One other possibility remains: that the Prince had contracted abdominal tuberculosis, which can appear years after initial exposure to the TB bacillus and cause symptoms clinically indistinguishable from Crohn’s. In 1861 it would have been impossible for the royal doctors to have diagnosed TB with any accuracy. The cause (the bacillus Mycobacterium tuberculosis) and tissue diagnosis of it were only described by Robert Koch in 1882 (work for which he was awarded the Nobel Prize in 1905). Abdominal TB was at that time much more common than it is today; it can affect the lining of the abdomen (the peritoneum) and, when it does, fluid known as ascites accumulates in the abdominal cavity. It is possible, therefore, that Prince Albert was suffering from ascites due to abdominal TB, although the Victorian doctors should have been able to detect this clinically by percussing his abdomen, which would have been taut and uncomfortable.
The evidence, when carefully considered, would thus seem to favour a diagnosis of Crohn’s disease. But such a diagnosis is, of course, entirely retrospective and anachronistic, for it was not described for the first time until 1913 (by a Scotsman, T. Kennedy Dalziel) and then again in 1932 by the Jewish-American gastroenterologist Burrill Crohn and colleagues. Nevertheless, Crohn’s disease, which is gradually progressive and fluctuating in intensity, could explain the chronic, relapsing and remitting problems with his gut that Prince Albert had suffered from, undetected, over many years. It would have caused episodic partial obstruction in the bowel, which, if untreated, can be complicated by small perforations or abscess, leading to peritonitis, septicaemia and death. But only explorative abdominal surgery – at that time unavailable – would have revealed this. Crohn’s disease is characterised in some patients by other, extra-intestinal problems that are quite independent of the activity of Crohn’s itself, such as arthritis. It is conceivable that the Prince’s frequent complaints of ‘rheumatic’ pain in his joints for much of his adult life, and which became so prominent in his final month, could also have been a manifestation of Crohn’s disease. Such symptoms often persist even when the intestinal inflammation is inactive and are thus more compatible with this overall diagnosis. Like abdominal TB, Crohn’s can be exacerbated by overwork and anxiety. A recent study by Charles Bernstein in Winnipeg has shown that the risk of relapse in Crohn’s is almost doubled in those suffering high levels of perceived stress.21 If this were true in Albert’s case, then the ultimate irony is that Victoria’s assertions that Bertie killed his father may in a way be true. Albert’s extreme response to his son’s escapade at the Curragh, and the excessive levels of anxiety and insomnia that followed, combined with a chill and overwork, may well have provoked a severe flare-up of his condition.22
In many respects, therefore, the natural history of Crohn’s disease would fit the long-term pattern of Prince Albert’s documented physical complaints: periodic diarrhoea due to inflammation of the gut, with abdominal pain and vomiting from intestinal obstruction, fluctuating between acute episodes marked by swinging fevers and periods of remission. The bouts of depression and lassitude that he latterly suffered are also highly characteristic of an abscess or chronic sepsis. A pink rash of spots detected by the doctors on his abdomen in early December – which they seemed to fix on, almost with relief, as a sure sign of typhoid fever – could have been a consequence of cutaneous vasodilation brought on by septicaemia.23 One must bear in mind how desperate the royal doctors must have been in those final days: their most important patient (apart from the Queen) dying at a young age; the eyes of Her Majesty, their (envious) colleagues and the world upon them; and there they were, uncertain of their diagnosis.
The final three-week cycle of illness would thus fit the time-frame for Crohn’s, complicated by an abdominal abscess, developing into a terminal event with the opportunistic onset of pneumonia (‘pulmonary congestion’) in the last two or three days.24 Although it was not widely reported at the time, this latter view concurs with that of other medical practitioners: what in fact carried the Prince off was that age-old nemesis of the sick and vulnerable – pneumonia.25 In the absence of solid clinical evidence, or detailed autopsy notes, we can only ever make informed guesses. Whatever it was that killed Prince Albert – and we must now lay the ghost of typhoid fever to rest – no antibiotics, steroids or abdominal surgery were then available to help him. To Prince Albert himself must go the final word; if his condition had not killed him in 1861, it is likely, as he told his stepmother, that the ‘weak stomach with which I came into the world…I shall take with me to my grave’.26
Bibliography
Archives
Arkhiv der Hessischen Hausstiftung, Schloss Fasanerie, Eichenzell:
Briefe Kronprinz Wilhelm von Preussen an Kronprinzessin Victoria, 1861, 7.1/1-BA 3
Balliol College, Oxford:
Morier Family Papers, K1/4/4, 1866–72, Queen Victoria’s letters to General Peel
Bodleian Library Special Collections:
Diaries of Lady Katherine Clarendon, Clarendon Papers, MSS Eng. e. 2122–5
Diary of Charles Pugh, MS.Eng.misc.d472
Journal of John Rashdall, MS.Eng.misc.e 359
British Library:
Gladstone Papers, vol. CCXL, Add. MSS 44325 and 44326, letters from the Duchess of Sutherland; vol. CXCV Add. MS 44289
Queen Victoria’s ‘Album Consolativum’, Add. MSS 62089, 62090
Cheshire Archives:
Correspondence and Papers of Dean Stanley, DSA 85
Public Record Office, Kew:
Lord Chamberlain’s papers, PRO LC 1-90-005
Royal Archives, Windsor:
Letters and journals of Queen Victoria, Prince Albert and members of the royal household; memoranda from the Lord Chamberlain and Comptroller of the royal household [itemised in detail in the Notes]
Royal Pharmaceutical Society of Great Britain Collections:
Peter Squire, pharmacist: Queen Victoria’s Account book, 1861–1869
Ian Shapiro collection:
Diaries of Sir John Cowell, 1861–2; letter of Ra Haniraka, 3 March 1862
Staatsarchiv Darmstadt:
Briefe von Prinzessin Alice, 1861, D24 Nr. 25/3–4 and 26/1
The Times Newspapers Limited Archive, News International Archive:
TT/ED/JTD/A/022, Lord Torrington letters to Delane
TT/ED/JTD/10–13, Delane Correspondence
Newspapers and Journals
British national and regional newspapers digitised in the online resource, 19th Century British Library Newspapers, available at the British Library, London, and other libraries and repositories. Major papers consulted:
Belfast News-letter
Daily News
Daily Telegraph
Leeds Mercury
Lloyds Weekly Newspaper
London Gazette
Morning Chronicle
Morning Post
Pall Mall Gazette
Reynolds’s Newspaper
The Times Digital Archive 1785–1985
New York Times Article Archive 1851–1980
Magazines and journals digitised in 19th Century UK Periodicals, British Library, London (availability as per the newspaper archive):
Illustrated London News
The Lancet
Medical Times and Gazette
Punch
Tomahawk
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