Abstract
The contemporary records of Queen Anne's health and disease are reviewed, including the strange diagnoses made and the treatments prescribed. A correct diagnosis is suggested.
Retrospective study of the medical disorders of famous historical characters is a fascinating occupation but seldom is a satisfactory diagnosis achieved. When contemporary accounts are confined to simple physical observations and descriptions, even by non-medical observers, there is the possibility of a reasonable conclusion but frequently the observations and conclusions of the contemporary physicians are unintelligible or just confusing. They cloaked their ignorance and maintained their dignity with verbose gobbledegook. What is one to make of this? At first they said it was ague and then they gave the Jesuits' Bark. She took but three doses, and that was left off, so that I suppose they found it no ague … Then it was conjectured to be the gout in her stomach, and now it is thought to be the gout all over excepting the joints. One of the doctors declared, because there was no intermission on the second day, that it was a tertiary postponed.
1
This was the physician John Radcliffe (1652–1714) writing about Queen Anne's illness six months before her death in 1714. He was a very successful doctor and very wealthy and many institutions and bequests are named after him but he could be remarkably rude and was sacked by Queen Anne when she was still a Princess. She had felt unwell and sent for him; he was in a tavern drinking with friends and dismissed the messenger saying that her trouble was ‘nothing but the vapours and she was in as good a state of health as any woman breathing could she but give into the belief of it’ and he did not attend her.
1
She was furious but in fact he was right on that occasion. He was sent for by other worried doctors to help on the day before she died but said, in an insolent way, that tomorrow would do. This subsequently caused a great outcry and he was even threatened with assassination. He probably was ill at that time; he became depressed and died with an apoplexy three months after Anne. He was known for effective prescriptions and one of the milder ones he used for coughs was made from An ounce of Consarve of Roses An ounce of Sirrup of Clove Gilly Flowers A teaspoon of Venice Treacle A teaspoon of Flower of Brimstone Take a teaspoon night or morn To be followed by milk or Asses milk if consumptive.
1
Sir David Hamilton (1663–1721), the physician who did attend her in her last days, considered that ‘Translation of the Gouty Humour from the knee and foot, first upon the nerves and then upon the Brain, was the immediate cause of the Queen's death and disquiet occasioned that translation’. 2
Sir David looked after her for much of her life, especially in her pregnancies since he was a ‘man midwife’. 3 He became a confidant at a time when she was having political troubles with conflict between her ministers. He did think that she often had what we would describe now as psychosomatic disorders and prescribed Spirit of Millipedes for them 4 – there is no record as to whether this medicine helped or not (Physicians could be rich in those days; Hamilton lost £80,000 in the South Sea Bubble catastrophe).
It is sometimes difficult to decide whether the progress of an illness in the time of Queen Anne was due to the disease itself or to the treatments given. Bleedings, emetics and curious concoctions could have disastrous effects; arsenic, lead and mercury were given freely in different forms. Voltaire in the 18th century said that ‘doctors poured drugs of which they knew little, to cure diseases of which they knew less, into human beings of whom they knew nothing’.
Anne's painful symptoms began about four years before she came to the throne and persisted until her death. It is a wonder therefore that she coped with so many problems, both personal and regal. There were endless difficulties with her council and advisers and concerns about her successor. In addition, Britain was at war for 13 years of her reign, the War of the Spanish Succession (1701–1714).
The family
Queen Anne was the daughter of James II (when he was Duke of York) and was Queen of England from 1702 until her death in 1714. Anne's husband, Prince George of Denmark (1653–1708) whom she married in 1683 when she was aged 17, was presumably responsible for all the pregnancies. He was said to have been ‘a man of monumental dullness, distinguished only by his appetites for food and drink’ and Charles II said ‘I have tried him drunk and I have tried him sober and there is nothing in him’. It was also said that he was obese and that his heavy breathing from asthma was often all that convinced people that he was still alive. 5 Some have thought him syphilitic but no evidence has been given for this. He died in 1708, aged 55, with asthma and a fever. He clearly presented another problem for her, sexually demanding in spite of both of them having disabilities, but she was said to have been devoted to him.
Mental state
Her mental state throughout her life must have been affected by endless family worries although it is clear that she became tough and capable of arguing and getting her own way. Her childhood was sad; her mother died young and Anne lived with other relatives. Contact with her father became poor mainly because of his Catholicism, his second marriage to a Catholic and his exile before he came to the throne from which he was removed by William and Mary. There was a stepbrother, an endless worry, James, born to James II's second wife (Mary of Modena) who became the so-called old pretender. Everything possible was done to deny his right to any succession to the throne – Anne always declared that he was not the son of James and Mary and that the whole pregnancy and birth had been pretence and that a baby was taken into the birth bedroom in a warming pan. There were nevertheless reliable witnesses to the birth.
The eyes
Her medical history is long. There are sufficient descriptions that should be capable of interpretation in spite of the many unintelligible contemporary conclusions. The earliest recorded trouble was ‘defluxion’ of the eyes, that is constant watering or discharge.
6
At the age of four she saw a French oculist but a possible cause is not mentioned in the records. Two portraits of her at that age do not show any disorder. It must have continued as she kept on seeing eye specialists or at least individuals who considered themselves specialists; her favourite oculist was William Read, a tailor who, it is said, ‘having failed as a mender of garments, set up as a mender of eyes’. Another oculist who attended her was Dr Grant who was said to have been a failed tinker and failed preacher. It was written about these two: Her majesty sure was in a surprise Or else very shortsighted, When a tinker was sworn to look after her eyes And the mountebank Read was knighted.
7
Anne thought one of her baby girls who died young had sore eyes. Her son also had sore eyes and was said not to be able to bear much light. Her sister Mary also had sore eyes. All the symptoms described suggest dryness of the eyes rather than watering.
The joints
Anne, from the age of 33, was said to have suffered from ‘gout’ first affecting her legs in particular. In those days this name was applied to any joint condition with pain and even to painful conditions elsewhere including the abdomen. Anne does seem to have had a painful general arthritis which moved about affecting feet, knees, hands and other joints but there is no description of the appearance of these joints and, not surprisingly, the hands look normal in portraits. Apparently, political crises made the condition worse and she was better in the summertime at Windsor. Two years after the onset she had to be carried to her Coronation in a chair and from then on she had difficulty in walking. A year before her death she was unable to stand at St Paul's Cathedral during the thanksgiving for the Treaty of Utrecht. The condition was very variable in severity and some descriptions put the disability down to obesity. Certainly increasing obesity is mentioned after the age of 24 and before that she had been an enthusiastic equestrian. She received a variety of treatments for the arthritis including ‘laudanum on toast floating in brandy’. She did occasionally go to the baths at Bath.
The skin
She also had a skin disorder affecting her face, said to have started at the same time as the gout, at first intermittent and then persisting, making it red and spotted. Sir John Clerk (1676–1755), politician and polymath, wrote that in 1708 she was having a severe fit of the gout and ‘her countenance was blotted’. Again it is not surprising that no abnormality is shown in portraits. Apparently she used some form of paint to try and hide the disorder – a great secret at the time. Was the skin affected elsewhere? Probably not for someone wrote in 1702, when she was 37, that ‘the hands and arms of Anne were, like those of her mother, very fine and considered the most perfect in Europe, in regard to delicacy and form’. Perhaps this was just undeserved flattery.
Obstetrics
The history of her obstetric problems is an important contribution to making a diagnosis. Her first pregnancy in 1684 ended with a stillbirth. In the next two years she had two daughters who were said to have died with smallpox aged 20 months and nine months. Then she had three miscarriages. In 1689 she bore a boy, William Duke of Gloucester (1689–1700), who died aged 11. In 1690 Anne had a girl, two months premature, who lived only two hours. In 1692 a boy only survived a few hours. Then there were another eight pregnancies ending in miscarriage or stillbirth. She never became pregnant again after 1700 when she was 35, perhaps not surprising as she was obese and with arthritic pain and her husband was obese and asthmatic. William Henry, Duke of Gloucester, the son, would have been heir to the throne and Anne was of course distraught at his loss. He was said to be hydrocephalic, weak and unsteady but intelligent. He died with pneumonia and was thought to have had smallpox but the evidence for this is poor. Postmortem did show distended cerebral ventricles and portraits do suggest the swollen head of hydrocephalus. It is doubtful whether he would have been a very satisfactory monarch with his cerebral disorder. 8
Sarah, Duchess of Marlborough
It is well known that Anne, while a princess and as a Queen to begin with, had a passionate friendship with Sarah, Duchess of Marlborough. This was manifested by intense correspondence between them using coded names, Anne being Mrs Morley and Sarah Mrs Freeman. However, Sarah fell out with Anne soon after she came to the throne and Sarah produced endless vituperative letters and accusations especially since Anne became closely associated with Abigail Hill, later Lady Masham (c1670–1734). Sarah's hate and unpleasant letters were directed at this relationship. Sarah sent this ballad about Abigail to Anne: When as Queen Anne of great Renown Great Britain's Sceptre sway’d Beside the Church, she dearly loved A Dirty Chamber-Maid O! Abi - that was her Name She stich’d and starch’d full well, But how she pierced this Royal Heart No Mortal Man can tell. However for sweet Service done And Causes of great Weight Her Royal Mistress made her Oh! A Minister of State. Her secretary she was not Because she could not write But had the Conduct and the Care Of some dark Deeds at Night.
10
It is possible that Sarah did not write this but that her devoted ‘secretary’ Maynwaring did. He certainly wrote some of the scurrilous letters to the Queen and was active in the campaign against poor Abigail whom he called a ‘little shuffling wretch’ and named her ‘Carbunculata’.
These relationships have inevitably suggested that Anne had lesbian inclinations but this is unlikely to have any relationship to her physical disorders. It has been reported that fully-blown polycystic ovarian syndrome was found to be present in 38% of lesbians and 14% of heterosexuals, striking statistics. 10 It was thought this suggested significantly greater rates of hormone imbalance in the lesbian women. Professor Balen, Professor of Reproductive Medicine who is familiar with this work, does not think that the endocrine disturbance with polycystic ovaries has any significant effect on sexual orientation and that Anne's ability to conceive so frequently was against any major hormone disorder that could manifest as miscarriages. 11
Dropsy
What other symptoms or signs that have been mentioned might be significant? Dropsy, oedema such as can occur with heart failure or renal disease, was definitely noted in the last 10 years of her life by several persons but this was hotly denied by her close doctor, Hamilton. He did this, someone said, because he thought it reflected on his care of her. Maybe it was difficult to observe in view of the great obesity also present at that time. She was said to have been so swollen 20 years before her death that she had to be carried upstairs. Was this regal oedema of renal origin? There was nothing to suggest heart failure as a cause. Addiction to alcohol has also been mentioned but this was denied by the duchess Sarah who might have been only too ready to describe it if it had existed. Other comments are either of little help or are incomprehensible – for example her pulse, when she was having an episode of gout and fever, was said to be plenus, durus, fevretalis et frequens.
Death
What were the manifestations when she died at the early age of 49 and do they help with diagnosis? The records give differing dates for the symptoms and treatments and the sequence given here may not be correct. It is often difficult to know whether some symptoms were due to her disease or to the ghastly treatment she was given.
On Christmas Eve of 1713 she had pain in her right thigh and violent shivering for more than two hours, then heat, great thirst and anxiety for three more days. She improved, continuing with her usual joint pains and skin problem. In June 1714 she was noted to be pale. On 27 July Sir David Hamilton said that she had ‘trembling in her hands, had heat in the head with sleepiness and a little bleeding at the nose’. The poor woman attended a council meeting that day when Robert Harley (1661–1724) and Henry Bolingbroke (1678–1751) quarrelled endlessly. 12 Anne dismissed Harley as Lord High Treasurer. The exhausting meeting ended at 2 a.m. and Anne said she did not think she could last much longer. On the next day she lost her appetite, her nose bled and she felt miserable. She was the same next day and on 29 or 30 July (the records do not make this clear) she felt very ill at 3 a.m. but slept till 7 a.m. when she managed to get up. She was determined to go to a meeting of the Privy Council but between 9 and 11 a.m. she suffered two violent convulsions with nose bleeding. She was cupped and slept and was unconscious for an hour and then, amazingly, was able to meet the Council and to appoint the Duke of Shrewsbury in place of Harley. She was bled again, had hot irons applied to blister the skin, was given cardis (possibly an extract from the thistle Carduus benedictus) to make her vomit, feet covered with garlic and head shaved. A wonder that she did not die then but on 31 July she was still alive and ate a large quantity of black cherries before becoming unconscious and dying at 7.30 a.m. on 1 August. Two strokes have been mentioned in some records as occurring in these last days but this may have meant two convulsions.
There was no detailed post-mortem examination, only an inspection of some organs during embalming. It was reported that she had a small umbilical hernia and a small ulcer on the left leg. The liver appeared normal and there were no stones in gall bladder, kidneys or bladder. 13 Someone said she was monstrously fat and thought she would need a square coffin. 14 These accounts do not help with diagnosis but seem to exclude heart failure and overwhelming infection.
Possible diagnoses
What diagnoses have been made in the past? It is said that at the time of her death the generally accepted cause was considered to be ‘suppressed’ gout, ending in erysipelas (red skin patches) which produced fever and an abscess on her leg. This does not help much.
Syphilis has repeatedly been held to have been responsible for several royal illnesses and has been mentioned in connection with Anne, her husband George and even her son Gloucester and his hydrocephalus. This is not surprising in view of the remarkable promiscuity of the male members of the royal family at that time; innocent little Mary, Anne's sister, wrote ‘… in two or three years men are always wery [weary] of their wifes and looke for Mrs [mistresses] as sone as thay can get them’. There is really no evidence that Anne had syphilis.
MacAlpine and Hunter 15 described porphyria in George III and thought it might have occurred in other members of the Royal Family and mentioned this possibility in Anne but there is nothing in her history to suggest it and in any case the diagnosis of porphyria has been questioned on many occasions.
Rhesus incompatibility has been mentioned as being responsible for her abortions but there has not been reliable agreement.
Listeriosis, a rare infection with the bacteria Listeria monocytogenes, has been blamed. It can be harboured in the genital tract for long periods and infect the uterine contents with little active involvement of the maternal tissues. It can cause abortion, stillbirth, early neonatal death and possibly ill-health in a surviving child, including cerebral infection with hydrocephalus. Very rarely it can lead to meningoencephalitis and convulsions in the mother. Evidence that it can cause repeated abortion, however, is conflicting and it would not explain Anne's other symptoms.
A contracted or deformed pelvis has been suggested but she had normal deliveries. Chronic pelvic infection has been considered possible with consequent kidney deterioration (amyloidosis) and renal failure; if true, there would surely have been more mention of the infection. Marked varicose veins in her legs with thrombophlebitis and terminal pulmonary embolism have been considered and this is possible but would not account for her long-lasting disabilities.
Here then is a woman who had eye problems as did other members of her family, smallpox aged 12, a skin disorder in her face, an arthritis, oedema, gross obesity, 17 pregnancies, 11 of which ended as miscarriages and three as stillbirths. The three live births were also doomed with two infants dying aged less than 18 months and one hydrocephalic child dying aged 11 years.
The very prominent obstetric disorders could well be explained by her having the antiphospholipid condition, Hughes Syndrome. 16 Marked autoantibodies do occur with systemic lupus erythematosus (SLE) and this condition may explain Anne's other disorders including her facial condition, her arthropathy and renal failure leading to her death. Poor Anne probably suffered from the various manifestations of SLE for many years and died with uraemia due to kidney failure, perhaps with severe hypertension and cerebral damage which can accompany renal failure. Convulsions, such as may have occurred in her terminal condition, can occur with SLE. Her kidneys were said to look normal at the embalming but they can be of normal size with a nearly normal external appearance in the nephrotic syndrome and would not impress an embalmer as abnormal.
Anne came to the throne virtually an invalid, ignorant and unprepared for reigning, with a rather useless husband and with endless quarrels and differences with others but she did work hard for England which she loved and she had a great sense of duty. Many have been critical of her activities but Winston Churchill for some reason thought Anne's reign ‘the supreme manifestation of British genius’. Whatever one thinks of her reign, one can but admire her activity in the face of so much disability. Our history might have been very different if she had not been ill and had surviving children and the Hanoverian Georges had not come to reign here.
Footnotes
Author biography
…it is a matter of interpretation, of translation, proving that even the best biography and the best history is still a work of the imagination. David Teems. Majestie, the King behind the King James Bible. Thomas Nelson, Nashville. 2010. Page XVIII.
Joseph Dombey (1742–1795) died in captivity in Montserrat after capture by privateers and an exciting life. He qualified in medicine in Montpellier and using his knowledge of botany collected plants including Salvia Dokbeyi an infusion of whose leaves is used in chills, urine retention, liver disease and epilepsy. The leaves of this sterile plant from Peru and Bolivia may also stop bleeding, treat rheumatism, clean the teeth and freshen the breath, almost a cure-all. (Wood, JRI. Salvia Dombeyi, Lamiaceae. Curtis's Botanical Magazine 2014;31:143–153.