwelcome achievement not only in the case of Prince Albert, but also during the final illnesses of the former Prime Minister Robert Peel, Queen Louise of the Belgians, and Albert’s secretary, George Anson. Queen Victoria’s biographer, Elizabeth Longford, concluded that Clark ‘erred on the side of optimism’ out of an eagerness to please.11 Yet when Victoria was sixteen he had nursed her through a severe attack of typhoid fever, so he was not unfamiliar with the disease. Clarendon put it all down to a matter of personalities and precedence: ‘One cannot speak with certainty,’ he added, ‘but it is horrible to think that such a life may have been sacrificed to Sir J. Clark’s selfish jealousy of every member of his profession.’12 Whether he agreed with Clark’s methods or not, Jenner was obliged to join in the misguided jollying along of Prince Albert by pandering to his restlessness, instead of sending him firmly to bed. Longford argues that by doing this Clark ‘hoped to keep the sufferer going simply by refusing to let him lie down and die’ – the continual dosing with brandy being a vain attempt to keep his pulse up (the alcohol’s function being to dilate his blood vessels) and prevent him slipping into unconsciousness.13 Whether or not the doctors concurred in the diagnosis of typhoid fever, it is clear that they remained highly reluctant to state its true nature, for fear of traumatising not only their patient, but also the Queen. Nebulous explanations therefore persisted: when Crown Prince Frederick arrived at Osborne on 19 December, the Queen told him that according to the doctors, Albert’s disease in addition to its ‘rheumatic character’ had had ‘a certain typhic element to it, without actually becoming typhus’. The confusion of typhus and typhoid here may well be the Queen’s or Fritz’s, or both – it was common enough at the time; but the following day, in a second letter, Fritz told Vicky that he had spoken at length to Dr Jenner, who had ‘attributed dear Papa’s suffering to “an abdominal typhus”’ – a rather contrived euphemism at best.14
The claim that typhoid fever killed the Price Consort was not challenged in medical literature until 1993, but as early as 1977 historian Daphne Bennett offered alternative diagnoses in her biography of Prince Albert, King without a Crown.15 In a brief discussion at the end of her book, Bennett suggested that perhaps the Prince had been suffering from a chronic wasting disease such as cancer, with the proviso that at that time doctors were unable to detect many of the deeper-seated or slow-growing cancers, relying largely on visual identification.16 In his 1987 biography of Queen Victoria, the American historian Stanley Weintraub included a footnote regarding Albert’s death in which he questioned the diagnosis of typhoid fever as the sole cause. He argued that Albert’s frequent problems with sore and painful gums could have been caused by an oversecretion of hydrochloric acid in the stomach – caused perhaps by carcinoma of the stomach or a wasting disease such as a peptic ulcer, and arguing that perhaps he had been genetically predisposed to cancer (his mother died of cancer of the uterus at the age of thirty-one).17 Another suggestion made to the author is that on the basis of known symptoms and their duration, stomach or bowel cancer is unlikely, but that Prince Albert might have been suffering from neuroendochrine tumours – or, more specifically, gastrinoma. This was accompanied by speculation that this rarer form of cancer could have been complicated by a secondary neuroendochrine tumour in the pituitary gland, which might have been responsible not just for Albert’s increasing fatigue and weakness, but also for his distressed mental state – the irritability that Queen Victoria regularly commented on – and (though we have no way of knowing except by inference) a marked loss of libido. Gastrinoma is a type of malignant tumour that was first described in the 1950s; it usually arises in the pancreas or duodenum and grows slowly over many years, and is more common in men than women. Symptoms are often dramatic, since the tumour secretes gastrin, causing stomach ulcers, leading to intermittent stomach pain, vomiting and diarrhoea, all symptoms similar to those experienced by Prince Albert. In some cases gastrinomas metastasise in the later stages into the liver, causing it to become enlarged. Had this been the case with Prince Albert, it would not have escaped the notice of his Victorian physicians, who prided themselves on their clinical examination skills.
In December 1861 The Lancet came close to what is probably the most accurate contemporary assessment, when it pointed out soon after the Prince’s death that ‘there was enough of suddenness in the immediate termination of the disease to raise the question whether it might not have been due to ulcerative perforation of the bowel’, adding ‘that regrettably no facts had been provided to confirm this’. Quoting an article in the French medical press in January 1862, the Medical Times and Gazette supported this claim. The ‘hints of “gastric fever” given by the first bulletin did not say much, and were anything but scientific’. But the account of the Prince’s rapid decline and death suggested that ‘a perforation of the intestines’ had taken place.18
But what was the precise nature of the chronic, inflammatory condition of the gut that had led to this perforation and from which the Prince had suffered for so long? In 1993 J. W. Paulley was the first to suggest that Prince Albert may have been suffering from ulcerative coli
tis, or more probably a condition resulting from a fault in the immune system with which it is often confused: Crohn’s disease.19 The possibility of ulcerative colitis (first described in 1859, two years before Prince Albert’s death) can be dismissed, since the cardinal feature of this condition is bloody diarrhoea and not recurrent abdominal pain, vomiting and fever. The problem with a diagnosis of Crohn’s, in the view of some commentators, is that it tends to be a genetic condition, particularly prevalent in Jewish families. Such commentators misunderstand the condition, which is today commonplace and affects any race or creed. The diagnosis, however, inadvertently plays into arguments that Prince Albert was illegitimate and that his real father was a Jewish courtier, Baron von Meyer, who had an affair with his mother, Louise. But so far absolutely no substantive evidence in support of illegitimacy has come to light.20 As it happens, only about 5 per cent of sufferers of Crohn’s disease have an affected first-degree relative. Perhaps of more note is the predilection of Crohn’s disease to affect the upper socio-economic groups, and it remains today much more common in the developed world than in developing countries.
A Magnificent Obsession: The Death That Changed the Monarchy Page 34
